Final Exam

COGNITIVE PSYCHOTHERAPY CENTER

SUBJECT Psychopathology and Psychodiagnostics CYCLE
PROFESSOR Cristel Ortiz Rodriguez FINAL EXAMINATION
STUDENT: Nadja Magaña DATE : 08 August 2019

RESPOND

1. Mention the main symptoms of schizophrenia.

a) Delusional ideas
b) Hallucinations
c) Disorganized language
d) Severe catatonic/disorganized behavior
e) Negative symptoms

2. Sexual disorders can be divided into 3 categories, mention a disorder corresponding to each
category.
a) Sexual dysfunctions: Vaginismus
b) Paraphilias: Sadism
c) Sexual identity disorders:

3. What is the difference between anorexia and bulimia (mention some of the criteria).
In anorexia we find:
• Restriction of energy intake required by the individual
• Significantly low body weight in relation to its height
• Extreme fear of weight gain
• Alteration of your perception of your weight and figure
While in bulimia we see:
• Binge
• Inappropriate compensatory behaviors to prevent weight gain
• Symptoms must occur at least once a week for three months.

4. Mention 3 impulse control disorders.

* Oppositional Defiant Disorder
* Intermittent explosive disorder
* Piromania

5. What are dyssomnias?

Sleep disorders that have to do with a problem in initiating or maintaining sleep, or
excessive sleepiness, characterized by a disturbance in the quantity, quality and timing of
sleep.

ELABORATE THE CORRECT DIAGNOSIS

CASE 1

Ellen is a 35-year-old insurance saleswoman. She is treated by a psychiatrist after a suicide

attempt, where she wanted to throw herself off a cliff. She is an intelligent, sophisticated and
somewhat overweight person. It was noticeable that he had a lot of discomfort at the beginning of
the psychiatric consultation. She reports a 6-month period where she has felt progressively sadder,
lacking energy and not finding pleasure in things. She tells the psychiatrist that she gets to the point
where she feels so tired that she can spend 15 to 20 hours in bed. He also reports binge eating,
consuming very large amounts of food, such as whole packages of cookies and an entire chocolate
cake in less than 30 minutes. She has had problems with binge eating since she was a teenager,
"when I get into that mentality, I eat whatever is in front of me". However, over the past 3 months, he
has binged more frequently and gained 8kg. In the past, her weight has varied greatly, as she has a
cycle of dieting for a few months and then eating out of control for months. While you do want to go
down, you also don't think about it every day. She denies vomiting or using other weight control
methods such as laxatives or diuretics.

She attributes her depression to financial problems. She was fired from her job just 2 weeks
ago. The psychiatrist asks her about the reason for the dismissal, to which she replies "I owe my
company some money." The psychiatrist asks her to be more specific, and she reluctantly tells the
psychiatrist that she owes her last job 1,500,000 pesos. He also owes approximately another million
pesos in credit cards. Digging deeper, the psychiatrist discovers that she has always had trouble
managing her finances. From the age of 30 to 33, she used the company's credit card for episodes
of "extreme shopping", which led her to accumulate a debt of 1.5 million pesos. She denies having
manic symptoms, or compulsive shopping resulting from obsessive thoughts, simply stating to the
psychiatrist that shopping helped with the chronic feeling of sadness and emptiness. Shopping
provided temporary relief from his discomfort. Because she often felt unwell, she shopped
compulsively every 3 or 4 days, buying watches, jewelry and lots of shoes.

In addition to chronic feelings of emptiness, Ellen described confusion about her future and
what she wanted to do with her life. She has had several brief but intense relationships (boyfriends)
with both men and women. Relationships ended due to frequent fights, which could escalate to
blows and kicks. Ellen's mother was physically very abusive to her, from the age of 6 she would hit
her for any fault.

Diagnosis: Major depressive disorder, with binge eating disorder and compulsive thoughts.

