Avoidant Personality Disorder

ID CC During a routine physical exam, a young female patient tells her physician that she has fallen in love with him when he recommends that she see another physician, she threatens to commit suicide. HPI She denies any depression or suicidal ideation in the past. Treatment Psychiatric consultation and behavioral psychotherapy can be effective over time. Discussion Characteristics of such a personality disorder include unstable mood and behavior, suicide attempts, boredom, splitting, feelings...

Generalized Anxiety Disorder

ID CC A 21-year-old female student having a routine physical exam appears distracted and focused on the office ceiling when confronted by the physician she is embarrassed but admits that she is counting the number of tiles on the ceiling. HPI For the past 5 months, she has experienced an irresistible urge to count objects on a daily basis. She estimates that she spends 1 to 2 hours counting tiles each morning, often missing her classes or meetings as a result. The patient adds that she is...

Cd

PE large laceration on lip fundus normal 110 meningeal signs no focal neurologic deficit vitals maintained. Lytes normal. Blood glucose normal. EEG normal background interrupted by generalized spike and slow-wave discharges ranging from 3 to 5 Hz can be elicited by hyperventilation, photic stimulation, and sleep. Anticonvulsant therapy widi phenytoin or valproate. A seizure is a paroxysmal, abnormal discharge of neurons of the cerebral cortex that alters neurologic function. Epilepsy...

Vaginismus

ID CC A successful 50-year-old business executive becomes agitated upon his admission to an orthopedic ward with a fractured femur he complains that people are making derogatory comments about him and are accusing him of impotence (paranoid delusions). HPI On persistent questioning, he admits to moderate alcohol intake. There is no personal, past, or family history suggestive of any major psychiatric illness. PE Psychomotor agitation anxious and slightly tremulous but well oriented remainder of...

Malingering

ID CC A 37-year-old female with a history of insulin-dependent diabetes mellitus (IDDM) is admitted to the hospital for severe diabetic ketoacidosis (DKA). HPI The patient is educated, articulate, and assertive and seems to be extremely knowledgeable about her disease. She claims that she controls her diabetes rigorously. After some phone inquiries, it is discovered that she has been admitted for hypoglycemia 01 DKA at various local hospitals 23 times over the past 18 months. When confronted...

Gender Identity Disorder

ID CC A 40-year-old white female comes to the emergency room claiming that she is Jesus Christ. HPI She is now medically stable and admits thai she is not Jesus as the voices had told her. Over the past week, she has slept fewer than 3 hours per night. She initially excelled at work but recently became irritable and unable to concentrate. She then experienced auditory command hallucinations which told her that she had special powers. She recalls a similar episode several years ago and reports...

Schizophreniform Disorder

ID CC A 52-year-old female accountant complains that she has had difficulty falling and staying asleep for 2 months she states that the sleep she does manage to get is not restful and that she is easily awakened by noises. HPI The patient adds that she is fatigued during the day and as a result is performing poorly at her job. She says that she has always been a light sleeper. She denies feeling depressed, although she admits that she gets irritable when tired. She takes no medications and...

Panic Disorder

ID CC A war veteran complains of intense and vivid flashbacks with associated anxiety and hyperarousal. HPI The patient has witnessed and experienced traumatic events but cannot recall certain details of these events, and he becomes anxious both when questioned about the events and when he encounters cues that remind him of them. He also reports difficulty falling asleep, hypervigilance, emotional outbursts, difficulty concentrating, and recurrent nightmares that have begun to interfere with...

Anorexia Nervosa

ID CC A 20-year-old female college student reveals a secret problem to her family physician. HPI She has always been preoccupied by her body. Several times a week, she suffers uncontrollable eating binges. She almost always follows these binges with a visit to the bathroom, where she discreetly makes herself vomit. Following each such episode, she feels depressed. Treatment Pharmacologic approach uses antidepressants psychological approach tises psychotherapy, cognitive behavioral therapy....

Sublimation

ID CC A 28-year-old woman presents with a 3-month history of anxiety and depression following her breakup with her fianc of 3 years. HPI She has been overwhelmed by feelings of sadness, tearfulness, and depression and is concerned thai she will never be in a relationship again or fulfill her dream of having a family. Since her breakup with lier fianc , she has lost touch with friends and family, and her performance at work has steadily declined. PE Physical exam reveals a cachectic and poorly...

Pi

A female patient complains of uncontrollable anxiety of more than 6 months' duration together with daily symptoms that she attributes to a heart condition. The symptoms interfere with her social and professional life because she never knows when the anxiety will begin. She is irritable, fatigues easily, has poor concentration, and has difficulty falling asleep. She reports that during the exacerbations, her heart beats quickly, she sweats, and she occasionally has diarrhea. The patient has no...

Icu Psychosis

ID CC A 20-year-old man is brought into the ER after lie was discovered trying to hang himself. HPI The patient has become quiet and withdrawn, avoiding social activities and school events. His roommate reports that for the past 6 months, many friends have commented on his increasingly peculiar behavior. The roommate also reports that 2 months ago the patient began mumbling to himself and often pausing as if he were listening to someone else. Upon psychiatric evaluation, the patient speaks in a...