Download CASE STUDIES A. Category Diagnosis (circle one) – remember

CASE STUDIES
A. Category Diagnosis (circle one) – remember, even a “clinical” psychologist can
diagnose
MOOD
ANXIETY
DISSOCIATIVE
SCHIZOPHRENIA
PERSONALITY
Specific illness____________________________________________________________
Major symptoms that meet DSM criteria ____________________________________________
Prescription/contraindication considerations only a psychiatrist can prescribe BIOMEDICAL
TREATMENT
B. Category Diagnosis (circle one) – remember, even a “clinical” psychologist can
diagnose
MOOD
ANXIETY
DISSOCIATIVE
SCHIZOPHRENIA
PERSONALITY
Specific illness____________________________________________________________
Major symptoms that meet DSM criteria ____________________________________________
Prescription considerations only a psychiatrist can prescribe BIOMEDICAL TREATMENT
C. Category Diagnosis (circle one) – remember, even a “clinical” psychologist can
diagnose
MOOD
ANXIETY
DISSOCIATIVE
SCHIZOPHRENIA
PERSONALITY
Specific illness____________________________________________________________
Major symptoms that meet DSM criteria ____________________________________________
Prescription/contraindication considerations only a psychiatrist can prescribe BIOMEDICAL
TREATMENT
D. Category Diagnosis (circle one) – remember, even a “clinical” psychologist can
diagnose
MOOD
ANXIETY
DISSOCIATIVE
SCHIZOPHRENIA
PERSONALITY
Specific illness____________________________________________________________
Major symptoms that meet DSM criteria ____________________________________________
Prescription/contraindication considerations only a psychiatrist can prescribe BIOMEDICAL
TREATMENT
E. Category Diagnosis (circle one) – remember, even a “clinical” psychologist can
diagnose
MOOD
ANXIETY
DISSOCIATIVE
SCHIZOPHRENIA
PERSONALITY
Specific illness____________________________________________________________
Major symptoms that meet DSM criteria ____________________________________________
No prescription possible on this last entry. Psychotherapy only
What Axis is “heart murmur” and “high cholesterol”_____________________________
Case vignettes from the DSM-III
Case A
A 20-year old apprentice electrician was hospitalized one month ago with acute
confusion and psychosis. The psychosis includes statements that God has spoken to
him and given him great powers. He showed no severe dulling of affect. He was
doing well, in his training and socially, until about three months ago, when he began
to show deterioration in productivity and ability to concentrate. He drinks socially
and has used marijuana occasionally, but there is no evidence of continuous abuse
or other drug use.
The patient takes no prescribed medications and has a normal physical exam.
Case B
Ms. C. is a 34 year-old bank executive who is brought for evaluation by her husband.
According to her husband, she has been in excellent health until two weeks ago,
when she began staying up later and later at night. He was not initially too
concerned, until she began awakening him to talk about the revolutionary new ideas
she had about creating an international bank cartel (league or group). He notes that
she was “full of energy” and talked rapidly about the many ideas she had. He
became quite concerned when at 3am she telephoned European banks in an attempt
to find business partners. When her husband confronted her about the
inappropriateness of her phone calls, she became enraged and accused him of
purposefully trying to sabotage her venture. She was brought to the emergency
room by her husband and two friends.
Doctors in the hospital note her speech is quite rapid and she jumps from one
subject to another. Her brother had a severe depression two years ago that
required hospitalization. Her physical exam is normal and toxic screen is negative,
showing no drug abuse.
Case C
For the past six months, this 35-year-old woman has attacks of nausea, perspiring, a
feeling of unreality and impending doom, and trembling. These attacks occur when
she goes to work, but they can occur more than once a day. They become quite
intense within a few minutes and last less than half an hour. The episodes are so
uncomfortable that she occasionally stays home to prevent them. She says she
enjoys her position, handles it well, and feels comfortable while working with
people. She does notice the feelings come for certain job responsibilities, such as
board meetings and presentations to her superiors; however she denies any
discomfort from her job or meetings
Patient has good health, is taking no medications, has low caffeine intake, and denies
drug or alcohol abuse.
Case D
Ms. T is a fairly attractive, 34 year-old woman who comes to a community health
center for an evaluation. During an interview, she says she thinks she has symptoms
of depression. She reports feelings of emptiness and boredom. She has no trouble
sleeping, has a good appetite, and rarely cries, except as she says “except when I get
mad.” She has no manic or hypomanic episodes.
A friend, supplying corroborating history reports that Ms. T often gets angry.
During these times, she drives recklessly, and has taken or threatened to overdose a
number of times. She has children age 11 and 14 who often seem to take care of her
more than she takes care of them.
She says she has met a lot of men she thought would make prince-like husbands but
they turned out to be frogs. She has been married and divorced three times.
Ms. T has been on psychotropic medications before: she was hospitalized a few
years ago and she had benzodiazepines like Valium. She admits that she often takes
more than she should “to block everything out,” in spite of several warnings from
her employers and friends about overuse.
Ms. T lost her last job – she is a licensed vocational nurse, after six months
unemployment because she “couldn’t take the B.S.” She has been looking for
another job the past several months. She is stressed and anxious by the job search
and finances: Her ex-husband refuses to pay alimony. Ms. T and her daughters had
to recently move into a smaller apartment.
Case E
While checking into a motel on a fishing trip, a 36-year-old man was distressed to
find that he apparently had someone else’s wallet and credit cards and had
inexplicably lost his own. While talking with the manager to arrange payment, it
became apparent that he had no identifying papers or cards, yet he resembled the
person whose picture was on the “other person’s driver’s license” and from
documents in the glove box, he was driving the “other person’s car.” Subsequently,
it was determined that he was actually the “other person” and had unexpectedly left
his place of work that morning.
A detailed history revealed no prior serious psychiatric symptoms. He has been a
sales manager for the last six years, is married, and has a 17-year-old son. There
have been marital problems and the day before his “fishing trip,” the son was
arrested for breaking and entering a supermarket. Physical exam is normal except
for heart murmur and increased cholesterol.