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 A 16 year old girl  



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  #1

Following an argument with her boyfriend of three weeks, a 16 YO girl took an Overdose of aspirin. She was taken to the general hospital and admitted to the psychiatric unit. Four days later she threatened to punch out another girl on the unit after a verbal insult. On the day you interview her she is heavily made up, wearing tight spandex clothing and is despondent and angry. She claims she has been “really depressed” since the argument with her boyfriend.

Which of the following would be LEAST helpful?
a) Group therapy
b) Individual supportive therapy
c) Family history
d) Antipsychotic
e) Antidepressant




  #2

family hx :?


  #3

Think of the following:

1....the girl is young
2....has no mood or psychotic symptoms or substance abuse even though all these cld be co-morbidly present
3....disturbed relationship
4....impulsive behavior
5....unstable emotions.....angry
6...suicidal tendency
things that might be important but not there in the case......are
1...she has been like this most of the time
2...family h/o of alcoholism or mood disorder or similar disorder
3...h/o sexual abuse
:wink:

Well.....this sounds like a borderline personality disorder case even though it wld still be difficult to make the diagnosis with so little information on the case, BUT...Basically the point of this MCQ is that the diagnosis wasn't extremely important.....
The importance was the constellation of symptoms....Let us see how:

1....family history wld be very important ...actually family history wld never be wrong in any psychiatric disorder
2....The patient .... is aggressive therefore ...antipsychoitcs maybe useful
3....psychotherapy..be it group or individual is useful in any psychiatric condition in which the patient isn't psychotic...
4.....This patient is obviously not depressed...no feelings of guilt.....or worthlessness...even though she says she is depressed
On the day you interview her she is heavily made up, wearing tight spandex clothing and is despondent and angry

so basically the wrong answer is antidepressants.....

I know this is probably a confusing case......usually we strive for the diagnosis....but in Psychiatry usually it takes them a while to diagnose cases....usually that is why they wld admit many cases.....
But the principles of management are unified as described here
I am still not sure if i made sense.. :oops:


  #4

I definitely agree with you so looks far more psychotic than depressed to me! SO the family history is very important to determine whether there are any other members with psychiatric disorders or not so I also think that antidepressants are the wrong choice. :wink:


  #5

There's no evidence here presented that the girl is psychotic. She's not hearing voices or seeing things that aren't there (or if she is, she's not saying so). I'd recomend that no anti-psycotic meds be prescribed at this point. I'd say that doing whatever can be done to ensure she can feel safe and secure would be a good place to start with her. I'd want to keep her under observation at least long enough to better assess her mental state, and to get more details of the reported suicide attempt. Was this really an atempt by her to end her own life, or was she merely acting out? She is despndent, but is she clinicly depressed? That's the key issue here: Being sad becasue your boyfriend broke up with her, by itself, doesn't make her a candidate for a diagnosis of clinical depression.
BTW, I don't think that this question gives me enough facts to make a good assesment: It gives practicly no information regarding her phyisical state beyond that she is wearing makeup. What, there's no physician on the ward?


  #6

Hello

Thanx for ur comments..
First this is an MCQ and not a case in the ward. So you're left with the choices you got...
The whole point of this MCQ is to show you management principles.

Please read the first explanation I have given.....
Guest Posted: 27 Jun 2003 06:32 pm Post subject: Re: A 16 year old girl

--------------------------------------------------------------------------------

Think of the following:

1....the girl is young
2....has no mood or psychotic symptoms or substance abuse even though all these cld be co-morbidly present
3....disturbed relationship
4....impulsive behavior
5....unstable emotions.....angry
6...suicidal tendency
things that might be important but not there in the case......are
1...she has been like this most of the time
2...family h/o of alcoholism or mood disorder or similar disorder
3...h/o sexual abuse


Well.....this sounds like a borderline personality disorder case even though it wld still be difficult to make the diagnosis with so little information on the case, BUT...Basically the point of this MCQ is that the diagnosis wasn't extremely important.....
The importance was the constellation of symptoms....Let us see how:

1....family history wld be very important ...actually family history wld never be wrong in any psychiatric disorder
2....The patient .... is aggressive therefore ...antipsychoitcs maybe useful
3....psychotherapy..be it group or individual is useful in any psychiatric condition in which the patient isn't psychotic...
4.....This patient is obviously not depressed...no feelings of guilt.....or worthlessness...even though she says she is depressed
Quote:
On the day you interview her she is heavily made up, wearing tight spandex clothing and is despondent and angry

so basically the wrong answer is antidepressants.....

I know this is probably a confusing case......usually we strive for the diagnosis....but in Psychiatry usually it takes them a while to diagnose cases....usually that is why they wld admit many cases.....
But the principles of management are unified as described here
I am still not sure if i made sense..


This was my post and my reply but i just didn't log in
Read carefully and you will understand but your reply doesn't really show you spent time reading it..


  #7

As she's attempted suicide I don't think antidepressants could be the wrong answer. Group psychotherapy is used for certain disorders including substance-abuse and borderline, and antisocial PD, but I don't think it could be a treatment modality for now as we still have way to diagnose the patient's problem . Antipsychotics sound useful as the patient is combative and agitated. Family Hx is absolutely of help in this case for both diagnosis and outcome, and eventually individual psychotherapy could be useful, should the patinet have adjustment disorder, depression and so on.
All in all, I think 1 might be the answer.


  #8

Absolutely not medical but really funny, Anger Management w/ Adam sandler and Jack Nicholson. Had group therapy!! Probably NOT the answer but u when u finish for this test highly recommend it!


  #9

a difficult question!!!


  #10

i will go with antidepressant.





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