Work Text:
Schizoid Case Study
Name: Novak, Claire
Sex: female
Age: 17
Medical Diagnosis: Asthma
Other Relevant Diagnoses: Diagnosed with low BMI at age 14. Condition has improved and BMI is now in the normal range.
Past Psychiatric History: Diagnosed with panic disorder at 15 after moving to current foster home.
Current Visit Reason: Patient’s current foster mother, Jody Mills, was concerned with Claire’s withdrawn nature and inability to make friends in the 2 years since Claire has lived with her; Mills was concerned that Claire may be suffering from PTSD or depression related to her life before she entered the foster system. Patient was referred to Sioux Falls Mental Health Clinic by her PCP.
Case Study:
Clair Novak was brought to SFMHC by her foster mother following a referral by her PCP. Foster mother, Jody Mills, states that Claire is withdrawn and spends most of her time alone in her room. Mills states that in the two years that Claire has lived with her, Claire has not made any friends and remains reserved around her and Mill’s other foster daughter, Alex Jones. Claire was enrolled in the local high school when she first came to live with Mills. She performed poorly and claimed that there were too many kids around to concentrate. The following year Mills enrolled Claire in an online school program and Claire’s academic performance has markedly improved. After beginning to live with Mills and while still enrolled in public school, Claire began experiencing panic attacks 3 times in one month with symptoms of sweating, chest constriction and pain, rapid pulse, shaking, and dizziness. Her PCP diagnosed her with panic disorder r/t her new living arrangement and school and prescribed her alprazolam 0.5 mg TID. Panic attacks were reduced as Mills’ home became more familiar and school was dismissed for the summer break. Alprazolam was tapered and then discontinued. Mills reports that Claire has not had a panic attack in about a year, but Mills is concerned that Claire’s self-isolation and lack of emotion may stem from PTSD or depression caused by lasting trauma experienced before Claire entered the foster system.
Prior to entering the foster system and living with Mills, Claire was living with her maternal grandmother. Claire’s grandmother sued for custody of Claire, alleging that Claire’s mother, Amelia Novak, was unfit and neglectful. Claire’s father, Jimmy Novak, abandoned his family when Claire was 5 years old. According to Claire’s grandmother, Jimmy began to claim that he could hear angels talking to him and that because he was a devout man, he was being called to help an angel do God’s work. Jimmy left his family and has been unable to be located since. After her husband’s abandonment, Amelia appears to have sunk into a deep depression that only worsened over the years until it was debilitating. The grandmother stated in court that Amelia often stayed in bed for days at a time, neglecting to care for, or even feed, Claire. It was also shown that Amelia regularly smoked around Claire despite Claire’s asthma. It stated, as well, that Amelia withheld affection from her daughter and was, at times, verbally abusive towards her. When the grandmother was granted custody, Claire was found to be 90 lbs and was diagnosed as underweight with a BMI of 15.9. This has been improved in the past 3 years and Claire now weighs 110 lbs with a healthy BMI of 18.9. Claire entered the foster system only a year after her grandmother was granted custody after her grandmother was killed in an automotive accident.
During the initial interview with Claire, she is content to let her mother answer many questions and only responds when directly addressed. Claire shows no outward signs of nervousness or excitement at being in the clinic; she can best be described as being bored throughout the entire process. Discussing her schooling, she stated that she would prefer to remain in virtual school rather than return to public school, despite the isolation from her peers. When questioned if she would like the chance to make friends or maybe date, she responded in the negative stating that she just wasn’t that interested in people around here (her family is originally from Illinois). After it was remarked that her grades had greatly improved and that she could probably get into a good college if she maintained them, she responded that school was simply something to do to pass the time and that she had no plans for after high school. Claire also describes her hobbies of sketching still lifes and reading as things to do to pass the time.
The mother and daughter left the clinic after the interview and were told that they would be contacted in a few days after the interviewing psychiatrist consulted with his peers.
Eventually, Claire was not diagnosed with PTSD or depression as her mother thought that she might be. Instead she was diagnosed with schizoid personality disorder (ScPD) as she met six of the seven criteria for it:
1. Lack of interest in social relationships
2. A tendency toward a solitary or sheltered lifestyle
3. Little interest in other, broader activities
4. A lack of close friends other than first-degree relatives
5. Indifference to praise or criticism
6. Emotional coldness, detachment, and flattened affect
Claire’s diagnosis was also based on the contributing factors having a family history of schizophrenic behaviors (her father, Jimmy), being raised by a cold and neglectful parent (her mother, Amelia), and having an accompanying diagnosis of an anxiety disorder (panic disorder).