The Diagnostic Dilemma of Myxedema and Madness, Axis I and Axis II: A Longitudinal Case Report

1989 ◽  
Vol 18 (3) ◽  
pp. 263-270 ◽  
Author(s):  
Denis F. Darko ◽  
Alice Krull ◽  
Mark Dickinson ◽  
J. Christian Gillin ◽  
S. Craig Risch
Keyword(s):  
Differential Diagnosis ◽  
Medical Diagnosis ◽  
Psychiatric Care ◽  
Paranoid Schizophrenia ◽  
Diagnostic Dilemma ◽  
Chronic Thyroiditis ◽  
Axis Ii ◽  
Probable Presence ◽  
Axis I ◽  
Primary Axis

A patient with presumed chronic paranoid schizophrenia had chronic thyroiditis and Grade I hypothyroidism. Psychosis cleared following treatment with thyroid replacement. The probable presence of two axis II disorders may have contributed to the missed medical diagnosis and the patient's eventual suicide. The personality disorders were a major problem in the patient's medical and psychiatric care. The differential diagnosis among hypothyroidism and primary axis I psychotic and depressive psychopathology has always been problematic. When axis II pathology is also present, the diagnostic dilemma is increased.

scholarly journals Supportive Psychotherapy and Psychoeducation as a Media for Changing and Convincing Behavior in Clients with Paranoid Schizophrenia

2020 ◽  
Vol 8 ◽  
Author(s):  
Imam Shofi'i
Keyword(s):  
Paranoid Schizophrenia ◽  
Auditory Hallucinations ◽  
Supportive Psychotherapy ◽  
Axis Ii ◽  
Psychiatric Status ◽  
Apparent Reason ◽  
Axis I ◽  
Five Senses ◽  
Primary Support ◽  
Group Family

Schizophrenia is a psychiatric diagnosis that describes mental disorders with character abnormalities in perception or disorders regarding reality. Perception abnormalities can be in the form of disorders in the five senses, usually in the form of auditory hallucinations, paranoia, bizarre delusions, and can also be in the form of speech disorganization and disruption of real social communication. Case. Mr.SA, age 43, came with complaints of rampage to his family and surrounding community for no apparent reason. The patient was treated at Menur General Hospital Surabaya 2 years ago with a similar complaint. Psychiatric status obtained clear awareness, bad insight, blunt affect, auditory hallucinations, visuals, followed by delusions of control, suspicious. Diagnosis of axis I: paranoid schizophrenia, axis II and III: none, axis IV: Primary Support Group (Family) GAF axis scale 20.11 (danger of self-injury / others when entering hospital). Psychopharmaca therapy is chlorpromazine tab 1 x 100 mg, haloperidol tab 3 x 5 mg, and trihexyphenidyl 3 x 2 mg, and psychotherapy that is support. Conclusion The paranoid schizophrenia of this patient is due to work problems

Suicidal Behavior in Patients with Adjustment Disorders

Crisis ◽  
2001 ◽  
Vol 22 (3) ◽  
pp. 125-131 ◽  
Author(s):  
Ludmila Kryzhanovskaya ◽  
Randolph Canterbury
Keyword(s):  
Personality Disorder ◽  
Suicidal Behavior ◽  
Suicide Attempts ◽  
Adjustment Disorder ◽  
Adjustment Disorders ◽  
Involuntary Hospitalization ◽  
Axis Ii ◽  
The Past ◽  
Substance Abuse Disorders ◽  
Axis I

Summary: This retrospective study characterizes the suicidal behavior in 119 patients with Axis I adjustment disorders as assessed by psychiatrists at the University of Virginia Hospital. Results indicated that 72 patients (60.5%) had documented suicide attempts in the past, 96% had been suicidal during their admission to the hospital, and 50% had attempted suicide before their hospitalization. The most commonly used method of suicide attempts was overdosing. Of the sample group with suicide attempts in the past, 67% had Axis II diagnoses of borderline personality disorder and antisocial personality disorder. Adjustment disorder diagnosis in patients with the suicide attempts was associated with a high level of suicidality at admission, involuntary hospitalization and substance-abuse disorders. Axis II diagnoses in patients with adjustment disorders constituted risk factors for further suicidal behavior. Additional future prospective studies with reliability checks on diagnosis of adjustment disorders and suicidal behavior are needed.

