Question

Steven is a 56-year-old male who has been in and out of psychiatric hospitals for most of his life. His first hospitalization occurred when Steven was 19 years old and serving in the army. His commanders had him report to Medical because he refused to leave the barracks and was seen on several occasions to be “talking to the air.” Medical staff later learned that Steven refused to leave his room because he thought the base was under attack from Korean spies and that he had been keeping detailed records of their movements throughout the base for the last eight months. After Steven got better, he was given a medical discharge, and he went back home to live with his mother and father.

Over the next decades, Steven had several reoccurrences of his symptoms, and as a result, he was largely unable to keep a job or to develop supportive relationships. A couple of years ago, Steven started a new medication and seems to be doing better. He still spends the majority of his time alone, and he does not work, but the voices have disappeared. He does however still have thoughts that people are spying on him, and he reports being particularly bothered by rooms with fluorescent lights that flicker. He states that he always feels like the lights are flashbulbs from a camera even though he knows this is unlikely. To try to ward off these thoughts, Steven began smoking marijuana to “calm his nerves.” He has smoked off and on since his teenage years, but over the last year and a half, he has started to smoke more and more, both in terms of amount and frequency. He says that this helps him relax at night even though it is a major source of conflict between Steven and his now elderly parents. Steven has thought about trying to cut down on his smoking, and says he wants to, but every time he has tried, he’s been unsuccessful.

 

1. Using the DSM-5 system, give Steven a diagnosis.

 Diagnosis:

Notations:

Treatment: WHO-DAS

2. In no more than 5 sentences, describe how a cognitive behavioral therapist would treat Steven’s primary psychological disturbance.