Case Study: Susie

Susie is a 20-year-old sophomore at a small Midwestern college. For the past five days she has gone without any sleep whatsoever and she has spent this time in a heightened state of activity, which she herself describes as “out of control.” For the most part, her behavior is characterized by strange and grandiose ideas that often take on a mystical tone.

Susie often worries that she will forget some of her thoughts and has begun writing notes to herself everywhere; in her notebooks, on her computer---even on the walls of her dormitory. Susie’s family and friends, who have always known her to be extremely tidy and organized, have been shocked to find her room in total disarray with frantic and incoherent messages written all over the walls and furniture.

Susie has experienced two previous episodes of wild and bizarre behavior similar to what she is experiencing now; both alternated with periods of intense depression.

When she was in the depressed state, she could not bring herself to attend classes or any campus activities; she suffered from insomnia, poor appetite, and difficulty concentrating.

Some background information; Susie grew up on what she terms a “traditional

Irish home” with overprotective and demanding parents. Of the five children in her family, she was the one who always obeyed her parents and played the role of the good girl of the family, a role she describes as being “Little Miss Perfect.” Susie’s family history shows evidence of mood disorders; her maternal grandfather received electroconvulsive therapy (ECT) for depression and her father’s aunt was diagnosed with depression when she went through menopause.

Case Study: Terry

Terry is a 37-year-old married bank manager. He had developed a range of symptoms which caused him to fear that he had a brain tumor as he was having ‘migraine attacks’, blurred vision, dizziness, nausea and panic. Over time and following a range of investigations (CT scan, pathology tests, EEG) his beliefs changed and he worried about having a stroke. His strength of belief that he had a brain tumor was 60% and that he would have a stroke in the next year was 90%. His fears about tumor and stroke were triggered by headache, blurred vision, dizziness, being out of breath following exertion, and reading or hearing about illness on the television or in newspapers. He had a comprehensive knowledge and had purchased approximately $500 worth of medical texts as well as surfing the internet daily for medical information. Despite repeated reassurance, he was worried that ‘something had been missed’. He visited his GP on a weekly basis, with each consultation taking on average 20 minutes before he was suitably reassured.

He had a premorbid history of being anxious and had a family history of cancer and stroke.

Case Study: Jack

Jack graduated from high school and got a job working in a video store. After working for about 6 months Jack began to hear voices that told him he was no good. He also began to believe that his boss was planting small video cameras in the returned tapes to catch him making mistakes. Jack became increasingly agitated at work, particularly during busy times, and began "talking strangely" to customers.

For example one customer asked for a tape to be reserved and Jack indicated that that tape may not be available because it had "surveillance photos of him that were being reviewed by the CIA".

After about a year Jack quit his job one night, yelling at his boss that he couldn't take the constant abuse of being watched by all the TV screens in the store and even in his own home.

Jack lived with his parents at that time. He became increasingly confused and agitated.

His parent took him to the hospital where he was admitted. He was given medication.

From time to time Jack stopped taking his medication, and the voices and concerns over being watched became stronger.