Non-Gynecologic Causes of Adnexal/Pelvic Masses

2018 ◽  
Vol 15 (1) ◽  
pp. 46-49
Author(s):  
Michelle L. Gainty ◽  
Christina Jones
Keyword(s):  
Differential Diagnosis ◽  
Female Patient ◽  
Diagnostic Dilemma ◽  
Adnexal Masses ◽  
Pelvic Masses

Pelvic masses can pose a diagnostic dilemma with a broad differential to include both gynecological and non-gynecologic etiologies. While the initial instinct may be to search for gynecologic causes for the female patient, non-gynecologic etiologies must be considered as well. The presentation can be similar amongst many different causes of pelvic masses and imaging is generally required for further assessment to determine if the mass is intra- or extraperitoneal. The etiology of adnexal masses covers several subspecialties: gynecology, urology, gastroenterology, neurology, and oncology. For this reason, it is important for all to be aware of the differential diagnosis for pelvic masses.

Co-morbidity and disorder-related distress and impairment in purging disorder

2007 ◽  
Vol 38 (10) ◽  
pp. 1435-1442 ◽  
Author(s):  
P. K. Keel ◽  
B. E. Wolfe ◽  
J. A. Gravener ◽  
D. C. Jimerson
Keyword(s):  
Eating Disorder ◽  
Normal Weight ◽  
Self Report ◽  
Axis Ii ◽  
Clinical Interviews ◽  
Diagnostic And Statistical Manual ◽  
Purging Disorder ◽  
Co Morbidity ◽  
Axis I ◽  
Clinically Significant

BackgroundRecent studies suggest that purging disorder (PD) may be a common eating disorder that is associated with clinically significant levels of distress and high levels of psychiatric co-morbidity. However, no study has established evidence of disorder-related impairment or whether distress is specifically related to PD rather than to co-morbid disorders.MethodThree groups of normal-weight women [non-eating disorder controls (n=38), with PD (n=24), and with bulimia nervosa (BN)-purging subtype (n=57)] completed structured clinical interviews and self-report assessments.ResultsBoth PD and BN were associated with significant co-morbidity and elevations on indicators of distress and impairment compared to controls. Compared to BN, PD was associated with lower rates of current and lifetime mood disorders but higher rates of current anxiety disorders. Elevated distress and impairment were maintained in PD and BN after controlling for Axis I and Axis II disorders.ConclusionsPD is associated with elevated distress and impairment and should be considered for inclusion as a provisional disorder in nosological schemes such as the Diagnostic and Statistical Manual to facilitate much-needed research on this clinically significant syndrome.

The dexamethasone suppression test and DSM-III-R diagnoses in suicide attempters

2003 ◽  
Vol 18 (7) ◽  
pp. 350-355 ◽  
Author(s):  
Åsa Westrin ◽  
Karin Frii ◽  
Lil Träskman-Bendz
Keyword(s):  
Personality Disorders ◽  
Stressful Events ◽  
Suicide Attempter ◽  
Axis Ii ◽  
Suppression Test ◽  
Axis I ◽  
Cortisol Levels ◽  
Low Cortisol ◽  
Hpa Axis Activity ◽  
Dexamethasone Suppression

AbstractPrevious research on hypothalamic-pituitary adrenal (HPA) axis-activity in suicide attempter research has shown conflicting outcomes. The design of the present study was to test the influence of personality disorders and concominant axis I diagnoses on the dexamethasone suppression diagnostic test by use of multiple regression analyses. The sample consisted of 184 patients with a recent suicide attempt and 42 healthy controls. As expected, the lowest pre- and postdexamethasone cortisol levels were found in patients with personality disorders axis II, cluster B as compared to the other patients. The results remained significant when analysed for covariance with DSM-III-R axis I diagnoses, age or sex. Whether these low cortisol levels are due to previous experience of extreme stressful events or long-lasting burden, or whether they may be a consequence of biogenetic or psychological predisposal of interest, remains to be elucidated. Axis I comorbidity needs to be further examined.

scholarly journals Pneumatosis Intestinalis: A Case Report and Approach to Management

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Sean Donovan ◽  
Joseph Cernigliaro ◽  
Nancy Dawson
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Bowel Wall ◽  
Surgical Intervention ◽  
Wide Spectrum ◽  
Pneumatosis Intestinalis ◽  
Rapid Evaluation ◽  
Thought Process ◽  
Diagnostic Dilemma ◽  
Clinical Scenarios

