Hello! I’m Jackie Zinke. I sure hope

Hello! I’m Jackie Zinke. I sure hope you can help me, but I really don’t know. I’m a little confused about why I was sent to see a psychiatrist. 10 years ago, I was diagnosed with migraines. I take sumatriptan as needed. God that first year of college sucked until I got diagnosed. But then just under a year ago, let’s see, I think it was nine months? I started having what I think are seizures. I saw my neurologist–I’d been seeing her once a year or so because of the migraines. She ruled out epilepsy or any neurological cause. The seizures–they are like episodes of shaking and I kind of lose consciousness. When I wake up, I don’t know what happened. I didn’t know that’s what was happening at first, of course, but then it happened at work in front of someone and they told me. I’m so afraid it’s going to happen at work again. It’s so embarrassing. What if it gets worse, and I uh, you know, pee my pants next time? I work as a sales and marketing rep for a large publishing company. I got this job 18 months ago. It has been stressful and difficult to meet the company goals. It does cause me anxiety. [stressed/anxious; she is extremely anxious about these next 5 things happening] Am I underperforming? Will I lose my job? Am I meeting my financial targets? At least at work some of them know what’s going on, but what if this happened during a sales meeting? And I’ve stopped going out because what if this happens in front of strangers, too? But, it’s not like I’m dating much anyway. [nervous laughter] A year ago my divorce was finalized. I’m not depressed about that. Christian wasn’t the right person to marry. [a little sad] And I wasn’t the right person for him, either. He wanted kids…I didn’t. He wanted to play video games…I wanted to go out. You know…. All in all, these seizure symptoms are giving me a really poor quality of life and if I’m not really epileptic, I feel like my quality of life is similar to an uncontrolled epileptic Jackie Zinke 29-year-old African American female Medications: Sumatriptan, birth control pills Height: 5’9″ Weight: 159 pounds Labs: Electroencephalogram (unremarkable), neuropsychological testing revealed subtle cerebral impairments in memory and vigilance, brain imaging studies found hypometabolism of the nondominant hemisphere and impaired hemispheric communication. All other lab tests are unremarkable. Urine drug screen is negative. Objective testing: Information indicates symptoms may be caused by an excessive cortical arousal that sets off negative feedback loops between the cerebral cortex and the brainstem reticular formation, and elevated corticofugal output in turn inhibits the patient’s awareness of bodily sensation. This process explains observed sensory deficits in patients with conversion disorder and evidence of structural changes seen in brains of patients with conversion disorder. Medical history: No history of substance use disorder Family history: Divorced 1 year ago after 5-year marriage; no children Exam: Physical exam unremarkable. Vital signs normal. Answer the following questions. 1. What questions will you ask Jackie during her psychiatric evaluation?

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