Discussions By Condition: I cannot get a diagnosis.

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Posted In: I cannot get a diagnosis. 1 Replies
  • Posted By: kancha
  • November 1, 2008
  • 07:30 AM

CASE 3
The patient Mr.A is a college student of 21-year-old male with a history of one prior suicide attempt who was brought to the hospital emergency room by ambulance, accompanied by his boyfriend and roommate, after having taken an overdose of atenolol (Tenormin) (twenty-five 25-mg tablets), zolpidem (Ambien) (twenty 10-mg tablets), and possibly fluoxetine (Prozac) pills (number unknown) in a suicide attempt. All of these medications had been prescribed for the patient's boyfriend.
The evening before, the patient had had a fight with his boyfriend. He believed that his boyfriend wasn't giving him enough time and was not committed to the relationship. They slapped and punched each other. The patient went to a bar with another friend where he consumed four beers and a shot of vodka. When he arrived back at home, his boyfriend told him to go to sleep, which he interpreted as a continued lack of interest on the boyfriend's part. He locked himself in the bathroom and took many of his boyfriend's pills. The patient filled the empty pill bottles with water and left them in plain view on the sink.
The patient then unlocked the door and went to bed, telling his boyfriend where to find syrup of ipecac. (Mr. A. carries the ipecac in his knapsack to induce vomiting when he drinks too much alcohol.) His boyfriend saw the pill bottles, realized the patient had overdosed, and tried to induce vomiting by administering syrup of ipecac. Unable to get the patient to vomit, he called an ambulance.
Mr. A currently drinks alcohol once or twice each week, usually on the weekends. A usual amount of alcohol for him consists of two vodka tonics and eight or nine beers. Often, he drinks until he blacks out. He used cocaine this past New Year's Eve ("a few lines") and occasionally uses heroin intransally (unknown amounts). He denies any history of intravenous drug use.
He remembers always speaking and thinking very quickly, because he was always "so bright and talented and good looking and smart." In addition, he has needed little sleep since age 15. The racing thoughts, pressured speech, and decreased need for sleep have become more pronounced since September, when he started feeling "very up." Since then he has been getting at most 5 hours of sleep each night without feeling tired. He says he can be very influential, but that he has no special powers. He reports that he gets angry quickly and that his mood can change very easily. Since September he's also felt more depressed and physically restless. He considers suicide frequently, "just to escape the boredom of life." He has lost 6 pounds in the last 2 months. There is no history of hallucinations or of delusional thought.
Question:
1.Please list this patient’s psychiatric signs and symptoms.
2.Please give your diagnosis of this patient.
3.Please give your differential diagnosis.
4.What are your treating plan?


CASE4
A 50-year-old former schoolteacher had characteristic auditory hallucinations during each of her episodes. During mood elation, she heard celestial voices praising her and instructing her to start elaborate international businesses. When unhappy, she heard accusatory voices telling her that she had deeply hurt, offended, and harmed many of her students by not grading them accurately, and that as a result the FBI was searching for her and was certain to jail and torture her for the rest of her life.
Question:
1.Please list this patient’s psychiatric signs and symptoms.
2.Please give your diagnosis of this patient.
3.Please give your differential diagnosis.
4.What are your treating plan?


CASE5

A 23-year-old woman commonly heard several choruses of angels and "higher beings" who intermittently argued with each other about how she should be spending her time, and what she should do to hasten the arrival of the Messiah on earth. The multitudes of voices also addressed her directly, but the cacophony was often so great that she could distinguish only one or two voices, belonging to the more powerful or influential angels. She ordinarily took their advice and recommendations to heart, but she was quite perplexed by the fact that the angels often could not agree.
Question:
1.Please list this patient’s psychiatric signs and symptoms.
2.Please give your diagnosis of this patient.
3.Please give your differential diagnosis.
4.What are your treating plan?



CASE6

A 35-year-old man with a history of polysubstance abuse and who constantly smoked marijuana estimated that he had used hallucinogens including LSD and mescaline more than 100 times before having a series of devastatingly frightening hallucinatory experiences of devils, of his body being consumed and eaten by wild animals, and of burning in ***l-fires. These were accompanied by such profound paranoia and panic attacks that he swore off "heavy drugs," but continued to use alcohol and marijuana. Several months later, during a period of personal crisis during which he smoked an unusually large amount of powerful marijuana he suddenly reexperienced the worst devil-filled flashback; this experience lasted for several hours in spite of the efforts of several of his friends to talk him down.
Question:
1.Please list this patient’s psychiatric signs and symptoms.
2.Please give your diagnosis of this patient.
3.Please give your differential diagnosis.
4.What are your treating plan?



CASE 7

A 24-year-old engineering student from a rigid, devout, and loving home was convinced that his mild pectus excavatum condition was an atrocious deformity that accounted for his never having had a girlfriend. A mild deformity did exist, but his reaction to it was far in excess of the actual problem. He was embarrassed to take showers in the dorm, afraid that other students would see him and make fun of his deformity. He sought the services of a surgeon to fix the deformity; the surgeon sent him for psychiatric consultation prior to performing the surgery. No other psychiatric difficulties were evident, and the results of psychological testing were nonrevealing. His father, a rather literal-minded man, was in full agreement with the son's desires to have the corrective surgery. With no clear contraindication, the surgeon agreed to perform the operation. A 6-month follow-up revealed that the student was much happier, and was now dating for the first time in his life.
Question:
1.Please list this patient’s psychiatric signs and symptoms.
2.Please give your diagnosis of this patient.
3.Please give your differential diagnosis.
4.What are your treating plan?

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1 Replies:

  • Will we get the diploma if we help you with your test?
    Monsterlove 2921 Replies
    • November 2, 2008
    • 04:40 AM
    • 0
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