The Brainy Bunch
James, a 12-year-old student, was brought to a clinic by his parents due to persistent, involuntary movements and vocalizations that began around age 8.
Tourettes
In the DSM-5-TR, this disorder is filed under both schizophrenia and other psychotic disorders AND personality disorders
Schizotypal personality disorder
What is the difference between Bipolar I and II?
bipolar II - hypomania
bipolar I - mania
Shauna, age 20, reports to the office with persistant low mood, loss of pleasure in previously enjoyable activities, and significant weight gain. She sleeps over 13 hours each day but still reports exhaustion. She reports suicidal thoughts with a method but no plan. Shauna explains she has struggled with depression on and off since high school.
Major Depressive Disorder
Betsy, a 38-year-old accountant, presented with a six-month history of excessive worry that she described as constant and difficult to control. Her concerns ranged from work performance and finances to the health and safety of her family, even when there was no immediate cause for alarm. She reported associated symptoms including restlessness, muscle tension, difficulty concentrating, and trouble falling asleep. These symptoms were present on most days and significantly interfered with her ability to focus at work and enjoy daily activities.
Generalized Anxiety Disorder
Reagan is a 4-year-old girl who presents with delayed social skills and commonly throws tantrums. Her mother reports that tantrums often occur when Reagan's routine is off or when they are in crowded or noisy areas. The therapist notices that Reagan exhibits repetitive movements and highly restricted, fixed interests.
She's got autism, babe
For a schizophrenia diagnosis, there must be 2 or more of the listed symptoms and atleast 1 must be one of these three symptoms
delusions
hallucinations
disorganized speech
Emily, a 33-year-old teacher, sought help after noticing severe mood swings and emotional distress for about 1 week each month. The psychiatric intern, Dylan, is very stupid and MISDIAGNOSED her with Bipolar II. Why is he wrong
Bonus points for the correct diagnosis!
For a bipolar II diagnosis, she would have to experience hypomania and her symptoms would not be confined to 1 week per month
Premenstrual Dysphoric Disorder
Faith, 22, reports to the office with feelings of worthlessness, low mood, anhedonia, and insomnia. She reports that more days than not, she has felt this way since high school.
Persistant depressive disorder
Kimya, a 6-year-old girl, was brought to a child psychologist by her parents and teacher due to her consistent refusal to speak in her classroom, despite speaking normally at home and with close family members. At school, Kimya was able to follow instructions and participate nonverbally but remained completely silent with teachers and peers, even when directly addressed. Her mutism had persisted for over six months and was interfering with his academic performance and social development.
Selective Mutism
Carol Thompson, a 78-year-old retired teacher, developed sudden confusion and attention difficulties two days after hip replacement surgery. She exhibited fluctuating alertness, memory loss, disorientation, and occasional visual hallucinations, mistaking her daughter for her sister and her hospital room for her childhood home. Blood tests reveal that she is currently suffering from a urinary tract infection.
Delirium
Daniel, a 22-year-old college student, was brought to the hospital by his family after experiencing a gradual decline in academic performance and social withdrawal over the past year. His family notes that he has become less emotional expressive. He believes his thoughts are being broadcast to others and has frequent tangential conversations. He has had over 1 month of an active psychotic episode, and substance abuse and medical causes have been ruled out.
schizophrenia
Emmett, 34, sought psychiatric evaluation after experiencing recurring episodes of deep depression characterized by fatigue, hopelessness, and difficulty concentrating, lasting several weeks and impacting his ability to work. Upon further assessment, he disclosed past periods of elevated mood that lasted several days, during which he felt unusually energetic, needed little sleep, talked excessively, and impulsively took on multiple creative projects.
Bipolar II
In order to address concerns in the United States and, increasingly, internationally about the potential for the overdiagnosis and treatment of bipolar disorder in children, a new diagnosis was developed
disruptive mood dysregulation disorder
Harper, 22, reports to the office with persistent anxiety. Episodes came on unexpectedly and were marked by intense physical symptoms—racing heart, shortness of breath, chest tightness, dizziness, and a fear that she was either dying or losing control. The attacks typically lasted 10–15 minutes but left her feeling exhausted and fearful of having another one. She began avoiding certain places, like crowded stores and public transportation, for fear they might trigger another attack. Medical evaluations ruled out cardiac and respiratory conditions.
