Schizophrenia—Disorganized Type

Shine
Sample Answer Key

Date:
Your name:
Name of the client you are assessing: David Helfgott
Name of the movie: Shine

What is the chief complaint? (Why, in his/her “own words,”

would the client say he or she being assessed?)
David Helfgott makes few direct statements of distress. What he
seems to express most frequently are the old values instilled by his
father that were painful growing up. His mental illness is displayed
most evidently in his speech and behavioral patterns. He lacks social
skills regarding boundaries, often behaving too intimately with
strangers. On several occasions he is found in public places nude or
partially nude. His speech is pressured and he displays clanging,
flight of ideas, and loose association. He also displays occasional
disorientation to person.

Based on the above information and a close viewing of the

movie, what questions would you raise during history taking?
What are some possible answers?
You might base your questions on the:
History of your client’s present (and presenting) illness
Past psychiatric history, its treatment, and treatment
outcomes
Psychosocial history
Past significant medical history

1.) When did these symptoms begin? How long have they been going
on? Aside from confusion and difficulty concentrating, what other
symptoms is Mr. Helfgott aware of? Does he experience any
delusions, hallucinations, grossly disorganized or catatonic behavior,
or negative symptoms such as affective flattening, avolition, or alogia?
What events or situations exacerbate the symptoms? What coping
skills does he use at present? How well does he function with daily
living?

2.) What treatment has Mr. Helfgott’s received for schizophrenia or

any other disorder? Has he ever been treated with psychotropic
medications? What was the outcome? Has he ever suffered from
another mental illness such as depression? Has he had thoughts of
hurting himself or others? Aside from smoking, what are his patterns

This study source was downloaded by 100000840908496 from CourseHero.com on 02-09-2022 02:27:24 GMT -06:00

https://www.coursehero.com/file/46450277/MVG-Shine-Answersdoc/
 of use of substances such as alcohol or other non-prescribed drugs?

3.) Does Mr. Helfgott have any close friends? In light of the
estrangement from his father, how connected is he to other members
of his family? How often does he see other people? What does he do
on a daily basis for enjoyment? What kind of relationships does he
have with others? Has anyone in his family suffered with a mental
illness?

4.) Has Mr. Helfgott ever suffered from any medical or environmental
conditions that could be the cause of altered thinking? Has Mr.
Helfgott experienced any physical problems independent of or
associated with his mental illness or treatments (injuries or accidents
from bizarre behavior)? Has his health suffered in any way as a result
of schizophrenia? Has he ever been seriously ill with an infectious
disease or other illness? Has he had any hospitalizations or surgeries?
Is Mr. Helfgott taking any medications? What are they?

What observations do you have about the client’s behavior?

Mr. Helfgott seems to purposefully isolate himself from others. His
bitterness towards others may be his way of keeping others at bay in
efforts to keep control and order in his life. His anxiety worsens when
he encounters unpredicted events in his life, such as when someone
else is seated at his table or when the neighbor is ready for the dog to
return home.

The only people he seems to show an interest in are those who are
firm and unwavering with him. The waitress did not tolerate his
inappropriate attempts to control her, and the art dealer was first to
set boundaries of what behavior would not be tolerated. In these two
examples, control and predictability are present, even though
established by others. Mr. Helfgott seems to tolerate these
relationships with lessening anxiety.

In your opinion, is the diagnosis discussed above accurate?

Yes.

What DSM-IV-TR criteria support (or negate) this diagnosis?

Schizophrenia—Disorganized Type:
 Disorganized speech: pressured speech, clanging, flight of
ideas, loose association
 Disorganized behavior: running all day in the rain, lighting two
cigarettes at once
 Significant social/occupational dysfunction: socially
inappropriate, inhibited behavior (too intimate, playing outside
in the nude)

This study source was downloaded by 100000840908496 from CourseHero.com on 02-09-2022 02:27:24 GMT -06:00

https://www.coursehero.com/file/46450277/MVG-Shine-Answersdoc/
  Affective blunting: minimal facial expression and direct eye
contact
 Disoriented to person (sister)

Could the client have any other psychiatric disorder? If so, list
and include supporting DSM-IV-TR criteria.
No.

What treatment plan would you outline?

Medication with atypical antipsychotic medications coupled with
milieu management, individual and group therapy, cognitive-behavior
therapy, social skills training, and vocational rehabilitation.

With what expected outcomes?

 David will keep himself safe at all times.
 David will function optimally after being stabilized on
medications.
 David will verbalize understanding and insight into the nature
and treatment of his illness.
 David will meet his needs of daily living.
 David will identify and utilize psychosocial support of family,
friends, and community resources.

This study source was downloaded by 100000840908496 from CourseHero.com on 02-09-2022 02:27:24 GMT -06:00

https://www.coursehero.com/file/46450277/MVG-Shine-Answersdoc/
Powered by TCPDF (www.tcpdf.org)