Diagnostic Exercise Abnormal Psychology English Literature Essay

Directions: There are five clinical vignettes below. Match each vignette with one of the diagnostic labels below that BEST matches the clinical description. Note that each vignette has only one correct answer. However, each of the labels MAY be used more than once and cases may receive more than one diagnosis. Place the NUMBER of the correct diagnosis in the spaces provided at the END OF THE EXERCISE and below each vignette. Note that it might also be helpful for you to describe WHY you have picked the diagnosis you have on a separate piece of paper to facilitate our discussion.

DUE: AT THE TIME OF YOUR FINAL EXAM

Major Depressive Disorder

Dysthymic Disorder

Bipolar I Disorder

Bipolar II Disorder

Cyclothymic Disorder

Mental Retardation, Mild

Mental Retardation, Moderate

Mental Retardation, Severe

Mental Retardation, Profound

Attention-Deficit/Hyperactivity-Disorder

Conduct Disorder

Oppositional Defiant Disorder

Autistic Disorder

Separation Anxiety Disorder

Schizophrenia, Catatonic Type

Schizophrenia, Paranoid Type

Schizophrenia, Disorganized Type

Schizophrenia, Undifferentiated Type

Schizoaffective Disorder

Obsessive-Compulsive Disorder

Panic Disorder With Agoraphobia

Panic Disorder Without Agoraphobia

Post-Traumatic Stress Disorder

Generalized Anxiety Disorder

Acute Stress Disorder

Social Phobia

Specific Phobia

Schizoid Personality Disorder

Schizotypal Personality Disorder

Paranoid Personality Disorder

Borderline Personality Disorder

Histrionic Personality Disorder

Narcissistic Personality Disorder

Antisocial Personality Disorder

Obsessive-Compulsive Personality Disorder

Avoidant Personality Disorder

Dependant Personality Disorder

Substance Dependence

Substance Abuse

Anorexia Nervosa

Bulimia Nervosa

No Diagnosis on Axis I OR II

Case #1: Emilio is a 40-year-old man who looks 10 years younger. He is brought to the hospital, his 12th hospitalization, by his mother because she is afraid of him. He is dressed in a ragged overcoat, bedroom slippers, and a baseball cap, and wears several medals around his neck. His affect ranges from anger at his mother (“She feeds me shit…what comes out of other people’s rectums”) to a giggling, obsequious seductiveness toward the interviewer. His speech and manner have a childlike quality, and he walks with a mincing step and exaggerated hop movements. His mother reports that he stopped taking his medication about a month ago, and has since begun to hear voices and to look and act more bizarrely. When asked what he has been doing, he says “Eating wired and lighting fires.” His spontaneous speech is often incoherent and marked by frequent rhyming and clang associations.

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Emilio’s first hospitalization occurred after he dropped out of school at age 16, and since that time he has never been able to attend school or hold a job. He has been treated with neuroleptics during his hospitalizations, but doesn’t continue to take medication when he leaves, so he quickly becomes disorganized again. He lives with his elderly mother, but sometimes disappears for several months at a time, and is eventually picked up by the police as he wanders in the streets.

Case #2: Ray, age 22, brings his brother Danny, age 17, to the emergency room at 3:00 a.,. on a Sunday morning. Upon returning home from a date, Ray found Danny stumbling abut their parents basement den crying and mumbling, “Everything is blurry and double.” Ray says that his brother cursed him out on the way to the hospital. He says that Danny drinks alcohol and smokes both tobacco and marijuana, but he doesn’t know of any other drug use.

The examining physician notes that Danny is wearing an earring and a T-shirt that bears the inscription “Better Living Though Chemistry.” Around his neck on a chain is a coke spoon hanging outside his shirt. His breath has an odor suggestive of an organic solvent. There is a symmetrical erythematous rash around his mouth and nose. His pupils are symmetrical and responsive to light although the whites of his eyes are markedly inflamed. Close inspection reveals transparent viscous material just inside both nostrils.

