Psych Who Am I
What are the 3 important parasomnias?
- Non-Rapid Eye Movement (REM) Sleep Arousal Disorders: sleepwalking and sleep terrors -Nightmare disorder (REM sleep) -Restless leg syndrome
NREM Sleep Arousal Disorders (sleepwalking and sleep terrors)
-Sleepwalking: A phenomenon primarily occurring in non-REM sleep in which people walk while asleep -Sleep Terrors: Frightening dreamlike experiences that occur during the first third stage of deep slow-wave non-REM sleep, shortly after the child has gone to sleep
A psychological disorder marked by the appearance by age 12 of one or more of three key symptoms: extreme inattention, hyperactivity, and impulsivity
ADHD
Patient will present as → a 9-year-old boy is brought by his primary care physician by his mother after the child was suspended from school for being disruptive during class. The teacher noted that the patient is always fidgeting, has difficulty concentrating, and does not complete assignments. His mother notes that he often gets up and runs around the house when she is trying to call everyone for dinner and that this has been going on since he was 6 years old.
ADHD
Patient will present as → an 8-year-old boy is brought in by his mother due to his poor performance in school. She learned from his teachers that he will often yell out answers in class, will not wait in line, has trouble making friends, and obeying the rules of games. The mother states that he has been like this for "as long as she can remember." She is exhausted and has trouble taking care of him at home. On exam, you see a very active young child who during the exam grabs your ID badge and your stethoscope several times. Otherwise, his exam is within normal limits.
ADHD
Prolonged negative emotional reaction following a major life stressor (e.g., divorce, moving, new job)
Adjustment Disorder
Patient will present as → a 35-year-old woman who comes to your office with a 3-month history of feeling "depressed." She feels "extremely distressed at work" and tells you that she is "burned out." You discover that she moved into a managerial position at work 3 months ago and is having a great deal of difficulty (interpersonal conflict) with two of her employees. The patient has no history of psychiatric illness. She has no other symptoms. She is not taking any medications.
Adjustment Disorder Buzz -with a 3-month history of feeling "depressed." -You discover that she moved into a managerial position at work 3 months ago and is having a great deal of difficulty (interpersonal conflict) with two of her employees
Patient will present as → a 70-year-old gentleman is brought to his primary care provider by his son. He states that it seems like he has struggled more and more with every day living. Initially, he forgot simple things such as dates and addresses, but this has progressed over the last few years to an inability to pay his own bills. He has even gotten lost coming home from the library which is two block away from his house
Alzheimer (Ima go with this. they just say its neurocognitive disorder)
Patient will present as → a 19-year-old female who has lost 40 pounds over the last 6 months. Her body mass index is 16. When asked about her most recent meal, the patient reports that she ate an apple the previous morning.
Anorexia norvosa
Patient will present as → a 26-year-old male with an extensive criminal record assaults an elderly man in an attempt to rob his bicycle. During the interview, he is polite and has a normal affect and describes with excitement how he hit the old man with a wooden baseball bat prior to robbing him.
Antisocial Personality Disorder
A disorder that appears in childhood and is marked by significant deficiencies in communication and social interaction, and by rigidly fixated interests and repetitive behaviors
Autism
Patient will present as → a 12-month-old male whose mother is concerned that he does not seem to play with other children as his brother and sister did at this age. She indicates she has noticed that he does not seem to respond when she or other children call him by name, he is indifferent to other children or adults when they are present, and he does not seem to know any words and "just grunts."
Autism
Patient will present as → a 3-year-old boy is brought to your office by his mother due to abnormal behavior. She reports that he does not appear to respond to affection, does not look her in the eyes, and constantly lines up his toys. He becomes agitated when she tries to take him away from his toys or if the mother cooks a different meal for dinner. On physical examination, he does not respond to questions and is distracted by the texture of the exam-table cloth.
Autism
Patient will present as → a 47-year-old female office manager who refuses to attend the annual holiday party because she is afraid her coworkers will not like her. She would like to meet people but feels to shy to initiate a conversation.
