Eating disorders and Personality disorders
Eating disorders and Personality disorders
For the discussion boards this term please include:
Any differential diagnoses
Your diagnosis and reasoning
Any additional questions you would have asked
Medication recommendations along with your rationale. Note possible side effects or issues to address if attempting to obtain consent.
Any labs and why they may be indicated
Screener scales or diagnostic tools that may be beneficial
Additional resources to give (Therapy modalities, support groups, activities, etc.)
For an eating disorder case, what special considerations and/or treatments have evidence based backing in this population?
CASE 1
Hx of Present illness: A 32 y/o fashion photographer came to your office seeking therapy because of feelings of depression related to the recent separation from his girlfriend of 4 mon. He ended the relationship 1 mo ago after his girlfriend, a fashion model, agreed to work for a photographer other than himself. He felt she was becoming jealous of his fame. He described her as unwilling to make sacrifices for him and unable to appreciate the importance of his career. “She would insist that our relationship wasn’t progressing because I was only concerned about myself.” He complained that his x-girlfriend became too dependent on him–requiring too much attention and time.
He describes sadness since separating from her and reports feeling emptiness “like somethings missing from my life”. He has difficulty falling asleep and wakes up earlier than usual–getting only 4-5 hrs. of sleep. He reports a lack of interest in most activities-although he continues to exercise and attend social events. The pt. describes getting frustrated easily with other people and having on-going conflicts with coworkers. He is at his 4th job this year after abruptly quitting the previous three. He admits to the use of cocaine intermittently over the past 10 years and describes increased use since the breakup with girlfriend. “I’m not one of those junkies. I only snort cocaine to enhance my creative abilities and put me at ease.”
Past Psych Hx: Psych treatment 3 yrs ago after being terminated from a job at a leading magazine. He saw a therapist and described the experience as initially productive. He appreciated the opportunity to express his feelings….but as the therapist began to challenge his defense mechanisms, he felt uncomfortable and terminated therapy after 2 months. The pt. describes himself as an ambitious, driven person who was born to succeed.
MSE: Well groomed, with carefully styled hair and manicured nails. During the interview, he was initially concerned with the providers credentials.-closely examining the licenses on the wall. He related to the examiner that he had “very special needs that must be met”.
He maintained good eye contact throughout the interview. Speech was normal in rate, rhythm and volume, though at times would assume a condescending tone. Thought process linear and goal-directed. He denied disturbances of thought content-but had frequent fantasies of punishing those who betrayed him. He denied any perceptual disturbances as well as suicidal or homicidal ideation.
Include:
• Any differential diagnoses
• Your diagnosis and reasoning
• Any additional questions you would have asked
• Medication recommendations along with your rationale. Note possible side effects or issues to address if attempting to obtain consent.
• Any labs and why they may be indicated
• Screener scales or diagnostic tools that may be beneficial
• Additional resources to give (Therapy modalities, support groups, activities, etc.)
CASE 2
Hx Present Illness: A 16 y/o girl is brought to the ER by her soccer coach and a few teammates. Her coach told the doctor that during a routine practice that afternoon, the girl suddenly collapsed on the field. Her friends mentioned that following previous practices she c/o “feeling sort of dizzy” but never mentioned “passing out”. Her friends explained that she has been spending less time with them lately; often going straight home after practice instead of going out for a snack with her teammates, as she used to do. The pt. states that she hads a “weird pain in her chest, felt dizzy and then just passed out”. She describes several episodes of chest pain lately and apparently has been feeling more dizzy than usual. These feelings occcur throughout the day and not associated only with physical exercise.
When the girls mother arrived at the ER, she was visibly frantic. “What happened?” I told you you were practicing too much–it’s no wonder you passed out.–You play soccer more than 4 hrs a day”. Mother corroborates the absence of any past physcial or psychiatric Hx but states that the pt “has not been herself lately–spending most of the weekend lying in bes instead of going out with her friends. I know she is not sleeping well-just last night I found her looking through the frig at 3 am.”
Physical Exam: Pt is a slight girl , 65 inches tall, weighing 135 lbs. Resting pulse 48 beats/min in a regular rhythm. B/P 115/60 seated and 120/67 standing. She appears well nourished and hydrated. She is clearly anxious and states that she feels “nervous” being in the hospital. The HEENT exam is significant for enlarged parotid glands bilaterally. The remainder of the physical is unremarkable.
LABS: Sodium-138; K-2.7; Cl-82; Bicarb-35; Venous blood gasses=7.5 pH. All other labs WNL. with exception of Mg = 1.0.
The ekg showed prominent U-waves and a prolonged QT interval.
What is her Diagnosis? How does the medical workup confirm it?
What is your plan of care?
Include:
• Any differential diagnoses
• Your diagnosis and reasoning
• Any additional questions you would have asked
• Medication recommendations along with your rationale. Note possible side effects or issues to address if attempting to obtain consent.
• Any labs and why they may be indicated
• Screener scales or diagnostic tools that may be beneficial
• Additional resources to give (Therapy modalities, support groups, activities, etc.)
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