On questioning Danny, the doctor notes that he has an extremely short attention span. His manner at one moment is apathetic and disinterested, and at the next, belligerent and abusive. Neurological examination reveals no localized signs. Danny appears intoxicated, with slurred speech and unsteady, staggering gait. Reflexes are bilaterally depressed, his muscular strength is generally diminished, and there is an intentional tremor (a tremor of the hand when it is extended) and a horizontal and vertical nystagmus (involuntary rapid movements of the eyeballs). Examination of the oral and pharyngeal mucosa reveals diffuse irritation. Several times during the examination, Danny attempts to leave and once takes the reflex hammer and starts testing the doctor. The physical examination is otherwise unremarkable.

Over the 45-minute course of the examination, Danny comments that the blurring of his vision and double vision have disappeared. Over the same period, it was observed that his reflexes has become more vigorous. Despite these changes, Danny’s affect continues to vacillate between apathy and hostility.

A urine specimen is collected for a drug toxicology screening, and Danny is placed in a holding area while a psychiatric consultant is called. Danny waits a short while and then, against medical advice, leaves the hospital. All attempts to reach his parents are unsuccessful. Subsequently, the urine drug toxicology screen revealed aromatic inhalants.

Case #3: Jo Havel, a 54 year old administrator in a Midwestern university, was asked to tell the story of his struggle to give up cigarettes. Mr. Havel began smoking when he was age 18, usually smoking one or two packs a day. Beginning in his late 30’s, he vowed to stop every morning, but said that by 9:30 a.m., “It was over and I was lighting my first cigarette of the day.” When he was age 45, under a lot of pressure from family, friends and his cardiologist, he asked his colleague to prescribe him an antidepressant that has been used to help smokers break the habit. Over 4 days, the dosage was gradually increased, and he did not smoke. On the fourth day, he began to feel like he was on an LSD trip.” His surroundings seemed unreal, and “people opened and closed their mouths, but no words came out.” Frightened about what was happening to him, he stopped the drug abruptly. For the next few weeks, he still felt drugged, but did not smoke. Back to normal, he began smoking and is back up to a pack or two a day.

Mr. Havel stated that he began smoking partly due to peer pressure and the desire to “fit in.” He stated that during his adolescence and, to some degree during his adulthood, he had been nervous around other people. Mr. Havel also reported that he currently is what people might consider a “worry wart.” He states that he consistently finds himself anxious or uptight throughout his days. When asked what he worries about, Mr. Havel laughed and stated, “The better question is what I don’t worry about.” He proceeded to explain that his mind tends to jump from one worry to another worry and that his worrisome thoughts often felt out of control to him. Mr. Havel concluded the interview by stating that he thought that he might be better able to control his smoking if he was first able to control his constant sense of anxiety.

Case #4: Tina, a small, sweet-faced, freckled, 10-year-old child, has been referred by a pediatrician who was unsuccessful in treating her for refusing to go to school. Her difficulties began on the first day of school one year ago when she cried and hid in the basement. She agreed to go to school only when her mother promised to go with her and stay to have lunch with her at school. For the next 3 months, on school days, Tina had a variety of somatic complaints, such as headaches and “tummy aches,” and each day would go to school only reluctantly, after much cajoling by her parents. Soon thereafter she could be gotten to school only if her parents lifted her out of bed, dressed and fed her, and drove her to school. Finally, in the spring, the school social worker consulted Tina’s pediatrician, who instituted a behavior-modification program with the help of her parents. Because this program was of only limited help, the pediatrician had now, at the beginning of the school year, referred Tina to a psychiatrist.

According to her mother, despite Tina’s many absences from school last year, she performed well. During this time she also happily participated in all other activities, including Girl Scout meetings, sleepovers at friends’ houses (usually with her sister), and family outings. Her mother wonders if taking a part-time bookkeeping job 2 years ago, plus the sudden death of a maternal grandmother to whom Tina was particularly close might have been responsible for the child’s difficulties.