Avoidant Personality
Patient will present as → a 22-year-old female who admits to episodes of binge eating 3-4 days per week off and on for the past 3 years. She eats very quickly until she feels "stuffed" and she reports eating large amounts of food even when she is not hungry. Because she is embarrassed by her behavior she often chooses to eat alone. Afterward, she reports feeling disgusted, depressed, and guilty. The patient is 5 ' 7" and weighs 225 pounds, her BP is 135/75 and her fasting blood sugar is 121. She takes Fluoxetine (Prozac) 20 mg q day for depression.
Binge eating disorder
Severe mood disorder with manic episodes alternating with depression; psychosis during manic episodes
Bipolar I
Patient will present as → a 27-year-old man accompanied by his girlfriend. In the office, he seems to be running from topic to topic without a clear message. His speech is pressured. The patient's girlfriend reports that he took steroids recently for a bad sinus infection and since he started them, his behavior has been abnormal. After discontinuing the medication, he has still been having symptoms. He has not had a normal night of sleep for the past ten days, and he just bought a new sports car though he has no need for one or the money to afford it. She also reports that she has caught him with multiple other women in the past few days, though they were in a committed relationship. The physical exam is benign and the patient's vital signs are within normal limits.
Bipolar I Buzz -running from topic to topic w/out a clear message - his speech is pressured - he has not had a normal night of sleep for the past 10 days -bought a new sports car
Low-level mania with profound depression; no psychosis
Bipolar II
Patient will present as → a 19-year-old male who has had bouts of sadness for the course of 1 year in which he says that oftentimes cannot even get out of bed so he tells his parents he is ill. Jim states that he recently felt so energized that he could not keep his thoughts straight and jumped from one idea to another. During this energized state, he did become irritable and others stated that he was louder than usual and wondered if he took something that increased his energy. During the week of high energy, he maxed out two of his credit cards and is not sure how he will pay them off before he goes to school in the fall. It was only a week later that he became so depressed that he did not find any pleasure in anything he did, was so tired he did not want to get out of bed which has continued to be a struggle today.
Bipolar II Buzz -bouts of sadness for the course of 1 year -cannot get out of bed -recently felt so energized that he could not keep his thoughts straight and jumped from one idea to another -louder than usual -during the week of high energy, maxed out 2 of his cards -week later that he became so depressed he didnt find any pleasure in anything
Obsession with some perceived/imagined flaw or flaws in one's appearance
Body dysmorphic disorder
Patient will present as → a 24-year-old male with a history of acne is at your office for concerns of acne scarring on his face. On exam, you notice very few scattered pustules but no noticeable scarring. You recommend he use topical benzoyl peroxide cream and send him home. The patient returns for follow-up three months later this time very concerned. He reports that he is having trouble sleeping at night because of concern over his appearance, he feels people are staring at him because of his acne, he is very self-conscious, he has been avoiding social events, and has trouble approaching girls. He is having trouble concentrating in class and it is now affecting his grades. He washes his face at least 6 times per day and admits to spending several hours each day in front of the mirror. He is requesting something stronger for his acne and heard from a friend about Accutane. Again on the exam, you notice only very mild comedomes but no visible scarring.
Body dysmorphic disorder
Patient will present as → a 25-year-old female doctoral student comes to your office for a checkup. When you enter the room she is visibly upset and states that all of the office staff are incompetent and that you're the only medical provider who has ever understood her despite only having one brief clinical encounter. When you tell her that you cannot prescribe her the pain medication she requested, she states that you are incompetent and abruptly leaves the appointment.
Borderline Personality Buzz -states that all of the office staff are incompetent and that you're the only medical provider who has ever understood her -she states you are incompetent
Patient will present as → a 14-year-old is female who is brought to your clinic by her mother who claims to hear the child vomiting after dinner in the evenings. The patient reportedly denies vomiting and feels fine. On physical exam, you notice petechial hemorrhages of the soft palate and conjunctiva. Further exam reveals scars on her knuckles, swollen parotid glands, dental erosions. Her weight is normal. Lab tests reveal hypochloremia and hypokalemia.
