Shahida has been feeling very sad since her husband died 12 days ago.

Extra Credit Case studies – Stump the Diagnostician

1 point per correct answer

Read the information on the following cases, and state the most appropriate diagnosis for each person. Explain the rationale for each of your diagnoses and suggest treatment(s). Some of these cases may not have disorders. In that case, indicate that the person does not have a disorder, and indicate why this is your opinion.

1. You see Susan (age 24) in the emergency room of a hospital where her parents have brought her for evaluation. They are worried because she is giving away all of her possessions and says she is planning to move to New York so she can “save the world.” Her parents say that she has hardly been sleeping at all, but she seems very energetic. They say she has appeared to be “in a frenzy” lately but this is an improvement: months earlier she had been very unhappy and lethargic. When you interview Jill you notice that she speaks very rapidly. It is hard to get her to be quiet long enough for you to ask questions. She seems agitated, and has difficulty sitting still.

Diagnosis: ___________________________________________________________

Why: _______________________________________________________________

Suggested Tx: ________________________________________________________

2. Sulaiman has been referred to you for psychotherapy following a suicide attempt. When you interview him he is very teary. He speaks slowly and looks down at the ground as he speaks. He reports difficulty in falling asleep and staying asleep for the past month. Sulaiman states that he hasn’t had much of an appetite and has lost 15 pounds. He reports that things he used to like just don’t seem enjoyable anymore, and he thinks that life is not worth living. Sulaiman doesn’t expect things to improve in the future, which is why he tried to kill himself.

Diagnosis: ___________________________________________________________

Why: _______________________________________________________________

Suggested Tx: ________________________________________________________

3. Shahida has been feeling very sad since her husband died 12 days ago. She has eaten very little, and has difficulty sleeping. She is weepy most of the time. Shahida is preoccupied with thoughts of her dead husband and does not want to do much other than thinking about him. She has declined all invitations by friends and spends most of her time alone.

Diagnosis: ___________________________________________________________

Why: _______________________________________________________________

Suggested Tx: ________________________________________________________

4. Patricia, age 38, is a worrier. She is restless, irritable and has difficulty concentrating. She worries that she worries so much and isn’t always sure what it is that she is worried about. She can’t let her husband or children leave the house without making them call her regularly to reassure her that they are ok. Her husband is growing weary of her fretting. Her children can’t understand what all the fuss is about. Their impatience with her only makes her worry more.

Diagnosis: ___________________________________________________________

Why: _______________________________________________________________

Suggested Tx: ________________________________________________________

5. Breck, age 55, was in a major car accident 20 years ago during a cross country trip. Ever since, he has been unable to drive on major highways. Although he does drive, he goes to great lengths to travel only on back roads and scenic routes. He is able to go where he wants but it often takes him much longer to get there than it should.

Diagnosis: ___________________________________________________________

Why: _______________________________________________________________

Suggested Tx: ________________________________________________________

6. Eric is 40 years old and works on an assembly line in a brush factory. He is terribly afraid of being contaminated by germs. He avoids shaking hands with others. He won’t eat in the cafeteria. He has trouble leaving the bathroom because he isn’t sure he has washed his hands well enough.

Diagnosis: ___________________________________________________________

Why: _______________________________________________________________

Suggested Tx: ________________________________________________________

7. Misty, age 32, is involved with the first man that really counts in her life. As the couple has become more intimate, Misty has started to have flashbacks about an uncle who touched her sexually when she was only eight years old. She is distressed to find out that she is shutting down feelings about her boyfriend and distancing herself from him. Although she has been sexual with other men, she says she can’t stand to let herself be sexual with someone she loves and trusts. She startles easily and reports a general increase in anxiety. She is very angry that she has to deal with the feelings about the incidents with her uncle that happened so long ago. She says that she thought she had gotten beyond all that.

Diagnosis: ___________________________________________________________

Why: _______________________________________________________________

Suggested Tx: ________________________________________________________

8. Alicia, a 28-year-old woman, is a rising junior executive in her investment company. Her increasing duties require her to make periodic formal presentations to the senior management of the company. However, she becomes intensely anxious at the thought of speaking in public. When she is forced to give a presentation she begins to feel anxious days in advance of the talk and the anxiety increases as the time for the talk approaches. She is concerned that her anxiety will become noticeable during the talk or that she will do something to embarrass herself.

Diagnosis: ___________________________________________________________

Why: _______________________________________________________________

Suggested Tx: ________________________________________________________

9. Ying, a 28-year-old woman was walking through her local shopping mall when she began to feel intensely anxious. The anxiety was accompanied by sensations of choking, smothering, and a sudden sense that the people and stores around her were unreal. She began to fear that she was going crazy and the more she worried about this the more anxious she became. A guard, seeing that she was in distress, brought her to the mall office where she was able to lie down. A few minutes later the symptoms began to subside. She went home after leaving the mall but she did not tell her husband what happened. A week later she had a similar attack while she was walking down the street. She was able to reach her house where she lay down until the attack ended. In the following three weeks she had two or more attacks. Between attacks she was constantly worried about having another attack. The patient was finally forced to tell her husband Jamie about the problem because she was so fearful of not being able to get help if an attack occurred that she would not leave her house alone or travel on public transportation.