CASE 2

A 51-year-old woman is brought for consultation by her family because of her worsening
condition. The family reports that she has been gradually losing her memory over the past year. It
started with insignificant things but suddenly she could no longer find basic things in her own
apartment and therefore function on her own. She started carrying objects back and forth and then
hiding them. The woman's ability to remember was severely disturbed; upon evaluation, she could
recognize and name objects when they were shown to her, but she would forget almost immediately.
When I tried to read, she would jump from one line to another, reading meaningless statements or
even words. More recently she also became disoriented as to time and place, reporting being in
distant places, the woman resided in Colorado but claimed to be in Toronto, Canada, where she had
lived many years ago.

Diagnosis: Dementia
CASE 3

Emilio is a 40-year-old man. He is admitted to the hospital for the tenth time by his mother
because she is afraid of him. Emilio is dressed in torn clothes, slippers, a cap and several medals.
He occasionally shows anger towards his mother "she feeds me worms" he tells the doctor, and a
moment later he smiles at his mother and winks at the nurses, showing a positive mood. His way of
talking is like a child and he exaggerates a lot his hip movements while walking. The mother reports
that she stopped taking her medications a month ago, and since then she started hearing voices
(Emilio) and acting strangely. When the doctor asks him what he is doing, Emilio replies "eating
wires and fires". His speech is spontaneous and most of the time incoherent, with a tendency
towards rhyming words and strange sounds.

Emilio's first hospitalization occurred when he was 18 years old, just after finishing high
school. Since then he has not been able to study or hold a job for more than 3 months, as he gets
better but then has episodes of acting strange and is unable to function on his own, let alone with
the responsibilities of a job. For this reason he has not been able to be autonomous, he lives with his
mother and she takes care of him. However, Emilio very often refuses to take his medications, which
precedes relapses. He has occasionally left home during his relapses, lasting up to a month without
his mother hearing from him, most often picked up by the police for loitering in the streets. No history
of alcohol or drug use.

Diagnosis: Schizophrenia

CASE 4

The reason for Rocío's consultation is to eliminate her anxiety problem and to stop taking the
medication given to her by her psychiatrist. Rocio is 51 years old, married and has 2 adult children.
She had a hernia operation 6 months ago, but felt very bad during the procedure. A month after the
operation he presented some discomfort in his stomach, there were suspicions of cancer but it
turned out to be a doctor's mistake and tests showed that he was in excellent health. However,
these 2 events intensified a fear of death that had been forged 7 years earlier after the sudden death
of his father due to a heart attack.
In response to this fear of dying, Rocio was hypervigilant of her body, any sensation was
enough to make her worry. Soon after, she began to develop seizures where she felt like she was
going to die. The attacks were unexpected, they could happen at any time. Whenever she feels
discomfort in her stomach or pressure in her chest, her thoughts are "something bad is happening to
me" "it could be a heart attack" and "I'm going to die". Other sensations that Rocio has are dizziness,
cold hands and tachycardia. Whenever she has these sensations she looks for her husband or
anyone else to be with her and calls the doctor, if the doctor does not answer, she goes to the
hospital. She has been to the hospital 4 times in the last 2 months for fear that something is
happening to her. Rocio believes that any physical symptom can be a cause for concern and says "if
I am hypervigilant, I can detect something early" and "if I detect something early, I can do something
about it, otherwise I can die". Rocio has a lot of anxiety in anticipation of an attack which leaves her
in a constant state of hypervigilance. She tries to be alone as little as possible in order to have
someone close by who can help her and leads an exaggeratedly healthy lifestyle. He exercises a lot,
eats very healthy and has constant medical consultations and tests. Rocío is conflicted about taking
psychiatric medication because she says it puts extra stress on her heart.
In addition to her fear of dying, Rocio has other fears. She describes herself as very
insecure, she worries that her daughter's boyfriend is very aggressive and might hurt her, she also
worries about the crime situation, so she doesn't go out at night, the health of other family members,
and even when she has visitors (which is often) she worries that they will be okay and that they
won't think she is a bad hostess. All of these problems have the potential to cause sleep problems
and muscle tension. She says that what most often causes her discomfort is her husband's constant
business trips. Every time her husband goes on a business trip she worries a lot that something is
going to happen to him, she has thoughts like "he drives horrible, what if he crashes?" or when he
doesn't answer her call "surely something happened to him, that's why he doesn't answer" and she
can't relax until he finally answers, even a couple of times when he didn't arrive she went out to look
for him to make sure nothing happened to him. When the therapist asks her about the reason for so
much concern for her husband, she says that she is ashamed to tell the truth, but that beyond what
she would suffer if something happens to him because she loves him, she cannot imagine herself
alone.I don't know what would become of me" "I have always had someone to take care of me" "I
have a hard time making decisions and all my life I have leaned on him" "I am not a strong person".
Rocío was a very protected child, both parents were very religious and overprotected Rocío
and her sisters, not letting them go out much and forbidding them from "incorrect" friendships.
Rocio's mother was the typical submissive wife and raised her to be a "good wife". Rocío married
young, at 18 years old, so she went from the care of her parents to the care of her husband. The
husband always spoiled her, treated her well and has been an excellent provider, however he is
controlling and did not encourage Rocio to make decisions or solve problems. Rocío currently has a
business (which her husband set up for her to "entertain herself") but she lets her partner make all
the important decisions. "I have a hard time giving my opinions, I think they might be wrong." Rocío
finds it hard to give her opinions even when she knows she is right "I'm afraid that people will get
angry with me, I prefer not to say anything so that people won't get upset" "all my life I have put the
needs of others above my own". Rocio is a very religious person and is dedicated to various
altruistic activities, she says that it gives her a lot of comfort to think that God takes care of her.

