Mental Status Examination. 52 Challenging Cases, Model DSM-5 and ICD-10 Interviews, Questionnaires, and Cognitive Tests for Diagnosis and Treatment (The Mental Status Examination Series) by Wes Burgess

Author:Wes Burgess
Language: eng
Format: mobi
Published: 2011-07-06T21:00:00+00:00

CASE 24

SUZIE MOVES OUT

On New Year’s Day, I received a call from Suzie’s father.

“Doctor,” Mr. Thompson said, “I need you to see my daughter in the hospital. Suzie wasn’t doing well in college. In October, she left school and came back home. She was really skinny. I expected we would get closer but Suzie just locked herself in her room. She wouldn’t even come down to eat. After a week, when I came home from work one evening, she wasn’t in the house, and there was no letter or anything to tell me where she was or why she had left. When I didn’t get a call, I searched everywhere with the help of the police and all my friends, but we couldn’t find her. Finally, I gave up looking and figured that she would call me when she ran out of money. Yesterday, I was driving around the back of my bank to park and I saw her sitting in a little alcove around a boarded-up door they never use. I made her get in the car and I took her to the hospital.”

I saw 22-year-old Suzie on the psychiatric ward of a major private hospital. Her chart said that she had signed into the hospital weighing 100 pounds (down from her usual weight of 125) and that she denied having a menstrual period for the last three months. Her chart showed no prior history of mental or emotional treatment, and the Emergency Room staff had drawn laboratory tests that cleared her of general medical disorders. Urine drug and alcohol screens were negative.

When I interviewed Suzie, she told me that she had taken up residence in this doorway a few days after leaving her home and had spent the last three months living there. Suzie said that she sat motionless in the bank doorway all day long despite the cold and inclement weather, drinking water from a nearby park fountain at night, and occasionally eating food she found in nearby garbage cans. She used the public restrooms at the park late at night, but if she could not hold her urine during the day, she would just discharge it in her pants. When I asked her what she did all day, sitting there in that tiny space, she smiled and said, “I daydream. Just daydream.”

Suzie spoke very softly during her interview and stayed curled up in her chair, barely moving. Her affect was bright and effusive. Suzie would occasionally laugh as if at some personal joke, even when the topic was serious or sad. She denied feeling depressed, hopeless, anxious, irritable, or angry. When I asked her how she did feel, she smiled and said, “Dreamy. Just dreamy.”

Suzie denied any thoughts of violence to herself or others. When asked if she heard any voices or saw any visions, she turned her head and looked at me coyly, with a slight smile on her face. When she muttered under her breath and tracked unseen objects around the room, she appeared to be responding to unseen stimuli.

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