Case Files

These are the main characters in Institution. You will be introduced to them all throughout the plot, but here you may look them up at your leisure.

Identifying Information and Reason for Referral

Jaciam Katiyen is a 29-year-old anthropomorphic gryphon female who was hospitalized after a suicide attempt in which she overdosed on an over-the-counter painkiller (aspirin). Jaciam is unmarried and lives alone.

History of Presenting Problem

Jaciam reports that she attempted suicide because she was feeling “a little bit out of herself.” She was unable to give a more complete description of the events leading to her suicide attempt, but she appeared to regret her actions. She describes symptoms of severe depersonalization and derealization since early adolescence, including persistent detachment from mental processes, lack of body ownership, bizarre sensory experiences, temporal distortions, and out-of-body experiences. She reports that the symptoms have increased in severity since her brother’s suicide approximately two years ago. She states that she often feels numb and detached, and often can only evoke spontaneous emotions when she is absorbed in artwork.

Family Psychiatric History

Jaciam reports that both her father and her brother suffered from “ongoing melancholic depression.” Her father reportedly committed suicide when she was a year old, and her brother committed suicide two years ago. Jaciam describes her paternal grandfather as suffering from “mood swings” that appear consistent with a diagnosis of bipolar disorder. Jaciam reports no knowledge of any other mental illness in her family.

Mental Status Exam

Jaciam possesses a slender build and average height. She looks approximately her stated age. She evidenced no problems with hygiene and wore appropriate attire. She has no visible body piercings or tattoos. Her attitude toward the interview was cooperative but guarded. Thought process seems clear and goal-directed. Her speech is ordinary and easy to understand with normal rate and soft volume, but decreased reciprocal flow, as she only gave succinct answers to the examiner’s questions. Affect appears to have blunted range and constricted mobility. Her eye contact is moderate to minimal. She reports feeling numb, empty, “kind of depressed,” and “nothing seems real anymore; it’s like I’m living in a dream.” She denied suicidal ideation, intent and plan to direct questioning. Jaciam did not endorse any abnormalities with perception other than severe depersonalization and derealization. She did not demonstrate any problems with short-term memory, and was alert and oriented throughout the interview.

DSM-IV-TR Multiaxial Diagnosis

Jaciam’s provisional DSM-IV-TR multiaxial diagnosis follows:

Axis I: 300.6 Depersonalization Disorder

Axis II: No Diagnosis on Axis II (V71.09)

Axis III: None

Axis IV: Problems with primary support group

Axis V: GAF = 41-50

Identifying Information and Reason for Referral

Noxoic (“Nox”) Venezio is a 27-year-old male anthropomorphic lime-green feline. He was found unconscious by local fishermen on one of the coastlines of Eastern Germany. He was identified as a past suspect in connection to murders in America, but charges were dismissed on faulty evidence and a plea of insanity.

History of Presenting Problem

Nox claims to have been plagued by “something” that has been following him since adolescence. He declined to elaborate on what the subject of his anxiety was, growing despondent with this examiner. He reports that his paranoia of being followed has increased slowly throughout his teen years, and spiked dramatically after he hit his early twenties. He claims to have traveled the nation to “frustrate” whatever he believes to be plaguing him. He believes he feels quite safe in the asylum under the management, and being “properly medicated” greatly decreases his anxiety. Nox also reports regular nightmares that cause him severe anxiety and make him frequently reluctant to fall sleep.

Family Psychiatric History

Nox reports that his mother was not able to provide any emotional feedback to her son, and describes her as being “sociopathic.” He reports that his father has had an extensive history of episodes of mania until he married his mother. Nox refused to give comment on his sister.

Mental Status Exam

Nox possesses a lithe build with above average height. He looks more distinguished than his stated age. Nox has a tattoo on his right upper arm, a small insignia that he describes as having a connection with a sister, but he has forgotten its meaning. Medical records state that he has a slanted scar across his chest; he claims that his mother gave it to him when he was a child. He evidenced a few problems with hygiene; his metal horns showed signs of rust. His hair was in disarray and partially concealed his face. He explains that once his hair and horns were once quite stately. His attitude toward the interviewer was uncooperative and guarded. His thought process seems goal-oriented. Nox possessed constricted mobility of affect with a flat range. Reciprocal flow in conversation is considerably decreased. His eye contract appears moderate, but it should be noted there is a physical difference: Nox appears to have two pairs of pupils, and both eyes are mechanical, responding to light differently than a normal eye. Nox denied suicidal ideation, intent and plan to direct questioning. Nox continuously denies that he has any kind of mental disorder, claiming that it is all a part of an elaborate plan to humiliate him. Despite this, he claims “not to mind” being a patient at Schmerzen, and that he prefers the asylum to outside life. He did not demonstrate any problems with short-term memory and he appeared alert and oriented throughout the interview.

