Simulation 5 Flashcards
(24 cards)
You are in private practice, and a mother brings in her 17-year-old
daughter, Ellen. The presenting complaint is that the daughter has been accusing virtually everyone in the home of “talking about her behind her back.” Any verbal exchange leads the daughter to believe that some secret, pejorative dialogue about her is occurring. Further, other emotive episodes (laughter, arguing, anger, etc.) are all interpreted by the daughter as being about her, when they are not. The problem has escalated over the past 2-3 weeks, and recently spilled over into the school environment, with the daughter accusing classmates, teachers, and others of similar behavior. Most recently she has been seen and heard talking to herself, sometimes in a highly animated fashion. Upon meeting you, she smiles oddly and then declares that she knows “exactly what you’re thinking.” When you inquire further, her expression changes to one of intense distrust and anger, and she refuses to disclose her feelings further.
You are in private practice, and a mother brings in her 17-year-old
daughter, Ellen. The presenting complaint is that the daughter has been accusing virtually everyone in the home of “talking about her behind her back.” Any verbal exchange leads the daughter to believe that some secret, pejorative dialogue about her is occurring. Further, other emotive episodes (laughter, arguing, anger, etc.) are all interpreted by the daughter as being about her, when they are not. The problem has escalated over the past 2-3 weeks, and recently spilled over into the school environment, with the daughter accusing classmates, teachers, and others of similar behavior. Most recently she has been seen and heard talking to herself, sometimes in a highly animated fashion. Upon meeting you, she smiles oddly and then declares that she knows “exactly what you’re thinking.” When you inquire further, her expression changes to one of intense distrust and anger, and she refuses to disclose her feelings further.
What is the presenting complaint of Ellen?
Ellen accuses everyone at home of ‘talking about her behind her back’ and interprets verbal exchanges as secretive dialogues about her.
This behavior has escalated over the past 2-3 weeks.
What behavior has Ellen exhibited in addition to her accusations?
Ellen has been seen talking to herself in a highly animated fashion.
This indicates possible internal stimuli or hallucinations.
How does Ellen react when asked about her feelings?
She initially smiles oddly but then shows intense distrust and anger, refusing to disclose her feelings.
This reaction suggests a significant emotional disturbance.
What is indicated about Ellen’s past psychiatric history?
Ellen has no prior psychiatric history and is typically responsive and even-tempered.
This behavior is highly irregular compared to her usual conduct.
What is Ellen’s academic performance history?
Ellen has an outstanding academic performance record, making excellent grades and receiving praise from teachers.
This indicates a high level of functioning prior to her recent behavioral changes.
What changes in mood and behavior have been observed in Ellen?
Her mood has become suspicious, paranoid, and secretive, with reports of labile affect and agitation.
This contrasts sharply with her previous calm and positive demeanor.
Which diagnosis is indicated based on Ellen’s symptoms?
Brief Psychotic Disorder (F23) is indicated as she appears to be attending to internal stimuli and has experienced symptoms for less than one month.
This diagnosis does not require a response to stressors.
What is the relevance of a medical evaluation for Ellen?
A medical evaluation is necessary to rule out metabolic, endocrinological, or other disorders that could precipitate her symptoms.
All laboratory findings and drug screens were negative.
What does the Mental Status Exam (MSE) assess?
The MSE assesses cognitive deficits, impairments in insight and judgment, and psychotic features such as hallucinations and delusions.
The client revealed hearing voices during the exam.
What diagnosis might apply if Ellen’s symptoms continue for longer than six months?
Schizophrenia, unspecified (F20.9) could apply if the symptoms persist beyond six months.
Currently, her symptoms have not met this duration.
What is the prognosis for Ellen’s condition?
The prognosis is good due to her excellent premorbid functioning and the acute onset of her symptoms.
She has shown gradual improvement with treatment over four months.
What is not indicated regarding Ellen’s diagnosis?
Major Depressive Disorder, Single Episode, Severe with Psychotic Features (F32.3) is not indicated as her symptoms are not primarily depressive.
This diagnosis would require evidence of significant depressive symptoms.
Fill in the blank: Ellen’s current behavior has become highly _______ and secretive.
suspicious
True or False: Ellen has a history of substance abuse.
False
What is the significance of Ellen’s refusal to disclose her feelings?
It indicates a high level of distrust and possible paranoia.
This can be indicative of underlying psychotic symptoms.
What condition lasted for longer than a month and less than six months?
The condition with good prognostic features
The client’s symptoms became acute in less than four weeks and had excellent premorbid academic and social functioning.
What is the diagnosis code for unspecified schizophrenia?
F20.9
This diagnosis was not indicated as the condition did not meet the criterion of continuous signs lasting for at least 6 months.
What key feature was missing for the diagnosis of schizophrenia in this case?
Continuous signs of the disturbance persist for at least 6 months
The client exhibited paranoia but did not meet the duration requirement.
What is the diagnosis code for Brief Psychotic Disorder?
F23
The client met all criteria except for the condition resolving within one month.
What criterion was not met for the diagnosis of Brief Psychotic Disorder?
The condition did not resolve within one month or less
This disqualifies it as an accurate diagnosis.
What is the maximum possible score for section 5A?
6
The minimum passing level for this section is 4.
What is the minimum passing level for section 5B?
4
The maximum possible score for this section is also 6.
What is the maximum score for section 5D?
3
The minimum passing level for this section is 2.
