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Challenging Cases

About Challenging Cases

The cases here are culled from the real-life experiences of the authors, and some have previously been published in Psychiatric Times within the context of a clinical article. The identity of the patients in each of these cases has been altered. We feature them here because each case involves at least one diagnostic or therapeutic decision dilemma. We invite you to weigh in on the case vignettes presented in this space.

Do you have a challenging case? Send us the details at editor@psychiatrictimes.com. Please describe the clinical presentation, assessment, treatment, and outcome, followed by a compelling question to challenge readers.

Challenging Cases

Patients with borderline personality disorder or narcissistic personality disorder (or both) can feel entitled to special treatment and often seek only approving forms of attention from those who treat them.

What are the options for treating major depressive disorder in children and adolescents? This case offers readers a chance to give their feedback and to interact with the authors, who will present teaching points based on your comments.

A parent's heavy drinking can increase a child's risk of substance use disorder.

Propranolol therapy at a relatively low dose can cause anger and rage behaviors to subside in some patients. This case describes a man with Down syndrome who, after an accident, sustained minor brain trauma. Subsequently, he regressed to a rage state he had experienced when he was younger.

The California Supreme Court’s decision in the Tarasoff case over 30 years ago has become a standard part of mental health practice. This case influenced the legal requirements governing therapists’ duty to protect third parties in nearly every state in the US.

Eating disorders like anorexia nervosa are resistant to treatment. This case briefly outlines a treatment approach using a community-based, patient-centered model of care.

In treating a female who sexually abuses a minor, what should the clinician keep in mind? Is the treatment plan different for a female offender than a male?

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