Explain the nature of danger to Janet and others that exists in her current acute condition.

The Case Study Answer Report that you generate should be in APA format, approximately three pages in length, double spaced, written in complete sentences, and free from spelling, grammatical and punctuation errors. The case study is attached with questions.
CASE STUDY for Schizophrenia and Other Psychotic Disorders
Janet
Three months into Janet’s freshman year, her parents were summoned by the dean of the small
out-of-town college she was attending to come and pick up their daughter. The dean said Janet
was behaving strangely. She had begun to wander around the campus at night, barefoot and
dressed only in a short nightgown. According to her roommate, Janet had “not been herself” for
the past six weeks. She had stayed in her room continuously, hoarded food, wrote incessantly,
and refused to attend classes except for one taught by Dr. M., an older married man with whom
Janet had become intensely preoccupied. She acted a if she were in her own world. She was
unapproachable and was irritated by her roommate’s attempts to converse. During the past few
weeks, Janet had talked to herself frequently. It sounded to her roommate like one-half of a
dialogue about what Janet and Dr. M. should do, and whether he was angry with her.
Janet’s parents found their daughter in an extremely agitated state. She was dressed in a bizarre
way, wearing all kinds of mismatched clothing that was inappropriate for the weather as well as
for the setting. She was unkempt and obviously had not bathed. At first she was unresponsive
and barely acknowledged her parents’ presence. When she did speak she became overexcited.
She explained repeatedly that she had to stay at college because Dr. M. was passionately in love
with her. She said he was unable to come to her because his wife kept him imprisoned at home
at night. She reported that “voices” commanded her to unite with Dr. M at any cost in order to
save the world from destruction. Janet also was convinced that Dr. M.’s wife was reading her
thoughts and now intended to harm her.
When Janet’s parents told her they were taking her home, she became violent. She attacked them
and wrecked her dorm room. Her words indicated that she was experiencing her parents’ efforts
as an attack by some dangerous beings, and she argued vehemently but incoherently with these
persecutors. The police were called and Janet was taken to the emergency room of the local
hospital. The threatening and acutely alarming nature of her hallucinations led staff psychiatrists
to conclude that Janet was a danger to herself and others. Immediate hospitalization was
advised. Upon admission, Janet was so out of control she had to be put in restraints until the
medication she was given began to take effect. Janet was especially fearful that the hospital
staff was collaborating with Dr. M.’s wife. She thought they were incarnations of evil forces
intent on keeping Janet and Dr. M. apart so that they could not save the world. Janet became
more subdued as her medication took effect, but she continued to be uncommunicative around
the ward. Although the acute phase of condition passed, the general prognosis for full recovery
was guarded because of indications that this episode was only one part of a long and insidious
process of deterioration.
Clinical Discussion
Several features of the acute onset of Janet’s disordered condition are typical of schizophrenia,
including her rapid deterioration and its occurrence during her first major separation from home.
Her parents reported that she always had been a shy and socially awkward and sensitive girl. For
a time around age seven, she had refused to go to school. The whole family had undertaken a
brief therapy designed to enable Janet to return to school. This seemed to clear up her behavior
enough for her to attend school, but she she was not happy. During early adolescence, Janet
began to have frequent arguments with her mother. On several occasions, these arguments
culminated in a self-destructive act. On one occasion Janet scratched her wrists with a razor
blade in front of her mother, following which the school psychologist referred her to therapy.
Janet refused to go, although her more provocative and worrisome behavior decreased after this
episode. Janet continued to behave eccentrically, like needing to engage in complex rituals in
order to go to sleep, or not wanting to be seen eating, but these behaviors were accommodated by
her family and others. The depth of Janet’s anxiety and the rigidity and fragility of her coping
mechanisms, therefore, were masked while she remained at home. These quickly broke down,
however, when she left the safety and supportive atmosphere of her accustomed surroundings
and family.
Within her unfamiliar new environment, Janet found it impossible to feel safe. Her “substitute
reality” enabled her to feel more secure. In her fantasies, she attained the special status of being
desired by an important person, Dr. M. Also, dwelling exclusively on this one relationship
helped limit her focus so that she felt less overwhelmed by all the new surroundings. She
explained her anxiety about the imagined danger she was in as due to threats to her ties with Dr.
M. She saw these threats as coming both from his wife and from the hospital staff. The
pervasive sense of terror that accompanied her internal disintegration required a broader
explanation, however, which became her conviction of impending world destruction. Her
preoccupation with Dr. M. was a desperate attempt to save herself from this psychological
catastrophe. The theme of salvation in her delusional system (Janet and Dr. M. were to unite to
save the world) illustrates her hope of being rescued. Her parents, the dean, her roommate, and
the hospital staff all were part of a threatening system that stood between Janet and the safer
alternative reality she had constructed.
The elaborateness of Janet’s alternative reality makes it a systematized delusion. In this complex
story Janet uses a paranoid type of delusion to try to make sense of her anxiety and thereby to
control it. Accompanying the delusional system is Janet’s overall decline in hygiene, daily
functioning, appearance, and ability to manage her impulses in response to being challenged.
The broad sweep of these disruptions indicates that the delusional system was failing to contain
her overall breakdown. The appearance of mistaken sensory perceptions (in this case hearing
voices) indicates the presence of auditory hallucinations, which often are part of a schizophrenic
process. While delusions reinterpret the meanings of things, hallucinations change the actual
intake of reality through the perceptions. Janet’s hallucinations instruct her about increasingly
terrifying inner experiences (called command hallucinations). These, in turn, give rise to a
concern that she might endanger herself or others because she ins unable to use judgment and
reality testing, and because she is fearful and reacts explosively to anything she views as a
threat. This explains why she was hospitalized, even though she wasn’t voicing a direct threat at
the moment.
The outcome for Janet is unsure. While some of her more florid symptoms may be controlled by
medication, indications of weakness in her adaptation are long-standing and began years before
the onset of the acute schizophrenic phase. Her ability to resolve this crisis effectively is in
doubt, less because of the presence of delusions and hallucinations than because of her long
history of weakness in psychosocial functioning.
Case Questions
1. What is the precipitating stressor event that probably triggered the onset of Janet’s
schizophrenic episode? What other factors may have contributed?
2. Identify Janet’s primary delusion. How can we understand this as a way that Janet is trying to
“make sense” of her collapsing world? How do her hallucinations fit together with her delusion?
3. Janet’s hospitalization both makes her available for treatment and protects her and others.
Explain the nature of danger to Janet and others that exists in her current acute condition.

 
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