_ibrahimi_case presentation - bdd

8/14/2019 _Ibrahimi_Case Presentation - BDD

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Case presentation - BodyDysmorphic Disorder with

psychotic features

Dr Halit Ibrahimi, M.D.

Resident in Psychiatry, 4th year

Clinical University Centre of Kosova, Prishtina


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PATIENT HISTORY

A 17 years old female came to the Emergency Unit

of Psychiatric Clinic, associated from her parents,

with complaints about her appearance, depressive

mood, anorexia, insomnia, aggressive behavior

within family (especially towards her mother). Welearned that patients problems began four years

ago. From the beginning of illness, patient began to

neglect school and almost every other activity; her

grades became worst every day. In the beginning,she was preoccupied with her height (At the time,

she used to say: If I grow up just for another cm, I

will commit suicide).


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PATIENT HISTORY

She began treatment from a local psychologist,who visited her at her house. As result of thistreatment, vanished patients preoccupation withher height (now she is happy to be tall like aphoto model), but she began to be preoccupied

with her nose and her eyes (Quotation: As aresult of a medical treatment because of aneyelid irritation caused by excessive use of make-up - I lost eyes shining. Before this, I had the mostbeautiful eyes in town. I want to operate my nose,because it is very ugly. I want to have a nose likeAngelina Jolie, and after the operation, I will go tothe U.S. to become photo model).


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PATIENT HISTORY

In the last 12 months or so, the patient was treatedby a psychiatrist, who prescribed herantipsychotic treatment (Risperidone), butbecause she refused to take it, parents put it in herfood. In the near past, the patient manifested a

physical aggressive behavior toward her parents,especially her mother, saying to her that she is toblame for the patients nose, because sheinherited its form from her (mother). Lately, shedoesnt manifest physical aggressive behavior

(only verbal), and she began to read religiousbooks and pray to God to help her operate thenose.


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PATIENT HISTORY

In the last month or so, the patient began a diet, eating

mostly unhealthy foods (chips, wafers), saying that she

became overweight and must loose weight in order to be

a photo model. Parents confirm the fact that she really

began to gain weight.We must note that patient showed a special relationship

with her father (who is schizophrenic, under medication,

like two other of his siblings), who is very permissive to

her.

There are no other significant data from her lifeanamnesis. She has one sibling (brother) with whom she

has normal relationship.


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PHYSICAL EXAMINATION

The patient is 183 cm high, weights 56 kg, hernose is lightly wider than normal in the middle.


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LABORATORY EVALUATION AND

DIAGNOSTIC PROCEDURES

Blood and urine analysis were within normal values, CT of brainand EEG shows no pathological findings.

Psychological examination: The patient has been evaluated

using the test House, Tree-Person and Stories, from

observations and interviewing her

Conclusion: The patient manifests a symptomatology ofprogressive psychotic process; it is possible that she suffers

from some kind of personality, or affective disorder But, we

must know that in adolescence there can be some psychotic

symptoms, but if the patient is offered an adequate support, it is

possible to strength its ego structure. One possible mean of

intervention can be supportive psychotherapy, focused in the

ego structure. The patient must be under psychiatric

monitoring. (Vjollca Berisha, clinic psychologist).


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HOSPITAL COURSE

From the beginning of hospitalization, the patient was anxious,claiming that she is not sick and has no need to be treated. She

repeatedly asked to be dismissed from hospital. She manifested

bizarre behavior, e.g. she kept her lips like she was to whistle, an

excessive imitation of VIP posture. She accepted company of a

chronic schizophrenic patient, twice older than her, holding hands

with him and behaving like a couple. When asked, she said thatshe liked him. The patient manifested childish behavior, with

nave demands and became very easily frustrated, if others didnt

fulfill her demands. In the beginning she was treated with

Risperidone alone (from initial doses to 4 mg a day), but from the

4th

day of hospitalization till the dismissal from hospital, she tookFluoxetine, too (20 mg a day, in the morning). Often she used to

put excessive make-up. She took part passively in ward activities.


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OUTCOME

The patient was dismissed from hospital with the diagnosis of:Body Dysmorphic Disorder (DSM-IV-TR) with psychotic features.These are diagnostic criteria for Body Dismorphic Disorder

according to DSM-IV-TR:

Preoccupation with an imagined defect in appearance. If a slightphysical anomaly is present, the person's concern is markedly

excessive.

The preoccupation causes clinically significant distress or

impairment in social, occupational, or other important areas of

functioning.

The preoccupation is not better accounted for by another mental

disorder (e.g., dissatisfaction with body shape and size in anorexia

nervosa).


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QUESTIONS

What do you think about the diagnosis, is it

correct?

What about the patients father influence in the

course of disease and treatment?

Do you think that the course of illness is going

toward an psychotic disorder?


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Thank you for your time and

attention!

Prishtina, October 8th, 2009

_ibrahimi_case presentation - bdd

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