Presenting Problem: Antryg Windrose is a slightly disheveled and eccentrically (but not bizarrely) dressed man with somewhat but not markedly tangential speech, and somewhat labile affect. When asked what brought him here today, he states that he is sad and frustrated over his inability to work magic in Los Angeles.
Client denies suicidal ideation, but says he has moderate anxiety over realistic fears of being returned to his home country for execution. Client still takes pleasure in daily life and current relationship, and is employed.
Personal History: Childhood abuse, torture and imprisonment by government, refugee. Client discusses this with insight and appropriate emotion.
Family Background: Client was raised by unrelated abusive man; has no contact with biological family.
Psychiatric/Treatment History: Previous diagnosis of paranoia proved to be incorrect: the client’s seemingly paranoid beliefs were objectively true. Client states cheerfully that “everyone knows he’s mad.” When asked if he believes that he’s mad, he is evasive, then states that he understands why others think he is. Exploration of this point produces several statements of “odd” beliefs regarding magic theory and the likely truth of superstitions. Client has no hallucinations, and possible “delusions” are within the realm of eccentricity.
Differential Diagnosis: Evaluated for depression. Client states that he has no history of mania, major medical condition, substance use, somatic symptoms, symptoms of major depression, or dysthymia. Client agrees that depression and anxiety developed in response to stress.
Consider adjustment disorder with mixed anxious and depressed mood. Rule out on basis of lack of sufficient impairment of social and occupational functioning.
Rule out PTSD (due to trauma history): client states that he has no symptoms of PTSD. Rule out schizophrenia: no symptoms. Rule out paranoid personality disorder: no symptoms. Rule out schizotypal PD: Client is indeed “odd.” But he lacks a pervasive pattern of social and interpersonal deficits due to oddness, is comfortable with close relationships, and is not distressed by being “odd.”
Client appears to be quite well-adjusted and emotionally healthy, especially given his background and circumstances.
Treatment Plan: Therapy for grief over loss of magic. Refer to orthopedist for consultation on injuries to client’s hands.
Axis I (clinical disorders): No diagnosis.
Axis II (personality disorders and mental retardation): No diagnosis.
Axis III (general medical conditions): Injuries to hands from torture.
Axis IV (psychosocial and environmental problems): Loss of former career. Exposure to torture and imprisonment. Threat of execution. Refugee.
Axis V (GAF: Global Assessment of Functioning): 80. (Transient and expected reactions to psychosocial stressors.)