Description of the case study
Romulus Ledbetter is African American and a classically trained pianist/musician who attended Julliard. He is forty-five years old, and currently lives in a cave in NYC. He has a daughter who is presently an NYPD policeman. His wife lives nearby in the city with her daughter but
has been estranged from Romulus for many years. This study is directed towards the effects of delusions on patients such as Romulus, who appear to have awareness of their delusion but cannot escape their impact on the rest of their lives.
This episode began when the Department of Social Services (myself) was sent out to see this man who lived in a cave. Actually the incident was reported to Romulus’s daughter by him after he found a deceased man in a tree frozen to death directly outside of his cave. With a Police escort, I interviewed him regarding his involvement if any and was greeted by rants and profanity by Mr. Ledbetter.
He seems to have a fixation on someone named “Stuyvesant,” who seems to be his primary
stressor and in whom draws out the most fear and hate from the patient. When I inquire about his past he stares blankly off into the “sky” as if he is listening to someone who is speaking, I ask again and he says that the “moth- seraphs” in his head cause brain-storms or something to that effect. He says these “angels” are always flying around in his head. The incident of finding the body triggered his paranoia about Stuyvesant and he went on a crusade to find the truth about it.
This is significant because he demonstrates an ability to make use of transient mental clarity in order to investigate this murder.
Most Common Symptoms
His most noticeable symptoms are schizophrenia, he rants at invisible people and hears and believes that Stuyvesant is watching everything from his tower over the city. He is unkempt; he has an odor that could be classified as offensive. He talks to people but is aggressive and
The incidence of this problem in present society
The incidence of this problem is probably associated with crime and especially violent crimes. It is becoming more common across ethnic and racial lines and is seen in the news more often than in the past. A brief definition of its clinical description is, “Schizophrenia is a chronic, disabling brain disease that affects approximately 1% of the world’s population. It is characterized by delusions, hallucinations and formal thought disorder, together with a decline in socio-occupational functioning. While the causes for schizophrenia remain unknown, evidence from family, twin and adoption studies clearly demonstrates that it aggregates in families with this clustering and is largely attributable to genetic rather than cultural or environmental factors.” (Bj Mowry, 2001)
The most effective treatment (s) for this disorder
Treatment is complicated and includes clinical, medical and intense laboratory work in genetics,
“The current working hypothesis for schizophrenia causation is that
multiple genes of small to moderate effect confer compounding risk through
interactions with each other and with non-genetic risk factors. The same
genes may be commonly involved in conferring risk across populations or
they may vary in number and strength between different populations. To
search for evidence of such genetic loci, both candidate gene and
genome-wide linkage studies have been used in clinical cohorts collected
from a variety of populations. Collectively, these works provide some
evidence for the involvement of a number of specific genes (e.g. the
5-hydroxytryptamine (5-HT) type 2a receptor (5-HT2a) gene and the dopamine
D3 receptor gene) and as yet unidentified factors localized to specific
chromosomal regions, including 6p, 6q, 8p, 13q and 22q. These data provide
suggestive, but no conclusive, evidence for causative genes.”(Mowry.)
Possible Co-morbid conditions/disorders
Some shared features to Schizophrenia may be paranoid ideation, magical thinking, social avoidance, and vague and digressive speech. These possible co-morbid disorders are significant because they cross symptomatic lines; they overlap, and therefore any showing similar behavioral symptoms requires a professional clinical diagnosis.
The prognosis for this disorder
An article from Helpguide.org is optimistic about treatment, it says, “Treatment options for schizophrenia are good, authors: Melinda Smith, M.A., and Jeanne Segal, Ph.D., (Authors: Melinda Smith, 2012) and the outlook for the disorder continues to improve. With medication, therapy, and a strong support network, many people with schizophrenia are able to control their symptoms, gain greater independence, and lead fulfilling lives”… “To enable further progress there is a need to:
(i) collect fine-grained clinical data-sets while searching the schizophrenia phenotype for subgroups or dimensions that may provide a more direct route to causative genes; and (ii) integrate recent refinements in molecular genetic technology, including modern composite marker maps, DNA expression assays and relevant animal models, while using the latest analytical techniques to extract maximum information in order to help distinguish a true result from a false-positive finding.”
Any cultural considerations
His current living conditions could be attributed to his SES. His family may be inclined to tolerate his disorder, and live with or without him in the home for economic reasons, rather than seek help in a mental/clinical hospital. The course of his symptoms appears to be congruent with national onset statistics (psychotic episode in early mid-twenties in men…late twenty’s in women).
There is no record of any past generations of relatives with this disorder in his family. He does mention an uncle who was a medical doctor, who “lectured” in an old abandoned mental facility many years earlier but no other references.
What are some if any Psycho-social and environmental problems that may affect the diagnosis, treatment, and prognosis of the disorder? Again SES may be his families’ primary hindrance to seeking professional help with him. His ability to survive on his own in the street, is most likely the strongest factor for not receiving a diagnosis, treatment and from benefiting from the medical, laboratory and clinical advancements.
The family’s psycho-social background is stable in that the two women are independent and economically sound, they seem to be highly functional on their own. The live in a one family house, in the upper north-east coast where living expenses are some of the highest in the U.S. The daughter demonstrates love for her dad but also reveals some anger/frustration at times. Her mother seems to keep her distance from him.
Axis I- 295.30 – Schizophrenia, paranoid type, episodic with inter-episode residual symptoms.
300.23 – Social phobia,
300.3 – Obsessive-compulsive disorder.
Axis II – Paranoid Personality Disorder
Axis III – Unable to procure or maintain employment, or a habitable residence
Axis IV – lives in a cave in a New York park, disruption of family by estrangement. Problems with wife and daughter but has contact with them occasionally. Problems with general public, and is well known by police. He is highly educated, but unable to benefit from it. He is unable to procure employment, no housing or economic involvement, and no apparent access to health care. Other than this incident patient seems to have no interaction with the legal system.
Axis V – GAF= 30 (current)