Up And Down

Behavioral Health


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/Y4_F1.jpg"}},{"insert":"\n\n"},{"insert":"You\u0027ve just started your residency in psychiatry and your enthusiasm has never been greater.\r\n\r\nAs a child, you imagined yourself practicing inside a cute minimalistic room with a fluffy Freudian couch. As a doctor, you\u0027ve found that life on the psychiatry ward is considerably more daring!\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/Y4_F2.jpg"}},{"insert":"\n\n"},{"insert":"A patient has been referred to you from the maternity ward due to poor results on her mental health questionnaires.\r\n\r\nHer name is Daisy, she is a 40-year-old full-time TV producer, and she is in the 14th week of gestation of her second pregnancy. Her Edinburgh Postnatal Depression Scale (EPDS) score was 14.\n"}]}


{"ops":[{"insert":"When Daisy enters your office, you notice that she\u0027s certainly overdressed for the occasion, wearing red high heels, a figure-flattering outfit and an exorbitant amount of jewelry.\r\n\r\nBehind all the makeup there\u0027s a worried facial expression. She sits down, starts tapping her foot nervously, and then bursts into tears.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/Y4_F4.jpg"}},{"insert":"\n\n"},{"insert":"You start exploring her concerns.\r\n\r\nDaisy has felt exhausted since the start of her pregnancy and has felt highly emotional. Digging deeper, you find that her baby was conceived after a brief affair and that the father is married to another woman.\n\nAlthough her pregnancy was completely unplanned, she decided to keep the baby, as her \u0027biological clock is ticking\u0027 and she may not get another chance to have a child.\r\n\r\nA few days ago, after reading a magazine article about sudden infant death syndrome (SIDS), she started panicking about being a single mother.\r\n\r\nHer antenatal history has been unremarkable so far.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/Y4_F5.jpg"}},{"insert":"\n\n"},{"insert":"Daisy\u0027s medical history is significant for a previous pregnancy 18 years ago that was terminated at 9 weeks; treatment for a chlamydia infection 10 years ago; and, two episodes of major depressive disorder (MDD) 16 and 12 years ago respectively, both of which were treated by a course of selective serotonin reuptake inhibitors (SSRI).\n"}]}


{"ops":[{"insert":"Her social and family histories reveal that she was raised by a single mother who is at the moment alive and well. However, Daisy has a tense relationship with her and hasn\u0027t called her in months. To her knowledge, her mother only suffers from hypothyroidism.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/Y4_F7.jpg"}},{"insert":"\n\n"},{"insert":"Daisy smokes cigarettes regularly, with an estimated exposure of 5 pack years so far. She also drinks regularly, to around 15 units of alcohol each week. She tried to stop both once she found out that she was pregnant, but still \u0022sneaks a cigarette every now and then with her morning coffee\u0022 and \u0022drinks a glass of red wine on the weekends\u0022.\r\n\r\nShe doesn\u0027t use any drugs currently, but in her twenties she was a \u0022party-girl\u0022 and had experimented with many different illicit substances.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/Y4_F8.jpg"}},{"insert":"\n\n"},{"insert":"You wrap up the interview and start performing a mental state examination.\n\nDaisy is cooperative and makes good eye-contact. She has an extravagant style with provocative behavior. Her tone is emotional to the point of exaggeration but is consistent with the content of her speech, thought, and ideas.\r\n\r\nYou find signs of rumination, with excessive worry about taking care of a small human, and intermittent phobic thoughts about childhood illnesses. Her sensorium is intact. There is no suicidal or homicidal ideation or disorders of perception.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/Y4_F7.jpg"}},{"insert":"\n\n"},{"insert":"Her somatic complaints are: decreased appetite that led to a 5 kg loss during the first trimester, craving for cigarettes, crying spells, insomnia, waking up early in the morning, low energy levels, and poor concentration on most days of the week.\n"}]}


{"ops":[{"insert":"Daisy describes her mood as \u0022very low\u0022. She says she\u0027s been feeling like that ever since she found out about the pregnancy and confronted her ex-lover about it, following which he broke up with her.\r\n\r\nShe\u0027s been taking weeks off from work, has lost the interest in shopping and going out that always made her feel good, and she\u0027s been unable to concentrate on anything other than over-analyzing her current situation with her girlfriends.\r\n\r\nShe now finds it hard to even step out of her apartment.\n"}]}


{"ops":[{"insert":"You realize that Daisy\u0027s personality is:\n"}]}
1. Paranoid
2. Histrionic
3. Borderline