Bulimia nervosa
A pattern of repetitive behavior in which the rights of others or social norms are violated
Conduct Disorder
Patient will present as → a 14-year-old who is referred to your office for unusual animal cruelty and bullying at school.
Conduct Disorder
Patient will present as → a 13-year-old boy is brought in by police officers to the emergency department, where his parents soon arrive. He was placed under arrest and charged with destruction of property as well as assault and battery after police arrived at the scene and found the patient beating the owner of a liquor store with a baseball bat. According to police, the patient cut his arm on a piece of glass while jumping through a store window in an attempt to evade arrest. The police officer tells you, "We know this one ... he's a regular customer of ours. We've had him down at juvenile hall more times than I can count." The patient's parents tell you that his aggressive behavior started in the past couple of years: "Sure, he would argue and fight with us when he was younger, but he didn't start getting arrested until he was about eleven." His parents recount a number of disturbing instances of cruelty to animals, leading to the death or maiming of several neighborhood cats. After an examination, you note that his wounds are not serious. His vital signs are within normal limits. The patient appears cheerful and unconcerned. He is worried about getting the blood off of his favorite baseball bat more than about the fate of the man he injured.
Conduct disorder
Alternating hypomanic episodes with a long-standing low mood state (dysthymia) for at least two years
Cyclothymic
Patient will present as → a 24-year-old male with c/o episodes of depression alternating with times of increased energy, restlessness, and decreased sleep for 2 years.
Cyclothymic disorder Buzz -episodes of depression, increased energy, restlessness, decreased sleep for x2yrs
Patient will present as → a 77-year-old female who for the past 4 days, has been crying easily, confused, and rambling incoherently. Her medical history is remarkable for mild dementia and well-controlled hypertension. She has never had anything like this in the past and she has not had any recent changes to her medications. When questioned, she has no difficulty articulating a sentence but difficulty remembering what she was asked. Laboratory testing is significant for leukocytosis.
Delirium Buzz -crying easily, confused, and rambling incoherently, mild dementia, never had anything like it in the past, hard to remember what was asked
Otherwise normally functioning person with a belief in something that does not exist but no other symptoms of schizophrenia
Delusional disorder
Patient will present as → a 75-year-old woman has been receiving 24-hour care at home due to a fall risk. She has a history of severe diabetic neuropathy, and as a result, she is unstable on her feet. Two months ago, she began thinking that her daughter was telling her caretakers to steal her money, although both her daughter and the caretakers deny this. She continues to maintain an active social life, and cognitive testing shows no new deficit. She denies auditory and visual hallucinations and feeling like people are "out to get her."
Delusional disorder Buzz -her daughter was telling her caretakers to steal her money -Cognitive testing shows no new deficit. She denies auditory and visual hallucinations and feeling like people are "out to get her."
Patient will present as → a 29-year-old female who arrives at your office after a break-up with her boyfriend. She always did everything he wanted and cannot understand how he could not want to be with her. According to her, the boyfriend said she was "too clingy" and asked him to make every decision for her.
Dependent Personality
Patient will present as → a 34-year-old female who reports that several times last month she felt as if she was outside of her body. She struggles to describe the experience but says the feeling best approximates "watching a movie of herself."
Depersonalization/derealization disorder
Persistent feelings of detachment or estrangement from oneself
Depersonalization/derealization disorder
Patient will present as → a 43-year-old schoolteacher is surprised when a parent states that she saw him at a strip club several days ago. He denies these accusations and truly has no memory of the event.
Dissociative Identity Disorder
An abrupt change in geographic location with an inability to recall past and loss of identity
Dissociative amnesia
Patient will present as → a 23-year-old female is reported missing by her parents in California. Years later, it is discovered that she is living in New York. She has no recollection of her previous life in California.
