SOCW 6090

CASE PRESENTATION - IKE

Intake Date: November 2020

IDENTIFYING/DEMOGRAPHIC DATA: Ike is a 27-year-old African American, male student. He returned to school for his master's in social work degree. Ike is ready to graduate and will soon be working in the field. He is the youngest in his family and the only one to graduate from college. He lives on campus in graduate housing.

      

CHIEF COMPLAINT/PRESENTING PROBLEM: Ike was referred for a psychiatric consultation after a workup for gastrointestinal distress proved negative. Ike has consulted his family physician after months of feeling bloated and nauseated in anticipation of certain distressing events and circumstances.

HISTORY OF PRESENT ILLNESS: Ike described the past 3 years of anxiety attacks accompanied by palpitations, shortness of breath, hot flashes, sweating and parathesias, in addition to abdominal discomfort. The symptoms’ onset was clearly traced to a blind date arranged by a close friend. On the way to pick up the girl with his friend, he suddenly felt extreme nausea and was forced to pull the car off to the side of the road got out for a breath of fresh air and promptly vomited. Although his friend forced him to go through with the date, Ike was extremely nervous and preoccupied throughout, took his date home immediately after the movie was over, and sped away without even walking her to the door. He frequently felt like staying home but forced himself with the help of some peer pressure to go out at least "with the boys."

As he is nearing the completion of his MSW program he is going to job interviews, which began to cause anticipatory anxiety. Ike finds himself reducing some of his anxiety by scratching his head and playing with his hair. He describes feeling "trapped" in interviews with "no way out." He is now developing a fear of talking on the phone to people to arrange interviews or follow-ups. He is a bit embarrassed as well since he has bald patches from pulling his hair and he has taken to wearing hats to cover up the spots. He realizes he needs to find other ways to calm himself down. He has the opportunity to be hired by a large municipal welfare agency, where he is completing his internship. He found himself staying mostly to himself lately. Ike senses his fear is now extending to conversations with clients.

PAST PSYCHIATRIC HISTORY: Although he had previously been shy around girls, following this incident, Ike panicked at the thought of a date. There were girls to whom he felt attracted, but whenever he brought himself to even consider asking one out, he became symptomatic. The anticipation generalized so that he became anxious going to local basketball games, bars, and concerts with friends because he might see girls he was interested in meeting, talking to, or dating.

SUBSTANCE USE HISTORY: Ike reports drinking with his friends on occasions. He denies drug use. Ike states he tried marijuana once with his friends but did not like it. Ike considers himself a social drinker and often is the designated driver.

PAST MEDICAL HISTORY: Ike had a workup for gastrointestinal distress which proved negative. Ike has feelings of being bloated and nauseated in anticipation of certain distressing events and circumstances.

FAMILY HISTORY INCLUDING MEDICAL AND PSYCHIATRIC: Ike reports no significant illness in his family either medically or psychiatrically.

 

CURRENT FAMILY ISSUES AND DYNAMICS: None reported

MENTAL STATUS EXAM: Ike is a casually dressed but neatly groomed male who appeared his stated age. He was anxious with mildly pressured speech, which was fluent, coherent and could be interrupted. There was no evidence of psychosis, paranoid ideation, delusions, or form of thought disorder. There was no looseness of association, flight of ideas, or ideas of reference. His affect was full range. Ike denied suicidal and homicidal ideation.