Scenario 1.

Smita, age 32 was diagnosed with borderline personality disorder when she was 26 years old. her
husband took her to the emergency department when he walked into the bathroom and found her
cutting legs with a razor blade. At that time, assessment revealed that Smeeta, had a long history
of self mutilation, which she had carefully hidden from her husband and others. Smeeta on
psychoanalytical psychotherapy revealed that she had been physically and sexually abused as a
child by her parents. She admitted to having chronic depression. Smeeta has been hospitalized on
the psychiatric unit for a week because of suicidal ideations.

Scenario : 2

Rahul, a 23 year old, has just been admitted to the psychiatric unit by his parents. They explained
that over the past few months he has become more and more withdrawn he stays in his room
alone. But lately has been heard talking and laughing to him.

Rahul, left home for the first time at age 18 to attend college. He started writing to his
parents that his roommate wanted to kill him and that his roommate was turning everyone
against him. He said he feared for his life. He started missing classes ant stayed in his bed most
of the time. His parents took him home and he was hospitalized and diagnosed with paranoid
schizophrenia. He has since been maintained on antipsychotic medications.

Rahul tells the admitting nurse he quit taking medications four weeks ago because the
pharmacist who fills the prescriptions his plotting to have him killed. He believes he is trying to
poison him. He says, he got this information from television message.

SCENARIO: 3

Sunil is a 4th standard student with learning difficulties. He along with his parents have come to
the class teacher raising concerns that the curriculum is not meeting his needs and is leading to
poor educational outcomes. For instance, his performance in reading and spelling is significantly
below what would be expected. The school does not have a special education teacher on staff
and the teacher acknowledges that the family’s concerns are recognized by the school. The
school has applied previously to the Department’s Program for Students with Disabilities but the
student is not eligible. This means that the school does not receive ‘additional’ resources under
that Program. The school is unsure of how to meet Sunil needs. The parents insist that it is the
school’s responsibility to provide the best learning environment for their son and would like
some changes to be made as soon as possible.
Scenario : 4
Mrs. Asha, age 68 was brought to the emergency department of the psychiatric hospital by her
sister in law who stated, she does nothing but sit and stare into space. I can`t get her to eat or
anything. Upon assessment it was found that 6 month ago her husband had died of massive
myocardial infarction. They had no children and had been inseparable. Since her husband`s
death, she has visited the cemetery every day, changing the flowers often on his grave. She has
not removed any of his clothes from the cupboards. His shaving material still occupies the same
space in the bathroom. Over the months Mrs. Asha has become more and more socially isolated.
She refuses invitation from friends, preferring instead to make her daily trips to the cemetery.
She has lost 10 KG. And her sister in law reports that there is very little food in the house. Today
she said to her sister in law, “I don`t want to live any more, my life is nothing without him.” Her
sister in law come frightened and with forceful persuasion, was able to convince her that she
needs to see a doctor. She is admitted to the psychiatric unit.

Scenario : 5
Mrs. Sangita, age 29, had been working in large corporation since last 5 years. Few months back
she was promoted as a supervisor. Shortly after the promotion she overheard two of her former
coworkers saying, “why in the world did they choose her? She is not the best one for the job. I
know I certainly won`t be able to respect her as a boss.” Hearing these comments added to her
anxiety & self doubt. After she began her new duties, her friends & coworkers noticed a change.
She had a great deal of energy & worked long hours on her job. She began to speak very loudly
and rapidly. Her roommate noticed that, she slept very little, yet seldom appeared tired. Every
night she would go out for parties. Sometimes she brought men she had just met home to the
apartment, something she had never done before. She bought lots of clothes and makeup and had
her hair restyled in a more youthful look. She failed pay her share of the rent and bills. She lost
her temper and screamed at her roommate to “mind your own business.” When asked to pay her
share.
She became irritable at work, and several of her subordinates reported her behavior to the
manager. When the manager confronted Sangita about her behavior she lost control, shouting,
cursing and striking out at any one and anything that happened to be within her reach. The
security officers restrained her and took her to the emergency department of the hospital where
she was admitted to the psychiatric unit and diagnosed as a case of bipolar I disorder.
Psychiatrist ordered olanzapine 15 mg stat and 15 mg qid and lithium carbonate 600 mg qid.
Scenario : 5
Smita, age 32 was diagnosed with borderline personality disorder when she was 26 years old. her
husband took her to the emergency department when he walked into the bathroom and found her
cutting legs with a razor blade. At that time, assessment revealed that Smita, had a long history
of self mutilation, which she had carefully hidden from her husband and others. Smita on
psychoanalytical psychotherapy revealed that she had been physically and sexually abused as a
child by her parents. She admitted to having chronic depression. Smita has been hospitalized on
the psychiatric unit for a week because of suicidal ideations.

Keywords: Borderline personality disorder, emergency department, razor blade, self mutilation,
psychoanalytical psychotherapy, chronic depression, suicidal ideations, abuse.

Scenario : 6

Ms. Swati, age 25, was taken to the casualty by her friends. They were at the dinner party when
Swati suddenly clasped her chest and started having difficulty breathing. She complained of
nausea and was perspiring profusely. She had calmed down some by the time they reached the
hospital. She denied any pain, and electrocardiogram and laboratory results were unmark able.

Swati told to the admitting nurse that she had a history of these attacks. She began having
them in her second year of college. She knew her parents had expectations that she should follow
in their footsteps and become an attorney. They also expect her to earn grades that would
promote acceptance by University. Last week Swati was promoted within low firm. She was
assigned her first solo case of representing a couple whose baby had died at birth and who were
suing the physician for malpractice. She has experienced these panic symptoms daily for the past
week, stating, “I feel like I am going crazy”

Swati is transferred to the psychiatric Unit the Psychiatrist diagnoses panic disorder
without agoraphobia.
Scenario :7

Swapnil, a 23 year old, has just been admitted to the psychiatric unit by his parents. They
explained that over the past few months he has become more and more withdrawn he stays in his
room alone. But lately has been heard talking and laughing to him.
Swapnil, left home for the first time at age 18 to attend college. He started writing to his
parents that his roommate wanted to kill him and that his roommate was turning everyone
against him. He said he feared for his life. He started missing classes ant stayed in his bed most
of the time. His parents took him home and he was hospitalized and diagnosed with paranoid
schizophrenia. He has since been maintained on antipsychotic medications.
Swapnil tells the admitting nurse he quit taking medications four weeks ago because the
pharmacist who fills the prescriptions his plotting to have him killed. He believes he is trying to
poison him. He says, he got this information from television message.
Keywords: Psychiatric unit, withdrawn, alone, paranoid schizophrenia, antispychotics.

Scenario:8

Mr. Pravin, a 62 years old accountant, began having difficulty remembering details to
perform his job. He was also having trouble at home, failing to keep his finances straight and
forgetting to pay bills. It becomes increasingly difficult for him to function properly at work, and
eventually he was forced to retire. Cognitive deterioration continued and behavioral problems
soon began. He became stubborn. Verbally and physically abusive and suspicious of most
everyone in his environment. His wife and son convinced him to see a physician, who
recommended hospitalization for resting.

At Pravin’s initial evaluation, he was fully alert and cooperative but obviously anxious
and fidget. He thought he was at his accounting office and he could not state what year it was.
He could not say the name of his parents or siblings, nor did he know who the current President
of India was. He could not perform simple arithmetic calculations, write a proper sentence or
copy a drawing. He interpretated proverbs concretely and had difficulty stating similarities
between two related objects. Laboratory serum studies revealed no abnormalities, but CT scan
showed marked cortical atrophy.