Dissociative amnesia
Presence of two or more distinct identities or personality states that recurrently take control of behavior
Dissociative identity disorder
Patient will present as → a 23-year-old male who goes to city park during the summer months in an overcoat. He enjoys walking around the park exposing his genitals to strangers. He then runs away so as to avoid getting caught.
Exhibitionistic disorder
Sexual gratification attained by exposing genitals to unsuspecting strangers
Exhibitionistic disorder
Patient will present as → a 35-year-old female with c/o palpitations and chest pain for 2 days. She reports that she had been sweating with nausea and vomiting. She reports that she "checked her pulse which was about 156." She denies any personal or family history of heart disease or anxiety disorders. She rated her chest pain as 10/10 "which radiates down my left arm and up my jaw." ECG reads normal sinus rhythm. Troponin, CKMB, and other labs were normal. When she was told that her labs were normal, she flopped onto the bed and started "seizing." She stated, "I am seizing. Why won't you help me?" When the ER PA calls her out, she got angry and left against medical advice.
Factitious Disorder Buzz - palpitations, CP, sweating w/ N/V, pulse was 156, CP 10/10, labs normal, "seizure"
A female dysfunction marked by a persistent reduction or lack of interest in sex and low sexual activity, as well as, in some cases, limited excitement and few sexual sensations during sexual activity
Female sexual interest/arousal disorder
Patient will present as → a 33-year-old woman with a chief complaint of trouble having intercourse. She is completely disinterested in sex and she is not receptive to her partner's attempts to initiate foreplay. She reports that when they do have sex she never achieves orgasm. This is affecting her current relationship with her boyfriend.
Female sexual interest/arousal disorder
A paraphilic disorder consisting of recurrent and intense sexual urges, fantasies, or behaviors that involve the use of a nonliving object or nongenital part, often to the exclusion of all other stimuli, accompanied by clinically significant distress or impairment
Fetish disorders
Patient will present as → a female brings her 29-year-old boyfriend to a couples therapist because she is uncomfortable with his behavior. She found him clutching her feet during intercourse, and noticed that he insists on being able to see her feet while they engage in sexual acts.
Fetishistic disorder
Patient will present as → a 20-year-old female with dizziness, along with numbness and severe weakness on the left side of her body and her left leg. She also complains of moderate low back pain. The patient was recently involved in a bicycle collision with a motor vehicle 3 days ago where she was clipped while crossing an intersection, causing her to crash hard on her left side. She doesn't remember if she hit her head, but she was wearing a helmet. She was taken to the local, rural hospital to screen for a concussion, which came back negative. She had a CT of the head in the ED which was normal and she was released quickly from the hospital. Since the injury 3 days ago, the patient reports her dizziness has converted to double vision, has difficulty swallowing like there is a lump in her throat, and notices occasional slurred words. She continues to have difficulty walking and loss of balance since the accident. She reports having increased stress and difficulty completing school work in the past couple of weeks. Her physical exam and vital signs are all normal. Her neurological exam reveals inconsistent paresthesia in dermatomes of the LLE.
Functional Neurologic Symptom Disorder (Conversion) Buzz -recently involved in a bicycle collision, double vision, swallowing lump, slurred words, paresthesias in LLE
A disorder characterized by chronic excessive worry accompanied by three or more of the following symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance for 6 months or more
General anxiety disorder
Patient will present as → a 35-year-old female with a complaint of worry which she cannot control for the last year. She tells you that her symptoms daily consisting of sleep disturbances, difficulty concentrating, and irritability. She reports her symptoms started around age 17 but have worsened.
Generalized anxiety disorder buzz -worry that cannot control for 1yr -sleep, concentration, irritable -started 1t 17 but now worse
Patient will present as → a 27-year-old female who arrives at your office in a short skirt and a very revealing top. At the beginning of the interview, she flirts with you and asks you if you like her dress. You overheard her yelling into her cell phone in the waiting room which later turned to tears. She describes her flu symptoms as if she's "dying."
