Behavioral Science

124 Deja Review: Behavioral Science
A 26-year-old female nurse is admitted after being found by a friend unconscious
in the hallway. On finger stick, her glucose is 17. She has no history of diabetes.
What psychiatric disorder might you suspect if medical workup is negative?
Factitious disorder. Note conscious behavior (likely insulin overdose), but no
obvious motivation/gain.
What laboratory testing can you do, and how would it support your diagnosis?
A C-peptide level would be useful, and if it was low you would suspect exogenous
insulin overdose, therefore supporting your diagnosis.
A 37-year-old man presents to the ED complaining of “10/10 right flank pain
radiating to the testicle.” He specifically requests 2 mg of IV hydromorphone and
states he is allergic to both NSAIDs and Tylenol. A nurse reports that she saw him
putting drops of blood into his urine collection cup. What is the most likely
diagnosis?
Malingering
A 12-year-old girl and her parents present to your office with a chief complaint of
dysphagia for 3 days. According to the girl’s parents, who are very concerned and
anxious, the girl choked while eating lunch 3 days ago and the Heimlich maneuver
was performed to expel the food. Since then she has been unable to swallow any
solids or liquids. Additionally, she is unable to swallow any of her normal oral
secretions, and has been spitting constantly in a container. On examination, the
girl is very quiet, calm, and somewhat unconcerned about her condition.
Assuming physical examination is normal and an upper gastrointestinal (GI)
series fails to reveal any pathology, what is the likely diagnosis?
Conversion disorder