31 Jan 1. Identify Janet’s diagnosis

Three months into Janet’s freshmen year, her parents were summoned by the dean of the small out-of-town college she was attending to come and pick up their daughter. The dean said Janet was behaving strangely. She had begun to wander around the campus at night, barefoot and dressed only in a short nightgown. According to her roommate, Janet had not been herself for the past six weeks.

She had stayed in her room continuously, hoarded food, wrote incessantly, and refused to attend classes except for one taught by Dr. M., an older, married man with whom Janet had become intensely preoccupied. She acted as if she were in her own world. She was unapproachable and irritated by her roommate attempts to converse. During the past few weeks, Janet had talked to herself frequently. It

sounded to her roommate like one-half of a dialogue about what Janet and Dr. M. should do, and whether he was angry with her. Janet’s parents found their daughter in an extremely agitated state. She was dressed in a bizarre way, wearing all kinds of mismatched clothing that was inappropriate to the weather as well as

the setting. She was unkempt and obviously had not bathed. At first, she was unresponsive and barely acknowledged her parents presence. When she did speak, she became overexcited. She explained repeatedly why she had to stay at college. It was because Dr. M. was passionately in love with her. She said he was unable to come to her because his wife kept him imprisoned at home at night. She reported that voices commanded her to unite with Dr. M. at any cost in order to save the world from destruction. Janet also was convinced that Dr. M’s wife was reading her thoughts and now intended to harm her.

When Janet’s parents told her they were taking her home, she became violent. She attacked them and wrecked her dorm room. Her words indicated that she was experiencing her parents efforts as an attack by some dangerous beings, and she argued vehemently but incoherently with these persecutors. The police were called and Janet was taken to the emergency room of the local hospital.

The threatening and acutely alarming nature of her hallucinations led staff psychiatrists to conclude that Janet was a danger to herself and others and immediate hospitalization was advised. Upon admission, Janet was so out of control she had to be put in restraints until the medication she was given began to

take effect. Janet was especially fearful that the hospital staff was collaborating with Dr. M.s wife. She thought they were incarnations of evil forces intent on keeping Janet and Dr. M. apart so that they could not save the world. Janet became more subdued within the next few days as her medication took

effect, but she continued to be uncommunicative around the ward. Although the acute phase of her condition passed, the general prognosis for full recovery was guarded because of indications that this episode was only one part of a long and insidious process of deterioration.

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Case Questions

1. Identify Janet’s diagnosis based on the information of this case. Make certain you identify all signs and symptoms connected to the diagnosis of your choice by naming the diagnostic criteria and the associated behavior from the case. You may also identify a differential but you must choose only one diagnosis.

2. What do you think is the precipitating stressor that probably triggered the onset of Janet’s mental disorder? Identify Janet’s primary delusion. How can we understand this as a way that Janet is trying to make sense of her collapsing world? How do her hallucinations fit together with her delusions?