Panic Disorder
Clementine, a 9 year old, exhibits a persistent pattern of inattention, such as frequently losing track of assignments, making careless mistakes, and struggling to follow multi-step instructions. Additionally, she shows signs of hyperactivity and impulsivity, including fidgeting, difficulty remaining seated, and interrupting others during conversations. These symptoms are evident in both her home and school environments, and significantly interfere with her academic performance and social interactions
What is an important factor to consider in this scenario before confirming an ADHD diagnosis?
For the past year, Winona, age 45, has been convinced that her colleagues are conspiring to sabotage her career, despite a lack of evidence. She remains highly functional in her daily life, maintaining personal relationships and job responsibilities.
delusional disorder
Iris, a 26-year-old graduate student, was hospitalized after exhibiting increasingly erratic behavior over the past week. She had gone four nights without sleep, was speaking rapidly and jumping between ideas, claimed to have discovered a new scientific theory, and impulsively spent large sums of money on lab equipment. Upon further assessment, she reported prior episodes of depression lasting several weeks
Bipolar I
Sunny, a 31-year-old marketing executive, reported experiencing severe mood symptoms including irritability, anxiety, tearfulness, and a sense of being overwhelmed in the week leading up to her menstrual period. These symptoms consistently resolved within a few days of menstruation and were absent during the rest of her cycle. She also noted accompanying physical symptoms such as breast tenderness and bloating. The emotional changes significantly affected her work performance and strained her relationship with her partner. Over a three-month period, symptom tracking confirmed a clear cyclical pattern tied to the luteal phase.
premenstrual dysphoric disorder
Peeta, a 20-year-old college student, reported intense anxiety in social situations, particularly when he had to speak in class, meet new people, or eat in public. He described a persistent fear of being judged, embarrassed, or humiliated, which often led to physical symptoms such as sweating, blushing, trembling, and nausea. These fears caused him to avoid social gatherings, skip classes that required presentations, and isolate himself from peers, despite wanting to connect with others. The symptoms had been present since early adolescence and were significantly interfering with his academic performance and social life.
Social anxiety
Liam, a 9-year-old, was referred for evaluation due to ongoing difficulties with social interactions and communication. he exhibits persistent challenges in using verbal and nonverbal communication in social contexts, including problems with understanding social cues, taking turns in conversation, and adjusting language to different social situations. The therapist has ruled out ASD
Social communication disorder
Jacob, a 19-year-old college freshman, was brought to the hospital by his roommate after experiencing a sudden onset of severe paranoia and hallucinations. For the past 3 months, he has exhibited disorganized speech, flattened affect, and auditory hallucinations
schizophreniform disorder
Syed, a 22-year-old college student, presented with a two-year history of frequent mood fluctuations that never fully met criteria for major depression or hypomania. He described periods lasting several days to a week where he felt more energized, talkative, and confident than usual, followed by stretches of low mood, self-doubt, and fatigue. Though these mood changes were noticeable and caused intermittent academic and social difficulties, they were never severe enough to result in hospitalization or significant functional impairment. He denied any full-blown manic, hypomanic, or major depressive episodes
Cyclothymic
Aiden, a 10-year-old boy, was referred to a child psychiatrist due to frequent, intense temper outbursts that occurred three to four times per week, often in response to minor frustrations. These outbursts were verbal and physical, out of proportion to the situation, and occurred both at home and school. Between outbursts, Aiden displayed a persistently irritable and angry mood nearly every day, noticeable to parents, teachers, and peers. These symptoms had been present for over a year, with no symptom-free period longer than a few weeks
disruptive mood dysregulation disorder
Olivia, age 8, has exhibited intense fear and crying when dropped off at school, frequently complained of stomachaches or headaches to avoid leaving home, and insisted on sleeping in her parents’ bed every night. Olivia expressed constant worry that something bad might happen to her parents when they were apart and became panicked even during short separations, such as a parent stepping out to run errands.
separation anxiety