When he was 3, Sam Watson's family had entered a witness protection program. At least that's what he tells you during the intake assessment at the student mental health center at ABC medical school in suburban Chicago. Sam's appearance was unremarkable; his clothing was neat and tidy. His eye contact was direct and steady, and he sat quietly as he described his experiences. "It was on account of my dad," he explained. "When we lived back East, he used to be in the Mob and they were looking for us." Sam's father, who attended the intake meeting with him stated; "OK, I'm an investment banker. That might not be great, but it definitely isn't the Mob."

Sam's ideas had come to him as a revelation 2 months earlier. He was at his desk, studying for a physiology test, when he heard a voice just behind him. "I jumped up, thinking I must have left my door open, but there was no one in the room but me. Then I heard it again." The voice was one he recognized. "But I can't tell you whose. She told me not to. She talked a lot!" he remarked with a laugh. She told him the mob had been after their family when he was little. Sam told his parents about the voice three days ago; his father immediately made arrangements to travel from their home in California to support Sam.

Sam was a little scattered in high school, but he made decent grades. He went to a good college, and then been accepted at a better medical school. That Fall, just before starting his first year in medical school, his physical exam (and a panel of blood tests) had been completely normal. His roommate stated he would testify that he hadn't used any drugs or alcohol. Sam was a relatively social person, however has been a bit more reclusive the last few months according to his roommate. He also hasn't seemed to enjoy going to college sports games or going to the gym like he used to at the beginning of the semester, and doesn't attend any of the medical school social events and parties anymore.

Please offer your own comprehensive diagnostic assessment for the client in the case study. Include any behavioral, emotional, social and cognitive symptomatology and duration. ** When referencing hallucinations, delusions, negative symptoms or disorganized thought/speech, be sure to specify what kind.

Provide a comprehensive diagnosis (including F Code) based on the information documented in your assessment.

Differential diagnosis is the process of weighing the probability of one disorder versus that of other disorders possibly accounting for a client's illness. For this case study, what other diagnoses did you consider and why? Why did you rule them out to provide the comprehensive diagnosis above?

Identify risk factors and protective factors as well as the best practice approaches/evidence based treatment for this client.

Discuss the sociocultural issues that affect your assessment and treatment of this case. (Hint: When applicable consider the influence of age, ethnicity, language, immigration, acculturation, gender roles, social class, stigma, spirituality/religion etc.)