The farmer

The Farmer
Case Study #1
I will place before you a farmer, aged 59, who was admitted to the hospital a year ago. The patient looks much older than he really is, principally owing to the loss of teeth from his upper jaw. He not only understands our questions without any difficulty, but answers them relevantly and correctly; can tell where he is and how long he has been here; knows the doctors; and can give the date and the day of the week. His expression is dejected. The corners of his mouth are rather drawn down, and his eyebrows drawn together. On being questioned about his illness, he breaks into lamentations, saying that he did not tell the whole truth on his admission, but concealed the fact that he had fallen into sin in his youth and practiced uncleanness with himself; everything he did was wrong. “I am so apprehensive, so wretched; I cannot lie still for anxiety. O God, if I had only not transgressed so grievously!” He has been ill for over a year. It began with stomachache and head troubles, and he could not work any longer. There was no impulse left: He can get no rest now, and fancies silly things, as if someone were in the room. Once it seemed to him that he had seen the Evil One: perhaps he would be carried off….as a boy, he had taken apples and nuts. “Conscience has said that that is not right; conscience has only awakened just now in my illness.” He had also played with a cow, and by himself. “I reproach myself for that now.” It seemed to him that he had fallen away from God. His appetite is bad and he cannot sleep. “If the mind does not sleep, all sorts of thought come.” He fastened his neckerchief to strangle himself, but he was not really in earnest. Three sisters and a brother were ill too. The sisters were not so bad; they soon recovered. “A brother has made away with himself through apprehension.”

The patient tells us this in broken sentences, interrupted by wailing and groaning. In all other respects, he behaves naturally, does whatever he is told, and only begs us not to let him be dragged away-“there is terrible apprehension in my heart.” Except for a little trembling of the outspread fingers and slightly arrhythmic action of the heart, we find no striking disturbances at the physical examination. As for the patient’s former history, he is married, and has four healthy children, while three are dead. The illness began gradually 7 or 8 months before his admission, without any assignable cause. Loss of appetite and dyspepsia (indigestion) appeared first, and then ideas of sin.

 
1. Background information of the individual

2. Symptoms/descriptions

a. Describe behavioral, emotional, cognitive, somatic symptoms
b. How distressing are the problems/concerns?
c. How long have the problems/concerns been occurring?
d. What strategies has the patient used to cope with/solve the problem?
e. What is the incentive for change?
f. Any previous experiences similar to current problem?

3. Differential Diagnoses

4. Your diagnosis
a. Provide your diagnosis
b. Explain how you reached your diagnosis, how the clients symptoms fit the diagnostic criteria for the disorder(s).

5. Treatment options and prognosis
a. Psychodynamic, behavioral, cognitive, humanistic?
b. Individual/couple/family therapy?
c. Explain your rationale.
d. List some specific suggestions regarding ways in which patient can
improve their current situation.
e. Projected outcome.