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Be) ) CASE FILES PSYCHIATR 60 cases help you excel on the ER CUES USMLE-style review questions Primer on how to approach the revi Award-winning learning system improves shelf exam scores LANGI Case Files”: Psychiatry EUGENE C. TOY, MD THE JOHN S. DUNN SENIOR ACADEMIC CHAIR AND PROGRAM DIRECTOR THE METHODIST HOSPITAL, OBSTETRICS AND Second Edition GYNECOLOGY RESIDENCY PROGRAM HOUSTON, TEXAS CLERKSHIP DIRECTOR, ASSISTANT CUNICAL PROFESSOR DEPARTMENT OF OBSTETRICS AND GYNECOLOC UNIVERSITY OF TEXAS—HOUSTON MEDICAL SCHOOL HOUSTON, TEXAS DEBRA KLAMEN, MD, MPHE ASSOCIATE DEAN OF EDUCATION AND CURRICULUM CHAIR, DEPARTMENT OF MEDICAL EDUCATION PROFESSOR, DEPARTMENT OF PSYCHIATRY SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE SPRINGFIELD, ILLINOIS Lange Medical Books/McGraw-Hill MEDICAL PUBLISHING DIVISION New York Chicago San Francisco. Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Case Files™: Psychiatry, Second Edition Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Printed in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a data base or retrieval system, without the prior written permission of the publisher. Case Files™ is a trademark of The McGraw-Hill Companies, Inc. 1234567890 DOCMDOC 09876 ISBN 13: 978-0-07-146282-2 ISBN 10: 0-07-146282-1 ‘This book was set in Times Roman by International Typesetting and Composition. ‘The editors were Catherine A. Johnson and Penny Linskey. ‘The production supervisor was Catherine Saggese. ‘The cover designer was Aimee Nordin. The index was prepared by Susan Hunter. RR Donnelley was printer and binder. This book is printed on acid-free paper. Library of Congress Cataloging-in-Publication Data Case files”: Psychiatry / [edited by] Eugene C. Toy, Debra Klamen, —2nd ed. p.iem. Includes index ISBN 0-07-146282-1 1. Psychiatry—Case studies, I. Toy, Eugene C, Il. Klamen, Debra L. IIL. Title: Phychiatry [DNLM: 1. Mental Disorders—therapy—Case Report. 2. Phychology, Clinical—Case Report. WM 40 C3364 2006] RC465.C285 2006 616.89°09—de22 2006042047 International Edition ISBN 13: 978-0-07-110465-4; ISBN 10: 0-07-110465-8 Copyright © 2007. Exclusive rights by The McGraw-Hill Companies, Inc., for manufacture and export. This book cannot be re-exported from the country to which it is consigned by McGraw-Hill. The International Edition is not available in North America. *“ DEDICATION To my grandmother, Lew Yook Toy, who at the age of 96 is still vibrant and active, and in loving memory of my grandfather, Manway Toy, who courageously pioneered our family s legacy in this great country. —ECT To my wonderful husband, Phil, who loves me and supports me in all things. To my mother, Bonnie Klamen, and to my late father, Sam Klamen, who were and are, always there. —DLK 7 . oo , oe serns —s " ir i Oo i + . hie ish : = 5 - “ CONTENTS CONTRIBUTORS ix PREFACE xiii ACKNOWLEDGMENTS xiv INTRODUCTION xv SECTION I How to Approach Clinical Problems 1 Part 1. Approach to the Patient 3 Part 2. Approach to Clinical Problem Solving 14 Part 3. Approach to the Diagnostic and Statistical Manual of Mental Disorders 16 Part 4. Approach to Reading 17 SECTION II Psychiatric Therapeutics 23 Part 1. Psychotherapy 25 Part 2. Psychopharmacotherapy 26 SECTION IIT Clinical Cases 45 Sixty Case Scenarios 47 viii CONTENTS SECTION IV Listing of Cases 445 Listing by Case Number 447 Listing by Disorder (Alphabetical) 448 Listing by DSM-IV Categories 450 INDEX 453 “ CONTRIBUTORS Joan Anzia, MD Associate Professor and Medical Director of Outpatient Services Department of Psychiatry Northwestern University Chicago, Illinois Acute Stress Disorder Bipolar Disorder (Manic) Conversion Disorder Dissociative Fugue Factitious Disorder Histrionic Personality Disorder Neurosis Panic Disorder Posttraumatic Stress Disorder Psychosis Secondary to a General Medical Condition Schizoid Personality Disorder Social Phobia Sean Blitzstein, MD Director, Third Year Clerkship University of Ilinois at Chicago Clinical Assistant Professor of Psychiatry University of Illinois at Chicago