Case Discussions

What factors predispose patients to TRD and what treatment strategies achieve response? Find out here, with a bonus case vignette.

Got a challenging case-a patient for whom the diagnosis is unclear or uncertain? Want a diagnostic opinion? This is a call for cases. Michael First, MD-a nationally recognized expert on psychiatric diagnosis and assessment issues-will review details and offer insights on select cases.

Your patient is excited to be pregnant. She is currently on sertraline, and has been stable on this for many years. She is very insistent that she would like to stop her medication. What should you do?

“Googling” a patient does not seem much different from the old-fashioned obtaining of collateral information, but the ramifications may be far more than you bargain for.

Does this patient have decision making capacity to refuse a blood transfusion that will likely save his life? You are the ethics consultant, and the decision is yours.

Ethics case quiz: A patient's inconsistent decisions regarding treatment are cause for concern. What to do?

Psychiatrists increasingly recognize that not all treatments for depression are created equal-but in this case, an entirely different diagnosis came to light.

A reminder that success in life requires paying attention to the basics, starting with showing up and hanging in there.

Renal failure is not an uncommon disorder either in the general public or in patients with psychiatric disorders, but accompanying depression, anxiety, and loss must be attended to during such an illness.

While opioid dependence is among the most severe and lethal of addictions, it also has the most effective medication treatments. The authors provide 2 case vignettes and a step-by-step process for clinical decision making.

The loss of control over urges and behaviors may be the central component of gambling disorders, but there is so much more to consider. Individuals with these problems have exponentially higher rates of suicide attempts and completions.

Is it possible to add creative twists to proven therapeutic techniques in order to encourage reluctant patients to try safe and effective treatments that we believe can benefit them? After reading the case, tell us what you think.

A 28-year-old married mother of 2 with a history of depression is brought to the emergency department after 6 months of near-daily methamphetamine use.

In clinical terms, one of the most distinguishing diagnostic features of addictive disorders is that those affected continually and repeatedly revert to their addictive behaviors, despite the devastating negative and adverse consequences.

We present the case of a patient for whom different attending providers had markedly different interpretations. As the case unfolds, we invite you to reflect on your diagnostic understanding of each presentation.

Delusional parasitosis can be difficult to recognize, but timely diagnosis and psychiatric treatment can improve quality of life and reduce medical costs.

A case report of an acute, transient, reversible depression prompts us to think in a different way about depression.

This case of a 14-year-old female patient with end-stage cystic fibrosis illustrates the psychiatrist's critical role in ensuring quality end-of-life care.

This article summarizes 5 cases from consultation services at several teaching hospitals. These challenging cases illustrate several points for the consultation/liaison psychiatrist to consider in caring for elderly hospitalized patients.

This case stresses the importance of identifying cultural issues that arise in mental health clinical encounters.

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.