DSM-IV-TR Multiaxial Diagnosis

Nox’s provisional DSM-IV-TR multiaxial diagnosis follows:

Axis I: 295.30 Schizophrenia, Paranoid Type

307.47 Nightmare Disorder

Axis II: 301.7 Antisocial Personality Disorder (Rule Out)

Axis III: Unusually heavy due to metal skeleton, history of headaches and pressure behind eyes

Axis IV: Problems with primary support group

Problems related to interaction with the legal system/crime

Axis V: GAF = 21-30

Identifying Information and Reason for Referral

Brune Dryocunda is a 16-year-old anthropomorphic rosy maple moth. She has been hospitalized ever since the age of 11 after an episode in which she cut off one of her limbs with a circular saw. This action was subsequent to a hallucinogenic episode in which she claimed that that limb had been possessed by a ghost, bent on murder.

History of Presenting Problem

Brune admits seeing “imaginary friends” at an age as early as three years, and they have been almost constant companions in her daily life up to her current age. She seems to follow a pattern of decompensation and stabilization in which her hallucinations and delusions range from being minimal and calm to high active and violent. Brune says that she has felt great physical pain from her hallucinations when she has refused to follow their instructions.

Family Psychiatric History

Brune reports that her family has not had any remarkable psychiatric history.

Mental Status Exam

Brune possesses a slightly stout build and below average height. She looks approximately her stated age. She evidenced some minor problems with hygiene, as she was not allowed to use a toothbrush. She had purportedly attempted to stab one of her siblings in the eye with a toothbrush. She wore a dress that was in dire need of washing. She has no visible body piercings or tattoos. Her attitude toward the interview was cooperative, if not amused. Her thought process was neologistic, as she invented new words for things, including renaming the interviewer. She did not avoid eye contact, but would often turn her attention completely to the ceiling. Her eye contract is moderate to above average. When asked what she was looking at, she explained, “only what all the house cats see when they look up at the ceiling.” Her speech appeared curt, but passionate. Exhibits some stereotypy, and appears to derive comfort by rocking gently back and forth in her seat. Brune denied suicidal ideation, intent and plan to direct questioning. She reports that she feels “pretty calm and happy” but complains that her neighbors are too loud. Brune accepts the idea that those around consider the existence of her hallucinations unreal. Her explanation is that she has the ability to see into alternate dimensions. She went on to say that “they will turn really nasty if I ignore them.” Brune did not demonstrate any problems with short term-memory and was alert and oriented throughout the interview.

DSM-IV-TR Multiaxial Diagnosis

Brune’s provisional DSM-IV-TR multiaxial diagnosis follows:

Axis I: 295.30 Schizophrenia, Paranoid Type

Axis II: No Diagnosis on Axis II (V71.09)

Axis III: Amputated limb with occasional pain

Axis IV: Problems with primary support group

Problems related to the social environment

Axis V: GAF = 21-30

Identifying Information and Reason for Referral

Wickett is a 37-year-old anthropomorphic saber-toothed cat who was hospitalized after he jumped from a window of a building 30 feet above ground level. He claimed that he had discovered the ability to fly with the force of his mind and that it was “time to show the world his powers.” After being treated for a broken leg, he was transferred to the inpatient unit of the Schmerzen asylum for delusions of grandiosity consistent with a manic episode.

History of Presenting Problem

Wickett reports periods of his life characterized by extreme depression and other periods similar to his current state. It was difficult to discern history of presenting problem due to his tangential reports, and the fact that he had no living relatives.

Family Psychiatric History

Wickett reports that his grandfather was hospitalized for years on an inpatient unit for “insanity,” although he could provide no additional details of his grandfather’s illness. No other family psychiatric history known.

