This is an 18-year-old female patient, diagnosed (DSM-IV-TR) with social phobia and personality-dependent disorder, referred from the Child and Youth Mental Health Service accompanied by her mother (CSMIJ)
She's the biggest of two sisters.
Separate pages.
She lives with her mother and sister.
During his childhood he highlights attention deficit and poor academic performance without repeating course.
Currently, she begins to attend a higher education module and collaborates in family business.
As a medical history of interest, there is a delay in isolated growth that required treatment with growth hormone (growth hormone) from 12 to 17 years.
Digestive intolerance to corticosteroids associated with bleeding and lactose intolerance.
Genetic testing is performed in childhood, with no genetic, numerical or structural changes being observed.
She denied toxic consumption.
Among the family psychiatric history, the mother reported long-term anxious symptoms.
They describe the father as a lonely, introverted person, and "poor emotional", characteristics that present several family members per paternal line.
From the psychiatric point of view, the patient in contact with CSMIJ at 14 years old, being the diagnostic orientation of Social Phobia.
At 17 years of age she was admitted to the Day Hospital for 2 months due to difficulties in relationships, school absenteeism and great dependence on the family environment.
The diagnostic orientation was Social Phobia and Personality Disorder (according to the discharge and evolution) toward a partial improvement.
High introversion is highlighted among the premorbid personality traits.
Her mother describes her as an isolated, "different" girl, with little social interest.
The initial examination revealed a distant contact, a little spontaneous language with no formal alterations.
Moderate psychophysical anxiety, obsessive hypochondriac ideas, onychophagia and nocturnal bruxism.
No symptoms of the affective or psychotic sphere were observed.
No changes in the course or content of thought.
No changes in sense perception.
Partial consciousness disorder.
The picture is oriented as a Personality Disorder C (phobic, obsessive and dependent features).
Pharmacological treatment is maintained from CSMIJ (Sertralina, 100 mg), and is derived to psychology to work social difficulties.
He made few visits with poor compliance with the proposed strategies (cognitive-behavioral model), and is disconnected by incompatibility with studies.
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Second contact within two years
The patient recovered after almost two years (20 years) of no follow-up.
Social difficulties persist.
An exploratory visit was made by psychiatry and psychology, including a visit to the mother.
They express the decision to abandon SSRI medication.
They do not accept pharmacological treatment, but psychological treatment.
During the assessment, the patient was more impressed by a "peculiar" contact than by usual fructose-anxious contact.
You have an extraneous -although subtle- change in eye contact
Language continues to be little spontaneous.
In addition to social difficulties and little interest in the environment, obsessive hypochondriac ideas and absolute rejection by physical and sexual contact stand out.
In order to assess the patient's difficulties/skills at the interpersonal level, simple social exposure exercises are proposed out of consultation.
The patient does not perform any of the proposed exercises.
There is also no concern about solving these difficulties.
On the contrary, it impresses a certain indifference to the matter.
Associated with this, doubts begin regarding social avoidance (wrong vs. anxious?), and regarding the desire to relate socially (the social discourse learned?).
These doubts raise the suspicion that these symptoms could be explained by other diagnoses: schizoid traits? Autism spectrum traits?; therefore, a new evaluation of the patient is proposed.
1.
Evaluation protocol and results thereof:
• Structured Clinical Interview for DSM-IV Axis II Disorders (SCID II):
- Schizoid Personality Disorder Criteria: 4/5.
Near the cut-off point.
- Avoidable Personality Disorder Criteria: 5/5.
Cut-off point.
• Theory of Mind Tests (TOM):
- "Happe Histories Test": It shows an adequate capacity to infer mental states in others, to understand metaphors and double senses.
- "Mental in Eyes Reading Test": It is capable of attributing to most elements (23/36) the adequate feeling or emotion shown in the photograph.
- the Pata's Fear Test correctly identifies foot-and-mouth disease stories but shows difficulties in attributing emotional states and intentionality to the characters.
• Wechsler Adult Intelligence Scale (WAIS-III): Verbal CI= 99 Manipulative CI= 94 Total CI= 97 Rank: Mean
• Revised autism diagnosis interview (ADI-R): Alterations in reciprocal social interaction are identified.
Limited variety of facial expressions to communicate and regulate social interaction.
Inability to develop peer relationships
There is a lack of socio-affective reciprocity, inadequate social responses and a deficit in the search to share pleasure with others.
Retroactively, qualitative alterations in communication are identified, such as lack of spontaneous and varied symbolic play.
Some restricted behavior patterns are also identified.
• Magnetic Resonance Imaging (MRI): a skull fracture within normal limits.
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Overall Assessment:
During the examination, the patient was shown to be a collaborating but unmotivated patient.
The information obtained allows objective signs of an autism spectrum disorder (ASD) in which there is little social interest, expressions and unsuitable behaviors, difficulties in establishing social relationships with peers, facial expressions and limited affectionate interests.
The cognitive profile and the performance in the domains 'TOM' (number of non-signifi cant errors, although difficulty in attributing emotional states and intentionality to the high character in the test ''Meteduras').
