1．A 27-year-old medical student is finding it increasingly difficult to sit through lectures. Over the past six months, she has had repeated episodes of heart pounding, difficulty breathing, light headedness and tremor. During these episodes, she feels “like I am going to die-it feels awful.” Your most likely diagnosis is
(A) somatization disorder
(C) panic disorder
(D) dissociation disorder
解释 Panic disorder is manifested by periodic, intense, spontaneous episodes of acute anxiety. An episode usually builds up in intensity for 5 to 15minutes, lasts typically 20 to 30 minutes and rarely persists for more than an hour. During the attack, the victim often fears dying, going crazy, or losing control. Agoraphobia is frequently associated with panic attacks.
2. A 24-year-old married man comes for marital counseling. At his request, the counselor gives fairly specific advice. The patient does not attempt to carry out certain suggestions and even seems to be acting directly counter to other directions of the counselor. The patient may be showing which of the following personality disorders?
解释Persons with passive-aggressive personality disorder are characteristically demanding and manipulatively dependent and yet act in such a way as to ensure that the help and support they are given is rendered ineffective. They want, they need, and they should be given care and attention but they cannot allow themselves to receive constructively and trustingly. The young man described in this question manifests some of these symptoms and personality characteristics.
3. A 49-year-old housewife is admitted to the hospital because she is having a “nervous breakdown.” She is restless, weepy, and states repeatedly that she is destined for the fires of hell. All her life she has been a hard-working woman, caring for her family, with no physical or emotional illnesses. In recent months she has been increasingly anxious and irritable. She was hospitalized when she refused to go upstairs in her home, claiming that men were waiting up there to kill her. The most likely diagnosis is
(A) early Alzheimer’s disease
(B) depression with melancholia
(C) adjustment disorder with depressed mood
(D) schizophrenia, paranoid type
(E) somatization disorder
解释This is the typical history of a patient with major depression with melancholia-involutional melancholia-a life-long, conscientious, hard-working woman in the involutional period of life, presenting with depression and bizarre self-accusatory delusions.
Alzheimer’s disease would usually manifest with greater confusion and memory loss. A thorough medical evaluation is always indicated when dementia is suspected.
A patient with an adjustment disorder with depressed mood would not manifest these bizarre delusions.
Paranoid schizophrenia would not manifest with this exaggerated affect but would present with inappropriate paranoid projection, often with overt auditory hallucinations.
A patient with a somatization disorder will express emotions through physical symptoms but not to this delusional degree; nor is such a patient profoundly depressed.