Use the DSM as a reference guide. Explain your diagnostic reasoning, and be specific – what do you need to rule out before making a diagnosis? What other questions would you need answered before feeling confident in your diagnostic direction? Why, specifically, are you tending towards the diagnosis you have chosen? I have purposely left out information in these vignettes so that you have the opportunity to describe the type of questions you would need to ask the patient.
1.Jeanette, a 25-year old female, comes into your office, and slumps into a chair. She avoids making eye contact with you. She speaks in a low voice, mumbling at times, and appears to be moving and speaking very slowly. She looks disheveled – her clothes are wrinkled, and her hair looks greasy and unwashed. She is seeking help because she has been feeling “black and empty” inside for several months. She states she cannot remember the last time she felt normal. She has dropped out of school, and is barely holding on to her job, because she has missed so many shifts lately. She states that she is always tired, and feels she can hardly get out of bed at times.
2. Stewie, a 21-year old college student, cannot stop thinking. He lies awake with worry after worry racing through his mind all night. He grinds his teeth – sometimes even when he sleeps. You notice that Stewie is very fidgety in his chair. He tells you that he is experiencing episodes involving shortness of breath, dizziness, and a rapid heart rate, and he doesn’t know why. His doctor checked him out and found nothing wrong with him on a basic physical examination. You notice that his skin appears flushed and his face has broken out badly.
3. Rachel, age 17, comes into your office and immediately starts talking at a rapid pace. She describes her life as “super, amazingly awesome” and says she is probably the happiest and most popular girl in her school, and very definitely the smartest. When you ask why she is coming in for help, she explains that the school nurse was worried about her and called her parents, who asked her to come in. She says she doesn’t mind though, because she would love to tell you all about all the thoughts in her head, which happen so fast she can barely write them down. She opens her backpack, and pulls out a stack of notebooks filled with writing and sketches, to show you how hard she has been trying to capture all of her thoughts. When you ask why the nurse might have referred her, she says “the nurse is just stupid. All of those people are just too stupid to understand me. I should be finishing a Ph.D. program in nuclear physics, not wasting my time in high school.” She starts flipping through her notebooks, and shows you a bunch of drawings that seem to make very little sense – she explains that she has solved all of the major problems in nuclear physics, and that if she could just find someone smart enough to understand her, they would probably just give her a doctorate right now, or maybe even declare her President of the United States – or maybe even President of the Whole World.
4. Read the posted article about the proposed diagnosis of “coronaphobia.” Critically analyze and discuss this diagnostic category and explain your feelings as to how valid it is or is not. Note: see the DSM-5 definition of a phobia.
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