Psychiatric Case Scenario

Client in Context:
A 40 year old school teacher presents with anorexia, mild to moderate insomnia, and
fatigability for 3 weeks. She has also lost some weight, although the amount has not been
qualified.
Further question reveals diminished interest in almost all activities, and reduced
pleasure when engaging in activities which she previously found pleasurable. She has low
mood, is unable to concentrate, and finds it difficult to carry out her day to day work.
She also confesses that she had missed school for the past week and sometimes have
suicidal thoughts. She denies hearing voices, or believing that she is fatally ill, or there is a
conspiracy against her.
She was completely healthy, prior to this, with no history of elevated mood, over-
activity, or expansive ideations. Nor has she ever required psychiatric consultation, or been
hospitalized due to medical or psychiatric disease. There is no history alcohol or drug abuse.
She divorced 6 months ago, and is raising her three children by herself, with the
youngest being 5 years old.
CC: anorexia, mild to moderate insomnia and fatigability

PMHx: HPN

MEDICATIONS: currently on Escitalopram (Lexapro), but has tried Sertraline (Zoloft), Biperiden
(Akineton) & Multivitamins
ALLERGIES: Penicillin

SOCIAL Hx:
Alcohol: Occasional
Tobacco: 1 pack/day since the divorced
Illicit drugs: Denies but has tried as an adolescent
Occupation: School Teacher
FAMILY Hx: Brother – died of suicide, recalls that mother had ‘nervous breakdown’.

PHYSICAL EXAM:
Vital Signs: HR- 65, BP- 90/60, Temperature- 37, O2 sat – 97%, RR- 18
Patient is afebrile, not pale, BMI is 20.1kg/m2. Vitals signs are stable; Heart, lungs,
abdomen & CNS findings are normal.
MSE:
Patient looks sad, good insight, satisfactory grooming & hygiene; cooperative, but has
poor eye contact. Attention & concentration preserved. No cognitive defects. No thought
content or perception changes. Depressed mood and congruent affect. Speech not affected. No
delusions or hallucinations.

Psychiatric consult: Dr. Ming, the psychiatric, ordered Brain MRI, Thyroid profile- TSH, free T3
and free T4, CBC, Drug test, liver profile

Assessment Methods to be accomplished:

Psychiatric History and Assessment-MSE
PHQ-9 questionnaire
Beck Depression Inventory

Guide Questions:

1. Based on the case above answer the following questions:

a. What is the possible psychiatric diagnosis? Classify if possible. Justify your answer.
b. List down all the manifestations and indicate if each is a manifestation that can be
observed for the psychiatric condition/diagnosis you have identified.
c. Select appropriate Psychiatric Management and justify your choice.

 Antidepressants
 Antipsychotics
 ECT (Electroconvulsive therapy)
 CBT (Cognitive Behavioral Therapy)
 Admission
 Suicide precaution
 Restraints