Assignment: Emilio is a 40-year-old man who looks 10 years younger

Assignment: Emilio is a 40-year-old man who looks 10 years younger

Assignment: Emilio is a 40-year-old man who looks 10 years younger. He is brought to the hospital, his 12th hospitalization, by his mother because she is afraid of him. He is dressed in a raged overcoat, bedroom slippers, and a baseball cap and he wears several medals around his neck. His affect ranges from anger at his mother (“she feeds me shit…what comes out of other people’s rectums”) to a giggling, obsequious seductiveness toward the interviewer.

His speech and manner have a childlike quality, and he walks with a mincing step and exaggerated hip movements. His mother reports that he stopped taking his medication about a month ago and has since begun to hear voices and to look and act more bizarrely. When asked what he has been doing, he says “eating wires and lighting fires.” His spontaneous speech is often incoherent and marked by frequent rhyming and clang associations (where sounds, rather than meaningful relationships; govern word choice).

Emilio’s first hospitalization occurred after he dropped out of school at age 16, and since that time he has never been able to attend school or hold a job. He has been treated with neuroleptics (medications used to treat schizophrenia) during his hospitalizations, but he doesn’t continue to take his medications when he leaves, so he quickly becomes disorganized again. He lives with his elderly mother, but he sometimes disappears for several months at a time and is eventually picked up by the police as he wanders the streets.