When Tina was interviewed, she at first minimized any problems about school, insisting that everything was “okay,” and that she got good grades and liked all the teachers. When this subject was pursued, she became angry and gave a lot of “I don’t know” responses as to why, and then she often refused to go to school. Eventually she said that kids teased her about her size, calling her “shrimp” and “shorty”; but she gave the impression, as well as actually stated that she liked school and her teachers. She finally admitted that what bothered her was leaving home. She could not specify why, but hinted that she was afraid something would happen, though to whom or to what she did not say; but she confessed that she felt uncomfortable when all of her family members were out of sight.

Case #5: Ellen Farber, a 35-year-old, single, insurance company executive, came to a psychiatric emergency room of a university hospital with complaints of depression and the thought of driving her car off a cliff. An articulate, moderately overweight, sophisticated woman, Ms. Farber appeared to be in considerable distress. She reported a 6-month period of increasingly persistent dysphoria and lack of energy and pleasure. Feeling as if she were “made of lead,” Ms. Farber had recently been spending 15-20 hours a day in her bed. She also reported daily episodes of binge eating, when she would consume “anything I can find,” including entire chocolate cakes or boxes of cookies. She reported problems with intermittent binge eating since adolescence, but these had recently increased in frequency, resulting in a 20-pound weight gain over the last few months. In the past her weight had often varied greatly as she had gone on and off a variety of diets. She denied preoccupation with thinness or a history of episodes of vomiting or other weight reduction procedures to compensate for the binge eating.

She attributed her increasing symptoms to financial difficulties. Ms. Farber had been fired form her job 2 weeks before coming to the emergency room. She claimed it was because she “owed a small amount of money.” When asked to be more specific, she reported owing $150, 000 to her former employers and another $100,000 to various local banks. Further questions revealed that she had always had difficulty managing her money and had been forced to declare bankruptcy at age 27. From age 30 to 33, she had used her employer’s credit cards to finance weekly “buying binges,” accumulating the $150,000 in debt. She denied past or present symptoms of mania, obsessive thoughts, or a compulsion to buy, but rather reported that spending money alleviated her chronic feelings of loneliness, isolation, and sadness. Experiencing only temporary relief, every few days she would impulsively buy expensive jewelry, watches, or multiple pairs of the same shoes.

Two years ago, when her employers noticed the massive credit card bills, Ms. Farber had nothing she could sell to reduce the debt. Her employers allowed her to pay off the debts by continuing to work for them and giving them part of her salary. However, she could not stop her spending. She financed further purchases by a process she called “check kiting.” She would open a checking account at one bank, overdraw from that account to open a second account at another bank, and then overdraw fro the second account to open an account at a third bank. Over 2 years, this escalating process led to her additional $100,000 debt. When the banks discovered the fraudulent practice 2 weeks ago, they contacted Ms. Farber’s employers, who promptly fired her, which led to her current depressed state.

In addition to lifelong feelings of emptiness, Ms. Farber described chronic uncertainty about what she wanted to do in life and with whom she wanted to be friends. She had many brief, intense relationships with both men and women, but her quick temper led to frequent arguments and even physical fights. Although she had always thought of her childhood as happy and carefree, when she became depressed, she began to recall episodes of abuse by her mother. Initially, she said she had dreamt that her mother had pushed her down the stairs when she was only 6, but she then began to report previously unrecognized memories of beatings or verbal assaults by her mother.

Name: _________________________________

Answer Sheet

Remember: You MUST have a diagnosis (number) on Axis I and II for each case!!!

Case #1:

Axis I ____________________

Axis II ____________________

Rationale/Explanation (optional):

Case #2

Axis I ____________________

Axis II ____________________

Rationale/Explanation (optional):

Case #3

Axis I ____________________

Axis II ____________________

Rationale/Explanation (optional):

Case #4

Axis I ____________________

Axis II ____________________

Rationale/Explanation (optional):

Case #5:

Axis I ____________________

Axis II ____________________

Rationale/Explanation (optional):