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A 17-year-old female came to a psychiatric clinic with complaints about her appearance. She had depressive mood, anorexia, insomnia, aggressive behavior towards her mother. In the last month or so, the patient began a diet, eating mostly unhealthy foods.
A 17-year-old female came to a psychiatric clinic with complaints about her appearance. She had depressive mood, anorexia, insomnia, aggressive behavior towards her mother. In the last month or so, the patient began a diet, eating mostly unhealthy foods.
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A 17-year-old female came to a psychiatric clinic with complaints about her appearance. She had depressive mood, anorexia, insomnia, aggressive behavior towards her mother. In the last month or so, the patient began a diet, eating mostly unhealthy foods.
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Attribution Non-Commercial (BY-NC)
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Unduh sebagai PPT, PDF, TXT atau baca online dari Scribd
psychotic features Dr Halit Ibrahimi, M.D. Resident in Psychiatry, 4th year Clinical University Centre of Kosova, Prishtina PATIENT HISTORY A 17 years old female came to the Emergency Unit of Psychiatric Clinic, associated from her parents, with complaints about her appearance, depressive mood, anorexia, insomnia, aggressive behavior within family (especially towards her mother). We learned that patient’s problems began four years ago. From the beginning of illness, patient began to neglect school and almost every other activity; her grades became worst every day. In the beginning, she was preoccupied with her height (At the time, she used to say: “If I grow up just for another cm, I will commit suicide”). PATIENT HISTORY She began treatment from a local psychologist, who visited her at her house. As result of this treatment, vanished patient’s preoccupation with her height (now she is happy to be tall “like a photo model”), but she began to be preoccupied with her nose and her eyes (Quotation: “As a result of a medical treatment – because of an eyelid irritation caused by excessive use of make- up - I lost eyes shining. Before this, I had the most beautiful eyes in town. I want to operate my nose, because it is very ugly. I want to have a nose like Angelina Jolie, and after the operation, I will go to the U.S. to become photo model”). PATIENT HISTORY In the last 12 months or so, the patient was treated by a psychiatrist, who prescribed her antipsychotic treatment (Risperidone), but because she refused to take it, parents put it in her food. In the near past, the patient manifested a physical aggressive behavior toward her parents, especially her mother, saying to her that she is to blame for the patient’s nose, because she inherited its form from her (mother). Lately, she doesn’t manifest physical aggressive behavior (only verbal), and she began to read religious books and pray to God to help her operate the nose. PATIENT HISTORY
In the last month or so, the patient began a diet, eating
mostly unhealthy foods (chips, wafers), saying that she became overweight and must loose weight in order to be a photo model. Parents confirm the fact that she really began to gain weight. We must note that patient showed a special relationship with her father (who is schizophrenic, under medication, like two other of his siblings), who is very permissive to her. There are no other significant data from her life anamnesis. She has one sibling (brother) with whom she has ‘normal relationship’. PHYSICAL EXAMINATION The patient is 183 cm high, weights 56 kg, her nose is lightly wider than normal in the middle. LABORATORY EVALUATION AND DIAGNOSTIC PROCEDURES Blood and urine analysis were within normal values, CT of brain and EEG shows no pathological findings. Psychological examination: “The patient has been evaluated using the test House, Tree-Person and Stories, from observations and interviewing her… Conclusion: The patient manifests a symptomatology of progressive psychotic process; it is possible that she suffers from some kind of personality, or affective disorder… But, we must know that in adolescence there can be some psychotic symptoms, but if the patient is offered an adequate support, it is possible to strength its ego structure. One possible mean of intervention can be supportive psychotherapy, focused in the ego structure. The patient must be under psychiatric monitoring”. (Vjollca Berisha, clinic psychologist). HOSPITAL COURSE From the beginning of hospitalization, the patient was anxious, claiming that she is not sick and has no need to be treated. She repeatedly asked to be dismissed from hospital. She manifested bizarre behavior, e.g. she kept her lips like she was to whistle, an excessive imitation of VIP posture. She accepted company of a chronic schizophrenic patient, twice older than her, holding hands with him and behaving like a couple. When asked, she said that she liked him. The patient manifested childish behavior, with naïve demands and became very easily frustrated, if others didn’t fulfill her demands. In the beginning she was treated with Risperidone alone (from initial doses to 4 mg a day), but from the 4th day of hospitalization till the dismissal from hospital, she took Fluoxetine, too (20 mg a day, in the morning). Often she used to put excessive make-up. She took part passively in ward activities. OUTCOME The patient was dismissed from hospital with the diagnosis of: Body Dysmorphic Disorder (DSM-IV-TR) with psychotic features. These are diagnostic criteria for Body Dismorphic Disorder according to DSM-IV-TR:
Preoccupation with an imagined defect in appearance. If a slight
physical anomaly is present, the person's concern is markedly excessive. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in anorexia nervosa). QUESTIONS What do you think about the diagnosis, is it correct? What about the patients father influence in the course of disease and treatment? Do you think that the course of illness is going toward an psychotic disorder? Thank you for your time and attention!