Staff Psychiatrist, Veterans Administration Chicago Healthcare System Chicago Illinois Alcohol Dependence Cocaine Intoxication Dependent Personality Disorder Dysthymic Disorder Generalized Anxiety Disorder Hypochondriasis Major Depression in the Elderly Major Depression, Recurrent Mood Disorder Secondary to a General Medical Condition Narcissistic Personality Disorder Obsessive-Compulsive Disorder (Child) Obsessive-Compulsive Personality Disorder Pain Disorder Primary Insomnia x CONTRIBUTORS Neeta V. Gautam, MD Faculty, The Methodist Hospital Family Medicine Residency Houston, Texas Altention-Deficit/Hyperactivity Disorder Psychosis Secondary to General Medical Conditions Schizophrenia Philip Pan, MD Director, Outpatient Services Assistant Professor of Psychiatry Southern Illinois University Springfield, Illinois Alcohol Withdrawal Antisocial Personality Disorder Benzodiazepine Withdrawal Delirium Dementia Fetishism Malingering Opioid Withdrawal Paranoid Personality Disorder Paranoid Schizophrenia Phencyclidine Intoxication Somatization Disorder Kimberly Rutter, MD Faculty in Obstetrics and Gynecology University of Texas Galveston Medical Branch at Brackenridge Hospital Austin, Texas Generalized Anxiety Disorder Amber D. Shamburger, MD Resident in Obstetrics and Gynecology ‘The Methodist Hospital Obstetrics and Gynecology Residency Houston, Texas Bipolar Disorder (Child) Bipolar Disorder (Adult) CONTRIBUTORS xi Steve Soltys, MD Professor and Chair, Department of Psychiatry Southern Illinois University Springfield, Illinois Anorexia Attention-Deficit/Hyperactivity Disorder Avoidant Personality Disorder Bipolar Disorder (Child) Bulimia Hallucinogen Persisting Perception Disorder Major Depression with Psychosis Mental Retardation Psychosis Not Otherwise Specific (Postpartum Depression) Schizotypal Personality Disorder Sleep Terror Disorder Substance-Induced Mood Disorder Tom Wright, MD Medical Director and Interim Executive Director Community Partnerships, Inc. Madison, Wisconsin Adjustment Disorder Amphetamine Intoxication Anxiety Secondary to a General Medical Condition Autism Borderline Personality Disorder Conduct Disorder Gender Identity Disorder Obsessive-Compulsive Disorder (Child) Obsessive-Compulsive Personality Disorder Schizoaffective Disorder (Child) Separation Anxiety Disorder Tourette Disorder ie ee =i” - ee a i r a a i. - iis - =: 7 oe : fh ne “% PREFACE We appreciate all the kind remarks and suggestions from the many medical students over the past 2 years. Your positive reception has been an incredible encouragement, especially in light of the short life of the Case Files series. In this second edition of Case Files: Psychiatry, the basic format of the book has been retained. Improvements were made in streamlining many of the chapters. Also, numerous clinical cases were rewritten to be representative of more typical patient presentations rather than the “flamboyant” presentation. We debated about whether to group the cases together so that students could compare related disorders such as cases 1-10 would be “personality disorders” to allow for side-by-side comparison. We decided not to use this systematic grouping approach, since patients do not present to their doctors in the real world in this manner. Rather, patients present with symptoms and signs, and it is the “job” of the student and clinician to sort out whether there is a psychiatric issue, and which one is likely. Nevertheless, the case listing in the back of the book and the index will allow a student to quickly reference similar cases for the sake of comparison. The multiple choice questions have been carefully reviewed and rewritten to ensure that they comply with the National Board and USMLE Step 2 format. Some new psychiatric medications have been introduced as well. By using this second edition, we hope that the reader will continue to enjoy learning psychiatry through the simulated clinical cases. It is certainly a privilege to be a teacher for so many students, and it is with humility that we present this edition. The Authers xii