Understanding the Psychopathology of Ms. Dean

Ms. Dean is a 17 year old female who presented to the ED with thoughts of harming other with a plan. Ms. Dean reports a plan to mix unspecified chemicals together, " to hurt people not specific people just anybody." She reports increased anxiety for the past week. Ms. Dean reports experiencing delusions. She denies suicidal ideation and current symptoms of psychosis. Ms. Dean expresses depressive symptoms as feelings of sadness, fatigue, tearfulness, anger, isolation, and irritability. Ms. Dean does not express any current issues that might have triggered these events.

During the time of the assessment Ms. Dean is 4X oriented, in a "happy" mood, has appropriate affect, guarded, good eye contact, and appropriate speech. She does not appear to be responding to any internal stimuli. Ms. Dean reports recently she has been having mood swings. She reports becoming increasingly anger and then experiencing time of being overly happy. Ms. Dean reports a history of 3 attempts when she tried or attempted to harm herself. She

Dean's mother, grandmother, and sister. The mother reports family history of Bipolar, Anxiety, depression, and PTSD from domestic violence in the home. The mother reports receiving text messages from her daughter stating,"... is definitely having people spy on me, I'm 100% sure about it or I'm out of my mind delusional." The mother reports no evidence was found that this was going on, however Ms. Dean recently switched schools two weeks ago to make her feel more comfortable. The grandmother reports Ms. Dean has not been acting like herself. The grandmother reports Wednesday night Ms. Dean was found in the middle of her bedroom floor chewing on a tissue box eating the box. Further, the grandmother expresses Ms. Dean would scratch herself or bite her finger when angry. The sister reports Ms. Dean stand with her for a last week while with the recent school change and Ms. Dean has told her about thoughts of harming