Reference no: EM133384264

CASE STUDY  Presenting Complaint
Thirty-two-year-old Rubin is a biracial male who lives in a cabin in a remote rural area of Montana. He moved here 10 years ago after he left his parent's home in suburban Sacramento, California. The cabin has no electricity or running water. Rubin considers himself a survivalist; he heats his house with wood and gets his water from a nearby mountain stream or from the rainwater he collects. He grows vegetables and hunts game and birds for most of his food. He has a 20-year-old truck that he uses to go into town, a 50-mile trip from his isolated home. He inherited $50,000 from an aunt several years ago. He keeps the money in a savings account in town and withdraws cash when he needs it. He doesn't have a regular job, but people have found that he is good with his hands and sometimes hire him for general handyman.
Those who are acquainted with Rubin refer to him as "odd" but harmless. He often talks to himself when he eats or works. Some say that if they listen closely, he appears to be carrying on a conversation with one or two other people. Rubin wears worn-out clothing, and has long unkempt hair and a bushy beard. He is often dirty and disheveled. This has discouraged some people from hiring him.
Rubin travels to town every couple of months. Usually he goes to the bank to get cash, buys a few things from the grocery store, treats himself to lunch at the diner, and ends with a visit to the library. It is also on these trips when he might try to pick up a job or two. However, jobs have been harder to come by. Some are put off by his odd behavior and appearance. Word has also gotten out that Rubin had quit before finishing a job after complaining that he could hear the electrical wiring buzzing and that it was trying to zap his brain with secret codes.
The diner where Rubin eats lunch has a television that is always on. Rubin appears agitated by the television and he mumbles something like, "Turn that thing off. It is sending me messages and is messing with my head." One of the waitresses humors him and asks the other customers if she can turn it off. Most agree. When that waitress isn't working, the television stays on. Then Rubin doesn't linger over his meal and leaves appearing agitated.
The librarian says Rubin must be very bright, because he checks out history and philosophy books. In fact, she often has to order the books he wants from a large city library.
One day, Rubin came into the restaurant extremely agitated. He was pulling at his hair and talking loudly. He asked the waitress to give him something to stop the noise. What noise, she asked? He said, "The noise in my head. Since the television is slamming me with all these messages, and I can't stop the noise." The waitress laughed and said, "Why don't you tell us what kind of noise is in your head? Maybe we want to listen, too." At this point, Rubin reached over the counter and grabbed the waitress by the blouse and shouted, "Kill the noise or I will kill you."
A scuffle ensued as the patrons in the restaurant rushed to the waitress's defense. As they struggled with Rubin, he became more upset. He kicked; he bit; he threatened. Someone called the police and they came to arrest Rubin. He actually calmed down and told the officers, "So, it's you. Go ahead and take me. You have been after me for years - putting arsenic in my garden plot, taking money out of my bank account. And stealing my brain - don't think I forgot that. But you will pay for this. The Chief is looking for you."
Rubin was arrested and charged with assault and battery on the waitress and the patrons who tried to restrain him - both misdemeanors. Rubin spent the night in jail before being brought before a judge the next day. During his night in jail he continuously banged on the bars demanding that the guards turn off the television (the closed-circuit television hung on the wall outside and across from his cell). He threw his metal dinner plate at the television, cursing it and yelling, "Why are you doing this to me? You are taking over my brain, what else do you want?" When he was taken in front of the judge, the officers reported on his comment at the restaurant and his behavior in jail. The jail superintendent reported that he wanted Rubin charged with destruction of jail property (his metal dinner tray dented the side of the television). The judge ordered a psychological evaluation to see if Rubin was suffering from a mental disorder of some kind. When the judge asked Rubin if he knew what a psychological evaluation as, Rubin said, "Sure. They want to get inside my head. But I'm telling you, they won't find anything. My brain is missing and I don't know where I left it."

Social and Family History
Rubin was the middle of three children. His father was an electrician and his mother taught elementary school. His older brother committed suicide at the age of 27 - having struggled with depression and substance abuse most of his adolescent and adult life. His father was never diagnosed with a mental disorder, but he was known for his paranoia and eccentric behaviors. Rubin's mother had learned to be quiet and passive in order to appease her volatile husband. They rarely communicated with one another, and when they did it usually ended up in an argument.
Rubin was a star high-school students and had a 3.8 GPA his first year in college. He was majoring in history. When a girlfriend broke up with him, his grades started to slip and everything about him seemed to change. He slept a lot, ate mostly junk food, and stopped going to class. His roommate and others who lived near him began to refer to him as the "crazy dude." Eventually Rubin was placed on academic probation. He accused the Dean of being out to "get" him. He even suggested that the Dean wanted his girlfriend for himself. Eventually Rubin was expelled from the college.
He went home to his parents, where he became withdrawn and paranoid. Rubin was angry with his father, who mostly ignored him. His mother was afraid of him, especially when he talked to himself and yelled at the television. Once when they were gone for the weekend, Rubin pulled the cable box out of the wall and took a hammer to the television set, smashing in the screen. He told his parents that the cable box was taking thoughts from his brain and sending them to the television for all to hear. "My thoughts belong to me, and to no one else. Whoever tries to take them is going to have to pay."
A neighbor of his parents suggested that Rubin ought to go to the community mental health clinic. Rubin's father forbad it, saying no son of his was going to a shrink. Shrinks are for the "weak." When the neighbor asked Rubin if he wanted to get some help, Rubin's response was, "I don't need help. Just turn off the damn TV."
One day, Rubin went to the police department, and said he wanted to file a criminal complaint.
"Against whom?" the officer on duty asked.
"Against WJTA-TV," Rubin said.
Sensing that Rubin was a "bit off," he asked Rubin, "What did they do to you?"
"Larceny - grand larceny," Rubin said. "They took over my brain and I want it back."
The officer pretended to write up a complaint and told Rubin he would give it to his supervisor for approval. That appeased Rubin. When he left, the officer laughed and said, "Boy, it takes all kinds."
Shortly after this incident, Rubin's aunt died and left him $50,000. Rubin bought an old truck, the same one he has now, packed up his clothes and books and took off. He left his parents a note reading, "Thanks for nothing." That was the last they heard from Rubin.

QUESTIONS #1- Refer to the DSM5 checklist for schizophrenia provided in the chapter PowerPoint and in your textbook. Identify each of the DSM5 criteria that Rubin meets for a diagnosis of schizophrenia. (Hint: There are at least four). Indicate which of the symptoms would be categorized as positive and which would be negative. (Be sure to first identify the symptom and match it to examples from the case study.)

#2- Identify and describe at least two different types or classifications of delusions exhibited by Rubin.

#3-

A.) What phase of schizophrenia was Rubin in during the days before the diner incident? Why do you think this?

B.) What phase was he in at the time of the diner incident that led to his arrest? Explain your reasoning.

#4- Given Rubin's history and the course of his illness, discuss factors that may have an impact on his recovery. (Consider those that may offer hope, and those that may hinder.) Is he likely to make a full recovery from schizophrenia? Why or why not?