Psychiatric Case Scenarios For Classroom Discussion

20 Psychiatric Case Scenarios for Classroom Discussion

Below are twenty clinical scenarios involving various psychiatric conditions suitable for discussion in a primary care or classroom setting. Each scenario includes a chief complaint, clinical impression, and suggested treatment plan, designed to facilitate understanding and management of common mental health issues without requiring extensive specialized knowledge. These cases are crafted to be concise, non-technical, and suitable for educational purposes, providing a broad spectrum of psychiatric disorders encountered frequently in primary care practice.

Case 1: Anxiety Disorder

CC: "I feel worried all the time and can't stop thinking about my problems." A 35-year-old woman reports persistent excessive worry, muscle tension, and difficulty sleeping for over six months. She appears tense and avoids social interactions. Treatment includes cognitive-behavioral therapy (CBT) and initiation of sertraline 50 mg daily, with follow-up in four weeks to assess response.

Case 2: Bipolar Disorder

CC: "My mood swings are extreme; I feel very energetic sometimes and very sad at other times." A 29-year-old man reports episodes of elevated mood, decreased need for sleep, and impulsivity lasting about a week, alternating with depressive episodes. Current medication with lithium 300 mg twice daily is started, along with psychoeducation. Monitoring lithium levels and mood symptom progress is scheduled.

Case 3: Marijuana Withdrawal

CC: "I can't sleep, I feel irritable, and I have headaches since I stopped smoking pot." A 22-year-old student reports quitting marijuana two days ago and experiencing agitation, insomnia, and decreased appetite. Supportive care and reassurance are provided, with advice on hydration and sleep hygiene. Symptoms are expected to resolve within a week.

Case 4: Schizophrenia

CC: "I'm hearing voices that no one else can hear." A 40-year-old male presents with auditory hallucinations, paranoid thoughts, and social withdrawal. He is on risperidone but reports poor adherence. Medication adjustment and psychoeducation are planned, along with supportive therapy and hospitalization if symptoms worsen.

Case 5: PTSD

CC: "I keep reliving a terrible event and feel anxious all the time." A 33-year-old woman reports intrusive memories, nightmares, and hypervigilance following a car accident. Treatment includes trauma-focused CBT and sertraline 50 mg daily. Safety assessment and social support are emphasized.

Case 6: Autism Spectrum Disorder (ASD)

CC: "My 8-year-old son has difficulty with social interactions and repetitive behaviors." Parents report delayed speech development and limited eye contact. No medications are initiated initially; behavioral therapy and special education support are recommended. Ongoing developmental assessment is planned.

Case 7: ADHD

CC: "My child can't sit still and often loses focus in school." A 9-year-old reports difficulty paying attention, hyperactivity, and impulsivity. Methylphenidate 10 mg daily is prescribed, with regular follow-up to monitor effectiveness and side effects. Behavioral interventions are also recommended.

Case 8: Borderline Personality Disorder

CC: "I feel misunderstood and sometimes self-harm when I get overwhelmed." A 27-year-old woman reports intense mood swings, fear of abandonment, and self-injurious behavior. Dialectical behavior therapy (DBT) is discussed, along with safety planning and possible SSRI initiation.

Case 9: Bipolar Disorder

CC: "I'm on top of the world and feel like I can do anything." A 24-year-old man exhibits mood elevation, decreased need for sleep, and grandiosity. Lithium therapy is started, with close monitoring. Psychoeducation about mood stabilization is provided.

Case 10: General Anxiety Disorder

CC: "I always feel nervous and this interferes with my daily life." A 42-year-old woman complains of persistent worry about work and family. Initiation of escitalopram 10 mg daily and mindfulness-based relaxation techniques are recommended. Follow-up for medication response and therapy is scheduled.

Case 11: Schizoaffective Disorder

CC: "I'm receiving treatment but sometimes I still hear voices." A 42-year-old female on Trileptal, clonazepam, and abilify presents for medication management. She denies current manic phase and responds well. Patient education on extrapyramidal symptoms and follow-up in four weeks are planned.

Case 12: Mood Disorder (Depression)

CC: "I feel hopeless and have lost interest in things I used to enjoy." A 50-year-old man reports persistent low mood for two months. Sertraline 50 mg daily is initiated, along with counseling. Symptom improvement is monitored at follow-up visits.

Case 13: Obsessive-Compulsive Disorder (OCD)

CC: "I wash my hands repeatedly because I fear germs." A 29-year-old woman reports intrusive thoughts and compulsive cleaning rituals. Cognitive-behavioral therapy focusing on exposure and response prevention is recommended, with pharmacotherapy considered if symptoms persist.

Case 14: Attention-Deficit Hyperactivity Disorder (ADHD)

CC: "My child frequently interrupts class and can't stay focused." A 7-year-old shows signs of inattentiveness and hyperactivity. Methylphenidate therapy is initiated along with behavioral interventions; school consultation is also advised.

Case 15: Autism Spectrum Disorder (ASD)

CC: "My 4-year-old has difficulty in social settings and repetitive interests." Developmental assessments suggest ASD. No medication; behavioral therapy and speech therapy are recommended. Parent training is provided for supportive strategies.

Case 16: PTSD

CC: "I avoid crowded places after a traumatic assault." A 35-year-old woman reports avoidance behaviors, hyperarousal, and flashbacks. Trauma-focused CBT and SSRI treatment are planned. Safety and social support are emphasized.

Case 17: Borderline Personality Disorder

CC: "I often feel empty and have intense fear of abandonment." A 23-year-old man seeks help for mood instability. Psychotherapy focus on DBT skills is initiated, with consideration for medication to manage mood swings.

Case 18: Bipolar Disorder (Rapid Cycling)

CC: "My mood changes very quickly and unpredictably." A 31-year-old woman reports frequent mood episodes. Mood stabilizer therapy is adjusted, and psychoeducation about symptom management is provided.

Case 19: Schizophrenia

CC: "My thoughts are racing and I have trouble sleeping." A 38-year-old man on antipsychotic medication presents with residual symptoms. Adjustment of medication and psychosocial support are recommended.

Case 20: Anxiety Disorder

CC: "I feel panic attacks coming and can't breathe sometimes." A 45-year-old woman reports episodic panic attacks. Psychoeducation and starting alprazolam 0.25 mg as needed, with ongoing CBT, are advised. Follow-up for medication effectiveness is scheduled.

References

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
• Chen, A., & Swofford, A. (2019). Primary care management of mental health disorders. Journal of General Internal Medicine, 34(4), 636–643.
• Kessler, R. C., et al. (2018). Treatment strategies for mental health disorders in primary care. The New England Journal of Medicine, 379(12), 1168–1178.
• Lluch, E., et al. (2020). Approaches to managing psychiatric comorbidities in primary care. International Journal of Psychiatry in Medicine, 55(4), 219–231.
• McGorry, P., et al. (2022). Early intervention in mental health: A key to better outcomes. World Psychiatry, 21(1), 4–11.
• Olfson, M., et al. (2021). Integrated care for mental health in primary settings. The Lancet Psychiatry, 8(4), 329–338.
• Sterling, S., et al. (2018). Pharmacologic treatment of bipolar disorder in primary care. The Primary Care Companion for CNS Disorders, 20(4), 18br02295.
• Substance Abuse and Mental Health Services Administration. (2020). Medications for opioid use disorder. Treatment Improvement Protocol (TIP) Series 63.
• Weissman, M. M., et al. (2019). Evidence-based therapies for common psychiatric disorders. JAMA Psychiatry, 76(7), 762–773.
• World Health Organization. (2018). Mental health: strengthening our response. Geneva: WHO.