Personality

Paige, a 27-year-old woman, is brought to the psychiatric inpatient unit from the emergency department. Both of her wrists have been sutured and are bandaged. She vacillates between being angry and crying. Paige states, “I know I am bad. I should not have done it. I do not want to die, but I am tired of the hassles. You wouldn’t understand.” During the admission interview, the nurse finds that Paige has had three previous admissions to this inpatient unit during the past 8 years. Paige states that she refuses to return to work because her boss accuses her of bothering the other employees instead of doing her own work. She states that her boss is falsely accusing her of using alcohol and drugs and does not accept her reasons for being absent from work. On the morning of admission, she called her outpatient therapist, whom she had not seen in a year and a half; he agreed to see her at 2 p.m. When she called the therapist back at noon and found that he was at lunch, she used her scissors to cut her wrists. “I used to think he understood me, but now I know he doesn’t care.” Her parents are on vacation out of state, and her only close friend is busy with a sick child. She had taken some of her mother’s Ativan, but it did not calm her down. She has averaged only about 3 hours of sleep each night for the past 5 days and has been unable to eat regular meals. Her attempts to clean her parents’ house were not complete. She could not even finish watering her mother’s plants. A male acquaintance of 2 weeks was no longer calling her, so she was frequenting several bars and inviting men home. She never heard from these men again, even though she thought that their relationships were sexually satisfying. Paige completed 2 years of college and is dressed attractively. She enjoys reading romance novels and has brought five of her favorite books.Include:

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Any differential diagnoses (state why each one should be considered for the case)
 Your diagnosis and reasoning. What are some unique considerations to keep in mind when treating a patient who has an eating disorder and/or a personality disorder?
 Any additional questions you would have asked to get more helpful information.
 Medication recommendations along with your rationale. Always discuss side effects vs benefits vs risks in your education of a medication. Note possible side effects or issues
to address if attempting to obtain consent.
 Any labs and why they may be indicated (What labs could rule out some organic causes of the behaviors?)
 Screener scales or diagnostic tools that may be beneficial?

 Additional resources to give (Therapy modalities, support groups, activities, etc.) Always include a hotline number for the patient to call if needed.