Week 5 Discussion Forum – Case Studies

1. This case is an 80-year-old male who is on an inpatient rehabilitation unit and you are being asked to see the patient to evaluate him for dementia versus delirium. The patient is a retired professor who was living alone and independently prior to his injury. He fell on the ice while retrieving his mail and sustained a right hip fracture. He underwent surgery for repair of his hip fracture two days prior to your consult. The patient has been exhibiting the following symptoms: occasional visual hallucinations, confusion about where he is, inconsistent recall as to the reason he is in the hospital, and behavioral outbursts (e.g., yelling and swearing at the staff).

2. This case is a 65-year-old married female with 16 years of education. She works full-time as an elementary school teacher. Her symptoms began suddenly one evening; her husband noted she referred to the dog food as “Jell-O” and called the television remote a “fork.” She appears to understand conversational language and can read and write normally, but is unaware of her paraphasic errors in speech.

3. This case is a 48-year-old male who is referred for an evaluation of behavioral and mood changes. Over the past year, his wife has noticed that he has become increasingly withdrawn and isolated. He no longer enjoys any type of social interaction and prefers to spend his time alone playing card games on his computer. He is college educated with no previous significant medical, neurological or psychiatric history. He works as an engineer and has been at the same company successfully for the past 20 years. In the past year, his supervisors have noticed that his work quality has declined and he seems less motivated and “excited” about his job. Tasks he had always completed early are now being done late or not at all, and he appears unconcerned that his job is now in jeopardy.

4. This case is a 16-year-old female with no previous history of any psychiatric conditions, learning difficulties, or a diagnosis of attention deficit hyperactivity disorder. She is a high school sophomore and her parents have noticed that her mood seems to be “up and down.” She often falls asleep if not involved in a stimulating activity. Teachers at school note good performance on tests, but homework is frequently turned in late and she appears distractible and fidgety during class. She works part-time as a waitress on the weekends but is in danger of losing her job due to frequent tardiness over the past 6 months.

5. This case is a 19-year-old male with 12 years of education who has worked in the field of construction successfully for the past two years. His girlfriend stated that he is often inattentive; she finds that he “spaces out” when they are talking and she frequently has to repeat information to him. He was involved in a car accident 6 months prior and sustained a very brief loss of consciousness, but his Glasgow Coma Scale at admission to the ED was 15/15. There was no evidence of pre- or post-traumatic amnesia.