Diagnosis: ___________________________________________________________

Why: _______________________________________________________________

Suggested Tx: ________________________________________________________

10. Antonio, a 35-year-old clothing salesman, was showing a particularly fussy customer a suit 2 months ago and suddenly began to sweat profusely. His heart started to pound, he felt dizzy, and became fearful that he was about to die. The customer didn’t notice his condition and continued to question him about the suit in minute detail. The patient, feeling faint, abruptly left the customer and went to lie down in the back of the store. The customer became insulted, complained to the manager, and left. When the manager found the patient he was slumped in a chair in the back room trembling. Approximately 10 minutes later the patient’s symptoms began to subside. He saw his physician the next day who found no evidence of any medical problems. Two weeks later, he had another similar unexpected attack. Since that time he has worried continuously about having another attack. His friends and colleagues have noticed that he is no longer as spontaneous and outgoing as he had been in the past.

Diagnosis: ___________________________________________________________

Why: _______________________________________________________________

Suggested Tx: ________________________________________________________

11. A 26 year old man is very concerned about securing his car and home. He spends a significant amount of time each day going back to his home and his car to make sure all the doors and windows are locked. The patient explains that he is concerned about crime in his area and the vulnerability of his family and belongings. He periodically acknowledges that the checking is excessive but explains that he becomes very anxious when he tries to stop himself from checking the locks and eventually feels compelled to check even more to be sure the house is secure in order to make up for the omission.

Diagnosis: ___________________________________________________________

Why: _______________________________________________________________

Suggested Tx: ________________________________________________________

12. A 27-year-old, athletic young man has an intense fear of needles. He tries to rationalize his fear by explaining that he is just being cautious and protecting himself from acquired immunodeficiency disease syndrome (AIDS). He realizes that his fear is irrational but is unable to control it. The patient has fainted twice in the past when his blood was drawn during a physical examination. He becomes extremely anxious at the sight of a needle and worries for days before an appointment with his physician or dentist.

Diagnosis: ___________________________________________________________

Why: _______________________________________________________________

Suggested Tx: ________________________________________________________

13. A 36-year-old man and his young son were driving through an intersection when another car ran through a red traffic light and struck them. The two were trapped in the car until a fire department rescue team freed them. The patient was bruised but not seriously hurt. His son had a broken leg. The first few days after the accident the patient was preoccupied with arranging care for his son and getting the car repaired. A few days later he began having recurrent distressing thoughts and images of the accident. The memory of his son’s screams after the car was struck seemed particularly vivid. The patient became irritable, had difficulty concentrating, and avoided talking about the accident. He went out of his way to avoid driving down the street where the accident occurred. These symptoms lasted for several weeks.

Diagnosis: ___________________________________________________________

Why: _______________________________________________________________

Suggested Tx: ________________________________________________________

14. Phoi graduated from high school and got a job working in a video store. After working for about 6 months Phoi began to hear voices that told him he was no good. He also began to believe that his boss was planting small video cameras in the returned tapes to catch him making mistakes. Phoi became increasingly agitated at work, particularly during busy times, and began “talking strangely” to customers. For example one customer asked for a tape to be reserved and Phoi indicated that that tape may not be available because it had “surveillance photos of him that were being reviewed by the CIA”. After about a year Phoi quit his job one night, yelling at his boss that he couldn’t take the constant abuse of being watched by all the TV screens in the store and even in his own home.

Diagnosis: ___________________________________________________________

Why: _______________________________________________________________

Suggested Tx: ________________________________________________________

16. Arlene is a 38-year-old woman suffering from a number of psychiatric symptoms. She has little apparent empathy for the feelings and desires of other people, though she is capable of exhibiting a great deal of superficial charm in order to manipulate people into getting what she wants. As a young teenager, she frequently violated her mother’s rules, was in trouble at school, and in a number of other ways exhibited the symptoms of conduct disorder. Her problems have kept her from developing and maintaining a career, and her present attempts to become a theater director are being severely hampered by her inability to understand and care about the rights of those with whom she is attempting to work.

Diagnosis: ___________________________________________________________

Why: _______________________________________________________________

Suggested Tx: ________________________________________________________

15. Z is a 27-year-old Caucasian who was referred to a treatment program because she was the highest user of emergency services in the county. She spent at least half of the year prior to entering treatment either in psychiatric hospitals or in jail (generally for assaulting health care workers or for drug or prostitution charges). She attempted suicide weekly and cut on herself daily. She had a history of severe childhood abuse and was abused by her first husband. She stayed with him mostly because she was terrified of being abandoned. Z entered treatment in transitional housing but quickly became homeless after she attempted to jump off her building. She began the program angry, out of control, and suicidal, but desperate for help.

Diagnosis: ___________________________________________________________

Why: _______________________________________________________________

Suggested Tx: ________________________________________________________

 

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