Case-psychosis+jealousy

Question 1

Case Description

Answer 1

36-year-old man, Stanley Torrance, stopped by police for speeding. Carrying a knife, heading to confront wife and her boss over alleged affair. Mental health assessment requested.

Question 2

Initial Presentation

Answer 2

Stanley Torrance, 36, stopped for speeding at 11 PM. Heading to confront wife and her boss over alleged affair. Found with a knife.

Question 3

Reason for Confrontation

Answer 3

Believes wife is having an affair with her boss. Has been hearing voices for 4 months, initially whispering, then saying ‘don’t trust her’, ‘don’t trust them’.

Question 4

Nature of Voices

Answer 4

Started as whispering, now saying ‘don’t trust her’ and ‘don’t trust them’. Became commanding before police detention, saying ‘they’re doing it now, stop them’.

Question 5

Wife’s Behavior

Answer 5

Wife working late for several months, explained as busy unit. Stanley noticed her getting along well with boss. Became convinced of affair due to voices and her behavior.

Question 6

Monitoring Wife

Answer 6

Started monitoring wife’s phone, email, bank accounts, placed tracking device in car. Found no direct evidence of affair.

Question 7

Hallucinations

Answer 7

Voices saying ‘don’t trust her’, ‘don’t trust them’. Olfactory hallucinations smelling her boss on her. Second-person and commanding nature.

Question 8

Escalation of Delusions

Answer 8

Delusions of infidelity escalated with intensity of hallucinations. Misinterpreting benign actions as evidence of affair.

Question 9

Behavioral Changes

Answer 9

Withdrawing from wife, spending more time in pub or playing games, distracted at work, poor sleep, persistently tired.

Question 10

Risk Assessment - Knife

Answer 10

Stanley admits to planning on threatening wife’s boss with knife. Must be questioned closely about potential harm to others.

Question 11

Risk Assessment - Wife

Answer 11

Denies intent to harm wife, but admits could have harmed boss. Must assess if wife could have been harmed indirectly.

Question 12

Risk Assessment - Public

Answer 12

Assess risk to wife’s colleagues, members of public who could intervene. Identify potential for harm.

Question 13

Risk to Self

Answer 13

No explicit thoughts of self-harm, but experiencing hopeless thoughts. Must identify potential risk to self.

Question 14

Stalking Behaviors

Answer 14

Engaged in stalking behaviors, now planning on acting on delusional beliefs. Still planning to confront wife and her boss.

Question 15

Mood Symptoms

Answer 15

Low mood, anhedonia, anergia, poor sleep, poor concentration, diminished appetite. Symptoms emerged after psychotic symptoms.

Question 16

Alcohol Use

Answer 16

Drinking more alcohol to cope with symptoms. Previously only drank on weekends, now drinking 4 cans of lager a night, 6-8 on weekends.

Question 17

MSE - Rapport

Answer 17

Establish rapport to conduct effective interview. Be prepared to question closely, particularly in risk assessment.

Question 18

MSE - Circumstances

Answer 18

Elicit history of circumstances leading to being in police station. Understand patient’s suspicions and escalating psychotic symptoms.

Question 19

MSE - Hallucinations

Answer 19

Enquire about progression and character of hallucinations. Identify if hallucinations are still present and what they are saying.

Question 20

MSE - Delusional Beliefs

Answer 20

Identify delusional ideas about infidelity, misinterpretation of benign actions. Delusions held without confirmatory evidence, unshakeable.

Question 21

Risk to Others

Answer 21

Identify potential risk to wife, her boss, colleagues, and public. Question closely about intentions with the knife.

Question 22

Insight

Answer 22

Patient has no insight into delusional ideation or hallucinatory experiences.

Question 23

Overall Assessment

Answer 23

Conduct mental state examination, assess risk to self and others. Address patient’s concerns and provide appropriate advice.

Question 24

Notes on Morbid Jealousy

Answer 24

Assess ability to conduct MSE, identify psychosis and morbid jealousy. Perform risk assessment, establish rapport, elicit history.

Question 25

Good Candidates

Answer 25

Identify second-person hallucinations, commanding nature, risk posed by delusions and hallucinations. Enquire about olfactory hallucinations, misinterpretation of benign actions, stalking behaviors.

Question 26

Mood and Psychotic Symptoms

Answer 26

Screen for mood symptoms, identify depressive symptoms. Explicitly identify mood symptoms emerged after psychotic symptoms.