Mental Status Exam

Wickett possesses a large, muscular build with above-average height. He looks approximately his stated age. He appeared unkempt due to poor hygiene and his attire was mismatched and not appropriate to context (wearing sleeveless shift and shorts in cold weather). Wickett has no body piercings but he sports a large tattoo on his left bicep with an image of a female face with the name “Amy.” His eye contact was moderate to appropriate but he appeared to look frenetically around the room as he spoke during intake. He is attentive and cooperative, but overly friendly and familiar with this examiner (repeatedly offers to administer a shoulder massage). Rate of speech is considerably increased with excessive amount of detail given in response to this examiner’s questioning and unusually high range of inflection. Wickett evidences tangential speech with occasional flight of ideas. He denied suicidal or homicidal ideation, intent and plan to direct questioning. Exhibits psychomotor agitation and excess movement of the limbs and trunk. Range of affect is expansive with normal mobility that is not congruent with his stated mood. He reports that he feels “wicked irritable but awesome inside in all other times.” Wickett exhibits mood-congruent delusions of grandiosity, stating that he had developed a way to fly with the force of his mind and that he had sold the invention to a “multibillion dollar company that is going to make me rich.” Wickett had moderate difficulty with short-term memory, claiming that he was “very distracted.” He was alert and oriented to person, time and place throughout the interview.

DSM-IV-TR Multiaxial Diagnosis

Wickett’s provisional DSM-IV-TR multiaxial diagnosis follows:

Axis I: 296.44 Bipolar I Disorder, Most Recent Episode Manic, Severe with Psychotic Features

Axis II: No Diagnosis on Axis II (V71.09)

Axis III: None

Axis IV: Problems related to the social environment

Occupational problems

Housing problems

Economic problems

Axis V: GAF = 11-20

Identifying Information and Reason for Referral

Shyah is a young anthropomorphic arctic fox of uncertain age. She was hospitalized after a concerned citizen discovered her homeless and brought her to the police station due to her unkempt appearance and inability to speak. She was referred to the Schmerzen asylum due to selective mutism and apparent inability to care for her basic needs.

History of Presenting Problem

Shyah was unable or unwilling to disclose any history of her symptomatology.

Family Psychiatric History

No information is known about Shyah’s family psychiatric history.

Mental Status Exam

Shyah possesses a slender build and below average height. She evidenced significant problems with hygiene, and appeared unkempt and unclean. She has no visible body piercings or tattoos. Her attitude toward this examiner was uncooperative and guarded. She was unable or unwilling to speak throughout the intake process. Although she was able to write her name on paper for the purposes of communicating her identity, she was unwilling to communicate via the written word for any other purpose. Affect was difficult to discern due to muteness, but the range appears flat with constricted mobility. Eye contact is appropriate but overly intense. She exhibits slight psychomotor retardation. Shyah did not deny or confirm suicidal ideation, intent and plan to direct questioning. Short-term memory was impossible to assess due to patient’s uncooperativeness. She appeared alert throughout the interview.

DSM-IV-TR Multiaxial Diagnosis

Shyah’s provisional DSM-IV-TR multiaxial diagnosis follows:

Axis I: 313.23 Selective Mutism

Axis II: No Diagnosis on Axis II (V71.09)

Axis III: Deferred

Axis IV: Housing problems

Economic problems

Axis V: GAF = 11-20

Identifying Information and Reason for Referral

Dr. Luisia Kuin is a 47-year-old anthropomorphic puma. She did not present to the asylum as a patient but as a psychiatrist. She has worked at the asylum for a year and a half.

Family Psychiatric History

Dr. Kuin states that her daughter was diagnosed with Antisocial Personality Disorder, but reports that she is unaware of any other family mental health issues. Dr. Luisia Kuin reportedly has struggled with Major Depressive Disorder in the past.

General Health

Dr. Kuin has occasional problems with arthritis in her hands and knees. She also tires very easily.

Mental Status Exam

Luisia Kuin possesses a slender build and average height. She appears slightly younger her than stated age. She evidenced no problems with hygiene and was dressed in appropriate, professional attire. She has no visible body piercing or tattoos. Her attitude toward the examiner is cooperative and polite, but somewhat weary. Thought process appears clear and goal directed. At one point she began a tangent from one of the questions, and laughed pleasantly when reminded that she was being interviewed. Her speech is ordinary and easy to understand, with normal rate, inflection, articulation and reciprocal flow. She appears to have a full range of affect with normal mobility and congruent mood. Dr. Kuin denied suicidal ideation, intent and plan to direct questioning. She evidences normal perception and thought content. Dr. Kuin did have some problems with short-term memory during the interview.