Diagnosis: Panic attack accompanied by social and separation anxiety disorder.

CASE 5

Panfilo is a 60-year-old real estate businessman. He left home at the age of 16 because he
was looking to escape his abusive father. Panfilo finished his studies up to university by supporting
himself by working on different things. By the age of 30 he was married and divorced. He comes to
psychotherapy on the advice of his cardiologist, who recommends him to reduce his general stress
and anger levels due to the medical problems associated with it (high cholesterol, arteriosclerosis).
He reports that he has always been an angry person and that he is "not in the mood to take crap
from anyone".
For him his difficulties in life have been much greater than for other people because he had to leave
home at a young age and support himself, he has very ugly memories of his father beating him
severely and without warning. Panfilo believes that other people owe him respect and that his life
should be free of discomfort because he has suffered enough at the hands of his abusive father and
has worked harder than others to establish his professional status and have peace of mind and
stability. He sees himself as a capable and autonomous person, without needing other people "I've
managed on my own so far".
Panfilo is constantly resentful of his past and acts hostile in many of his interactions. He says he has
learned never to be a trusting person "people always have hidden motivations, no one does anything
without gaining something in return". Thoughts like this are the aftermath of his childhood, always
thinking that people want to be clever and abusive in one way or another. Although he is not
physically aggressive, he gets angry easily when he perceives someone disrespecting him and
when he perceives any discomfort in general, no matter how small. A typical situation is to be in the
fast lane at the supermarket and see that the people lined up in front of him have more than 10
items in their cart. This makes him very angry because he thinks he has to wait longer than he
should and that people are selfish and mean-spirited. He even goes so far as to count things in other
people's carts to make sure they "don't overdo it." Other common situations are on the street while
driving, in other stores and public places such as squares and parks. His way of expressing his
anger is to constantly complain and grumble about how unfair life is and how unfair the disrespect
done to him was, which causes him to stay angry and ruminate for a long time about the event that
made him angry. He has trouble recognizing his role in interpersonal conflicts and when someone
points it out to him he gets very angry, blaming the other person even more for his own anger and
complaining that he is not understood. When he gets extremely angry he tends to shout and
threaten (for example in line at the supermarket), however he does not carry out his threats. He says
that it is hard for him to control his shouting and rudeness and recognizes that this has alienated
people and caused him to become lonely, but that it helps him not to be disrespected again and "not
to be overly abusive", he says that "you always have to keep an eye on things because people
always have bad intentions, they can hurt you when you least expect it". Thinking this way has led
him to have problems in all his relationships, since apart from constantly getting angry, he accuses
his partners of being unfaithful and of lying to him without much evidence.

Diagnosis:
Intermittent explosive disorder accompanied by a delusional disorder.