Gina was a 28-year-old female brought into the emergency room by University police officers. She had been suspended from the university a few months earlier. Apparently, Gina had walked into a classroom shouting that she was looking for Spiderman and that she was one of Spiderman's enemies meant to destroy him. The professor in the classroom asked Gina to leave but she refused. At which point, university police were called and she was taken to the emergency room. According to Gina (and corroborated by her mother), as a teenager, Gina was an honor roll student who had much academic success throughout high school and early college. However, her behavior started to become more and more odd and eccentric over the past year to 18 months. She had stopped seeing her friends and family but was previously quite social. Instead, she started spending most of her time lying in bed and staring blankly at the ceiling. Although she lived with several of her close family members, she didn't speak to them very often anymore. She appeared to lack motivation and interest in social activities. Her suspension from the University was due to a lack of attendance in her classes. Her professors had assumed that she just didn't want to come anymore or assumed that she had been depressed. Her cousin who she was close with also indicated that she had seen her mumbling to herself frequently but she was unable to make out what exactly she was saying; however, she noted that he appeared to be responding to someone, although he was by himself. In addition, she noted a couple of instances in which Gina would stand on the roof of her house and move her arms as if she were in front of an orchestra, conducting. Gina denied adamantly that she ever wanted to jump off the roof or had any thoughts of harming herself but she felt that she was liberated when she was on top of the roof and was in touch with the music as she conducted the symphony. Over the past year to year and a half, Gina's family strongly encouraged her to see a counselor at the University's counseling center but she never agreed. In fact, she had never actually seen a psychologist, therapist, social worker, or psychiatrist in the past and had never been in a psychiatric hospital. Over the past several months, Gina started to become preoccupied increasingly with a male friend of hers who lived nearby. She told her family that they were engaged and that she felt on top of the world when she thought about him. The male friend, though, stated that they had rarely spoken and were not even dating. Gina's family denied that she had used any illicit substances or alcohol and her toxicology urine screen was also negative, suggesting that she had not used any substances recently.

Upon mental status examination, Gina was observed to be a well-groomed young adult. She appeared quite guarded and agitated during the evaluation. She also appeared to have poor attention and was preoccupied. When a nursing staff brought her dinner the night of her emergency room hospitalization she became quite angry yelling loudly at the nurse indicating that she believed the food was poisoned and requested only a specific type of bottled water. She was noted to have paranoid thoughts, thoughts of grandiosity, and romantic delusions. She appeared to be internally occupied however she did deny having any hallucinations. She told the psychologist that she felt bad about herself but denied feeling depressed. She also denied sleep problems. She noticed eating somewhat less recently but stated that it was because she was too busy with other things. She was oriented to person, place, time, and situation. Her speech was observed to oscillate between pressured/fast and guarded/minimal. She denied any formal cognitive testing while at the emergency room. His insight and judgment were poor.

In terms of family history, Gina's maternal grandmother spent over 25 years in a psychiatric hospital where she passed away in her 60s. Her cousin stated that she was "bipolar or had multiple personalities or something. She was always talking to herself and hearing voices." Gina was raised by her father and paternal grandparents; her mother was "crazy" and abandoned the family when she was young.

• Evaluate the diagnosis, etiology, and treatment plan presented by the group, then indicate your support or rejection using evidence from this module. Specifically, state evidence supporting or contradicting the group's diagnosis, etiology, and treatment plan.
• What other diagnoses would you consider?
• What other etiological factors would you consider?
• What other treatments are available for the diagnosis?