Histrionic Personality Disorder
Persistent difficulty discarding or parting with possessions, regardless of their actual value
Hoarding Disorder
Patient will present as → a 25-year-old female is brought to your office by her mother who is concerned about her recent behaviors. The mother states that her daughter has been collecting "useless items" in her apartment over the last year. When she tried to persuade her daughter to throw away several years' worth of old newspapers, her daughter had an angry outburst and refused to speak to her for two weeks. The patient reluctantly admits that she keeps "most things just in case they become useful later on." She also states that she has felt less interested in seeing friends because she does not want them to come over to her apartment. She has also not been sleeping well, as her bed has become an additional storage space and she must sleep on her futon instead. The patient states that she is frustrated with herself and feels hopeless, and she sometimes wishes she were "away from all of this," but she cannot control her behaviors.
Hoarding Disorder Buzz - collecting "useless items" -angry outburst and refused to speak -felt less interested in seeing friends -she is frustrated with herself and feels hopeless
Excessive nighttime or daytime sleep for > 1 month
Hypersomnia
Patient will present as → a 25-year-old male graduate engineering student who is at your office for the fourth time in 1 week to be sure he does not have chlamydia. Despite having one sex partner, he learned there is an increase in the incidence of STDs on campus. He reports that he has only had sex once but learned that chlamydia is hard to culture. He reports he may have dysuria intermittently but is not sure. He has been evaluated at each visit, and physical and laboratory examination has been completely normal each time.
Illness anxiety disorder (Hypochondriasis) Buzz -offices for the 4th time this week, all tests/labs have been WNL
Difficulty initiating or maintaining sleep at least 3 times per week for 3 months
Insomnia disorder
A mood disorder in which a person experiences, in the absence of drugs or a medical condition, two or more weeks of significantly depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities.
Major Depressive Disorder
a 33-year-old woman complaining of fatigue and decreased interest in "the things that used to make me happy." She is sleeping less and eating less, and she says that she is forcing herself to eat "because I know I have to eat something." She finds herself spending less time with her kids and husband as she retreats to her room. She feels guilty that she lacks the energy and enthusiasm she used to have.
Major Depressive Disorder BUzz -fatigue and decreased interest in "the things that used to make me happy -She feels guilty
A male dysfunction marked by a persistent reduction or lack of interest in sex and hence a low level of sexual activity
Male hypoactive sexual desire disorder
Patient will present as → a 53-year-old male complaining of a lack of desire for sex with his wife causing him marked distress for the past year. His wife has been very hurt by his lack of response to her advances and he reports that this is having a significant strain on their relationship. Prior to this, he was interested in sex and he and his wife would have intercourse 1-2x per month. He is very active and continues to compete in triathlons. He has no significant past medical history.
Male hypoactive sexual desire disorder
Patient will present as → a 45-year-old male lawyer is being worked up for low back pain. He demands that he sees the chief neurosurgeon and won't let any staff in the room. He says he knows "very important people" and that there will be "trouble" if he waits longer than 5 minutes in the waiting room.
Narcissistic Personality Disorder Buzz -demands that he sees the chief neurosurgeon -he knows "very important people"
A sleep disorder characterized by uncontrollable sleep attacks. The sufferer may lapse directly into REM sleep, often at inopportune times.
Narcolepsy
Patient will present as → a 19-year-old female complaining of an irresistible urge to sleep at sudden times throughout the day. This has disturbed her school functioning. She sometimes feels like she "is paralyzed" for several minutes when she wakes up. She "passed out" one day at school when she was startled by her boyfriend.
Narcolepsy
Patient will present as → a 23-year-old man complaining of feeling tired during the day. He is concerned as his grades in school have worsened and he does not want to lose his scholarship. Upon further questioning, the patient describes frequently experiencing a dreamlike state before falling asleep and after waking up. He also has frequent nighttime awakenings where he finds himself unable to move. He denies snoring. The patient does not drink alcohol or abuse any other drugs. The patient's BMI is 21 kg/m2, and his vital signs are all within normal limits.
