case #1

Karen is a 30-year-old single woman. She was referred to a psychiatrist after six visits to her primary care physician complaining of headaches, body aches, sharp pains above her left ear, and a ringing in both ears. She was convinced she had a brain tumor, but a CAT scan revealed no physiological cause. During the interview, Karen mentions that she doesn’t like being in a hospital “because being in a hospital puts you at risk for so many other diseases.” When pressed, she mentions swine flu, avian flu, and AIDS. Karen does not use illegal substances or alcohol. She carries hand sanitizer and discreetly spritzes it on her hands about every ten minutes or so. Part way through the interview, Karen put on sunglasses “to block the fluorescent rays” from the overhead lamps.

Family History: Father died three years ago of cancer. Mother is still alive. Grandmother committed suicide at 31 when mother was eight. Grandfather is still alive, with history of alcoholism.

case #2

Perla is a 50-year-old woman in a same sex partnership. She arrived with a stack of pages from the Internet that “proved” that she has adult-onset ADHD. She mentions that she has long periods of activity, including not sleeping for days. She says she “self-medicates” with marijuana, energy drinks like Red Bull, and sleeping pills. During the interview, it is hard to keep up with Perla. She bounces around the room and from topic to topic. When the interviewer asks her to fill out a questionnaire, she asks for a stapler. She then proceeds to simply staple her ADHD pages to the form. The interviewer asks Perla to complete the survey on the form, Perla becomes irate: “I already did your damn work for you. I told you I have ADHD!”

Family History: Unknown. Perla was adopted from Venezuela as a baby.

case #3

Jordan is a 22-year-old man who received medical discharge from the army after a 2- year tour in Iraq. The initial discharge was for depression, but Jordan’s family has begun to believe that it may be more complicated. Jordan has been discovered wandering at night “following the way the flags are showing me to go” or following a possibly imaginary woman with a scarred neck. During the interview, Jordan seems lucid, but lethargic. He drums his fingers slowly on each thigh, as if playing a slow piano scale. His answers are all one or two words, such as “fine” or “I guess.” When asked about the woman with the scarred neck, he becomes slightly more animated.

Jordan: She’s a beautiful woman, isn’t she? Interviewer: I don’t know, Jordan. I’ve never seen her. Jordan: Right, because you don’t have the ring. Interviewer: What ring? Jordan: [mumbles] Interviewer: Can you tell me about the ring? Jordan: I said the ring is the fuse. Interviewer: The fuse to what, Jordan? Jordan: Without the fuse… well, you know what happens. It’s a fuse. Interviewer: I don’t, Jordan. What happens? Jordan: Fuses light up you know. And then, they blow up. That’s all.

Family History: Mother and father are still alive, but divorced. Mother is remarried. Mother has history of diabetes. Father’s leg was amputated during first Gulf War. History of emotional abuse by father.

For each case, include the following:

  • An analysis of the situation and possible causes for the subject’s behavior
  • A preliminary diagnosis of the subject’s disorder using the symptoms he or she displays
  • The set of therapies you suggest for helping the subject deal with his or her symptoms
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