Case#1 A 24-year-old male graduate student without prior medical or psychiatric history is reported by his mother to have been very anxious over the past 6 months, with increasing concern that people are watching him. He now claims to “hearing voices,” telling him what must be done to “ fix the country.” Important workup ? thyroid-stimulating hormone TSH, rapid plasma reagain (RPR),  and brain imaging. Questions: 1. What is the diagnosis of this patient? 2. What is the age onset of this disorder? 3. What socioeconomic group suffers from this disorder? 4. What is the subtype of this disorder in this patient ?  5. List five positive and negative symptoms that we can find in schizophrenia disorder> 6. What is the treatment?  7. What are five characteristics associated with better prognosis?  Case#2  Ms. Torrez is a 17-year-old Caucasian woman without prior psychiatric history who is brought to the Emergency room by ambulance after her parents called 911 when they found her having a seizure in their living room. She was admitted to the medical intensive care units in status epilepticus and was quickly stabilized with intramuscular lorazepam and fosphenytoin loading. Her heigh is 5 feet 6 inches, she is of medium build, and her weight is 101 lbs. (BMI16.3kg/m2). She does not suffer any medical conditions, and this is her first seizure. Laboratory workup shows an electrolyte imbalance as the most likely cause of the seizures. Although initially reluctant, she admits to purging with the use of ipecac several times this week. She reports that although she normally restricts her daily caloric intake to 500 calories, she regularly induces vomiting if her weight is above 100 lbs. Her last menstrual cycle was 1 year ago. Psychiatric consultation is requested in order to confirm the diagnosis  The on-call psychiatry notes in Terry’s chart Patient appears underweight and younger than her stated age. She is mild distress, has a nasogastric tube in place, and exhibits poor eye contact. She reports feeling “sad” and admitted to experiencing constant preoccupation about her physical appearance and says, “I am fat; I hate my body.” She also reports insomnia, low energy levels, and history of self-harm behavior  by cutting her forearms. She reports that she is careful hiding her symptoms from her parents, whom she describes as strict disciplinarians. She also expresses concerns that she will disappoint them. Ms. Torrez’ parents describe her as a perfectionist. They say that she is involve in multiple school activities, takes advanced placement classes, and has been recently concerned about being accepted at her college of choice. They report that she maintains a 4.0 grade point average in high school, and they are expecting her to become a lawyer. Her parents have noticed that she is underweight and rarely see her eat but attributed this to stress from her many academic pursuits. Ms. Torrez’ mom was diagnosed with obsessive-compulsive disorder. Qu.

1. Case#1
A 24-year-old male graduate student without prior medical or
psychiatric history is reported by his mother to have been very
anxious over the past 6 months, with increasing concern that
people are watching him. He now claims to “hearing voices,”
telling him what must be done to “ fix the country.” Important
workup ? thyroid-stimulating hormone TSH, rapid plasma
reagain (RPR), and brain imaging.
Questions:
1. What is the diagnosis of this patient?
2. What is the age onset of this disorder?
3. What socioeconomic group suffers from this disorder?
4. What is the subtype of this disorder in this patient ?
5. List five positive and negative symptoms that we can find in
schizophrenia disorder>
6. What is the treatment?
7. What are five characteristics associated with better
prognosis?
Case#2
Ms. Torrez is a 17-year-old Caucasian woman without prior
psychiatric history who is brought to the Emergency room by
ambulance after her parents called 911 when they found her
having a seizure in their living room. She was admitted to the
medical intensive care units in status epilepticus and was

