Case History 1
Alex would not shake hands when he came in to see the doctor.
He looked at the two chairs in the doctor's room and chose the one that he thought looked least dirty. He perched on the very edge of the seat and folded his hands. Alex told his doctor that he was sleeping badly and that his degree work at the University was suffering. When the doctor asked about his sleep Alex told him that he would lie awake worrying whether he had switched off all the lights or pulled out all the electric plugs in the living room or locked all the doors. He would get up to check not once, not twice, but at leats ten times. If he did not get up to check these things he was overwhelmed with anxiety until he did so. In addition he was washing his hands up to twenty times a day to rid himself of germs. Whenever he went out of the house he always had to shower on his return and put on clean clothes. He had always been a neat person and a meticulous worker. All his essays at University were word-processed and laced with detailed references. However, in the last two months he had fallen behind on the deadlines for his essays, because he had been checking and re-checking every sentence for mistakes. He was troubled by thoughts that he had become contaminated by other people. he had stopped seeing his girlfriend because he could not bear her to touch him lest she give him germs. he knew that the idea was illogical, but he could not stop thinking about contamination.
Is Alex suffering with a neurotic or a psychotic illness?
What is the most likely diagnosis?
What treatments can be offered?
Case History 2
Elaine, 60, was a passenger in a car in a road traffic accident. She sustained a broken pelvis and spent some months in hospital. When she was discharged Elaine could not face travelling in a car again. She went to her family doctor complaining of poor sleep with early morning wakening. She was also troubled with recurrent nightmares about the crash. During her waking hours she was haunted by sudden visual images of the accident coming into her mind. "It's as if it's all happening again," she said. "I am there in the car again. I can see the other car coming towards us. I can hear the crashing metal. I can't get the smell of petrol out of my mind." Anything on the television to do with cars brings the unwanted pictures and sensations back into her mind. Since television programmes and advertisements repeatedly feature cars, Elaine has stopped watching television altogether.
What additional features of Elaine's history would you want to know about?
What are the main differential diagnoses?
How could Elaine be treated?
Alex would not shake hands when he came in to see the doctor.
He looked at the two chairs in the doctor's room and chose the one that he thought looked least dirty. He perched on the very edge of the seat and folded his hands. Alex told his doctor that he was sleeping badly and that his degree work at the University was suffering. When the doctor asked about his sleep Alex told him that he would lie awake worrying whether he had switched off all the lights or pulled out all the electric plugs in the living room or locked all the doors. He would get up to check not once, not twice, but at leats ten times. If he did not get up to check these things he was overwhelmed with anxiety until he did so. In addition he was washing his hands up to twenty times a day to rid himself of germs. Whenever he went out of the house he always had to shower on his return and put on clean clothes. He had always been a neat person and a meticulous worker. All his essays at University were word-processed and laced with detailed references. However, in the last two months he had fallen behind on the deadlines for his essays, because he had been checking and re-checking every sentence for mistakes. He was troubled by thoughts that he had become contaminated by other people. he had stopped seeing his girlfriend because he could not bear her to touch him lest she give him germs. he knew that the idea was illogical, but he could not stop thinking about contamination.
Is Alex suffering with a neurotic or a psychotic illness?
What is the most likely diagnosis?
What treatments can be offered?
Case History 2
Elaine, 60, was a passenger in a car in a road traffic accident. She sustained a broken pelvis and spent some months in hospital. When she was discharged Elaine could not face travelling in a car again. She went to her family doctor complaining of poor sleep with early morning wakening. She was also troubled with recurrent nightmares about the crash. During her waking hours she was haunted by sudden visual images of the accident coming into her mind. "It's as if it's all happening again," she said. "I am there in the car again. I can see the other car coming towards us. I can hear the crashing metal. I can't get the smell of petrol out of my mind." Anything on the television to do with cars brings the unwanted pictures and sensations back into her mind. Since television programmes and advertisements repeatedly feature cars, Elaine has stopped watching television altogether.
What additional features of Elaine's history would you want to know about?
What are the main differential diagnoses?
How could Elaine be treated?
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