DSM-IV-TR Multiaxial Diagnosis

Dr. Kuin’s provisional DSM-IV-TR multiaxial diagnosis follows:

Axis I: No Diagnosis or Condition on Axis I (V71.09)

Axis II: No Diagnosis on Axis II (V71.09)

Axis III: Unusual fatigue, arthritis

Axis IV: Problems with primary support group

Occupational problems

Axis V: GAF = 71-80

Identifying Information and Reason for Referral

Dr. Nicodemus Liok is a 64-year old anthropomorphic grey wolf. He did not present to the asylum as a patient, but as a psychiatrist. He has worked at the asylum for 20 years as a psychiatrist, and has published prolifically on the topic of psychodynamic psychotherapy, dissociation, and authenticity in the therapeutic relationship.

Family Psychiatric History

Dr. Liok reports that his mother suffered from alcohol dependence throughout his childhood, but denied any other history of mental illness in his family.

Mental Status Exam

Nicodemus Liok possesses a slender build and above average height. He appears approximately his stated age. He evidenced no problems with hygiene and was dressed in appropriate, professional attire. He has no visible body piercings or tattoos. His attitude toward the examiner is cooperative, pleasant, and attentive. Thought process appears clear and goal-directed. His speech is ordinary and easy to understand, with normal rate, inflection, articulation, and reciprocal flow. He appears to have a full range of affect with normal mobility and congruent mood. Dr. Liok denied suicidal ideation, intent and plan to direct questioning. He evidences normal perception and thought content. He did not demonstrate any problems with short-term memory, and was alert and oriented throughout the interview.

DSM-IV-TR Multiaxial Diagnosis

Dr. Nicodemus Liok’s provisional DSM-IV-TR multiaxial diagnosis follows:

Axis I: No Diagnosis or Condition on Axis I (V71.09)

Axis II: No Diagnosis on Axis II (V71.09)

Axis III: Chronic pain in left leg

Axis IV: None

Axis V: GAF = 81-90

Identifying Information and Reason for Referral

Dr. Phaedrus is a 34-year-old anthropomorphic ermine, or stoat. He did not present to the asylum as a patient, but as a psychiatrist. He has worked at the asylum for 8 years, and through the resignation of his superiors, has gained the rank of director of psychiatry of the asylum.

Family Psychiatric History

Dr. Phaedrus cannot state any mental illness in his family, as he was orphaned as a child and grew up in a community foster home. There are no records of his family.

General Health

Dr. Phaedrus reports that his fur takes an unnaturally long time to molt between winter and summer, which is why his fur remains white throughout much of the summer, causing discomfort in hot weather. He remains brown and white for only a month, which is an unnaturally short period for his species. He explains that this is because his natural photoperiodicity does not work well, and that this problem contributes to regular periods of insomnia.

Mental Status Exam

Dr. Phaedrus possesses a slender build and average height. He appears approximately his stated age. He evidenced no problems with hygiene and was dressed in appropriate, professional attire. He has no visible body piercing or tattoos. His attitude toward the examiner was cooperative, but curt. Thought process appears clear and goal-directed. His speech is ordinary and easy to understand, with normal rate, inflection, articulation and reciprocal flow. Dr. Phaedrus’s affect seems to be incongruent with his mood. He seems to have limited mobility, remaining in one position throughout the entire interview, with overly intense eye contact towards the interviewer. Dr. Phaedrus denied suicidal ideation, intent and plan to direct questioning. He evidences normal perception and thought content. He did not demonstrate any problems with short-term memory and was alert and oriented throughout the interview.

DSM-IV-TR Multiaxial Diagnosis

Dr. Phaedrus’s provisional DSM-IV-TR multiaxial diagnosis follows:

Axis I: 327.01 Sleep Disorder due to Irregular Photoperiodicity, Insomnia Type

Axis II: Diagnosis Deferred on Axis II (V799.9)

Axis III: Irregular photoperiodicity

Axis IV: None

Axis V: GAF = 71-80

*Note: Although the International Classification of Diseases (ICD) is the diagnostic system used in Germany, the authors chose to use the Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic taxony due to the authors’ familiarity with this system.

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2 Responses to “Case Files”

  1. What is this website? I find it most interesting as a PSY Postgrad.

    • Hi there, this site hosts a co written storyline that takes place in mental institution, and is updated once a month. Glad to hear that you find it interesting!

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