2. quickly stabilized with intramuscular lorazepam and
fosphenytoin loading. Her heigh is 5 feet 6 inches, she is of
medium build, and her weight is 101 lbs. (BMI16.3kg/m2). She
does not suffer any medical conditions, and this is her first
seizure. Laboratory workup shows an electrolyte imbalance as
the most likely cause of the seizures. Although initially
reluctant, she admits to purging with the use of ipecac several
times this week. She reports that although she normally restricts
her daily caloric intake to 500 calories, she regularly induces
vomiting if her weight is above 100 lbs. Her last menstrual
cycle was 1 year ago. Psychiatric consultation is requested in
order to confirm the diagnosis
The on-call psychiatry notes in Terry’s chart
Patient appears underweight and younger than her stated age.
She is mild distress, has a nasogastric tube in place, and
exhibits poor eye contact. She reports feeling “sad” and
admitted to experiencing constant preoccupation about her
physical appearance and says, “I am fat; I hate my body.” She
also reports insomnia, low energy levels, and history of self-
harm behavior by cutting her forearms. She reports that she is
careful hiding her symptoms from her parents, whom she
describes as strict disciplinarians. She also expresses concerns
that she will disappoint them.
Ms. Torrez’ parents describe her as a perfectionist. They say
that she is involve in multiple school activities, takes advanced
placement classes, and has been recently concerned about being
accepted at her college of choice. They report that she maintains
a 4.0 grade point average in high school, and they are expecting
her to become a lawyer. Her parents have noticed that she is
underweight and rarely see her eat but attributed this to stress
from her many academic pursuits. Ms. Torrez’ mom was
diagnosed with obsessive-compulsive disorder.

3. Questions
1. What is the diagnosis of Ms. Torrez?
2. Is her condition more common in men or female?
3. What subdivision of her condition, does Ms. Torrez belongs
too?
4. List three criteria of Ms. Torrez’ disorder?
5. What are some physical findings related to Ms. Torrez’
disorder?
6. What are some medical complications associated with her
condition?
Case#3
Ms. Ross is a 31-year-old woman who was refereed to the
psychiatrist by her gynecologist after undergoing multiple
exploratory surgeries for abdominal pain and gynecologic
concerns with no findings. The patient reports that she has
extensive medical problems dating back to adolescence. She
reports periods of extreme abdominal pain, vomiting, diarrhea,
and possible food intolerances. The obstetrician is her fourth
provider because “my other doctors where not able to help me.”
Ms. Ross reports fear that that her current physician will also
fail to relieve her distress. She was reluctant ton see a
psychiatrist and did so only after her obstetrician agreed to
follow her after her psychiatric appointment.
Ms. Ross states that her problems worsened in college, which
was the first time she underwent surgery. She reports that due to
her health problems and several lack of energy, it took her 5 ½
years to graduate from college. She did better for a year or two

4. after college but then had to return of symptoms. She reports
recently feeling very lonely and isolated because she has not
been able to find a boyfriend who can tolerate her frequent
illness. She also reports that physiological intimacy is difficult
to her because she finds sex painful. Additionally, she is
concerned that she might lose her job due to the large number of
days she has missed. On review of systems, she endorses period
where she is short of breath , has double vision , regular heart
palpitations, irregular menses, bloating , frequent urinary tract
infections and burning on urination, diffusion muscle and joint
pain, frequent headaches and periods of ringing in her ears.
Questions
1. What is Ms. Ross diagnosis?
2. What are the four criteria of Ms. Ross Disorder?
3. What is one pharmacological treatment for Ms. Ross
disorder?
Case#4
A 25-year-old female was brought to the ER by her family after
experiencing sudden neurologic symptoms. She had been
delivering food while working in a local retiree resident facility
when she reported “suddenly passing out for a couple of
seconds while on the elevator.” She stated that she woke up
with blurred vision that developed into loss of vision in both
eyes. She also reported an inability to stand due to weakness in
her left leg.
While in the emergency department, the patient described
seeing only shadows. She stated that she was generally in good

