In the short hospitalization unit of Dr. Rodríguez Lafora Hospital in Madrid, a 19-year-old Dominican patient voluntarily entered the hospital referring to a low mood state.
The patient attends the interviews with a care aspect, cleaned and appropriate to the social situation in which he is.
She remains oriented in the three sessions coherently and maintains a fluid and coherent discourse, referring to her biography without discrimination or distraction.
She has no difficulty in visual contact and is skillfully related.
The patient reports that the symptoms that concern him appear for the first time when he arrives in Spain, 18 years old.
These begin with a depressed mood.
When the mood is lower, he explains, a tall man dressed in black, called Noob2, appears as an external figure, whose eyes are only seen.
You can talk to him about things to forget his mood.
Tiempo after the eruption of the Noob entity in the life of the patient begins to have occasions in which she feels like a woman, adopts feminine postures, paints her nails and says things themselves.
When she adopts this female role - it should be noted that the patient says “when she appears” and that she does not speak at any time of “feeling protected” - she feels away from fights and knows what things.
To date, the patient does not report episodes of drug use.
Subsequently, it begins to consume marijuana and soon begins to adopt - the term to refer to this adoption, never possession, is again "appearing" - which considers as the most dominant, the strongest of the personality.
When the patient appears, sometimes the notion of time can do things that he/she does not remember and then experiences loss in face of his/her fault (amnesia and diversion).
This personality is called “Cruza or dies”.
Its arrival is linked to a particularly traumatic event for the subject: his stepfather, who was dealing with drugs, obliges him to help him exercised rectally and as a person, thus carrying the medication from Spain to Germany
During the trip, the patient reports this dark presence.
At first, “Cruza or dies” shows up dialoguing and tries to persuade him through thought.
He says he kills his stepfather because he is making life impossible, and he insults him.
Progressively, this personality moves from the inner dialogue to the domain of their acts, involving them in serious fights and encouraging them to drink.
When reviewing his biome, during the process of preparing the anamnesis, the patient mentions that since he was very young he had an invisible friend called “Jack”, who shows that these episodes in traumatic childhood have a very complex nature.
The patient says that “Jack” and he spent many years together, until at the age of 15 he took leave of him and left him, saying that he was much older than to be alone.
When asked about the details of his childhood, he remembers it generally sadly, as a child who was mistreated by his father, abandoned in the streets of Santo Domingo shooting and had to survive the fights.
The fact is that his father threw him home at 11 years of age and accidentally shot him at 13 years of age.
Later, when she arrived in Spain, she lived with her mother for a while, but then she left him when she left alone abroad, specifically the Netherlands.
The patient reported that at that time he tried to commit suicide by tiring from a ninth floor, as he believed he did not paint anything in this world and that he was very alone.
Expanded that he was dealing with an activist and unplanned, which finally did not end when he did not feel valuable for it and was a religious person, who considered that this conduct would be a paminose
After a while he goes to Holland, where he lives with his mother and stepfather, who abuses both.
One day after returning from a school excursion, they do not find their mother at home and inform her that she has taken care of her stepfather.
The news surprised him.
The patient reports that she is afraid to harm someone, because “Being or dying” will not hurt him but can harm others.
Evaluation and results
Patient assessment is proposed from different instruments:
1.
Psychological anamnesis mentioned above, which is summarized in Table 1.
Semi-structured Symptom Simulation Inventory (SIMS; Widows and Smith, 2005; Spanish translation of González Ordi and Santamaría Fernández, 2009).
It is composed of 75 true and false items that assess five scales: psychosis, neurological impairment, mental disorders, low intelligence and mental disorders.
It is a brief application test of easy interpretation.
Let us observe, through screening, which symptomatology appears in a way that harms or harmlessly if the subject tries to simulate a particular disorder, a cut-off point from which simulation can be considered (see 1).
Multiaxial Clinical Inventory of Mild II (MCMI-II; Mild, 1994; Spanish version, 2004).
The MCMI-II provides empirically validated information to support the diagnosis in various fields: clinical, medical and forensic.
It is suitable to apply to individuals who have both emotional, behavioral or interpersonal problems.
It has 4 validity indexes and 24 clinical scales according to severity level: clinical personality patterns, severe personality pathology, clinical syndromes and severe clinical syndromes (Winberg and Vilalta, 2009).
The qualitative assessment of the results obtained by the patient is presented in Table 2.
1.
The results found after applying the SIMS to the patient manifest suspicion of malingering, both in psychosis and neurological deterioration, after obtaining a direct score of 7 and 5 respectively.