Pneumatosis intestinalis (PI), defined as gas within the bowel wall, is an uncommon radiographic sign which can represent a wide spectrum of diseases and a variety of underlying diagnoses. Because its etiology can vary greatly, management of PI ranges from surgical intervention to outpatient observation (see, Greenstein et al. (2007), Morris et al. (2008), and Peter et al. (2003)). Since PI is infrequently encountered, clinicians may be unfamiliar with its diagnosis and management; this unfamiliarity, combined with the potential necessity for urgent intervention, may place the clinician confronted with PI in a precarious medical scenario. We present a case of pneumatosis intestinalis in a patient who posed a particularly challenging diagnostic dilemma for the primary team. Furthermore, we explore the differential diagnosis prior to revealing the intervention offered to our patient; our concise yet inclusive differential and thought process for rapid evaluation may be of benefit to clinicians presented with similar clinical scenarios.

Discriminating between Substance Abusers with Single and Dual Diagnoses Using MMPI Profiles and the MAC Andrews Alcoholism Scale: Axis I and Axis II Subtypes

1988 ◽  
Vol 63 (3) ◽  
pp. 985-986 ◽  
Author(s):  
Ronald H. Rozensky ◽  
Barbara Neirick ◽  
Gary M. Slotnick ◽  
Debra Morse
Keyword(s):  
Substance Abuse ◽  
Dual Diagnosis ◽  
Substance Abusers ◽  
Substance Abusing ◽  
Psychiatric Diagnoses ◽  
Axis Ii ◽  
Heterogeneous Nature ◽  
Dual Diagnoses ◽  
Axis I

The MacAndrews Scale of the MMPI differentiated 21 dual-diagnosis substance abusers with a DSM-III—R, Axis I diagnosis from a group of 21 single-diagnosis substance abusers and 18 dual-diagnosis substance abusers with an Axis II diagnosis. Subjects were 50 substance-abuse only and 39 dual-diagnosis, hospitalized men. Research must take into account the heterogeneous nature of psychiatric diagnoses within the substance-abusing population.

The Utility of Self-Report Measures and the Continuous Performance Test in the Diagnosis of ADHD in Adults

CNS Spectrums ◽  
2004 ◽  
Vol 9 (9) ◽  
pp. 649-659 ◽  
Author(s):  
Mary V. Solanto ◽  
Kenneth Etefia ◽  
David J. Marks
Keyword(s):  
Differential Diagnosis ◽  
Attention Deficit ◽  
Attention Deficit Disorder ◽  
Adult Adhd ◽  
Performance Test ◽  
Continuous Performance Test ◽  
Self Report ◽  
Continuous Performance ◽  
Presenting Symptoms ◽  
Axis I

ABSTRACTBackground: Attention-deficit/hyperactivity disorder (ADHD) occurs in as many as 4% of adults yet it is often not recognized in clinical settings because the presenting symptoms may resemble those seen in other disorders or because symptoms may be masked by commonly comorbid conditions such as anxiety and depression.Objective: The purpose of this study was to examine the diagnostic utility of instruments commonly used in the assessment of adults presenting with symptoms of ADHD.Methods: We reviewed several widely used self-report and laboratory measures and empirically examined the utility of the Brown Attention-Deficit Disorder Scale for Adults (Brown ADD Scale) and the Conners Continuous Performance Test (CPT) in differentially identifying adults with ADHD and those with other Axis I disorders.Results:Ninety-three adults who self-referred to the ADHD program for adults at a university medical center participated in the study. Of these, 44 had ADHD combined subtype (ADHD-CB), and 26 had ADHD, predominantly inattentive subtype (ADHD-IA). Thirty-three non-ADHD adults diagnosed with Axis I mood or anxiety disorders comprised an “Other Psychiatric” group. Rates of comorbid disorders, including substance abuse, in the ADHD groups were typical of those reported in the adult ADHD literature. Data on the Brown ADD Scale and on the CPT were available for subsets of 61 and 46 participants, respectively. Analyses showed that the ADHD-CB, ADHD-IA, and Other Psychiatric groups all received mean scores in the clinical range on the Brown ADD Scale, with a trend toward even higher elevations in the two ADHD groups. Among 12 CPT variables assessed for the three groups, the mean scores on only two variables for the ADHD-IA group were clinically elevated. Neither the Brown ADD Scale nor CPT scores evinced sufficient sensitivity and specificity to qualify them to assist in differential diagnosis of ADHD vis-a-vis other, predominantly internalizing, psychiatric disorders.Conclusion: The results indicate a need for closer examination of executive and adaptive functioning in adults with ADHD compared with those with internalizing disorders in order to identify features that could assist in differential diagnosis.

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