Low
Behavioral Health
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/Y3_F3.jpg"}},{"insert":"\n\n"},{"insert":"It is a gloomy winter day, and the rain is pouring as if the sky were crying in despair. Fortunately, you are indoor today, seeing patients at the family medicine clinic of your hospital.\n\nYou ask the nurse to send the next patient in and are introduced to Anna, an 18-year-old student, who has come to see you due to \u0022trouble sleeping\u0022 for the last three weeks.\n\nAnna sits down and starts describing her problem:\n\n\u0022Doctor, I find it difficult to fall asleep and I toss and turn in bed until late at night. When I wake up in the morning, I just feel awful and tired.\u0022\n\n\u0022I can\u0027t concentrate at school, and I have my final exams coming up in a few months. If I don\u0027t change something about my sleep, I won\u0027t pass. Passing my exams is the only thing that matters right now. I\u0027m losing hope about my future.\u0022\n"}]}
1
{"ops":[{"insert":"Anna reports no other symptoms and denies suicidal ideation. She is otherwise in good health, with no significant medical, surgical, or psychiatric history. She is not in a relationship right now and still lives with her parents.\n\nShe has been on the combined oral contraceptive pill for two years, and has also been taking one valerian tablet at night for the last three weeks. She states that she has never smoked or consumed alcohol, or used recreational drugs.\n\n\u0022Was there anything else other than studies that you were interested in doing?\u0022, you ask.\n\n\u0022The only thing that helps is basketball practice, but I\u0027ve been skipping sessions lately since I\u0027m trying to study\u0022, she answers.\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/Y3_F4.jpg"}},{"insert":"\n\n"},{"insert":"Anna\u0027s body mass index (BMI) is 21.0 kg\/m2. Her physical examination is unremarkable. During the mental state examination (MSE), you note the following:\n\n- Appearance and behavior: Anna looks healthy and fit. She is teary and stressed, but cooperative. \r\n- Motor activity: there is no psychomotor retardation or agitation. \r\n- Speech: her speech is fluent, and of an appropriate amount, rate, tone, and volume.\r\n- Mood: she defines her mood as \u0022stressed\u0022, with congruent affect. \r\n- Thought content: she reports intrusive, repetitive thoughts about her exam results. \r\n- Thought Process: her thought process is normal. \r\n- Cognition: her cognition is normal.\n- Insight: she has full insight.\n- Judgement: she shows good judgement.\n"}]}
3
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/Y3_F6.jpg"}},{"insert":"\n\n"},{"insert":"As you complete the MSE, Anna suddenly breaks down in tears. You offer her some tissues, and say, \u0022the final year at school can be very stressful, Anna. I\u0027ve been in the same situation, and I know how you feel.\u0022\n\nWhat will you recommend for her?\n"}]}
1. Supportive counseling
2. Anti-depressant medications
3. Supportive counseling, with anti-depressants as a bridging measure
5
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6
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4
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