Must review
St. George’s University Tourette Syndrome
PSYCHIATRY Cocaine Intoxication
Substance Use, Anxiety, and Neurodevelopmental and Withdrawal
disorders General Anxiety
High-Yield Topics disorder
CASE 01:
A 7-year-old boy in second grade is brought to the physician by his parents for an evaluation of his eyes.
They state that he blinks them repeatedly and that this behavior seems to be worsening. They first noticed
it a year or more ago, but it became very obvious in the past several weeks. They note that their son cannot
control the blinking, and that it appears worse at some times of the day compared to others. In the past
year, he has also had a twitch of his neck for 2 months and then a shrug of his shoulders for 3 months. The
boy’s teacher reports that other children tease him because of his rapid eye blinking. The pediatrician
observes that in addition to blinking, the child seems to clear his throat frequently, although his nose and
throat appear normal on physical examination. The parents report that this behavior occurs several times
daily too. The patient is doing well at school, although he sometimes has trouble completing his homework.
The patient’s father has a history of obsessive-compulsive disorder (OCD).
1. What is the most likely diagnosis?
2. Discuss the other differential diagnosis for tics
3. Outline the DSM criteria for diagnosing this disorder
4. Clinically differentiate Simple and Complex
5. Discuss the treatment for this patient
The patient is commenced on clonidine and sent home with a referral for behavioral therapy. The mother
brings the patient back to the physician several days later complaining that the child is sleepy throughout
the day.
6. Discuss the mechanism of action and side effects of alpha adrenergic drugs
CASE 02:
A 29-year-old single woman is brought to the emergency department by the police after they picked her
up attempting to break into a grocery store. When they apprehended her, they noticed that she “seemed
high” and that she was sweating with dilated pupils. The patient admits to “doping” daily for the majority
of the past year and losing 30 lb in the past 6 months. She claims that her habit now costs more than $100
per day, although she used to get the “same high” for $20. When intoxicated, she describes her mood as
“really good” and that she has “loads” of energy. When she does not use, she craves the drug, becomes very
sleepy, feels depressed, and has a large appetite. She has tried to quit on numerous occasions, even entering
an inpatient treatment program at one point, but she always quickly begins using again. The patient used
to work part-time as a secretary, but she lost her job because she was chronically late and, in fact, stole
money in order to pay her dealer. She freely admits that she was trying to rob the grocery store to “pay off
my debts.”
1. What is the most likely diagnosis?
2. Discuss the mechanism of action of this disorder
3. Outline the clinical features and complications encountered with this disorder
4. Clinically differentiate this condition from other stimulant use disorders
5. Describe the DSM criteria for diagnosis
6. Discuss the treatment options for this disorder
The patient is admitted to the hospital for observation and on day 3, the patient is restless and agitated.
She reports feeling “dead on the inside” and has indicated on several occasions that she wants to kill herself.
The nurses report that the patient has been sleeping excessive
7. What is this patient’s current diagnosis?
8. Discuss the management for this patient’s condition
CASE 03:
A 25-year-old man presents to his primary care physician for recurrent headaches. The patient states that
the headaches have been going on for the past week, and he is concerned that he may have cancer. Based
on his symptoms, he strongly believes that he needs further diagnostic workup. The patient works as a
nurse at the local hospital and is concerned that he is going to lose his job. The patient is also concerned
about his sexual performance with his girlfriend, and as a result he has ceased to engage in sexual activities.
Finally, the patient is concerned about his relationship with his family. He states that his concerns related
to these issues has persisted for the past year. The patient has a past medical history of obesity, diabetes,
hypertension, and irritable bowel syndrome. His current medications include metformin, insulin,
lisinopril, and hydrochlorothiazide. The patient has a family history of colorectal cancer in his grandfather
and father. The patient’s neurological exam is within normal limits. The patient denies having a headache
currently.
1. What is the most likely diagnosis in this patient?
2. Describe the DSM criteria for diagnosis of this disorder
3. Differentiate this patient’s condition from other anxiety disorders
4. Discuss the management of this patient