Axis I-IV:
I. Substance-Induced Mood Disorder (291.8); R/O Bipolar Disorder (296.80)
Alcohol Abuse (305.00)
Bereavement (V62.82)
Sleep Disorder, Insomnia type (780.52)
II. R/O Borderline Personality disorder
III. Obesity
IV. Psychosocial stressors: death of wife, threat to patient’s life
V. GAF: 40
Identifying Data:
Achashveirosh is a 40 year-old, Middle-Eastern male who lives with his wife and entourage of servants in his palace in an upper-class city In Persia. The patient presents as elaborately dressed, groomed, with care to ADL’s. The patient is 5’2” with a heavy build.
Presenting Problem:
This is the first HODU-AD-KUSH PSYCH Services, Inc. admission for the pt, a 40 year-old Middle Eastern male king, who was referred by his high advisor, Haman Ben-Hamdasa, for further assessment and evaluation. The referral source reported noticing an “alarming” fluctuating mood pattern; Mr. Ben-Hamdasareported that the patient recently hosted and engaged in an ongoing party, lasting 180 days, which involved drinking excessive alcoholic beverages. The patient reportedly requested that the patient’s wife appear before him and his guests unclothed, and when the patient’s wife refused, the patient decided to have her killed immediately. While sober, the patient entered a period of depression, seemingly initiated from bereavement over his wife’s demise.
The patient presented in milieu as guarded, moderately vigilant, alert and oriented. However, the patient was forthcoming with details with some prompting from the writer.
The patient described a history of struggle with external power and internal self-esteem, which the patient claims, “has been in the family for centuries.” The patient described feelings of inadequacy from his “undignified youth as a stable boy,” and struggles to “prove himself” to the kingdom over which he rules. The patient stated, “I didn’t want them to think that I’m king just because Vashi comes from royal blood! I’m King because I DESERVE to be king!”
The patient described a history of unstable interpersonal relationships, self-image, and emotions. The patient’s referral source stated: “Sometimes he loves, sometimes he hates. But he always suspects.” The patient also reported instances of impulsivity and grandiosity; patient reports offering others positions of power and leadership or material wealth on the whim, or feelings of being “on top of the world.”
The patient described insomnia-type symptoms, which he states, “can be resolved once I finally get through my Book of Chronicles and pay everyone back already!” The patient also attributes some of this nocturnal anxiety to the recent threat to the patient’s life, which patient described as “supremely traumatic.” The patient’s royal guards reportedly plotted to assassinate the patient, however an associate officer thwarted the plot.