Narcolepsy
Patient will present as → a 26-year-old PA student presents to the student health center with the complaint being unable to sleep. Although he is a very successful student, over the past few months he has become increasingly preoccupied with failing. The patient states that he wakes up 10-15 times per night to check his textbooks for factual recall. He has tried unsuccessfully to suppress these thoughts and actions, and he has become extremely anxious and sleep-deprived. He has no past medical history and family history is significant for a parent with Tourette's syndrome. He is started on a first-line medication for his disorder, but after eight weeks of use, it is still ineffective.
OCD Buzz -very successful student -increasingly preoccupied w/ failing -wakes up 10-15 times per night
Patient will present as → a 26-year-old PA student presents to the student health center with the complaint being unable to sleep. Although he is a very successful student, over the past few months he has become increasingly preoccupied with failing. The patient states that he wakes up 10-15 times per night to check his textbooks for factual recall. He has tried unsuccessfully to suppress these thoughts and actions, and he has become extremely anxious and sleep-deprived. He has no past medical history and family history is significant for a parent with Tourette's syndrome. He is started on a first-line medication for his disorder, but after eight weeks of use, it is still ineffective.
Obsessive-Compulsive Personality Disorder Buzz -very successful student -increasingly preoccupied with failing -wakes up 10-15 times per night to check his textbooks
Repetitive thoughts or behaviors that are disabling and cause anxiety or distress
Obsessive-compulsive disorders
A pattern of negativistic, hostile, and defiant behavior, during which a child often loses her or his temper, often argues with adults, and often actively defies or refuses to comply with adults' requests or rules.
Oppositional Defiant disorder
Patient will present as → a 15-year-old who back talks and resists following instruction from parents or authorities.
Oppositional defiant disorder Oppositional defiant disorder is a less intense form of conduct disorder. Children who continue with the chronic behavior are at risk of developing conduct disorder. This disorder is most often seen in boys, with problems being worse at school. The behavior can occur at home and with peers."
An anxiety disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, and/or insomnia that lingers for four weeks or more after a traumatic experience
PTSD
Patient will present as → a 29-year-old male presents with a recent onset of upsetting dreams, anxiety, and disturbing flashbacks. The patient reports that he returned from active duty in Iraq three months ago and was adjusting to life back at home until about seven weeks ago when he began having an intense fear of loud noises and seeing sudden flashbacks to bombing attacks he endured during his time in Iraq. He had to take a leave from his army instructor duties as he was not able to handle the familiar settings of practice shooting ranges and sudden loud explosions during battalion training. After refusing to leave his house, he was finally persuaded by his wife to visit your clinic.
PTSD
Patient will present as → a 29-year-old veteran of the Iraq War who reports that he can "go from zero to sixty in a few seconds," and he often finds himself getting angry at strangers at the grocery store, on the road, and at restaurants. The patient reports frequent flashbacks to a particular battle, in which his tank was ambushed and several of his comrades were killed. He is having difficulty sleeping and reports nightmares that wake him up 3-4 nights per week over the past 12 months.
PTSD
Patient will present as → 33-year-old male presents with difficulty sleeping. The patient states that these symptoms began approximately 3 months ago when he lost his close friend while they were both in combat. He re-experiences this loss during the day and in his dreams. The patient reports anxiety and depression.
PTSD Buzz -sleeping, x3mo ago, lost friend in combat, anxiety/depression
An anxiety disorder marked by unpredictable minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations.
Panic Disorder
Patient will present as → a 26-year-old male presents with 'voices in my head." The patient was well until 8 months ago when he began to hear the voices of two men plotting to kill him. His fear of being killed has resulted in his missing multiple days of work, and he was recently fired. On physical exam, he is disheveled and has incoherent, disorganized speech.
