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MENTAL STATUS EXAM (MSE) – A female in her 20’s looking stated age, recently changed out of sweatpants and into pajamas with a loud coffee stain.  Dark circles under her eyes prominent, and personal hygiene found lacking.  She was initially calm and cooperative but got increasingly agitated as the interview went on, asking “Is this relevant?  Unless you would like to discuss characteristics of atypical depression, or the positive prognostic factors of schizophrenia, you are WASTING my TIME.”

stressed medical student
“All of this psychiatry reading makes me think I’m crazy”

Her mood was “stressed” and her affect was reactive but irritable.  She denied any visual or auditory hallucinations, but reported she had a very vivid dream about her preceptor last night quizzing her on atypical antipsychotics.  She denied they were of distressing nature to her, stating “I need all the help I can get and I appreciate learning in my sleep!”

Her thought form was linear but agenda-driven to psychiatry-related topics, as she would frequently interrupt and ask questions unrelated to the interview, such as “how often would you really see pancreatitis with divalproex?” or “How do I keep a borderline patient from admitting themselves?”

She has a long-standing grandiose delusion of saving the world, one patient at a time.  She denied any persecutory delusions, thought insertion, thought withdrawal or thought broadcasting.  She denied ideas of reference, although reported, rather tearfully, “Sometimes when I read a GomerBlog post that really speaks to me, you know?.”

Insight was fair but poor judgement was present, choosing to spend the last two weeks wandering aimlessly around the psych ward, clutching at her clipboard and gnawing at her fingernails.  She denied any suicidal or homicidal ideation but was reported to be saying casually, “Oh, I would just DIE if I failed this exam” and “I am going to kill my preceptor if she gives me a crappy evaluation.”

Differential Diagnosis (DDx):

  1. Sleep deprived, stressed out medical student with a block exam in two days.
  2. OCPD traits.

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