My Boss Told Me to Come

by Shaikh Shahriyar Wahab | April 28, 2008 9:22 am

Mr. V. Toxo is a 39-year-old senior Executive official came to a private Psychiatrist. "My boss thinks I need help with my management style." He stated the reason to the Psychiatrist.

Mr.Toxo first confirms with the Psychiatrist that the content of the sessions is confidential and will not "get back to" his boss. He runs a department with three people reporting to him, and three reporting to each of them.
Mr.Toxo admits that recently, in the wake of Rod, one of his subordinates, transferring to another department; he has been more "testy" with the other staff. He states that he is concerned that Rod may have taken some of the files when he left. He worries that one of the remaining two, Masi, is trying to undermine his authority in a possible bid for his job, or may be planning something with Rob.
The third person Anny told him last week that she was pregnant, Mr.Toxo accused her of "doing it on purpose" so that he would lose his department and they would be subsumed into a larger division with Masi at the helm.
Mr.Toxo says that, looking back on it, he may have "overdone it," but says, and “Don’t you think the timing is a bit suspicious? She is friend with Rod and Masi …”
On further enquires by the Psychiatrist he denies depressive, manic, and Neuro vegetative symptoms. Mr. Toxo has no past medical and psychiatry problem.

While describing his childhood to Psychiatrist he stated that his mother was "extremely protective." She always said "you can’t trust anyone better than yourself." Mr. Toxo excelled in school, but had social difficulty. "Other kids resented me. They were always trying to outmanoeuvre me."
Mr Toxo had few friends and has never married. He says that he’s known as a "stickler" and "prickly" at work. His intelligence has helped him progress, despite a reputation for being hard to work with. "I am very attuned to other people’s actions and motives."

Given his symptoms and suspiciousness, the Psychiatrist carefully assesses his thought process and content, looking for perceptual abnormalities and organized delusions which were absent.

Mr Toxo was well groomed, anxious, guarded. He was somewhat restricted but his Thought pro¬cess was goal directed. His thought content has suspicious themes but no organized delusions or no perceptual abnormalities; Mr.Toxo has no suicidal or homicidal ideation. The Psychiatrist organized some neurological and fundoscopic examination and to done a CT scan to rule out an organic cause which was reported normal. The blood test was Non-contributory.

With above findings and assessment of Mr.Toxo’s suspicious of his co-workers, of their actions and motivations; the Psychiatrist considered a diagnosis of delusional disorder-paranoid type.

In delusional disorder, patients have non-bizarre delusions that do not interfere with other aspects of functioning; that is, he might believe that FBI is watching him, but he takes precautions like only making personal calls on public phones and is able to function at work.

The nearest possible diagnosis could be Chronic paranoid schizophrenia but which is characterized by bizarre delusions and sometimes hallucinations. If the diagnosis were chronic paranoid schizophrenia, he might believe that the Secret Service and newscasters are sending messages through him to aliens, so he must insulate his hats with aluminium foil to prevent the transmissions.

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