When I worked at a psychiatric hospital in my early twenties a 17-year old boy, "Omar" (not his real name) was brought in for an evaluation after telling his mother he heard voices. While I applaud her decision to move quickly on what she suspected was a grave mental disorder in her son I ultimately decided he was fine. This was over 15 years ago. I was just contacted by him recently and he told me he is now a college graduate, married father and enjoys a successful career in the Army. Here are my notes from his intake (Tx means "therapist" and Pt means "patient"): Tx: Do the voices tell you to hurt yourself or others? Pt: No Tx: Do you recognize the voices? Pt: No Tx: Why do you think the voices are talking to you? Pt: I don’t know Tx: When is the first time you remember the voices talking to you? Pt: About two months ago, when I was alone at home. I Heard a female voice telling me to lie to my parents. Tx: Who is trying to steal your thoughts? Pt: Nobody. Tx: Why are they trying to steal your thoughts? Pt: Nobody is trying to steal my thoughts. Tx: What do you need to do to feel safe again? Pt: Nothing. I feel safe. Tx: Can you remember feeling safe? Pt:Yes. Tx: Do you want my help? Pt: No. Tx: Do you trust me? Pt: Not really. My Notes: Omar has revealed what seems to be an auditory hallucination that he recently had. At 17 years old, Omar is presenting for a clinical evaluation somewhat younger than is normally seen in cases of Schizophrenia. Other than the one time Omar self-reports, there are no indications of frequency or increasing regularity of auditory hallucinations or any other type. Omar explained that the voice he heard on only one occasion was a female voice and it told him to lie to his parents. I suspect that Omar felt guilty about something and his guilty conscience tried to protect his own interests by telling him to lie to his parents. It is not at all uncommon for a female voice to be heard in cases of a guilty conscience since it is often the role of the family matriarch to warn and advise in areas of safety and self perseverance. Omar is not paranoid and self-reports that he feels safe. He also does not want my help which is most likely because there is no real need. Further, Omar has none of the typical delusions seen in Schizophrenics who believe an outside source is out to harm them or steal their thoughts. For a diagnosis such as 295.70 Schizoaffective Disorder to be made; Omar would have to experience delusions lasting at least 2 weeks. Clearly, neither Schizophrenia nor Schizoaffective Disorder is warranted as proper diagnostic labels for Omar. For 295.40 Schizophreniform Disorder to be given; Omar would have to meet Criteria A, D, and E of Schizophrenia; which has already been ruled out as likely. There is nothing in this client’s personal history to make me feel any of the mood disorders, personality disorders, or psychotic disorders correctly describe the one time occurrence of Omar’s auditory hallucination. I would like to see Omar if more hallucinations of any type occur again. If no more occur I do not see any need to see Omar unless he has specific symptoms for which he is seeking relief and wants my help. Axis V GAF= 90 (on admission) and GAF= 90 (at discharge).
