NURS 663: Feeding and Eating Disorders Group

NURS 663: Feeding and Eating Disorders Group 4: Dathan Carmichael Dathan Carmichael (he, him, his) 33-year-old White man, presents to the outpatient clinic. CC: “I’ve gained so much weight over the last year; I have no control over my eating.” HPI: Patient complains of “uncontrollable eating” leading to weight gain of more than 50 lbs over the past year. He describes progressively frequent episodes of overeating during which time he feels he has no control over the amount of food he consumes. He reports eating as much as 10 times in a day and overeating to the point of physical discomfort during most meals. “For example, just yesterday for dinner I ate an entire large pizza, my left-over Chinese take-out from the night before and my wife’s left-overs, 20 chicken wings, and half of a chocolate cake.” He admits that on several occasions he has vomited after meals, “I just feel so bloated and filled to the brim that I can’t help it. I don’t want to throw up, and I’ve never made myself throw up after I eat like that.” He denies restricting food intake, has never misused diet pills or laxatives, and denies engaging in excessive exercising. “I am just humiliated by how much weight I’ve put on this past year. My self-esteem is shot; I’m so embarrassed by how big I am that I’ve avoided hanging out with my buddies like I usually do on weekends. I’m tired all the time; I’m struggling to stay motivated; and it’s been hard to concentrate—I’m always thinking about food. It’s starting to affect my marriage; I’ve been so short with my daughter, too.” He reports episodic mood swings, “I snap at people easily; it’s always when I’m feeling stressed or overwhelmed. I never get violent with anyone; I just have a short temper sometimes.” No history of manic or hypomanic symptoms. He reluctantly admits that 3 years ago he had a less severe episode of uncontrollable eating and weight gain of 20 to 30 lbs. “I was able to get a handle on that by going on the Subway diet. Right now, I just can’t control myself. I’m interested in bariatric surgery to see if that’ll help me lose this weight.” History Medical hx: Motor vehicle accident 2 years ago, chronic pain secondary to MVA injuries, thyroid carcinoma—diagnosed 2 years ago, treated with radiation and surgical resection Surgical hx: Multiple arm and elbow fractures repaired post MVA 2 years ago; thyroid carcinoma resection 2 years ago Social hx: Married, though currently separated, has 1 daughter, is unemployed and receives disability benefits from injuries sustained in the MVA 2 years ago; distant history of “problems with alcohol” and had DWI in the past, denies alcohol use since the DWI; former 10 pack-year history of cigarette smoking; denies any illicit substance use Psych hx: Was seeing an individual therapist weekly for CBT/psychodynamic therapy—was inconsistent with attendance and stopped going; reportedly was prescribed Prozac (fluoxetine) by PCP but never started it, “I had an uncle who took that, and it made him crazy.” Family hx: Uncle—depression, questionable bipolar disorder Current Medications Synthroid (levothyroxine) 150 mcg daily Tests TSH—normal for the past 2 years on current dose of levothyroxine Triglycerides—202 mg/dL Total cholesterol—210 mg/dL UA/UDS—normal BMI—37.2 Mental Status Exam Cooperation: Somewhat guarded Awake, alert, oriented x 4, obese man Thoughts: Linear, goal-directed Thought content: shame, embarrassment about weight gain, somewhat preoccupied with undergoing bariatric surgery, no suicidal/homicidal ideation, no hallucinations, delusions, or obsessions Mood: Mildly irritated Affect: Constricted Questions What differential diagnoses would you consider? What psychiatric diagnosis would you give Dathan? Why? How would you proceed in Dathan’s treatment? What medication(s) would you prescribe him? What type of psychotherapy would you recommend

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