how to diagnose the below case study according to DSM IV-TR & DSM 5? 

Mr. K is a 38 year old single (never married, no children) male who experienced his first symptoms of mental illness in 2005, 11 years ago. He was living out of state at the time and sought treatment at his local hospital. At this time he reported having feelings of déjà vu experiences off and on for the past two years and these experiences were intensifying. He received some medications (unknown) in the emergency room but was not admitted. He had completed college and had worked full-time ever since. At the time of the NGRI offense, Mr. K was employed full-time in an occupation that required him to travel from state to state. Mr. K reported that he smoked marijuana once per week and drank alcohol occasionally. In June of 2007, at the age of 29, Mr. K was hospitalized for 6 days in his home town. At this time he was experiencing delusions, paranoia and isolation. Examples of his delusions included the following: beliefs that the television was sending him messages; belief that mythological creatures were trying to entice him to battle; belief that a celebrity on TV wanted to marry him; misinterpretation of numbers to indicate that he was GOD. Again he received medication but stopped the medication once he felt better. Mr. K contends that he was never instructed to get the medication refilled once he left the hospital. Mr. K was again hospitalized for one week in January of 2008. Records indicate that upon admission Mr. K reported feeling down, depressed, and crying a lot and that he believed he was not himself. He also expressed beliefs that he had been in the military but that he was not sure. In actuality, he had been in the Navy for approximately 4 months but was discharged due to reported feelings of suicide. At the hospital he reported that his thoughts seemed jumbled. Records indicate that he was treated with Risperdal and diagnosed with Psychotic Disorder, NOS. Again, he took the medication until the prescription ended but did not seek a renewal. 

In April 2008, at the age of 30, Mr. K was travelling through Virginia and had stopped to get some dinner at a restaurant. He reported feeling very paranoid as if someone was going to harm him. He stated that he believed some of the people in the restaurant looked like devils and were possessed by demons. Mr. K went back to his vehicle and secured a knife for protection. He reentered the restaurant and sat down to have dinner. Another patron approached him and began a casual conversation. At this time Mr. K responded by pulling the knife and stabbing the bystander to death. Mr. K left the restaurant but stopped to talk to the cashier on his way out the door as if nothing out of the ordinary had transpired. He was arrested a short time later driving on Interstate95. After Mr. K’s arrest he spent time at Central State Hospital for restoration to competency. After receiving medications, he was able to be restored and he was also evaluated for a second opinion sanity evaluation requested by the Commonwealth’s Attorney. In December, 2009 he was found Not Guilty by Reason of Insanity and subsequently committed to the custody of the commissioner to begin the privileging process. Mr. K’s initial progress in the hospital was slow and was laden with numerous medication changes in order to maximize his treatment efficacy. Psychiatric treatment was complicated with the medical problem of brittle diabetes. Additionally, once Mr. K was stabilized and was able to fully appreciate the gravity of the fact that he had committed murder, he was despondent, isolated and overwhelming remorseful thus requiring further medication adjustments. He began to work with a therapist to address the guilt and shame that he felt due to his actions. Slowly, Mr. K began to make progress and by November, 2011 he was able to receive approval from the Forensic Review Panel for Unescorted Community Visits (up to 8 hours) to a day program. Although Mr. K’s psychiatric stability remained constant, his insulin levels were unpredictable and often dangerous. At one point his passes for unescorted community were held for two months in order to regain control of his medications for his diabetes. However, by March, 2012 Mr. K was ready to request 48 hour overnight passes. Until that time, he had continued to do well psychiatrically and was especially vigilant of his blood sugar levels and has learned to administer his own insulin and other medications. After several months, he was able to begin 48-hour passes to a local crisis stabilization facility (because his housing was not yet available). Mr. K has never experienced any aggression or loss of privileges during his hospitalization. He has been totally compliant with all aspects of treatment. At this time the treatment team and CSB are preparing for conditional release to a shared apartment (with a roommate who is also NGRI).

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Medications are invaluable in the management of patients with mental illnesses Pharmacists are therefore indispensable in improving the quality of service rendered to patients with mental illnesses su... View the full answer