Schizophrenia Buzz -voice, disheveled, incoherent, disorganized speech >6mo ago
Psychotic disorder involving the symptoms of schizophrenia for > 1 week but < 6 months and no social or occupational impairment
Schizophreniform
Patient will present as → a 30-year-old male who arrives at your ED in distress stating that he had " a heart attack." The event started suddenly and was associated with diaphoresis, chest pain, tachycardia, and tachypnea. Troponins and ECG are within normal limits. Upon further questioning, he reports some numbing around his lips and that he has such episodes every few days for the past three months. The attacks have become so severe that he has been missing work and didn't go to last week's Christmas party. He denies recreational or illicit drug use. He further shares that he recently divorced and has had no social support. Recent lab results have all been normal or within standard limits, including TSH and vitamin B12.
Panic Disorder Buzz - diaphoresis, chest pain, tachycardia, and tachypnea. Troponins and ECG are within normal limits. every few days for the past three months. lab results have all been normal
Patient will present as → a 26-year-old first-year PA student with a medical history significant for GERD comes to your office because of frequent episodes of palpitations. The palpitations are sudden in onset and are accompanied by sweating and a sense that she is going to "pass out." The episodes typically last no more than 10 minutes, and although the patient feels as if she may pass out, she never has. The episodes first appeared when she started PA school and have increased in frequency to the point where she is afraid to attend lectures out of fear of having an "attack."
Panic Disorder Buzz -first yr PA -Palpitations, sweating, going to pass out, afraid for fear of having an attack
Patient will present as → a 33-year-old female says that her coworkers are planning to have her fired and they often ridicule her when she is not there. She is attempting to pursue legal action to get her coworkers reprimanded for this behavior as she knows that they have an intention to harm her in some way.
Paranoid Personality Disorder Buzz -coworkers are planning to have her fired -she knows that they have an intention to harm her
Patient will present as → a 49-year-old female who reports feeling an uncomfortable deep crawling and aching sensation in her legs. The patient notes that she typically experiences this sensation at night when she gets into bed. Also associated is a strong urge to move her legs and she has to get up several times each night to relieve the feeling. She denies associated low back pain or recent blood donation. The neurologic and vascular examination is normal.
Parasomnia
A paraphilic disorder in which a person has repeated and intense sexual urges or fantasies about watching, touching, or engaging in sexual acts with children, and either act on these urges or experiences clinically significant distress or impairment
Pedophilic disorder
Patient will present as → a 33-year-old male gymnastics teacher insists that all his students take a shower after class. He supervises the children showering and becomes sexually aroused.
Pedophilic disorder
Mood disorder involving persistently depressed mood, with low self-esteem, withdrawal, pessimism, or despair, present for at least 2 years, with no absence of symptoms for more than 2 months.
Persistent depressive disorder
Patient will present as → a 30-year-old married male who feels down most of the time for the past three years. He experiences frequent, intrusive thoughts that he is not good enough, despite personal and professional successes. He tries to overcompensate for his thoughts by taking on more than he can handle, which leads to failure and furthers his feelings of inadequacy. His wife suggests that he seek help after finding him crying.
Persistent depressive disorder (Dysthymia) Buzz -feels down most of the time for the past 3yrs -he is not good enough -taking on more than he can handle, which leads to failure and furthers his feelings of inadequacy
A group of anxiety disorders involving a pathological fear of a specific object or situation
Phobias
Patient case presentation → a lab technician calls to tell you that a 22-year-old man you have sent for a blood draw is very anxious. He says he is terrified of having his blood drawn and almost faints at the sight of the needle.
Phobias
A disorder marked by repeated episodes of significant depression and related symptoms during the week before menstruation
Premenstrual dysphoric disorder
Patient will present as → a 26-year-old patient is complaining of depression and anxiety just prior to her menses. The symptoms have been going on for more than 1 year, but are now starting to interfere with her relationships and her productivity at work. One week prior to menses each month she experiences a depressed mood, a feeling of being on edge, increased irritability, difficulty sleeping, a feeling of being overwhelmed, and is easily fatigued. She charted her symptoms daily in a log and returned to the office two cycles later. The log is consistent with the history. Her physical examination and general laboratory profile showed no abnormalities.
