NAME: Karen Wilkins
SYMPTOMATOLOGY AND ADMISSION: Karen is a healthy young woman who was admitted to the central city psychological disorder unit with an abrupt loss of speech and motor function, after first being exhaustively examined and treated in the hospital’s emergency department. Several specialists have been brought in to consult, and it has been determined that she is not suffering from any neurological deficit, infection or malignancy, and all brain scans have produced classically normal results.
Diagnoses including Munchausen’s and psychosomatic disorders have been considered, in the absence of any detectable organic condition.
During Karen’s first twenty-four hours as an in-patient, she was non-verbal, appeared to be unable to make normal use of her limbs despite absence of neurological damage, injury or brain abnormality, soiled herself, removed clothing and refused to co-operate in any attempt to dress her, and rejected any offers of food. When offered drinks she screamed and exhibited extreme distress, twice knocking them out of staff’s hands and onto herself.
Karen did allow herself to be bathed, and exhibited a slight diminution in distress. However, any benefit was reduced by staff requesting her to get out of the bath and attempting to remove her, after she submerged herself and appeared to attempt to drown herself.
After her first twenty-four hours of inpatient status, Karen began to regain some normal functions, standing, walking, and talking to a limited degree in a monosyllabic manner. She allowed staff to dress her in a hospital gown and has resumed acceptable levels of self-care, although she is still being accompanied by a member of staff during bathing and showering.
Karen’s speech, mental status and social integration are still unsatisfactory despite this progress, and after two weeks she is still an in-patient.