Posted: December 27th, 2014

medical cases

medical cases

The assignment is a case study about people who are mentioned in the assignment paper.

Case 4: Attempted suicide/deliberate self-harm

Introduction and demographic data:
Mrs. CM is a 45 year old female, a cleaner, from Marsa, was seen in female ward 1 on 28/11/2013, who is married (but currently separated), mother of 4 children, who

has been admitted to Mount Carmel hospital on account of repeated attempts of suicide and deliberate self-harm. Mrs. CA was brought to hospital by her husband, and is

currently admitted under voluntary choice.

Psychiatry- PSC 4001 23’‘1 November 2012
USE SEPARATE BOOKLETS FOR EACH ANSWER
SECTION B
LONG ESSAY – ANSWER ONE QUESTION ONLY
Question 1
You are a GP working in the Valletta area and are called to see a young person at home
because he will not come to the clinic. This is a family you have known for a good
number of years. A hard working father has two jobs to make ends meet. Both jobs are
lowly paid. The mother is a quite reserved housewife who does not speak much and has
struck you a number of times as being somewhat different but you cannot understand
exactly why. They have two children aged twenty three and twenty one. The house is
usually relatively well kept but with clutter and is not exactly very clean.
Their son John is twenty one years old. When you get to their home, the father tells you
that he decided not to go to work today and felt he needed to be present for your visit.
The wife is present in the background but does not speak. John is in his room where he
has been for the past fiVe days not going out except to the toilet. Sometimes they hear
him talking on his own as if there was someone in the room. He has been eating little
and repeatedly asks his mother if she had put something in his food. At times he shouts
at them when they try to talk to him about what is wrong with him and at other times he
does not talk at all. They had noted that he started changing about five weeks ago,
talking increasingly little, compiaining that people at work where picking on him (he
works in a supermarket, filling shelves with groceries) and stopped going out with friends
on Saturdays which he previously enjoyed. In truth his father was initially not too worried
about this because a number of his friends had a criminal history related to theft and
may have aiso used drugs.
On going to his room he is sitting in a corner, staring into space. His room is in a mess
with clothes and possessions scattered all over the place and with many cigarette butts
on the floor. John looks at you, appears afraid or suspicious, and refuses to talk to you.
In the corner of the room there is a nylon rope which you find strange. When you ask the
father about this he says that he does not know why it is there and it had previously
been in their garage and they used it occasionally when they have wet clothes to dry and
it is raining.
1. What is your differential diagnosis?
2. What other information do you require?
3. How would you manage this case?
4. What is your prognosis? Discuss.
OR
10

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