Clinical cases

Clinical Case 1: Conduct Disorder 

Jay is a 10-year-old male who is referred for assessment by the school psychiatrist. He is socially isolated in school and in the community where he lives with his mother and father. In school, teachers have labelled him a troublemaker as he has problems with maintaining boundaries. He also does not stay still in class and always gets in trouble for agitation, speaking while the teacher is speaking, and failing to follow instructions. He is aggressive and often described as angry. Although he attempts to interact with other children, he is often clumsy and aggressive in contact, causing injury and does not play well with other children. He has also been described as destructive in that he destroys objects and sets them on fire. He recently dismembered a rat he had caught in the school store. In this assessment, he is diagnosed with conduct disorder comorbid with ADHD. Start risperidone 2mg oral daily and refer patient and parent to psychotherapy. 

Clinical Case 2: Tourette Syndrome 

Jane is a 12-year-old girl who presents to the clinic with her mother complaining of increased rate of involuntary and uncontrollable movements. The symptoms include eye-blinking, randomly moving her arms, shrugging, mouth movements, and head jerking. She claims that the symptoms started when she was 7 years and have persisted but of late have become worse. In school, she often tries her best to control of the symptoms because classmates call her ‘weirdo’ but is often tired when she gets home. She and her parents are worried about the symptoms and how they affect her daily activities and want something ‘just to make it stop.’ Patient is diagnosed with Tourette syndrome. Comprehensive behavioral intervention is indicated and medications withheld.  Observation for 14 days is indicated and patient may be prescribed for Sulpiride 2.5 mg/day PO. 

Clinical Case 3: Psychotic Disorder 

Ken is a nine-year old female who presents to the clinic with her mother regarding concerns of loss of touch with reality. Ken has been speaking about a person who speaks to her and follows her around. She claims that the figure has been instructing her to hurt herself and claims that she can see her regardless of where she goes. She is paranoid and insecure in her environment. Her parent claims that Ken is the typical nine-year-old but lately has been worried about her wellbeing as she speaks of people in her room speaking to her and giving her instructions. Symptoms have persisted for the last three months but have worsened in the last one month. Start risperidone 1mg PO qday