Case History:
- Mr. Cowardly Lion is a single male (?) who lives alone, and has no children or family to speak of. He is not currently employed, and recent employment records do not indicate gainful employment at any time during the past 24 months.
Chief Complaint:
- Mr. Lion did not actively seek treatment. He was involuntarily committed after being arrested for vagrancy. He has since been exhibiting nervous and paranoid tendencies in addition to a generally aggressive personality. He also appears to be experiencing schizophrenic hallucinations of a land he calls “Oz” where he intends to meet a “wizard”. The hallucinations also reference three other individuals, namely a young woman called Dorothy, a “Tin Man”, and a scarecrow. Multiple personality disorders are not to be ruled out.
Preliminary DSM-IV Diagnosis:
- Axis I: Clinical Syndromes (Diagnosis)
o Generalized Anxiety Disorder:
§ Evidenced by Mr. Lion’s excessive worry, and accompanying physical symptoms of such anxiety (shaking, tail wringing, etc.)
§ Possibly the result of childhood abuse (would explain the aggressive/self-defense tendencies toward even non-threatening others).
o Schizophrenia:
§ Delusions of Oz and the Wizard
§ Delusions that someone (a small dog named Toto, or a witch) is trying to hurt him
§ Visions of grandeur (often heard singing “If I were king of the forest…”)
§ Hallucinations of other individuals (both visual and auditory)
o Sheep Phobia:
§ Claimed he could not count them to get to sleep because he was afraid of them.
- Axis II: Developmental and Personality Disorders
o Borderline Personality Disorder:
§ History of negative self view and inconsistent moods combined with significant impulsivity (with an exaggerated inability to control aggressive impulses).
§ Indicative, again, of childhood abuse and a resulting history of unstable relationships.
§ Also currently exhibiting the fear of abandonment and attachment to imagined figures (see above).
- Axis III: Physical Conditions which play a role in the development, continuance, or exacerbation of Axis I and II Disorders
o None
Treatment Plan:
- Therapy:
o Role play therapy needed to work through childhood issues (possible hypnotherapy if voluntary regression is unsuccessful)
o Intensive cognitive-behavioural therapy needed to reduce negative self thoughts and behaviours
o Desensitization/flooding therapy to alleviate phobia of sheep
- Medication:
o Traditional antipsychotic medication
o Possible antidepressant program
Prognosis:
- Hard to determine. If schizophrenia is ruled out (unlikely), the anxiety and personality disorders should be treated more successfully.
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