Case-psychosis+jealousy Flashcards
Case Description
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.
Initial Presentation
Stanley Torrance, 36, stopped for speeding at 11 PM. Heading to confront wife and her boss over alleged affair. Found with a knife.
Reason for Confrontation
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’.
Nature of Voices
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’.
Wife’s Behavior
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.
Monitoring Wife
Started monitoring wife’s phone, email, bank accounts, placed tracking device in car. Found no direct evidence of affair.
Hallucinations
Voices saying ‘don’t trust her’, ‘don’t trust them’. Olfactory hallucinations smelling her boss on her. Second-person and commanding nature.
Escalation of Delusions
Delusions of infidelity escalated with intensity of hallucinations. Misinterpreting benign actions as evidence of affair.
Behavioral Changes
Withdrawing from wife, spending more time in pub or playing games, distracted at work, poor sleep, persistently tired.
Risk Assessment - Knife
Stanley admits to planning on threatening wife’s boss with knife. Must be questioned closely about potential harm to others.
Risk Assessment - Wife
Denies intent to harm wife, but admits could have harmed boss. Must assess if wife could have been harmed indirectly.
Risk Assessment - Public
Assess risk to wife’s colleagues, members of public who could intervene. Identify potential for harm.
Risk to Self
No explicit thoughts of self-harm, but experiencing hopeless thoughts. Must identify potential risk to self.
Stalking Behaviors
Engaged in stalking behaviors, now planning on acting on delusional beliefs. Still planning to confront wife and her boss.
Mood Symptoms
Low mood, anhedonia, anergia, poor sleep, poor concentration, diminished appetite. Symptoms emerged after psychotic symptoms.
Alcohol Use
Drinking more alcohol to cope with symptoms. Previously only drank on weekends, now drinking 4 cans of lager a night, 6-8 on weekends.
MSE - Rapport
Establish rapport to conduct effective interview. Be prepared to question closely, particularly in risk assessment.
MSE - Circumstances
Elicit history of circumstances leading to being in police station. Understand patient’s suspicions and escalating psychotic symptoms.
MSE - Hallucinations
Enquire about progression and character of hallucinations. Identify if hallucinations are still present and what they are saying.
MSE - Delusional Beliefs
Identify delusional ideas about infidelity, misinterpretation of benign actions. Delusions held without confirmatory evidence, unshakeable.
Risk to Others
Identify potential risk to wife, her boss, colleagues, and public. Question closely about intentions with the knife.
Insight
Patient has no insight into delusional ideation or hallucinatory experiences.
Overall Assessment
Conduct mental state examination, assess risk to self and others. Address patient’s concerns and provide appropriate advice.
Notes on Morbid Jealousy
Assess ability to conduct MSE, identify psychosis and morbid jealousy. Perform risk assessment, establish rapport, elicit history.
Good Candidates
Identify second-person hallucinations, commanding nature, risk posed by delusions and hallucinations. Enquire about olfactory hallucinations, misinterpretation of benign actions, stalking behaviors.
Mood and Psychotic Symptoms
Screen for mood symptoms, identify depressive symptoms. Explicitly identify mood symptoms emerged after psychotic symptoms.