5. health without significant medical issues or any history of
chronic medical conditions or surgeries, which was confirmed
by her mother. The patient had no reported mental health
history and no history of aversive childhood experiences (i.e.,
abuse or neglect). She had never been seen by a psychiatrist or
been on any psychiatric medications. There was also no reported
use of tobacco, alcohol, herbal supplements, or over-the-counter
or illicit drugs. The patient’s family history was not significant
for medical or psychiatric diseases, including anxiety,
depression
, or psychosis; however, the patient’s mother reported that her
daughter was experiencing significant situational stressors from
working 2 jobs, attending school, being a single parent to a 4-
year-old child, experiencing significant financial difficulties,
and having a difficult relationship with her child’s father.
On physical examination, the patient was alert, awake, and
oriented to person, time, and place. Her vital signs were stable
with a blood pressure of 120/80 mm Hg and no orthostatic
changes, a heart rate of 80 beats per minute, and a temperature
of 97.6ºF. A thorough systemic examination was normal,
including of her cardiovascular system, with no abnormalities
detected on her electrocardiogram.
On neurologic examination, her speech was normal, her pupils
were slightly sluggish but reactive, she was able to see light
that was shined into her eyes, and she demonstrated a full range
of eye movement, but there was no visual acuity to hand motion
or finger counts. The patient had no facial asymmetry and had
normal strength in her upper extremities. She had some trouble
lifting her left leg off the bed but was able to walk with
assistance. No sensory deficits were noticed. A Mini-Mental
State Examination yielded a score of 30, indicating normal
cognition.
All laboratory work was normal, including a complete blood

6. count, comprehensive metabolic panel, blood glucose test, and
drug screening. Imaging studies—including CT scan, contrast-
enhanced CT angiogram of the brain, MRI, and magnetic
resonance angiography of the head and neck—were normal.
The patient was admitted to the hospital and observed for 24
hours, during which time neurology and ophthalmology
consultants examined her. Their evaluation revealed no clear
anatomical cause for her vision loss or left leg weakness,
prompting consultation with the psychiatry department. The
psychiatrist who examined her made a diagnosis of CD based on
the findings of unexplained vision loss (i.e., it was not
associated with an identifiable lesion in her visual pathway);
normal physical examination and patient history; and
observations of the patient and her family. Following the
diagnosis, the psychiatrist engaged the patient in a brief session
of cognitive behavioral therapy and supportive therapy, to
which she responded well. The following day, she reported
feeling less stressed, was able to walk normally, and her
eyesight gradually improved but was still blurry. The patient
was referred for outpatient psychotherapy. After a few days, she
was in complete remission per a follow-up visit with her
primary care physician.
Questions
1. What is the diagnosis of this patient?
2. What is the
(la belle indifference)?
Case#5
A 6-year-old boy was seen in a physician's office for possible
pneumonia. According to his mother, the child had been
coughing and wheezing for the past 6 days. In addition, the

7. mother stated that the child had a temperature of 103.9°F
(39.9°C), decreased oral intake for the last 3 days, and
decreased urine output for 2 days. The child had been treated
with home albuterol nebulizers and antibiotics for 3 days. Over
the last 24 hours, the child developed nausea, vomiting, and
diarrhea. A sibling in the house had been diagnosed with
bronchitis.
The child's past medical history included neurofibromatosis,
asthma, seizure disorder, attention-deficit/hyperactivity
disorder, and pneumonia. The child had a prior workup that
showed negative results for hyperglycemia. Current medications
included methylphenidate, 20 mg twice per day; the albuterol
nebulizer treatments; and amoxicillin, 250 mg 3 times per day.
He had no known drug allergies.
Family history was positive for a mother with neurofibromatosis
and insulin-dependent diabetes mellitus. There was also a
family history of asthma. The child lived with his parents and 1
sister. There were no smokers in the household, but there was
an inside dog. They had central heat, and the boy's
immunizations were current.
Physical examination revealed a well-nourished, well-
developed, lethargic, and ill-appearing boy who was
uncooperative and somnolent during the initial examination. His
temperature was 96.5°F (35.8°C), pulse rate was 129 beats per
minute, blood pressure was 116/56 mm Hg, and respiratory rate
was 28. His eyes had a disconjugate gaze, but the remainder of
the HEENT examination was normal. Results of cardiovascular
examination were normal, and his lungs were clear to
auscultation with no wheezing noted. Although the neurologic
examination was difficult to assess secondary to the child's
lethargy, he did move all extremities. His skin showed multiple
café-au-lait areas and was extremely diaphoretic.

