IMC – sciences psychiques

1.1 Mike His mother taught the man has a problem although he doesn’t think he has

any issue – so was hospitalized as a fear that he might hurt his mother. Doesn’t remember much – why he was hospitalized? Multiple hospitalization Had to take medications – they make him tired but forced to take the

medications (in the hospital). After his leave from his hospital, he might stops taking them.

Lives with his mother – desire to move out one day, and get a job (he worked once at a restaurant cleaning table).

“I dunno” – his characteristic statement. Feels people might hurt him such as his mother Auditory hallucination (negative statement – don’t like his mother the voice) Doesn’t think he’s depressed at the moment or never before. Never attempted suicide Took illicit drugs in the past (years ago - apparently doesn’t do it anymore) Occasional drinker…. Actually never did in the past according to him He apparently doesn’t remember much – but it seems rather he is hiding info.

Not a memory issue (cuz he remembers things from episodic memory) but rather an attentional deficit cuz he’ll often ask the therapist to repeat the Q and take the same sentence to build answer the Q. They can often be mistaken for memory deficit.

Magical thinking: he’ll find a job and move out – expect everything will resolve overnight. He seems rather passive.

Lacks insight – about the medical condition such as cessation of medication and also in regards to his auditory hallucination.

Affect “plat” – no fear about his auditory hallucination, no emotions towards his mother…

Delirious disorganized/paranoid – some people out there to get him not sure whom.

Impaired functionality ALWAYS – eliminate all organic causes (medical condition: hyperthyroid)

and substance abuse then eliminate all affective diseases (cuz more readily treatable eg. Depression, suicidal, bipolar) which allows to move to psychotic diseases dx. Personality disorders = long term and not acute cuz becomes a definition of one’s identity; hence, try to keep as a last recourse.

DX: Schizophrenia (delirium, hallucination, discourse disorganized, catatonic comportement) Sx –‘ve: perd motivation, isolation – retire quelque chose present au comportement. Sx +’ve: ajout de sx avant absent comme hallucination.

1.2 Joan Constant worry (eg. Job performance, her teenagers being abducted) Almost all her life Aware people doesn’t like to be around her in her worry stade

Came to seek therapist help in the past and today voluntarily Has taken medication eg. Valium Never hospitalized afore Can somewhat make her depressed (the sx). Her worry may cause her some

difficulty to fall asleep but once asleep it doesn’t impact her sleep pattern. Never thought about hurting herself in past. VERY hard to make decision – mind can become blank No member of her family has psychiatric issue Not comfortable talking to therapist – find comfort at home but no issue in

leaving home. Doesn’t need to avoid crowd Fatigue and tired most of time Never took drug beforehand Not an easy person to get along Her worry interferes with her work – trouble staying at work and completing

it. Worry in a generalized manner – many spheres of her life (work, kids,

chicken, work performance). Very alert of her issue and its interference in her life (insight present).

Her anxious nature interfere her life, work, etc. Affect: trouble sleeping, fatigue, irritable. (but no sx agoraphobia) Suffering from her condition and can verbalized her pain Chronic (months, years) kinda like her normal mode of functionality. DX: trouble anxiety generalized (soucis excessive for at least 6 mths, tension

musculaire, changement de sommeil, always moving – can’t stop, don’t feel comfortable). Not always related to substance abuse or medical condition.

NOTE: depression – 1) sadness on continuous basis almost everyday or 2) lack of interest in activity but here she has general sx of depression yet capable to go to work and doesn’t seem sadden.

1.3 Mel Things fine at work: promotion Feels great. Play golf. Has down period will sleep more and may have hard time getting out of bed. Getting 4 hours of period currently and feel “great”. Contrasts btw up and down period. Work long hours and may skip meal to get work done but very passionate of

his work in his up period. Never lose touch with reality. Doesn’t result in conflict with other but on the contrary very productive.

Down period: difficult, low energy, some suicidal thoughts – work doesn’t seem to be worth going to- but never attempted it, last 2-4 days, food not the same – lack of appetite, weight loss, never hospitalized. Seek tx for these periods – psychotherapy but wasn’t helpful so then was given ATB.

Family history – requiring hospitalization for depression. No medical program. Occasional drinker

Not a drug user except coffee - “couple cups at morning” Duality of two periods: depressive vs euphoric good period. ATCD medical psychiatrique. His mother’s disease is worse requiring

hospitalization. When depressed – typical classical portrait In his episode = hypomaniac cuz it doesn’t interfere with his functionality (vs

maniac where you have interference). DX: Bipolar disorder type 2 The moment you have a maniac episode either immediate or in the past = BP

type 1. Irritable in manic or hypomanic episode cuz preventing them from doing

their activity. Some people are very functional in mode of hyperactivity (here important to

note the change in his workability or his baseline functionality). If at the basis, a person is very hyperactive, requires little sleep, dedicated, etc. not hypomanic.

1.4 – Marcella Horrible attack: heart pounding, can’t breathe, gets shaky, losing control,

feeling that could die which worsen her fear further of death. 3X/ yrs no problem except during the episode episode for her seems like hours but in fact a few minute unexpected onset – worry her cuz doesn’t know when the next attack will

come Constant eye movement DX: panic disorder

1.6 – Eddie He doesn’t remember much – his friends took to his hospital, god sedative

injection and remained there for a couple of days. His friends took him to the hospital that he might hurt himself or someone

else. Couple of strangers whispering about getting Eddie kidnapped and take him

to new Orleans He gets vibe of people Never been to hospital or psychiatric ward (up till now all sx points toward

psychotic portrait) Doing meth at the time of episode (ALWAYS remove organic cause cuz the

drug plays an important role in contributing to sx. Gives very similar portrait of psychotic. Hard to distinguish hence why always seek the information)

Urinary test – only confirm or infirm the dx we pose based on SX. Furthermore, test not entirely reliable cuz some drugs are eliminated very rapidly (eg. Cocaine)

1.8 – Jane

Problem – several onset fainting + dizziness – interference with work and her life

Numerous tests done plus seen several consultants Been in hospital for 5 days now was about to be discharged but then fainted

again. Afraid to drive – but haven’t miss her work and so far can keep up with it No medication or prescription Medication found in her room – she says not her medication despite doctor

believing otherwise No psychiatric problem beforehand – she is NOT mental No family history of psychiatric problem Her hospital record shows that she has been hospitalized beforehand – cuz

she is sick! She is going complaint to about everyone in all the boards possible. Changement of attitude when confronting. From being open to closing up and

becoming irritable. Aware of a problem but belief not of psychiatric disorder. Sx may be linked to the medication and she is probably aware that they are

her own. Seeking attention of her doctor as role of patient. She is SICK but not

MENTAL. Goes to work, not looking for financial compensation. DX: trouble factitious (provoque sx dans le but d’etre malade)