I have a colleague who has moonlighted as an on call clinician in the Emergency
ID: 3496837 • Letter: I
Question
I have a colleague who has moonlighted as an on call clinician in the Emergency Room of a local hospital for about three decades and has seen it all but he is now training you to take over for him so he can retire to Florida and be assured that you are able to handle all situations that may crop up once he is gone. Imagine it is the evening of December 24th and the police bring in a man- with rosy cheeks and a long white beard, dressed in a red suit with a red cap, thick black belt and black boots- for evaluation as he was found on the roof of a house. He tells the two you that his name is Santa Claus and that he was planning to climb down the chimney of the house he was found at to deliver gifts for the children in the home. According to the police, he was carrying a huge bag filled with wrapped gifts but no burglary tools. He claims to be from the North Pole and is very fuzzy about his age and background though he is quite pleasant. He speaks clearly and makes eye contact with you so he appears to be cooperative during the exam. In spite of your attempts to provide him a reality check, he absolutely insists and believes he is Santa and that he needs to leave so that he can continue to deliver gifts around the world with his flying reindeer.
What specific biomedical treatment (for example a particular drug) would you consider based on your preliminary diagnosis and why would you choose this based on his symptoms?
What other therapeutic interventions would you consider?
Based on what you've learned what you you say to my colleague if he asks you what you think would happen to this man if he was found on someone's roof in the 1500's claiming the same
Explanation / Answer
Answer.
The case presents symptoms of Delusional disorder and his major positive grandiose delusion is his belief that he is Santa Claus and that he has to deliver gifts to people on Christmas Eve. His delusion is not accompanied by any prominent hallucinations, thought disorder, mood disorder, or significant flattening of affect and thus a differential diagnosis of paranoid schizophrenia is made. He shows specific symptom of delusional disorder as he seems to function in a normal manner and is alert and cooperative during medical inspection. his behavior does not necessarily generally seem odd which rules out the possibility of delusions under to the effect of any substances consumed.
In his case, The delusion, as acted out, lead to behavior which is abnormal and/or out of character, although perhaps understandable in light of the delusional beliefs in his identity as Santa Claus.
In suggesting a treatment, Antipsychotics may be more useful in managing agitation that can accompany his delusional symptoms. Although hospitalization may be required given that there is a risk of harm to self or others if he continues to act out his delusions and climb other people’s private property. Individual psychotherapy is recommended and it can include cognitive therapy which is conducted with the use of empathy. Psychotherapy has been said to be the most useful form of treatment because of the trust formed in a patient and therapist relationship.
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