Try out the following vignette. I suggest you use a scoring system.
The AATBS system ranks each of the total sixteen answer elements from 0 to 2. The score of zero indicates the element is clearly a wrong answer and a score of two represents a likely answer.
Innovative Testing Services uses a scoring system from 0 to 3. The score of zero indicates the element is clearly a wrong answer, a score of one is a "maybe," a score of two represents a likely answer and score of three indicates a response that should appear in any correct answer. I think this system makes more sense as it allows you to rank essential elements higher than elements that are simply good.
Vignette
Harrison, a high school student, is referred by a medical doctor. The doctor suggests that an unhealthy family dynamic may have resulted in Harrison developing an ulcer and then not following medical treatment even though it would likely relieve his ulcer symptoms. Harrison's parents say that he seems unhappy and that athletics has taken over his life. Harrison angrily says he is the victim and the problem is his parents constant worry about him. He insists that his mother is controlling and that his father goes along when his mother is "getting crazy." His father describes pride in Harrison's athletic prowess and commitment to wrestling but is concerned that Harrison eats excessively after dieting for days in an attempt to make his wrestling weight. After sessions of eating Harrison often engages in strenuous exercise and takes pills he purchases at a health food store to manage his weight. Harrison insists that he follows the label instructions on the diet supplements. Harrison is not underweight and family members deny any evidence of throwing up to keep his weight down. Recently Harrison has been skipping school to work out which has affected his grades.
What diagnosis should be considered for Harrison?
A
Obsessive Compulsive Personality Disorder.
Bulimia Nervosa
Eating Disorder NOS
Anorexia Nervosa
B
Binge Eating Disorder.
(Unknown) Substance Abuse
V Code Partner Relational Problem
V Code Academic Problem
C
Major Depressive Disorder, with Atypical Features.
Borderline Personality Disorder.
Binge Eating Disorder.
Obsessive Compulsive Disorder.
D
Major Depressive Disorder, with Atypical Features.
Bulimia Nervosa
V Code Noncompliance With Treatment
(Unknown) Substance Abuse
****************************************
Post your responses and I will post the answer and the next question about Harrison next week.
I believe it's D. Keep the questions coming!
ReplyDeleteWhat's the answer ? I think A
ReplyDeleteHere is how I score A.
ReplyDeleteElement A1 Scores 1. Harrison does not show evidence of Obsessive Compulsive Personality Disorder. There is little evidence his symptoms are pervasive. This is almost a zero.
Element A2 Scores 3. There is a strong suggestion that Harrison binges on food. The vignette also suggests that he may be engaging in excessive exercise. Finally, there are also parts of the element that suggest that he may be using pills as well as exercise to purge after binging.
Element A3 Scores 0 There is no more Eating Disorder NOS in the DSM-V. If you are using DSM-IV this would score a three. We don't have enough evidence to clearly diagnose Bulimia. Eating D/O NOS is another strong possibility if the clinician finds that Harrison does not meet criteria for Bulimia.
Element A4 Scores 0 We can be confident that Harrison is not anorexic. He appears to be a normal weight and there is no indication he fears becoming obese or has a distorted body image.
I believe the answer is C
ReplyDeleteHere is how I score C.
ReplyDeleteElement C1 Scores 1. However, some raters may rank it just high enough to score a 2. Harrison's parents describe him as unhappy and the vignette alludes to irritability (although his anger appears contextual as opposed to habitual). Harrison's weight change and psycho motor agitation are clearly driven by a focus on athletics more than depressive symptoms.
Element C2 Scores a 1. There is an absence of BPD symptoms in the vignette.
Element C3 Scores a 3. There are strong indications that Harrison meets criteria for Binge Eating Disorder. BED is more common than anorexia nervosa or bulimia nervosa. Approximately 40 percent of those with binge eating disorder are male. Harrison's age puts him at additional risk and BED often begins in the late teens or early 20s.
Element A4 Scores 1. Neither Harrison or his parents describe him as plagued by recurring, unwanted thoughts, ideas or sensations (obsessions) that make him feel driven to take an action like eating repetitively (compulsions).
i think its D
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