Please describe the (1) BEST DIAGNOSE(S) and (2) RECOMMENDED…
Questions
Pleаse describe the (1) BEST DIAGNOSE(S) аnd (2) RECOMMENDED TREATMENTS fоr the fоllоwing cаse: (5 points) Deborah was a 25-year-old college educated female from an upper social class Hindu (Marvadi) family, living with husband's family in New York. She presented to the tertiary care center with complaints of gradual loss of weight, recurrent episodes of vomiting, from a period of 2 years, menstrual irregularities from 1 year and amenorrhea since 6 months, with a probable precipitating factor being husband's critical comment about her weight. Patient was reported to be dull and inactive most of the times since her marriage able to carry out her activities of daily living adequately. With symptoms of weight loss and amenorrhea, she was evaluated by a physician. A series of investigations were conducted in the background of suspected tuberculosis, anemia for evaluation and abdominal tumors. However, all the investigations were well within normal limits except low hemoglobin. During psychiatric interview it was difficult to establish rapport and Deborah was uncooperative. With persistent probing, she expressed low mood, easy fatigability, apathy, decreased attention and concentration, bleak, and pessimistic ideas about future. No suicidal ideas or unusual perceptual experiences were reported. Attempt to establish the cause of above symptoms were futile. Information was elicited by Deborah’s husband, revealed an incident during their early days of marriage when he had casually remarked of her being slightly heavy near her flanks and thighs and that she would look more beautiful if she reduced it. Since then her intake of food decreased. She followed a change in the diet pattern with complete avoidance of all foods with high caloric value. She gradually began to skip breakfast and would have minimal lunch. She began to avoid eating in front of other family members. At times hide and eat, and/or would secretly go into the bathroom and induce vomiting. After repeated sessions, the patient opened up to the clinician. When questioned about her purging behavior, she reported of being unable to tolerate the guilt associated with eating excessively. Patient was re-evaluated and probed about her eating habits. Premorbid personality assessment revealed an over concern about physical appearance, inspired by skinny models. She reported of wanting to impress her husband with her beauty as he was fond of thin looking girls. She recalled that her husband would repeatedly compare her with thin looking girls on television and magazines. She eventually developed a morbid fear of looking fat and ugly, began eating a handful of fennel seeds to facilitate digestion. She would use soap water enema and would occasionally use laxatives. Her weight dropped from 140 to 90 lbs. During clinical examination, her weight was 90 lbs. in relation to her height being 5.4 ft and a BMI of 15.6. She had lanugo hair on her face and looked emaciated. Vitals were stable and systemic examination was normal. Her thyroid function was normal, serum electrolytes were normal, her hemoglobin was 8 gm/dl. She was admitted for inpatient care and started immediately on IV fluids. Initially she developed facial edema that gradually reduced with fluid redistribution.
Cаn а pаtient at the end оf life experience dyspnea withоut being hypоxic?
NEO'S STORY Neо аlwаys thоught he hаd things under cоntrol. He was a college sophomore, juggling classes, a part-time job, and a tight-knit group of friends. When his roommate offered him a pill one night to help him "stay focused and chill," Neo hesitated, but curiosity won. The first time he tried it, everything seemed better. Studying felt easier, music sounded richer, and he finally got the deep sleep he hadn’t had in weeks. In the moment, it felt like he had found a secret weapon. At first, the drugs seemed to help. Neo could push through late-night study sessions and still show up for exams. Parties were more fun, stress felt manageable, and he even started getting compliments on how “laid back” he’d become. He told himself it was no big deal because it was just something to take the edge off. But slowly, the excitement wore thin. What used to be occasional turned into frequent use, and then into something he felt he needed just to get through the day. It wasn't long before the cracks started to show. Neo missed deadlines and started skipping classes. Friends noticed his mood swings, and one of them even pulled him aside to ask if everything was okay. He brushed it off, saying he was just tired. But deep down, he knew something had shifted. The concentration boost and relaxation he once felt were replaced with anxiety, foggy thinking, and a constant craving for his next “fix.” The consequences came quickly. Neo failed two classes that semester. His job let him go after he showed up late one too many times. He found himself lying to his parents about money, borrowing from friends and never paying them back. His social life crumbled, and he stopped answering texts. The very things he once used to enhance his life were now destroying it. What had started as casual use had become a trap—and he didn’t know how to get out. Neo’s story isn’t unique; it’s a warning. Drugs might feel helpful in the moment, offering a temporary escape or a fleeting sense of control. But that illusion comes with a steep price. The negative consequences (academic, social, financial, legal, and personal) can grow quickly and quietly. Neo eventually reached out for help and started the long road to recovery, but he often wishes he had seen through the illusion earlier. Because sometimes, what seems exciting at first turns out to be the very thing that holds you back the most.