Get your health question answered instantly from our pool of 18000+ doctors from over 80 specialties

154 Doctors Online
Doctor Image
Dr. Andrew Rynne

Family Physician

Exp 50 years

I will be looking into your question and guiding you through the process. Please write your question below.

Have loss of appetite, getting suicidal ideas and feeling depressed. Required treatment?

Answered by
Dr. Jonas Sundarakumar


Practicing since :2003

Answered : 2190 Questions

Posted on Thu, 20 Dec 2012 in Mental Health
Question: In this case, we will assume the previous information wasn’t true…….

You ponder the case of XXXXXXX and conclude that you have more questions than answers. You again interview XXXXXXX and her mother. In the course of this second interview, you learn the following:

• Prior to the interview, XXXXXXX has delivered to you some of the vials and flasks under XXXXXXX bed, and requests that you have them tested. You do so, and learn that they are old home canning supplies, with residues of tomatoes, corn relish, and pickled turnips.
• You interview XXXXXXX alone. In questioning her about the episodes of violent behavior in XXXXXXX XXXXXXX seems to be telling a different story. XXXXXXX seems more to have "chipped XXXXXXX not broken, the furniture. XXXXXXX collects antiques, and uses them as furniture. She has asked XXXXXXX to be very careful when sitting on them, but she is not. XXXXXXX notes that she tries very hard to create a warm home, and even though these pieces are valuable, she wants them to be used by the family.
• The incident with the car in the garden may have occurred when XXXXXXX tried to drive, but was unfamiliar with the standard transmission. The car lurched into reverse, went through the garden, and XXXXXXX ran screaming to her room, pummeling herself on the face and chest. XXXXXXX states that she never actually saw the interaction between the housekeeper and XXXXXXX but was told of it by the housekeeper. XXXXXXX says that XXXXXXX is turning out just like her other daughter. This time, she wants to "get on top of it" fast, and she wants you to persuade XXXXXXX to enter an inpatient eating disorder program.
• The mood swings and disengagement from school and friends sound robust. XXXXXXX reports many convincing behavioral examples of these.
• You interview XXXXXXX alone. Initially, she is unresponsive. You eventually ask her why she would keep old canning supplies under her bed. XXXXXXX hardened look softens, and she says: "They belonged to my grandmother; I like to keep her stuff near me, no matter what it is XXXXXXX She begins to talk about her grandmother, how much she misses her since her death last year. She says that she felt her grandmother was the only person in the family who accepted her, other than her new friend XXXXXXX who has been through a lot herself, with her suicide attempts and all.
• XXXXXXX and XXXXXXX have been spending a lot of time together at the cabin, but she does not like to talk about it with her mother, because she thinks her mother would not accept or understand their relationship. Recently, though, XXXXXXX has become very depressed again, and has decided to "take a break" from everyone. XXXXXXX has not seen XXXXXXX for more than a week, and tears up at this point.
• You ask about XXXXXXX eating habits. She says she just is not hungry anymore.
• Finally, you ask XXXXXXX about the marks on her arms. She looks down at the floor and says, "I was kind of trying it on for size. I go to the high bridge over the river at night, climb onto the fence, and look down at the river. The wire on top of the fence cuts into my arms. I wouldn't do anything, though XXXXXXX XXXXXXX states she does this two or three times a week.

1. What would the new diagnostic AXIS hypotheses would be just for this scenario?

Again, like you mentioned before, since the limited information given is insufficient to make a definitive diagnosis. But if I had to put it would be
Axis I:     311 Depression disorder NOS
     V62.82 Bereavement
Axis II: None – nothing to indicate that she has a borderline personality disorder
AXIS III:     None
Axis IV:      Family problems, social problems, problems at school
Axis V:     65

2. What further diagnostic evaluation do you believe is warranted?
3. What other psychological measures or evaluations/medical data that you would recommend to assist in your diagnosis?

Answered by Dr. Jonas Sundarakumar 17 hours later
Hello and welcome to Healthcare Magic. Thanks for your query.

