1. Read the following case vignette. You

1. Read the following case vignette. You will then be asked to provide an open response regarding the key symptoms and signs that you noticed that would contribute to your diagnosis. After that, you can choose what you believe to be the correct diagnosis in a multiple-choice . Temper Tantrums Brandon was a 12-year-old boy brought in by his mother for psychiatric evaluation for temper tantrums that seemed to be contributing to declining school performance. The mother became emotional as she reported that things had always been difficult but had become worse after Brandon entered middle school. Brandon’s sixth-grade teachers reported that he was academically capable but that he had little ability to make friends. He seemed to mistrust the intentions of classmates who tried to be nice to him, and then trusted others who laughingly feigned interest in the toy cars and trucks that he brought to school. The teachers noted that he often cried and rarely spoke in class. In recent months, multiple teachers had heard him screaming at other boys, generally in the hallway but sometimes in the middle of class. The teachers had not identified a cause but generally had not disciplined Brandon because they assumed he was responding to provocation. When interviewed alone, Brandon responded with nonspontaneous mumbles when asked questions about school, classmates, and his family. When the examiner asked whether he was interested in toy cars, however, Brandon lit up. He pulled several cars, trucks, and airplanes from his backpack and, while not making good eye contact, did talk at length about the vehicles, using their apparently accurate names (e.g., front-end loader, B-52, Jaguar). When asked again about school, Brandon pulled out his cell phone and showed a string of text messages: “dumbo!!!!, mr stutter, LoSeR, freak!, EVERYBODY HATES YOU.” While the examiner read the long string of texts that Brandon had saved but apparently not previously revealed, Brandon added that other boys would whisper “bad words” to him in class and then scream in his ears in the hall. “And I hate loud noises.” He said he had considered running away, but then had decided that maybe he should just run away to his own bedroom. Developmentally, Brandon spoke his first word at age 11 months and began to use short sentences by age 3. He had always been very focused on trucks, cars, and trains. According to his mother, he had always been “very shy” and had never had a best friend. He struggled with jokes and typical childhood banter because “he takes things so literally.” Brandon’s mother had long seen this behavior as “a little odd” but added that it was not much different from that of Brandon’s father, a successful attorney, who had similarly focused interests. Both of them were “sticklers for routine” who “lacked a sense of humor.” On examination, Brandon was shy and generally nonspontaneous. He made below-average eye contact. His speech was coherent and goal directed. At times, Brandon stumbled over his words, paused excessively, and sometimes rapidly repeated words or parts of words. Brandon said he felt okay but added he was scared of school. He appeared sad, brightening only when discussing his toy cars. He denied suicidality and homicidality. He denied psychotic symptoms. He was cognitively intact. 1 Use this space to take notes regarding prominent symptoms and signs that you noticed, which will help guide your selection of the most likely diagnosis. Feel free to use your DSM-5 or class notes. 2. Read the following case vignette. You will then be asked to provide an open response regarding the key symptoms and signs that you noticed that would contribute to your diagnosis. After that, you can choose what you believe to be the correct diagnosis in a multiple-choice . Increasingly Odd Gregory Baker was a 20-year-old African American man who was brought to the emergency room (ER) by the campus police of the university from which he had been suspended several months earlier. The police had been called by a professor who reported that Mr. Baker had walked into his classroom shouting, “I am the Joker, and I am looking for Batman.” When Mr. Baker refused to leave the class, the professor contacted security. Although Mr. Baker had much academic success as a teenager, his behavior had become increasingly odd during the past year. He quit seeing his friends and spent most of his time lying in bed staring at the ceiling. He lived with several family members but rarely spoke to any of them. He had been suspended from college because of lack of attendance. His sister said that she had recurrently seen him mumbling quietly to himself and noted that he would sometimes, at night, stand on the roof of their home and wave his arms as if he were “conducting a symphony.” He denied having any intention of jumping from the roof or having any thoughts of self-harm, but claimed that he felt liberated and in tune with the music when he was on the roof. Although his father and sister had tried to encourage him to see someone at the university’s student health office, Mr. Baker had never seen a psychiatrist and had no prior hospitalizations. During the prior several months, Mr. Baker had become increasingly preoccupied with a female friend, Anne, who lived down the street. While he insisted to his family that they were engaged, Anne told Mr. Baker’s sister that they had hardly ever spoken and certainly were not dating. Mr. Baker’s sister also reported that he had written many letters to Anne but never mailed them; instead, they just accumulated on his desk. His family said that they had never known him to use illicit substances or alcohol, and his toxicology screen was negative. When asked about drug use, Mr. Baker appeared angry and did not answer. On examination in the ER, Mr. Baker was a well-groomed young man who was generally uncooperative. He appeared constricted, guarded, inattentive, and preoccupied. He became enraged when the ER staff brought him dinner. He loudly insisted that all of the hospital’s food was poisoned and that he would only drink a specific type of bottled water. He was noted to have paranoid, grandiose, and romantic delusions. He appeared to be internally preoccupied, although he denied hallucinations. Mr. Baker reported feeling “bad” but denied depression and had no disturbance in his sleep or appetite. He was oriented and spoke articulately but refused formal cognitive testing. His insight and judgment were deemed to be poor. Mr. Baker’s grandmother had died in a state psychiatric hospital, where she had lived for 30 years. Her diagnosis was unknown. Mr. Baker’s mother was reportedly “crazy.” She had abandoned the family when Mr. Baker was young, and he was raised by his father and paternal grandmother. Ultimately, Mr. Baker agreed to sign himself into the psychiatric unit, stating, “I don’t mind staying here. Anne will probably be there, so I can spend my time with her.” 2 Use this space to take notes regarding prominent symptoms and signs that you noticed, which will help guide your selection of the most likely diagnosis. Feel free to use your DSM-5 or class notes. SCIENCE HEALTH SCIENCE NURSING SWGS 6440

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