Case Discussions

Severe alcohol dependence and frequent relapses in this patient prompts his son to produce a durable power of attorney for health care. He demands that the physicians declare his father to lack decision-making capacity. More in this ethics case report.

Depression is a frequent psychiatric comorbidity among patients with restless leg syndrome. The case presented here illustrates the importance of evaluating for RLS symptoms in patients with major depressive disorder who complain of insomnia.

After thorough examination and history-taking, bipolar II disorder was suspected in a 19-year-old college student. What psychiatric screening tools might be used to further confirm the diagnosis for this patient?

Psychiatrists have found ways to bring their expert skills and knowledge to the care of medically ill patients who are nearing the final phase of life.

Case-based dialogues illustrate some virtues required in psychiatric practice.

During the first year of her child and adolescent psychiatry fellowship, this psychiatrist received an invaluable lesson regarding the importance of “treating the whole patient” in this case, a 16-year-old patient who is pregnant.

This case study of a 21-year-old woman-referred by a relative because of long-standing severe interpersonal, academic, and occupational impairment-illustrates the importance of screening patients with brief episodes of depression for mixed features.

As practicing physicians, we constantly ask ourselves when and where to alert patients to bad possibilities that may occur in the future. More in this installment of "Why Psychiatrist Are Physicians First," by Sharon Packer, MD.

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.

After scoring high on the Panic Disorder Severity Scale, this patient sought panic-focused psychodynamic therapy.

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?

Insight can be assessed in the course of a typical evaluation or follow-up interview with augmentation by questions borrowed from any of the validated insight rating scales.

Here are 9 tips to make the process easier

Being a psychotherapist is a complicated job. Not only must you be knowledgeable about human behavior, psychodynamics, and various techniques of doing therapy, but you have to be prepared for unexpected dilemmas.

An ABN is a written communication given to a Medicare beneficiary by a physician prior to providing a service that is expected to be denied by Medicare Part B.

The responsibility for improvement was placed on psychiatrists: diagnostic skills had to be improved and patients and their families and caregivers as well as the general public needed to be better educated about the disorder and treatment options.

Educated and successful individuals, Mr H's children seem able to understand that their father can no longer make his own decisions, but they continue to defer to him for medical and disposition decisions stating, “whatever he wants to do.”

Mrs E, who is 80 years old, lives in the community with the help of a 24-hour-a-day home health aide. She is forgetful and requires assistance with many activities of daily living.

For this psychiatrist, group therapy has proved to be an extraordinarily effective treatment for a range of mental disorders.

A 52-year-old female college professor was referred to a psychiatrist by a nurse practitioner at the college health clinic. The referring diagnosis was “adjustment disorder with depressed mood versus atypical depression with somatization; rule out fibromyalgia.”

Psychotic symptoms--delusions, hallucinations, paranoia, thought disorder--are mostly attributed now to aberrations in brain structure and function.

Rather than looking at the biological basis for depression, it may be more useful to look at the patient's worldview and how that may have primed them for depression. Examining events that took place in the patient's past lead to a solution to their current depression.

Known as "the cancer of mental illness," schizophrenia can core a life, robbing a previously well-functioning person of what made the person uniquely them.

Once the distortions are cleared away, most patients who come to the emergency room tell stories that seem to grow out of the problems they claim to have and the pain they claim to feel.