Schizophrenia

Case history #1

A 22-year-old African American woman presents to the clinic with her mother. She spends most of her time in the house. She used to live independently and worked until a few months ago. The patient states she made an error on her taxes and is convinced the Internal Revenue Service (IRS) hired detectives to gather information about her whereabouts. She states that since her mistake, she uncovered an essential flaw in the taxation algorithm which may expose the underpinning of IRS, and is convinced they have hired assassins disguised as bikers. After moving in with her mom, she has not seen the bikers, but states that they are trying to trace her "mental activity." Also, she hears them outside of her house talking about how they will kill her. She reported the problem to the police and FBI and is seeking help "to defeat the IRS." She appears suspicious, avoids eye contact, and her answers to questions are delayed, during which she appears internally preoccupied.

Case history #2

A 25-year-old white man is brought to the emergency department by the police after being found walking in traffic at a busy city intersection. The police place him on an involuntary commitment after he states that he was instructed to kill himself by accusatory, commanding voices. On examination the patient appears dishevelled, with an indifferent and flat affect, and disorganized thought processes. He answers most questions monosyllabically. When questioned about experiencing auditory hallucinations he answers in the affirmative, but he is unable to articulate coherently the details of his experience. Throughout the examinations he appears intermittently distracted by internal stimuli; when asked what his experience is in the moment, he states: "They are talking to me." The patient’s family reports that he became increasingly withdrawn after he moved away from home to attend graduate studies at a local university. The family reports that his academic performance in college was above average, but since starting university he has struggled to complete his school work. Since moving, he has also become more isolative: he made no new friends, stopped talking to his college friends, and maintained only sporadic contact with his family. The family was unaware of the patient experiencing any hallucinatory experiences. He has no past history of drug use and his urine toxicology screen is negative, effectively ruling out a drug-induced psychosis.

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