PATIENT NAME: Miss Agnes Skinner
(Her favorite phrase is, “Don’t look where I’m pointing,” while pointing to Bart Simpson’s ‘doodle!’

IDENTIFICATION & BIOSOCIAL HISTORY: 85 years old
(A brief description of how this patient looks and acts)
Agnes see
ms very kempt. Always wears a dress, but seems a bit odd to wear a sweater all year round.
She keeps her hair up in a bun. Miss Skinner is socially active with friends from her church and organizations she is involved in; The First Church of Springfield, Springfield Investorettes Club, Springfield Book Club and the NRA. She is very possessive of her son, Seymore, and believes that “he owes everything to her swift hand and watchful eye.” She has been taking care of her son since he returned home from the military for 26 years.
Lives with and dependant on son, domineering, grouchy, controlling, yells at her son, causes trouble with others, always making harsh comments about Marge Simpson and Edna Krabappel.
She represents the domineering virago of a mother that emasculates sons in a Freudian manner.

MAIN COMPLAINT:
(Why this patient is coming for treatment)
Miss Skinner has reoccurring thoughts of murdering Edna Krabappel, so that her son has to stay living with her.
She also desires that someone shoots the school superintendent, Gary Chalmers, for working her son so hard.
She would love to kill Mr. Montgomery Burns for raising the energy prices just to get richer.
She also desires to burn Homer Simpson at the stake for being such a stupid idiot.
Finally, Agnes has shown a great deal of interest to see Rev. Timothy Lovejoy, Marge Simpson, and Ned Flanders dead.

CURRENT SYMPTOMS:
(A list of symptoms as explained in the text)
Forgetfulness; disregards other peoples’ rights; controlling, manipulative; feels no empathy towards others; behavioral eccentricities; discomfort in close relationships; extremely bizarre patterns of thinking; uninterested in the needs of others.

Regarding her son and his affairs, Miss Skinner seems to have the following symptoms: fear of separation, clingy, desires much admiration from, repetitive behaviors toward; persecutory, jealous, and obsessive; cold and domineering.

PRECIPITATING FACTORS:
(Are there any ‘prodromals’ (physical, social, stressors, abuse or cognitive causes) that bring out the symptoms)
Widowed, (husband’s name is Sheldon Skinner,) lives with adult son, has dated Superintendent Chalmer’s & Comic Book Guy (aka Jeff Albertson )

CULTURAL/RELIGIOUS BACKGROUND:
(Including divorce, substance abuse, family dynamics, etc.)
Eighty-five year old widow living with her son.
Even though her adopted son, Armin Tamzarian is a grown man, she constantly refers to him as “Spanky,” who goes by the name of her biological son, Seymore Skinner, whom she cannot stand.
She does not allow her adopted son to have any interaction with his on-again/ off-again girlfriend, Edna Krabappel.

INTELLECT: Average

INSIGHT & JUDGMENT:
(Any observations of abnormalities, otherwise write “Patient appears to have normal insight & judgment.”)
Patient appears to have a slightly skewed insight and judgment on specific neighbors and her son.

SUBSTANCE USE / ABUSE: None that patient is revealing.

OTHER:
(Comments on any other relevant issues)
Her hobbies include making silhouettes and collecting pictures of cakes, even though she cannot stand eating cakes because they are too sweet.

(The following group of questions is only looking for hints of psychosis such as Schizophrenia)
APPEARANCE: Neat, slumped

SOCIABILITY: resistant, hostile,

MOTOR ACTIVITY: normal

RELATEDNESS: good eye contact

SPEECH: fast, halting, variable, slurred, mumbles

ORIENTATION: Person

AFFECT: blunt, dysphoric, angry, irritable

IMPULSE CONTROL: inadequate

HALLUCINATIONS: none

SELF-CONCEPT: adequate

THOUGHT CONTENT: obsessions, jealousy, persecutory, bizarre, illogical

PATIENT’S STRENGTHS / RESOURCES –
(Look for positives)
Patient seems to be able to care for herself, although she wants someone, specifically her son, to care for her.

DSM-IV DIAGNOSIS

Axis I, Primary Dementia

Secondary Delusional Disorder

Axis II Obsessive-Compulsive P.D., Anti-Social P.D., Dependant P.D., Narcissistic P.D., Schizotypal P.D., Schizophrenogenic mother.

[Axis II Is only for Personality Disorders and/or Mental Retardation; not considered to be treatable –
use ‘V71.09’ (which means ‘none’) if neither of these conditions exist]

Axis III Osteoporosis, Arthritis (History of medical conditions: significant illnesses, surgery, etc.)

Axis IV Social Environment, Housing Problems (Environmental / social stressors – see following page)
Axis V 68
(See following pages for explanation)

CASE FORMULATION & TREATMENT PLAN
(Specific issues as ‘focus of treatment’, and specific types of treatment)
It is my opinion that, although Miss Skinner is 85 years of age, she could undergo treatment to help her become less controlling of her son, it is my belief that she will not be able to change at this stage in her life. I give the patient five to 25 years left to live, and see no possibility of this patient changing her ways.

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