CASE 35 - Hallucination

Question 1

Do you think someone is trying to give me instruction through the writing I see on the wall?

Answer 1

I don’t think anyone is trying to give you instruction.

If you have been taking illicit drugs, it may be that the drugs are causing you to see this writing.

In any case, we are going to do some tests to try to figure out what is going on.

Question 2

Specific Qs:

Answer 2

1. Content ==> It is NOT clear, and I can’t read it most of the time.
2. Duration — constant/intermittent — frequency.
3. Do you see the writing while your eyes are closed?
4. Major life changes or stressors.
5. Content of voices.
6. Feeling of being controlled.
7. Do the voices/writing order you to harm yourself or others?
8. Do you think about harming yourself or others?
9. Mental illness in the family?
10. Do you ever have these symptoms without drug use?
11. Illicit drug use?
12. Which illicit drug do you use?
13. Last use of illicit drugs?

Question 3

PEx:

Answer 3

1. Eye exam ==> Inspected pupils — checked for reactivity.
2. CV ==> A + VS.
3. Chest ==> A.
4. Abdo ==> P.
5. Neuro ==> Mini-mental status exam, CN, motor exam, DTRs, gait, sensory exam.

Question 4

DDx:

Answer 4

1. PCP intoxication.
2. Substance-induced psychosis.
3. Brief psychotic disorder.
4. Psychosis 2o to a medical condition.
5. Narcolepsy.
6. Seizure.
7. MDD with psychotic features.
8. Schizoaffective.

Question 5

Workup:

Answer 5

1. Urine toxicology.
2. Electrolytes.
3. CPK.
4. Urine myoglobin.
5. Mental status exam.
6. TSH.
7. Beck depression inventory.

Question 6

Narcolepsy w/o cataplexy (muscular weakness w/ or w/o an emotional trigger) is classified as …

Answer 6

Major SOMNOLENCE disorder in DSM-5.