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THE CASE OF THE WOMAN WITH “FITS” Mrs. Chatterjee, a 26-year-old…
THE CASE OF THE WOMAN WITH “FITS”
Mrs. Chatterjee, a 26-year-old woman, attends a clinic in Melbourne with complaints of “fits” for the last 4 years. The “fits” are always sudden in onset, and usually last 30-60 minutes. A few minutes before a fit begins, she knows that it is imminent and she usually goes to bed. During the fit she becomes unresponsive and rigid throughout her body, with bizarre and thrashing movements of the extremities. Her eyes close and her jaw is clenched, and she froths at the mouth. She frequently cries, and sometimes shouts obscenities. She is never incontinent for urine or feces, nor does she bite her tongue (things commonly seen in seizures).
After a “fit” she claims to have no memory of it. These episodes recur about once or twice a month. She functions well in between the episodes and reports no prominent depressive or anxiety symptoms. She handles routine household tasks and management of the household quite well. Both the client and her family believe that her “fits” are evidence of a physical illness and are not under her control. However, they recognize that the fits often occur after some stressor, such as arguments with family members or friends.
Mrs. Chaterjee comes from a middle-class Indian family. She has been married for 5 years to a clerk in a government office. They have 2 children ages 4 and 7. She is not employed outside the home. Her mother-in law and father-in-law live with the family, and this has sometimes led to conflicts over how the household is managed, how the children are raised, and other important family decisions. Her husband often sides with his parents in these disputes.
She is described by her family as being somewhat immature, but quite “social” and good company. She is self-centered. She craves attention from others, and she often reacts with irritability and anger if her wishes are not immediately fulfilled. On physical examination, Mrs. Chaterjee was found to have mild anemia but was otherwise healthy. She did not display any mood change and her memory was normal. An electroencephalogram (a graphical record of electrical activity of the brain; produced by an electroencephalograph) showed no seizure activity. A skull X-ray was normal.
I need help with the following questions.
1. What are the salient symptoms this client is reporting? (Be attentive to not only what the client is saying/reporting but their patterns of behavior, habits, actions, context)
2. What more information would you want to know or questions would you want to ask to help you better assess their situation?
3. What assessment tools or techniques might you use to help you better pinpoint your assessment or improve the reliability of your diagnosis? (Refer to Chapter 3 and the many different assessment tools available to help you answer your questions from #2)
4. What diagnosis do you think best fits this case material, based on the information you have here? (Use the DSM criteria to find your best fit based on what you know).
5. What other possible diagnoses might you be considering or wanting/needing more information to rule out or add? (Use the DSM criteria for other possible diagnoses that you might suspect but don’t have full information to meet criteria).
6. What recommendations for treatment would you have for this client based on your preliminary diagnosis? (Based on what you believe to the be diagnoses what are the recommended treatments typically used? Are there other things that might be helpful to this client?)
