Psychiatry Vignette

A 49-year-old married man is evaluated for stress at work. As a young man, the patient attended school to become a minister. However, after having an affair with a married woman in his congregation, he decided that he wasn’t “worthy.” He has held various jobs since and for about six years has been a teacher in the public school system. He says he is having trouble keeping control of his classes, and he is actively looking for a new job. He has been in his third marriage for about eight years. He has no children from any of them. The patient had an uneventful childhood but tended to be shy and unathletic. He was an above average student. He was somewhat moody as a teenager but hasn’t had any previous psychiatric contact. He experimented with marijuana as a youth and drinks socially. He is college educated and has no legal history. He mentions during questions in the developmental history that when he was 12 years old he discovered that he had some “homosexual tendencies.” The patient has had hypertension and hesitancy on urination in the past few years. He is being evaluated by his internist for these problems. Otherwise, he has been in good health. His evaluation is shown below.

Sample Questions

Given the information shown in the exhibit, this patient’s initial presentation is most consistent with which of the following diagnoses? (Choose two)

  • Dysthymic disorder
  • Obsessive compulsive personality disorder
  • Dependent personality disorder
  • Acute stress disorder
  • Adjustment disorder

Given the information shown in the exhibit, this patient’s tendency to blame circumstances and others is most consistent with: (Choose one)

  • the warding off of affect
  • psychological mindedness
  • a lack of experience in treatment
  • the presence of a personality disorder
  • an underlying paranoid process

 

Given the information shown in the video titled “Clip one,” and “Clip two,” upon learning that this patient was a pedophile years ago the psychiatrist should (choose three)

  • explore the possibility of other minors currently at risk
  • identify his clandestine relationship as a real problem
  • expand his awareness about the possible consequences of his acts
  • inform him that legally it is required to report him as a pedophile
  • insist that he tell his wife about the affair

Given the information shown in the video titled “Clip one,” and “Clip two,” which of the following areas of inquiry is most urgent regarding this patient’s sexual involvement with a minor? (Choose one.)

  • How much money was paid to the youth involved
  • What the patient plans to tell his wife
  • The details of the patient’s specific sexual acts with the youth
  • The details of past or present sexual urges and fantasies involving minors
  • Whether or not “safe sex” practices have been used

 

Given the information shown in the video titled “Clip one,” “Clip two,” and “Clip three,” which of the following two treatment options are the most appropriate for this patient? (Choose two.)

  • Medications
  • A specialized treatment setting for sexual identity disorders
  • Acute inpatient treatment
  • Insight-oriented psychotherapy
  • Group therapy for sexual dependence

Given the information shown in the video titled “Clip one,” “Clip two,” and “Clip three,” for which of the following reasons may confidentially be breached in this case? (Choose one.)

  • As a means to engage the patient’s wife in therapy
  • In order to fulfill a duty to warn homosexual lover
  • In order to learn more about the patient’s HIV status
  • Only with new information about the patient’s suicidal intent
  • To alert his school principal of his pedophile tendencies

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