What Would Be Your Diagnosis

Case Study 2

Mrs. Smith is a 30-year-old married woman whose familybrings her to the emergency room due to what they call “odd behavior.” Mrs.Smith is the youngest of 5 children. She was born prematurely, but despitebeing low in weight, there were no other negative consequences from this. Shemet all her developmental, cognitive, and social milestones on time. It wasreported that she did well in school academically, made friends easily, andinteracted in several extracurricular activities to include yearbook andcheerleading. After graduating from high school she began working in a bank, asher family did not have enough money to send her to college. She was married 5years ago and has 2 children, ages 1 year and 3 years. Mrs. Smith did notreturn to work after the birth of her first child. One week prior to her familybringing her to the emergency room Mrs. Smith went to her primary carephysician complaining of dizziness and trouble sleeping. She also reported tohim that she has been feeling “down in the dumps” and that she was a failure asa mother and wife. Her doctor made her an appointment with a therapist for thefollowing week. Before she could attend the appointment though, her familybrought her to the emergency room due to her “odd behavior.”

Four months prior, Mrs. Smith had left her husband and movedin with her mother and father. Shortly after she moved back home with her motherand father, her brother was in a car accident and was seriously injured, andthe man she had been dating went to jail on a drug charge. About a month aftershe moved home, her family began to notice a deterioration in her ability totake care of herself, including making her own meals and bathing. Thisculminates in the police finding her wandering about a mile from her home. Sheis unable to tell them who she is or how she got there. On that day she isbrought to the hospital in a very agitated state and reports to the hospitalstaff that voices are telling her to kill herself and her husband. Mrs. Smithis hospitalized and treated and discharged 3 days later to begin outpatienttreatment. Three months later she is brought to the hospital by her family. Shereports at this time that she has been experiencing anxiety, insomnia,delusions, and auditory hallucinations during the past 3 weeks. On furtherinvestigation, she reveals that the hallucinations and delusions have beenoccurring for the past 3 months, but she was worried she would get readmittedto the hospital, and so she did not want to share this with her outpatienttherapist. She describes that she thinks others are out to get her and that sheis getting messages from the television. She reports that she can hear otherstalking about her but when she looks no one is there.

Mrs. Smith’s mother also reports that about 3 weeks ago herdaughter started to go on frequent shopping sprees. At first this made hermother happy, as she thought her daughter was coming out of the “funk” she hadbeen in. But her mother reports that Mrs. Smith also had an overabundance ofenergy and had difficulty sleeping in the evening, often pacing the floor. About3 days before this hospital admission, she became irritable and was talkingabout how the teacher at the college she was attending was “out to get her”. Onreturning home from school she reported that she heard God talking to her andthat voices were discussing her, accompanied by the feeling that someone wastouching her although no one was there. She slept for only 1 or 2 hours on thenights prior to being admitted to the hospital. Instead she would sing loudly,dance, and recite Scripture.

During this second admission, she isirritable and hyperactive, displays a flight of ideas, and talks nonstop. Shealso believes she can heal others with her thoughts.

Case Study 2 is due by 11:59 p.m. (ET) on Sunday ofModule/Week 6.

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