Premenstrual dysphoric disorder Buzz - depression and anxiety just prior to her menses -more than 1 year -starting to interfere with her relationships -One week prior to menses -depressed mood, a feeling of being on edge, increased irritability, difficulty sleeping, a feeling of being overwhelmed, and is easily fatigued
Psychotic disorder featuring symptoms of BOTH schizophrenia and a major mood disorder such as depression or bipolar disorder. Symptoms may occur at the same or different times
Schizoaffective disorder
a 45-year-old truck driver who c/o hearing things that are not there for 2 weeks. He reports that he was severely depressed 5 months ago and was placed on Prozac by his PCP. His depression got better and he was "fine" until 2 weeks ago when he started to "hear things." His work and social life are not impaired by the hallucinations at this time. His friend was diagnosed with schizophrenia a few years ago and he was afraid that he now has schizophrenia.
Schizoaffective disorder Buzz - hearing things, depressed
Patient will present as → a 50-year-old male who lives alone in a cabin on several acres of land. He rarely interacts with his family or community other than when he comes to town once a month to pick up supplies.
Schizoid
Psychotic disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression for greater than 6 months + difficulty functioning
Schizophrenia
Patient will present as → a 23-year-old male with c/o visual & auditory hallucinations that have been ongoing for 2 months. He is a graduate student at a local university, and he states that his hallucinations have been getting worse. He is still able to attend classes, but it is becoming more difficult to focus in class. His father was diagnosed with schizophrenia when he was about his age. He is currently taking no medications. His labs and imaging are all within the normal range.
Schizophreniform Buzz -visual/auditory, 2mo, able to attend class, father had schizophrenia
Patient will present as → a 47-year-old female has recently quit her job in order to start a small business. She claims that the spirits have told her to sell trinkets each of which has a unique power. She is known for dressing oddly and due to her strange behavior has trouble making friends.
Schizotypal -Spirits told her to sell trinkets
A paraphilic disorder characterized by repeated and intense sexual urges, fantasies, or behaviors that involve being humiliated, beaten, bound, or otherwise made to suffer.
Sexual masochism disorder
Patient will present as → a 23-year-old male who concerned that his behavior has resulted in his inability to maintain a relationship. He reveals that he requires his partners to strangle him and humiliate him in order for him to achieve and maintain an erection.
Sexual masochism disorder
Patient will present as → a 25-year-old female who presents today with multiple complaints that have been ongoing for more than 6 months. She reports that "it all started about 10 months ago with pain in my neck, shoulders, back, legs, and feet." She denies any trauma. There is no family history of juvenile rheumatoid arthritis or osteoarthritis. She stated that the pains do not respond to treatments, and they "just come and go making it difficult to hold a job." She is constantly worried about her symptoms. Now, she has a headache, abdominal pain, bloating, and "some seizures." She previously had seen a headache specialist, gastroenterologist, and obtained a number of electrocardiograms in the emergency department. Their respective thorough workup was negative. Her mother had similar episodes as well. On physical exam, you note an anxious woman with a depressed affect. No significant physical exam findings are noted. Labs/imaging are all within normal range.
Somatic Symptom disorder Buzz - multiple complaints, ongoing >6mo, worried, seen specialists, no PE findings, labs WNL
Patient will present as → a 44-year-old physician with a history of alcohol abuse and depression is transferred to the ER after being found on the floor of his apartment next to an empty bottle of oxycontin and a handle of whiskey. Prior to this event, he had been giving away large amounts of money and was very thorough in creating a will.
Suicidal homicidal behaviors
An impulse-control disorder involving the compulsive, persistent urge to pull out one's own hair
Trichotillomania
Patient will present as → a 15-year-old girl who is brought to your office by her mother. The patient has no prior medical history, but after having been in a car accident, she started pulling her hair out. Distressed by her daughter's appearance, her mother asks for your help.
Trichotillomania Buzz -after car accident -started pulling her hair out
A paraphilic disorder in which sexual arousal is derived from observing unsuspecting individuals undressing or naked
Voyeuristic disorder
Patient will present as → a 20-year-old male college student was reported by others for spying through the windows of his fellow female dormmates.
voyeuristic disorder