You are on the right track. I agree with your Axis I differential diagnoses of a Depressive disorder / Bereavement, with Depressive disorder being my first priority since
- her depressive symptoms seem to be out of proportion to the the expected grief reaction
- biological disturbances like loss of appetite
- suicidal ideas.

I would probably put Axis II as ?Boderline personality "traits", since her mother confirms the mood swings and erratic behaviour and during the interview, there are some hints of emotional instability and self-harming. But, like you said the limited information is insufficient to make a diagnosis of a Borderline personality disorder. Axis III & IV remains unchanged. For Axis V, I would give a score of 30 - 40, since she seems to be suffering from significant socio-occupational dysfunction (disengagement from school and friends).

Further diagnostic evaluation would include:
...a more detailed and targetted history
- to check for a other features of a major depression
- history of past depressive or manic episodes
- presence of any psychotic symptoms
- exploration for substance abuse
- exploring her personality, to check whether she would fulfill the criteria for a borderline personality disorder

...if possible, corroborative history from some one else in a different setting, say a school friend or a more unbiased history from some other relative, say her sister or dad.

...and a detailed mental status examination.

Other psychological measures would include:
- Depression inventories, for example Beck's depression inventory
- Personality inventories
- Brief Psychiatric Rating Scale (BPRS) to rate the level of severity of her symptoms.

Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions ,   ,  

Recent questions on  Personality disorder

doctor1 MD

Is the a form of Multiple Personality Disorder or a new DID entirely?
I'm going to have to ask you to take me seriously and believe everything i say. I'm Have you ever heard of a case of Multiple Personality Disorder where the person has NO HOST personality, only the alters???
I go by Silas, I'm the most intellectual of the alters. There are 9 of us total. Me, Sasha, Gabriel, Lily, Melody, Rose, Fang, Serah, and Shadow. They are all essentially their own people, with thier own memories and traits.
The "us" is a 14 year old female, but, for example I ,Silas, am a 17 year old male.

Is this a diagnosed disorder, or are we in new territory????

doctor1 MD

My daughter is obsessed and loves seeing people in pain. she watches vid and movies that show people in pain She does that all day long. whats wrong with her?

doctor1 MD

I recently changed from Atenolol 100mg taken daily to Metoprolol Succ Er 100mg daily. I am experiencing difficulty making decisions, mood swings and depression . By depression I mean I am not finding XXXXXXX in the usual things I enjoy doing, such...

doctor1 MD

Hi, I am concerned about a loved one. I am not sure if what he has is Bipolar or somesort of a personality disorder . He takes medication daily for depression . He has said he has felt unhappy most of his life. He explained to me that when he...

doctor1 MD

What happens to 30 year old female patient with antisocial personality disorder. This same patient two years ago had a cardiac arrest due to low potassium level, four shocks had to be given to bring back to life. Due to lack of oxygen in the brain my daughter my daughter suffered a setback, such as derogative memory, lack of initiative, slow thinking. My daughter is an alcoholic, with an eating disorder, and past drug abuse. What are her chances at living a normal life?

doctor1 MD

This might sound silly but I'm really fed up of having so much wrong with me and I'm beginning to wonder if there's an under-lying cause to be addressed. List of things I have been diagnosed with/suffer from:
Depression, anxiety, OCD, ADHD, some sort of personality disorder (currently being addressed), focal dystonia, dry eyes, eczema, fast heart rate, food allergies, skin allergies, hypermobility, extremely tight hamstrings & glutes leading to back problems, constant nausea, diarrhoea, fatigue all the time, thrush etc etc

doctor1 MD

I am a mother of a 16 year old boy. For a few years (since12 years old) he began engaging in behaviors such as disobeying and ignoring all home rules, staying out late at night, having friends a few years his senior and either waking up late for school or missing school due to illness complaints. He turns from being a very amazing person to this other person. He is highly intelligent except he is barely passing or failing subjects. Everyone sees his potential, yet he has this other side to him. Should I be concerned about dissociative personality disorder?