Reference no: EM133226922

Biopsychosocial Background Information for Edward Elliott

Identifying information: Edward Elliott is a 20-year-old cis-gender African American man who was brought to the emergency room by the campus police of the university from which he had been suspended several days earlier. The police had been called by a professor who reported that Mr. Elliott had walked into his classroom shouting, "I am the Joker, and I am looking for Batman." When Mr. Elliott refused to leave the class, the professor contacted security, and he eventually ended up in a psychiatric emergency room.

Presenting problem: Per client, "I am the Joker and I need to find Batman." Per sister: Increasingly bizarre and erratic behavior with slow onset over the last 18 months. Problems are in all settings, with significant problems at school, having been escorted to university ER by security after bizarre behavior in class (shouting "I am the Joker and I need to find Batman" repeatedly and refusing to leave the class when asked). It is unclear what led to the onset of bizarre behavior; there appear to be no times or places where there is an exception.

Current and historical information:

• History of presenting problem: Increasing bizarre behavior for 18 months. Per sister's report: Client has been unable to complete coursework on time, seems distracted, has disengaged from his family life. Spends most of his time alone in his room. He is sometimes seen by family members and neighbors on his roof waving his arms, as if conducting a symphony. Frequently talks about "Annie," but Annie is not known to any family member or friends.
• Psychiatric history: None until now
• Family history and current issues: Sister describes family as "tight knit" and Edward as the "academic star" of the family. He has one sister; parents describe a strong marriage. No direct family history of mental illness but has an aunt with bipolar disorder. Father is a chef and mother is staff in a local elementary school. His parents and sister appear to be psychologically minded. He has generally stopped communicating with his family, but there was no conflict and he still lives with them. The family does not know why he has stopped communicating.
• Social history and current issues: Was well liked by peers growing up and in high school. Had trouble meeting people in first two years of college, which he felt was because he was a commuter student and not living in dorms. When he began college, he spent time with childhood friends in the neighborhood rather than meeting new friends in college. In the past year, he has stopped spending time with the neighborhood friends, and his sister says he spends time alone in his room mumbling and staring at the ceiling. He claims to be "in love" with someone named Mary, but the family doesn't know who this person is and believes she might be fictional. He claims to be speaking to her on the phone at times, but call records show no calls have been made. He often appears to be mumbling to himself.
• Work/occupational history and current issues: His primary occupation is college student (see below for details). In high school and year 1 of college, he worked at a local grocery store as a cashier to have spending money, but quit at the end of the first spring semester because he said he was "overwhelmed."
• Educational history and current issues: He is currently suspended from school due to the behavior that brought him into the ER. He has been a high academic achiever until this point. Grades in the last year have slipped, according to family. He received an academic merit scholarship to fully fund his undergrad work. His family describes him as the "academic star" and "driven."
• Medical history and current issues: None. All labs and medical exam findings are negative.
• Housing history and current issues: None. Lives with family. Feels safe in his home and neighborhood. Family agrees he can return home after treatment.
• Military history: Client has none. Father served in military and client was born on a U.S. military base in Turkey. They have lived in the Boston area since father completed his service (at client age 3).
• Trauma history: Client and family deny exposure to trauma or violence.
• Substance use: None; toxicology reports are negative. Sister reports that client neither drinks nor smokes cannabis because he never wanted it to interfere with his academic achievement.
• Legal involvement: No official legal involvement, but there may be further disciplinary action at school.
• Cultural factors: Client is African American; the role and meaning of his culture has not been explored with him or his family at this time but will be further explored as treatment progresses and as part of discharge planning.
• Religion and spirituality: Sister reports the entire family is "active in the church;" client reports he "believes in Annie if nothing else."  

I am finding it difficult to consider what the macro level will be and, what social justice issues surround this assessment and the differential diagnosis process for the given case.