8. Initial laboratory evaluation revealed a white blood cell count
of 16,200/mL (normal range, 3500–10,000/mL), plasma sodium
level of 140 mmol/L (normal range, 135–145 mmol/L), plasma
chloride level of 106 mmol/L (normal range, 98–107 mmol/L),
plasma potassium level of 2.3 mmol/L (normal range, 3.5–5.0
mmol/L), plasma carbon dioxide level of 20 mmol/L (normal
range, 22–28 mmol/L), normal serum urea nitrogen and
creatinine levels, and a plasma glucose level of 31 mg/dL
(normal range, 60–110 mg/dL). Owing to mental status
concerns, a computed tomography scan of the head was
performed with normal results. The child was admitted for
further evaluation.
Following multiple injections of intravenous (i.v.) glucose
during the first 3 hours after admission, the child's blood sugar
rose appropriately, only to fall again shortly after the physician
left the room. The patient's blood sugar level then normalized
for the next 48 hours. On day 3, the child's mother was
informed that administration of i.v. glucose was being
discontinued. That night, the child's blood sugar level dropped
into the high 40s despite repeated attempts to treat with i.v.
solutions. Curiously, once the day shift started, the child's
blood sugar level again normalized.
Very early the next morning, the child's blood sugar level once
again dropped, this time into the 30s, with poor response to
appropriate measures. Growth hormone, cortisol, insulin, C
peptide, and lactate levels were measured. The child's blood
sugar level continued to fluctuate despite aggressive
management. Of interest is that at one time during this episode,
the i.v. tubing was noted to be leaking. Upon inspection, the
tubing had a hole that looked like it was created by a needle.
Once the blood sugar level normalized again, dextrose was
removed from the i.v. solution. Without the mother's
knowledge, however, the i.v. bag was intentionally mislabeled

9. to suggest ongoing dextrose administration. The child's
subsequent blood sugar levels remained normal.
Suspicions that the mother was injecting some of her insulin
into the child's i.v. access were triggered by the fact that her
son's abnormally low blood sugar levels occurred only when she
was in the room. The mother also voiced concern that her child
was becoming a diabetic just like her, and the child knew how
to perform his own finger prick for glucose monitoring.
Behavioral aberrations on the part of the mother were also
noted, as evidenced by her remaining curled up in a fetal
position on the parent's bed during her child's most severe
hypoglycemic episode.
On the fifth day of admission, the mother was removed from the
room and the child's blood sugar level subsequently remained
normal. Laboratory results received that day from analysis of
blood drawn on day 3 showed an insulin level of 9776 µU/mL
(normal range, 5–25 µU/mL) and a C peptide level of 0.5 ng/mL
(normal range, 0.8–4.0 ng/mL). The mother subsequently
expressed concern about her child's blood sugar level and
confessed to covert administration of insulin. The child was
removed from the mother's custody and made a full recovery.
Questions
1. What is the name of this disorder?
2. To which cluster of personality disorder this disorder comes
from?
Case #6
A patient claim that he frequent episodes of “seizures.” Starts
on medications, and joins an epilepsy support group. It becomes
known that he is doing this in order to collect disability money.

10. Questions
1. What is the diagnosis of this patient ?
2. What personality disorder is most common in this disorder?
Case#7
A 22-year-old female is found by a couple, walking alone at
night. She states that she is ok, but she is unable to state a name
or any contact information. She was found holding a bus ticket
that suggested that she traveled from a nearby state. When
questioned she could not remember how she got there?
Questions
1. What is the diagnosis?