Hallucinations/Disordered Thinking Case Study
Sample Case
Mr P is a 21 year old university student. He was referred to a psychiatrist by the University Health Service as he was complaining of hearing voices. During an outpatient interview, he told the psychiatrist that he had been upset for the last year as he had been hearing someone talking about him when he was alone. He said he would typically hear two male voices discussing him on average three times a week. These voices would also sometimes comment on his actions. He had put off going to see his GP for over a year because he was afraid of being spied on by M15 security agents, who he was convinced were plotting to kill him.
Mr P lives alone in rented accommodation. He told the psychiatrist that his father was “sectioned” to a psychiatric ward many years ago because of a similar problem. He has no past medical history of note. He admits to having smoked cannabis regularly for 2 years when he was 17 years old but denies any illicit drug use since coming to university.
During the interview, Mr P kept scanning the room and appeared very suspicious. At one point he became distracted, suddenly stopping in mid-sentence, looking over his right shoulder and shouted: “You shut up!” He went on to say that he felt low in mood and frustrated as he did not understand why the security agents were after him. He admitted that he had thought of jumping in front of a car so that he could escape this “torture”. When asked what he thought the problem might be, Mr P denied that he had a mental illness or that he needed medication.
What symptoms does Mr P have and what is the differential diagnosis for him? Discuss possible aetiological factors and the important management issues in this case.
