Dis 2

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Arizona State University *

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Medicine

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Apr 3, 2024

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It is noted that Jerome met with two different physicians who evaluated him physically and could find nothing wrong. Why is it important to consider the possibility of a medical cause that could be contributing to his symptoms? - Hint: page 236 of the DSM-V-TR. It is important for Jerome to be considered for medical causes contributing to his symptoms because there are times when underlying medical conditions can lead to psychological issues. Jerome's symptoms, such as the heart pounding, sweating, chest pain/tightening all correlate with a panic disorder but also a heart attack. He also experiences a fear of dying since both his grandfathers passed from a heart attack. The DSM 5 mentions that the disturbance is not attributed to physiological effects of a substance or other medical conditions like hypothyroidism ( American Psychiatric Association 2022, p. 236). Medical conditions like hypothyroidism can lead to weight loss, fatigue or even cognitive impairments. He might also develop depression from wanting to stay locked in his room so he wouldn't have any public episodes. Panic disorders can also lead to concerns about excessive drug use or drinking to control episodes which is why it is important to consider other medical issues because it could lead to worse conditions in the future. Notably, there is no discussion of any substance abuse assessment for Jerome *prior* to the onset of his symptoms. If you were assessing Jerome, what kinds of questions would you ask about his pattern of abuse for things like caffeine, energy drinks, or perhaps if he had been using a stimulant, such as Adderall? How might this change the diagnostic picture? Hint: page 236 of the DSM-V-TR again. Since there is no discussion of his prior drinking, we can say that he started to drink because of his panic disorder. If I were to assess Jerome I would most likely ask him questions that pertain to his caffeine drinking, like how often do you consume caffeine (everyday, multiple times a day, once a week?) The DSM 5 mentions that intoxication or withdrawal can precipitate a panic attack, even a withdrawal from caffeine. (American Psychiatric Association 2022, p. 236). With that being said, I would continue to ask him questions such as ● Has your mood improved or decreased after drinking caffeine? ● Do you get the shakes/jitters when you drink caffeine? ● Do you ever take any drugs such as adderall? ● Do you experience any symptoms after not consuming caffeine or adderall? You also have to ask questions about his past use or family use - Does his family drink caffeine or use drugs? If so, there could be a sign of heredity and we would have to look closer into substance abuse. With substance abuse, his treatment and diagnosis would be different than that of a panic disorder. Related to the case of Ernest, take a moment to research/find a case in the news or other popular media and post a link in your discussion, followed by a brief discussion about what occurred (or is suspected to have occurred).

https://www.nbcnews.com/health/health-news/man-loses-memories-wanders-25-days- flna1c9471159 This case was about Joe Bieger. One morning, he went out for a walk with his dogs and didn't return for 25 days. He was wandering the streets of Dallas and ended up 20 miles from his house. He had lost 25 pounds and looked like a whole different person. His wife had mentioned that he had previous disappearances before, but they only lasted a few hours. He doesn't recall anything that happened or what he ate or did to survive, but he was found with jelly packets in his pockets. He remembers a few moments such as being searched by officers looking for a suspect, on a playground and under a construction trailer. He was actually found by a contractor that was building his home for Beiger and his wife. He was diagnosed with a very rare dissociate condition called psychogenic fugue or dissociative fugue. To this day, he still does not recall what happened. Doctors are unaware of the statistics of a psychogenic fugue or what its underlying causes were for Joe. He did suffer a seizure which led to some memory loss. In the case of Forest, individuals with a broad array of physical complaints without obvious medical causes are often looked down on by society as attention-seeking or worse, malingering (the intentional production or exaggeration of bogus symptoms, see pg. 835 in the DSM-V-TR for a reference on Malingering). Discuss how this potential bias might affect how individuals like Forest receive treatment. The idea of malingering has been an ongoing issue for the psychology and medical field. There are alot of biases that might be brought up. Cases like Forests are seen as attention seeking or malingering which can cause issues for them to receive treatment. People who go back and forth to the hospital or doctor numerous times often get turned away because there is no evidence to show that they are in pain or need help. It's almost like they can't see it so they don't help it, just as Forest's sister started to resent her. They get turned away because doctors might not want to help someone when they feel they are faking it. In the long run, this could lead to them not diagnosing the patient correctly or at all which could escalate the symptoms they have. Sometimes people will also turn to drugs or alcohol to help with the pain when they aren't able to receive any help which can also cause more issues with their mental health. Although cases like Forests can be seen as attention seeking or malingering, it is important for healthcare workers to treat all patients the same whether they are able to “see” it or not. American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787 NBCUniversal News Group. (2007, January 26). Man loses memories, wanders for 25 Days . NBCNews.com. https://www.nbcnews.com/health/health-news/man-loses- memories-wanders-25-days-flna1c9471159

Wilonsky, R. (2006, October 23). Have you seen this man? . Dallas Observer. https://www.dallasobserver.com/news/have-you-seen-this-man-7132005

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