By: SOPHIA F. DZIEGIELEWSKI
In a comprehensive diagnostic assessment, the importance of examining complicating or interacting
medical conditions cannot be underestimated. Consider this example.
Late
one night, a client who was extremely unkempt, delusional, and paranoid was brought
to the emergency room. He reported bizarre
delusions: Demons had invaded his teeth and were trying to capture his mind.
The
client had a
past history of schizophrenia and often reported persecutory auditory
hallucinations. This time, however, the
delusions he was reporting were extreme compared with previous presentations.
He was so convinced that demons were inside his
mouth that he had started to tear at his gums with his fingers in an
attempt to get at the demons inside.
In
his state of poor hygiene and malnourishment, it was not hard to see how he had managed to
remove most of his teeth from his mouth, ripping them out with his fingers.
Immediately on admission, a physical exam was ordered, along with an X-ray of
his teeth to see
the extent of the damage he had created by ripping the teeth from his mouth.
The
X-ray revealed
that the client had an extensive sinus infection and made it obvious how much
pain the untreated infection was causing. The
pressure the sinus discharge placed on the roots of his teeth was causing him extensive pain and heightening the paranoid
delusion of demons occupying his teeth. Once the sinus infection was treated, the severity of
the paranoid delusions subsided.
As
can be seen in this example, it is critical that medical issues, especially
when clients present with extreme signs and symptoms, be clearly assessed and
documented as part of the comprehensive
diagnostic assessment process.
diagnostic assessment process.
References
SOPHIA F.
DZIEGIELEWSK, 2015, DSM-5TM
in Action, by John Wiley & Sons, Inc.
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