1. Psychosis Case # 1

2. 19 year old white male presents to the emergency room with his new college roommates. He will only say he can’t sleep because the noise in his head is too loud. His friends say he started to act differently one week after their college orientation. He has not showered in two weeks and looks disheveled. He also stopped eating at the school cafeteria one week ago saying the food was radioactive.

3. Further history gathering from his mother in New Hampshire reveals that her brother, the patient’s uncle spent many years institutionalized after he had a “nervous breakdown” after joining the military. His paternal grandmother also became depressed after she had her second child.

4. What is the most likely diagnosis? Why?

5. Schizophrenia If it is less than six months we must diagnose it as Schizophreniform Disorder First psychotic break: Males are usually 19-25 Females 25 Strong Family History

6. Psychosis Case # 2 Dr. Jones had been putting off his knee replacement for the last two years but could not tolerate the pain any longer. He tolerated surgery well, however post op day # 2 he became more irritable with the daytime nursing staff demanding they reheat his food. The nighttime Physician Assistant was called to his room when Dr. Jones was screaming about the large bugs that were crawling on the wall in his hospital room.

7. What is the most likely diagnosis? What is the cause of his symptoms? Why did it occur two days post operatively? What was likely minimized/left out on the history and physical?

8. ETOH Withdrawal Life Threatening Usually occurs 48-72 hours after last drink Tactile Hallucinations are the most common

9. Jane is a 32 year old woman who has worked at the phone company for many years. She started to become depressed over the Christmas holidays. Her PCP prescribed Sertraline for her, but she does not believe in taking any medication so she never filled the Rx. She is now starting to believe her co- workers do not like her and have been taking things from her desk. She also believe she does not deserve to be liked.

10. What is her diagnosis? What promient symptom is Jane demonstrating? How might you treat it?

11. Case # 4 Mrs. B is a 59 year old woman who retired from teaching after a successful 30 year career. Her family noticed that she had become more forgetful, however, lately she started seeing people come into her house to try and steal her groceries. She also had noticeable difficulty with her gate when she walked into your office. Her daughter reports she becomes quite agitated and tried to bite her last week when she tried to help her change her clothes she had soiled.

12. What is the most likely diagnosis? How might you treat the psychosis and the agitation?

13. LB Dementia Quetiapine Clozapine but must monitor WBC’s