Put your knowledge and skills to the test with the case of a 15 year old woman who is 35 weeks pregnant and presents to obstetrics triage with dizziness, tinnitus, headache, and difficult walking. All of her symptoms resolve after three days, except for her gait disturbance which persists. She is seen by neurology and otolaryngology which cannot identify a cause for her ataxia.
In further work-up, the patient reports that she was recently abandoned by her boyfriend after he learned about the pregnancy. The patient also has a history of depression and self-harm, but states she feels fine and does not believe she needs psychiatric care. While the patient does not endorse a history of trauma or symptoms suggestive of a mood, anxiety, or psychotic illness, she is observed to display childlike mannerisms and her aunt reports that she has become more dependent recently. She displays indifference to these recent stressors and demonstrates alexithymia.
Other noteworthy history include the fact that the patient was sent by her parents from Guatemala to the United States at age 5 in hopes that she would lead a better life than she would have had in Guatemala. The patient's cousin was also diagnosed with a cholesteatoma after he presented with symptoms similar to this patient's initial presentation a number of years back.
Can you come up with a diagnosis or treatment plan?
"Young, Pregnant, Ataxic-and Jilted'" by Nancy Byatt and Ramanpreet Toor (Current Psychiatry).
In further work-up, the patient reports that she was recently abandoned by her boyfriend after he learned about the pregnancy. The patient also has a history of depression and self-harm, but states she feels fine and does not believe she needs psychiatric care. While the patient does not endorse a history of trauma or symptoms suggestive of a mood, anxiety, or psychotic illness, she is observed to display childlike mannerisms and her aunt reports that she has become more dependent recently. She displays indifference to these recent stressors and demonstrates alexithymia.
Other noteworthy history include the fact that the patient was sent by her parents from Guatemala to the United States at age 5 in hopes that she would lead a better life than she would have had in Guatemala. The patient's cousin was also diagnosed with a cholesteatoma after he presented with symptoms similar to this patient's initial presentation a number of years back.
Can you come up with a diagnosis or treatment plan?
"Young, Pregnant, Ataxic-and Jilted'" by Nancy Byatt and Ramanpreet Toor (Current Psychiatry).
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