Date: March 29, 2004
Client: George Asakura (Joe)
DOB: November 15
Marital Status: Single
Place of Examination: ISO Health Center
Joe is a 19-year-old heterosexual Caucasian male referred by Dr. Kozaburo Nambu of the International Science Organization. Joe reports dizziness, blinding headaches, and strong reactions to bright lights. He also states that he has recently remembered parts of his childhood that he "had totally forgotten." These memories were also preceded by reactions to flashes of light. His current symptoms are often juxtaposed by stressful situations, such as having to fight, or being in a situation in which the team is relying upon him.
Joe describes himself as "someone who likes to be left alone," who would "rather do something than stand around discussing options," and who has at times been censured for his temper and behavior, including recently "taking off when Dr. Nambu told me he wanted me to talk to a head-shrinker." He noted that he was speaking with the interviewer under duress, and had agreed to do so to keep from being removed from the Gatchaman team.Behavioral Observations
Joe arrived for his intake appointment several minutes late. He was appropriately dressed but initially reticent with the interviewer. His affect  was slightly depressed, bordering at times on sullen.Family History
Joe states that his parents were killed when he was a child; this information is confirmed by Dr. Nambu. The client found his parents' bodies, and was confronted with "the bitch that murdered them." He reports that he experienced feelings of horror and rage and, in spite of significant reported derealization , he attempted to shoot the assassin, but instead was caught in the explosion caused by her rose grenade. Though Joe is able to recount what happened to him after the explosion (being taken to the hospital, going to stay with Nambu), he says these are repetitions of what he has been told; he has no memories for several days following the explosion.
Joe reports that his memories of his parents, Giuseppe and Katarina Asakura, are warm, which is "why Jun says I'm still so pissed off that Galactor killed them." Joe's memories of his parents' murder were repressed until recently. At that time, with the help of Ken, he was able to recover them. Prior to the recovery of the memories, he reports intrusive and distressing piecemeal recollections in response to particular stimuli, including bright lights. These recollections took the form of dreams, illusions , visual and auditory hallucinations, and dissociative flashbacks , and left him in a state of heightened arousal, indicated by a racing heart, panting, and sweating. His repeated attempts to avoid or push away the memories were futile.Relationship History
Joe is not currently in a romantic or sexual relationship saying he doesn't "have time for that kind of thing." However, when pressed, he said that he "tend[s] to pick the wrong kind of girls…like Galactor agents." He became angry when the interviewer asked him to say more, and refused to discuss the issue further, saying "you keep it up and we're going to be done right now."Occupational History
Joe is a member of the Kagaku Ninjatai, "the best shot on the team," and maintains a cover occupation of private race car driver. He reports that he enjoys the "adrenaline rush" of both occupations and "can't imagine doing anything else."Medical History
Joe reports several past head injuries, followed by periods of unconsciousness lasting anywhere from "a few minutes" to "probably an hour." The most recent significant injury led to shrapnel lodged in the client's skull; it was removed with the use of an experimental centrifugal method  with unknown side effects. Joe reports that he did not have any of his current symptoms after that injury.
Joe was also injured in an explosion when he was a boy.
Joe states that he has not used recreational or illegal drugs, though he commented that he wouldn't tell the interviewer if he had. When assured that a full assessment of drug and alcohol history is necessary to rule out the influence of a substance, he reported that he drinks "rarely" and "tried marijuana a total of once…I'm not good to be around when I'm paranoid." He noted that at times he resents not being able to live "a normal life like other kids…being able to drink and party," but rather one that requires him to constantly be alert.
Documentation received from neurologist Jane Doe suggests that symptoms cannot be fully explained by a medical condition. She and her colleagues are continuing their investigation, which has to date included an MRI, a CAT scan, and a PET scan. Though "negligible" remnants of shrapnel have been found in the parietal and temporal lobes, they are, according to Dr. Doe's report, "in associative areas , and should not affect speech, temperament, or functioning in any way other than the loss of information contained by the damaged neurological areas."Summary and Differential Diagnostic Impressions:
Given Joe's history of dissociative amnesia, derealization, and avoidant behavior, and his recent experiences with intrusive symptoms and hyperarousal, a preliminary diagnosis of PTSD is appropriate. Given the significant neurological and sensory impairments, as yet unexplained by a medical condition, a diagnosis of Conversion D/O may also be appropriate; the examiner has chosen to leave this as a rule-out pending additional medical results at the end of this week.
In addition, Joe's extensive history of irritability and withdrawal, particularly given his unusual upbringing, may indicate a mood disorder. Because the client articulated bouts of moodiness, rather than a consistent lack of energy, appetite, or sadness, a major depressive disorder currently seems diagnostically more appropriate than dysthymia ; because features of mania were not indicated, even during periods of irritability, the bipolar  disorders were not included for consideration.
Axis I: 309.81 Posttraumatic Stress Disorder, acute, with delayed onset
296.3 Major Depressive Disorder, Recurrent, with Melancholic features
R/O Conversion Disorder
Axis II: V 71.09 No diagnosis
Axis III: Traumatic brain injury, including shrapnel lodged in the brain.
Axis IV: Work pressures, incomplete social system, unusual upbringing, discord with Nambu
Axis V: GAF current 50 Notes for readers
 Deficits affecting voluntary motor or sensory function that suggest a neurological or other general medical condition.
Psychological factors are judged to be associated with the symptom or deficit because the initiation or exacerbation of the symptom or deficit is preceded by conflicts or other stressors.
The symptom or deficit cannot, after appropriate investigation, be fully explained by a general medical condition, or by the direct effects of a substance, or as a culturally sanctioned behavior or experience.
 Emotional presentation
 Derealization is feeling like things aren't real, like they're happening in a dream, or are otherwise strange -- sounds, time, and objects can be distorted.
 Misperceptions of real external stimuli -- as opposed to hallucinations, in which you see something that totally isn't there.
Dissociation is when you split off from yourself in some way -- for example, derealization is a kind of dissociation.
 Associative areas are parts of the brain that do whatever specialized parts of the brain don't -- mostly, they hold memories.
 Under the medical model of psychology, you make an actual diagnosis (so you can bill the insurance!) but you "rule out" the diagnoses you're not sure about. They're things you need to get more information about before you're prepared to make an official diagnosis.
Actually, the way I wrote this, if this was real, I wouldn't have ruled out depression, I'd have made the actual diagnosis, but since I know there are people who won't like the idea of Joe being depressed, I left it as a rule-out. (In the biz, we call that "politics." ;-)
 Long-term, low-grade depression
 aka "manic-depression"
And I know, my numbers are out of order. Sue me. (Well, don't -- I don't have any money :-)
 It is inappropriate to write "moronic treatment method," so you learn to use euphemisms like "experimental." See how that works? ;-)
 Global Assessment of Functioning – let's just say that's as high as the number can possibly be, and if he goes much lower, he's not going to be functioning much at all. But then, that's the problem he's facing, isn't it?