Case study

Case study

PART A

Gina Strowalski was a 23 year-old part-time student at a local community college who also worked as a barista at a local coffee shop. Gina was brought to the emergency room after having collapsed at work. She reported that she had not been sleeping well for the past month—she was averaging only four to five hours of sleep per night, and she was having difficulty both falling asleep and staying asleep. Gina also revealed that she had not been eating much lately because she did not have an appetite. Gina had been feeling extremely sad since finding out three weeks ago that her boyfriend, Enrique, was making plans to move to another city to take a better-paying job. Gina's grades were slipping because she was not attending classes and appeared to have difficulty focusing and concentrating on her schoolwork. Gina had a difficult childhood, having strained relation with her mother and father. The relation with her parents was still unhealthy. Gina met Enrique, who was a substitute math teacher at her high school. After Gina graduated from high school, she and Enrique began dating. She became clingy and jealous of Enrique and suspected him of having another girlfriend, and she started spying on him. She had a major argument with Enrique, after which she sliced her forearms several times due to which she was transferred to a hospital.

PART B

Axis I Clinical Disorders

Mood Disorders

296.34 Severe with psychotic features Major depressive disorder, recurrent

308.3 Acute stress disorder

307.42 Primary insomnia

307.50 Eating disorder not otherwise specified (EDNOS)

309.4 With mixed disturbance of emotions and conduct

Axis II Personality Disorders

Mental retardation

318.2 Profound mental retardation

Antisocial Personality Disorder

301.7 Antisocial personality disorder

Axis III General Medical Conditions

310.1 Personality change due to Aggressive

Axis IV Psychosocial and Environmental Problems

V61.1 Partner relational problem

Axis V Global Assessment of Functioning 20

PART C

Panic disorder Assessment

Patient History: Ask about medical and mental health history to help distinguish symptoms as anxiety-based or due to a medical condition

Laboratory Tests That May Be Ordered: There are no laboratory tests specific to the diagnosis of panic disorder, although arterial blood gas (ABG) testing may confirm hyperventilation (respiratory alkalosis) and exclude hypoxemia and metabolic acidosis; other laboratory testing is usual to rule out suspected medical conditions as a cause of anxiety, including urinalysis and drug screening to assess for infection, other medical abnormalities, and substance use, CBC to assess for anemia and T3, T4, and TSH to assess for hyperthyroidism and blood glucose levels to assess for hypoglycemia as a cause of anxiety symptoms

Major Depressive Disorder Assessment

Laboratory Tests That May Be Ordered: There are no specific laboratory tests that diagnose MDD, but thyroid function tests may be ordered if thyroid dysfunction is suspected as a cause of depression.

Other Diagnostic Tests/Studies: The Patient Health Questionnaire (PHQ-9) is useful for monitoring functional impairment, symptoms, and treatment outcomes in patients with MDD, Standardized screening tools such as the Zung Self-Rating Depression Scale and the Beck Depression Inventory (BDI-II) may be administered as an initial part of the diagnostic process and ...