case study psych review

Question 1

person comes in and you do a whole screen and also need to ask…

Answer 1

when did the symptoms start, how often do they occur, how long do they last

Question 2

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?

Answer 2

conversion disorder

Question 3

frequent visits to family practice, 8 months, constantly worries about her health, never complains of pain,

suspect…

Answer 3

illness anxiety disorder

Question 4

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?

Answer 4

factitious disorder

Question 5

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…

Answer 5

Major depressive disorder

Question 6

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

Answer 6

Disruptive Mood Dysregulation Disorder

Question 7

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

Answer 7

bipolar disorder type I

Question 8

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

Answer 8

panic disorder

Question 9

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

Answer 9

generalized anxiety disorder

Question 10

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

Answer 10

PTSD

Question 11

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?

Answer 11

conscious level

Question 12

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

Answer 12

borderline personality disorder

Question 13

kid is eating cookies before dinner, and lies to his mom

unconscious defense mechanism blurts out conscious

which unconscious defense mechanism did he use?

Answer 13

denial

Question 14

19 yo junior in college, for 3 weeks hearing voices, then disappears

doing well in school, no other problems

Answer 14

brief psychotic disorder

Question 15

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

Answer 15

schizophreniform

Question 16

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

Answer 16

schizophrenia

Question 17

32 yo male, mildly anxious and depressed, MDD disorder and taken medication

slowed DTRs, underlying physical disorder?

test to order?

Answer 17

TSH

Question 18

54 yo male Coors, hasnt been eating well, confused and trouble remembering, making up stories

denies etoh, but we suspect it so we order…

Answer 18

MCV, GTT, and B1

Question 19

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?

Answer 19

Urine drug screen

Question 20

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?

Answer 20

past suicide attempt

Question 21

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?

Answer 21

conduct disorder

Question 22

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?

Answer 22

electroconvulsive therapy and hospitalization

Question 23

10 yo, losing temper, arguing with parents and teachers, blames others for his mistake, deliberately annoys others

suspect?

Answer 23

oppositional defiant disorder

Question 24

15 yo with repetitive eye rolling and head rolling, nasal sniffing and throat clearing

wax and wane but persisted for more than a year

Answer 24

tourettes

Question 25

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

Answer 25

conduct disorder

Question 26

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?

Answer 26

SI, HI

Question 27

mental status exam, what is the most important part?

Answer 27

establish rapport

Question 28

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?

Answer 28

is there a family hx of bipolar disorder

Question 29

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?

Answer 29

past violent behavior

Question 30

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?

Answer 30

onset of ssx, frequency of ssx, duration of ssx

Question 31

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?

Answer 31

borderline personality disorder