DSM-V Case Study: Axis I, Bold as Love

Jimi, a male of indeterminate age was wheeled in by his manager and various family members. As the patient’s court-appointed guardian, his manager informed us that the patient was “too fragile” to participate in the interview unless covered by a blanket. I expressed concern and agreed to conduct the interview with the blanket on, deciding instead to deal with this rather strange quirk therapeutically. No defining physical characteristics were observed. The patient’s affect was static.

I communicated with the patient’s minders to discuss their concerns about previous medical diagnoses, assuring them that while other medical specialists might rush to morbid prognoses simply because they didn’t know what to do with his symptoms, the psychiatric profession prided itself on really listening and being comfortable with uncertainty.

The interview was, indeed, extremely informative. The patient was anhedonic, bordering on catatonic. He was unable to confirm experiencing a sense of hopelessness and depressed mood, so all consuming was his misery. This observer also noticed the patient’s poor personal hygiene, as evidenced by a body odor so profound that one of the janitorial staff was heard to observe “yikes, who died in here?”, hours after the interview.

Discussion of Axis I, Bold as Love

The patient’s catatonic state, total disruption of social functioning and disregard for personal hygiene are indicative of a Major Depressive Disorder. Patient was given a prescription for sertraline, a selective serotonin reuptake inhibitor, with a plan to begin cognitive therapy.

Follow Up

The patient’s manager wheeled him in six weeks later, reporting that there had been no change in his condition. I concurred that he looked somewhat lifeless. His manager became defensive. “What are you saying? Are you saying he looks dead? Well, I’ll tell you mister, he put out three albums last year. Does that sound like a dead guy to you?”

The patient is not responding well to cognitive therapy, we will concentrate on more behavioral strategies like short walks and relaxation breathing. It is also recommended that the patient switch from sertraline to zyprexa.