CASE STUDY
PSYCHIATRY
Case study: 1
A 21-year-old man is brought to the emergency department by the
police after he was found sitting in the middle of traffic on a busy
street. By way of explanation, the patient states, “The voices told me
to do it.” The patient says that for the past year he has felt that “people
are not who they say they are.” He began to isolate himself in his room
and dropped out of school. He claims that he hears voices telling him
to do “bad things.” There are often two or three voices talking, and
they often comment to each other on his behavior. He denies that he
currently uses drugs or alcohol. He denies any medical problems and is
taking no medication.
On a mental status examination, the patient is noted to be dirty and
disheveled, with poor hygiene. He appears somewhat nervous in his
surroundings and paces around the examination room, always with his
back to a wall. He states that his mood is “okay.” His affect is congruent,
although flat. His speech is of normal rate, rhythm, and tone. His
thought processes are tangential, and loose associations are
occasionally noted. His thought content is positive for delusions and
auditory hallucinations. He denies any suicidal or homicidal ideation.
- What is the most likely diagnosis for this patient?
- What conditions are important to rule out before a diagnosis can be
made?
- Should this patient be hospitalized?
- Which medication is most likely to be helpful in treatinig this patients
psychosis?
Case study: 2
A 27-year-old man is brought to the emergency department by his friends.
The friends state that the patient had not slept for the past 3 or 4 weeks.
They have noticed that he stays up all night cleaning his apartment. He has
bought new computer equipment and a digital video disc player, although
his friend claims that the patient cannot afford these kinds of items. The
patient has also been bragging to his friends that he has slept with three
different women in the past week, behavior very unlike his usual self, and
he has been very irritable and explosive. The friends state that they have
not seen the patient using drugs, and they do not think he has any medical
problems or takes any prescription medication. They are not aware of any
family history of medical or psychiatric disorders.
They state that the patient is a graduate student in social work. On a
mental status examination, the patient is noted to be alternately
irritable and elated. He is wearing a bright orange top and red slacks,
and his socks are mismatched. He paces the room and refuses to sit
down when asked to do so by the examiner. His speech is rapid and
loud, and it is hard to interrupt him. He claims that his mood is “great,”
and he is very angry with his friends for insisting that he come to the
emergency department. He states that they have probably insisted that
he come because “they are jealous of my success with women.” He
states that he is destined for greatness.
- What is the most likely diagnosis for this patient?
- Which medication is most likely to be helpful in treating this patient?
Case study 3
A 16-year-old student is brought to the emergency department by her
parents. She says that for the past 6 weeks, she feels as if she “just
can’t cope with all the pressure at school.” She broke up with her
boyfriend 6 weeks ago. Since that time, she cannot sleep more than 3
or 4 hours a night. Her appetite decreased. She says that nothing
interests her and that she cannot even concentrate long enough to
read a magazine, much less her textbooks. Her energy level is very low.
She is not doing things with her friends like she was in the past and
says that when she is with them “things just aren’t fun like they used
to be.” She tends to be irritable and gets angry with slight provocations.
On a mental status examination, she is observed to be a well-dressed
teenager with good hygiene. She notes that her mood is very
depressed. Her affect is dysphoric and constricted. She admits to
having had thoughts of suicide frequently over the past several days
but denies that she would act on these thoughts because it would be a
“sin.” She does not have a suicide plan. No delusions are present, and
she is alert and oriented to person, place, and time.
- What is the most likely diagnosis for this patient?
- Which medication is most likely to be helpful in treating this patient?
- Should this patient be hospitalized?
Case 4
A 23-year-old medical student comes to the emergency room with
elevated heart rate, sweating, and shortness of breath. The student is
convinced that she is having an asthma attack and that she will
suffocate. The symptoms started suddenly during a car ride to school.
The student has had episodes such as this on at least three previous
occasions over the past 2 weeks and now is afraid to leave the house
even to go to school. She has no history of asthma and, other than an
increased pulse rate, physical findings are unremarkable.
- Enumerate 4 differential diagnosis for this case ?
Case study 5
A 22-year-old man with schizophrenia who has been taking an
antipsychotic for the past 3 months reports that recently he has
experienced tremor, decreased facial expression and salivation.
Explain?
Case study 6
A 54-year-old woman with schizophrenia who has been taking a high-
potency antipsychotic agent for the past 5 years has begun to show
torticollis and the patient was unable to speak clearly .
Explain?
Case study 7
A 45-year-old woman presents with the symptoms of a major
depressive episode.
The patient has never previously taken an antidepressant. Her
physician decides to prescribe Escitalopram. WHY?
Case study 8
A 44-year-old woman with schizophrenia who has been taking a high-
potency antipsychotic agent for the past 5 years has begun to show
involuntary chewing and lipsmacking movements.
Explain?
Case study 9
A 33-year-old woman with major depressive disorder who has been
taking antidepressant agent, has begun to show headache, nausea and
sexual dysfunction.
Explain?
Case study 10
A 22-year-old female comes to the PHC with abdominal pain for 7
months duration and persistent thoughts about the seriousness of her
symptom, that result in significant disruption. She has no history of
medical illness and physical findings are unremarkable.
- Enumerate 2 differential diagnosis for this case?
- What is the management for this case?
