case study psych review Flashcards
person comes in and you do a whole screen and also need to ask…
when did the symptoms start, how often do they occur, how long do they last
Psych eval - unable to move right arm, starting one month ago. cares for invalid father and had a dream of pushing away a snake with her arm.
unremarkable neuro and physical exam
dx?
conversion disorder
frequent visits to family practice, 8 months, constantly worries about her health, never complains of pain,
suspect…
illness anxiety disorder
on her way to work and likes work, isn’t feeling well, and things she needs a UA at the ED; she empties sugar into her UA
dx?
factitious disorder
can’t sleep, bad appetite, memory and concentration isn’t going well, energy is shot and decreased libido,
lost interest in daily life criteria;
most of the day every day for the past two weeks
suspect…
Major depressive disorder
8 yo displaying verbal rages, temper outburts, grossly out of proportion to the situation,
3x a week
persistently irritable and angry between outburts most of the day every day
since he was 6 yo
period of about 2 months that he was outburst free, but never again
Disruptive Mood Dysregulation Disorder
Hasnt been herself for 7 days, friends have noticed her persistently elevated and expansive mood with increase in energy
more talkative, easily distracted, grandiose in self perception,
3 h of sleep per night to do shopping spree, poor work status
bipolar disorder type I
driving trip, doesnt have a care in the world, suddenly has intense discomfort that reaches a peak in minutes
this is the second episode of sweating, heart racing, etc.
he has been worried about a second episode for the last month
panic disorder
3rd year law student, most of the day, more days than not, for the past year, has been anxious about school and life
restless, easily fatigued, mind goes blank, difficult to fall asleep, mild irritability and muscle tension
generalized anxiety disorder
almost died in MVA on Xmas about 2 mo ago
since then, lost control, sliding on ice, totaled car
‘certain I was going to die’
dreams of the event almost every night
avoids talking about it and avoids places that remind him about it. doesn’t like family get togethers, easily irritated, exaggerated startle response
PTSD
presents to ED not feeling well, on her way to work and loves her job, feels she needs a UA, fills it with sugar
what topographical level is she creating her ssx?
conscious level
20 yo gets distraught when roomie doesnt go with her. calls her greatest person or worst person
permiscuous in dating, spending money inappropriately
irritable and angry easily,
roomie walked in and caught her cutting her wrist
borderline personality disorder
kid is eating cookies before dinner, and lies to his mom
unconscious defense mechanism blurts out conscious
which unconscious defense mechanism did he use?
denial
19 yo junior in college, for 3 weeks hearing voices, then disappears
doing well in school, no other problems
brief psychotic disorder
19 yo college roomie brings him in
for 6 weeks, hearing voices, phone is being bugged by CIA
rather than wait to see if it resolves within 6 months, make a provisional disorder
schizophreniform
19 junior in college brought in by SO,
hearing voices, apathetic, not attending personal hygiene, others looking in windows and having fixed false beliefs
7 and a half months
schizophrenia
32 yo male, mildly anxious and depressed, MDD disorder and taken medication
slowed DTRs, underlying physical disorder?
test to order?
TSH
54 yo male Coors, hasnt been eating well, confused and trouble remembering, making up stories
denies etoh, but we suspect it so we order…
MCV, GTT, and B1
21 yo to ED by police, physically agitated, talking to himself, joined frat, some kind of initation tonight
roomie says its super abnl for him
test to order?
Urine drug screen
72 yo w wife passed 2 years ago, recurrent depression, drinking etoh, dx with SLE, no friends left, hospitalized earlier for bottle of pills ingestion,
worries us the most?
past suicide attempt
19 yo high school senior, can he go back to school after bringing a gun to school
ADHD, ODD, conduct disorder (starting fights, breaking into cars, striking a student with baseball bat)
etoh and weed use
indcation of future violence?
conduct disorder
35 yo female with husband, has MDD since 20 yo, numerous trials of all the antidepressant drugs including atypicals
nothing has been very successful
SI with intent and plan currently
recommendation?
electroconvulsive therapy and hospitalization
10 yo, losing temper, arguing with parents and teachers, blames others for his mistake, deliberately annoys others
suspect?
oppositional defiant disorder
15 yo with repetitive eye rolling and head rolling, nasal sniffing and throat clearing
wax and wane but persisted for more than a year
tourettes
12 yo for a year and a half
bully at school and online, physical fights, burned down neighbors garage, shoplifting
strict rules but disobeys mom for sleepovers - police called
skipping school
conduct disorder
disturbance of sleep, appetite changes, decreased memory and concentration, down energy
if you can’t ask any other questions during the interview, what do we ask?
SI, HI
mental status exam, what is the most important part?
establish rapport
9 yo fidgeting at school, getting out seat, occasional episodes of silliness, or anger outburts
episodes for 9 months, similar episodes at home
difficulty completing his homework, difficulty focusing, concentrating, can’t get to sleep
most important question to ask parents?
is there a family hx of bipolar disorder
32 yo male released from prison after 5 years for assault and battery, football game/fight
ADHD, social phobia, alcohol
indicator for future violent behavior?
past violent behavior
23 yo F with intermittent episodes of anxiety, anger, and mood changes
has not benefitted from anti anxiety depressants
has had TSH, blood glucose, etc. all done
what do we ask?
onset of ssx, frequency of ssx, duration of ssx
24 yo F with superficial lacs to L wrist
feels abandoned by bf after break up
chronic feeling of emptiness, 3 traffic citations, uses marijuana recreationally
yells angrily at her mother
What is her greatest risk for Suicide by accident?
borderline personality disorder
