A 25-year-old female presents to her primary care physician

A 25-year-old female presents to her primary care physician with complaints of muscle tension, especially in her shoulders and neck, contributing to tension headaches.

A 25-year-old female presents to her primary care physician

Give a diagnose and reason why you have determined the diagnosis. There is a “correct” answer; however, you will earn points for justification of your answer by identify symptoms that align with the criteria.  How might a mental health care provider decide to treat the individual?

1. A 25-year-old female presents to her primary care physician with complaints of muscle tension, especially in her shoulders and neck, contributing to tension headaches. She describes decreased sleep, chronic fatigue and constant restlessness in addition to poor concentration at work, with repeated run-ins with her coworkers. She has been a worrier since childhood, with worsening bouts when under stress. Physical exam reveals a healthy, tense female with normal vital signs and generalized muscular tension. She does not abuse substances, and medical history is unremarkable.

2. A 53-year-old female has longstanding shyness dating back to childhood. She always feels self-conscious around others, and never feels that she knows what to say or how to act. Has never dated, and reports few friendships over her life. She works as a computer programmer so that she does not have to interact with others face to face. Has passed up advancement opportunities at work as these would have placed her in a more interactive role with others. After these situations, she will often replay these events in her head in an extremely self-critical manner. Spends most of her time alone and lacks social skills. She is sometimes describe d by others as “odd” or “a loner”. She avoids almost all social situations.

3. A 25-year-old woman presents to the emergency room complaining of sad mood, nervousness, difficulty falling asleep, and disinterest in her friends for the past 2 months.

She notes these symptoms started following a rape by a former male friend after a party. She appears visibly uncomfortable when asked further questions about the attack. The patient has disclosed the incident to some of her peers, but did not report it to authorities. She reports nightmares.

4. A 62-year-old man is arrested for disturbing people on their way to work by insisting they take his prepared reading materials with them. The topic of the materials was the man’s special communications with God and his instructions for following him on a special path to heaven. There are no other known symptoms and no known history of mental illnesses according to the man’s family.

5. A complained of continued hypersomnia and daytime lethargy, increased appetite, frequent crying, headaches, and memory problems. We asked her to describe the timing and quality of her initial improvement on the increased dose. Her hypersomnia reversed abruptly to her needing only 3 to 4 hours of sleep per night. Ms. A described feeling of elation and of having her mind filled with ideas and activities, racing from one thought to another.

She became markedly more talkative and social. Those around her noticed her behavior as distinctly different than usual. This sudden and dramatic response lasted about 1 week, ended suddenly, and was followed by a steady decline in energy and motivation over the next several weeks. When asked if these episodes had ever occurred in the past, Ms. A described experiencing similar brief periods of expanded mood that occurred every 2 to 3 weeks, typically lasting from 2 to 3 days, but occasionally as long as 5 days.

6. The patient is a 42-year-old single male, who lives with his parents.

He has been unemployed for some time. He presented to the anxiety disorders clinic at a major teaching hospital, because of concerns regarding his long-term unemployment. His intention to procrastinate when making decisions or carrying out plans. On weekends, when the family planned to visit the grandparents he would start packing on Friday afternoon, but on many occasions, did not finish the packing until Sunday, by which time it was too late to go. He spent long periods of time in the bathroom, would take half an hour to wash his hands-first washing the tap, then his hands, then the tap again.

This routine also made it difficult for him to go out and look for job. In fact, it totally prevented him from doing so. After leaving school, he has had 30 or 40 jobs, mostly factory work. The longest he has lasted in a job has been one week, often only one day. He was very punctual in treatment and never missed a session; he talked freely, and in great detail. The initial part of therapy mainly dealt with family relationships. When the time came to leave the sessions, he would often continue talking and delaying even when the therapist was standing at the door.

7. A 27-year-old male, Brian, has a history of misconduct and has stayed in a high-security hospital for 10 years for semi-violent and petty crimes beginning at 17. He was an intelligent boy who did well in school until his peers began to tease him. This made him feel helpless and unable to defend himself.

A peer introduced him to the criminal milieu where he felt accepted and appreciated.

During a robbery, he became incredible angry and physically violent without really understanding why. The victim died as a consequence of his attack. He was send to prison for 2 years, followed by a high security hospital for treatment. While he accepted his prison sentence he protested treatment in a psychiatric hospital
What else do you need to know? List specific questions. What could this diagnose be?


8. A 23 years old woman reacted with depressive symptoms and suicidal thoughts after the death of her grandfather.

She was treated with antidepressant medication without addressing the loss. Three years later after a suicidal attempt, she was admitted to hospital where she first presented with depressed mood and suicidal thoughts, but quickly engaged in vivid conversations with the others patients. Since childhood she had unstable mood, aggressive temperament and self-destructive behavior (head banging).

At the age of 10 she was sexually abuse d by an older man. Suicidal thoughts and urges to kill herself was first experienced at age 11. Since age 13 she has had multiple sexual partners but also one 7-year long relationship which was quite unstable with frequent conflicts and impulsive acts. She dropped out of school and has been living on government benefits, interrupted by short periods of unskilled employment. In a two-year psychoanalytic treatment program with one individual session and one group session a week in addition to psycho education, she worked together with other patients understanding the characteristic, and dynamics of on self-destructive behavior.

In addition to a mood disorder, what are other possible diagnosis?

9. Stephanie is 20 something, fragile appearing waitress who attends college part-time off and on.

She lived with a roommate who recently moved.  After leaving home at 18, to attend a four-year university, Stephanie has suffered several physical problems. Once an “A” student, her grades began to suffer and she could no longer concentrate or complete assignments. Recently, she stated to her supervisor that she was having problems getting to work on time because one of her neighbors was following her. She called the police and reported the neighbor; however, the police were not able to locate a man that matched the description.

Formerly, happy and outgoing, Stephanie tends to stay alone much of the time. Her former friends note her odd behavior and conversations, but finally dismiss anything serious stating that Stephanie was known to smoke marijuana and then say odd things. Stephanie is about to lose her job because many of the customers have complained about her and she often misses work.

10. Patricia has been married to Peter for 19 years.

The couple have two children, 15 and 17. They own a home and have no health problems. Peter is a contractor, whose jobs have been off and on for most of their marriage. Patricia initially thought that Peter would find a new career, but instead he goes on unemployment in the winter and picks up jobs in the spring, summer, and fall. Patricia is an administrative assistant for a legal office and earns about $65,000 a year, but still the couple have money problems.

Their son attends a private school because of a learning disability. Patricia does not have any close friends, and had gained about 100 pounds over the last 19 years. Although she is a good employee, she does not enjoy her job or many things about her life in general. She attends all of her children’s school events, and sees her out of town family on holiday. She often picks up side jobs as a paralegal so that she can buy extra things for her kids.One day her daughter asked her what he favorite activity was and Patricia, responded honestly, that she did not have a favorite activity and found nothing very pleasurable.