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Section 10: Scenario for Analysis


Please take a few minutes to look over the following scenario. If you wish, you may look back over some of the material from earlier sections, or refer to the tables from the previous chapter. Following the scenario, there will be a few questions concerning what concerns you have about possible medical conditions, and how you might shape the process of discussing these concerns with the client.



James W. is a twenty year old college student attending a small liberal arts college in the mid-west. Throughout the course of his academic career, James has been a very motivated and successful student. During Christmas vacation, his parents became alarmed when he came home from college complaining of depression and disinterest in his course work at school. They set up a visit with a mental health clinician through the Employee Assistance Program with his mother's company. In the first session, the mental health clinician gathers recent historical information, including when his depression and apathy began, and any information that might suggest any medical reasons for the problems. James reports that he spent the previous summer working as a counselor in an outward bound program for disadvantaged children. The camp was based out of southeastern New York State, about 80 miles due north of New York City. The campers were taken on numerous outdoor camping excursions, as well as taken through both rock climbing and ropes training exercises. James reports the summer went very well, but he did experience fatigue as the summer came to an end, and had come down with what seemed to be the flu right before going back to school. Additionally, he had had a couple of minor injuries while leading some of the camping expeditions. His apathy and depressed mood were evident to him when he went back to college in the fall, but he thought it was just that the summer had been very strenuous, and he had not sought out any help while at school. He assumed that he would get his energy back when he had a chance to rest up over the holidays.


Questions: Given the brief history presented here, what medical concerns might warrant some additional scrutiny? Are there any aspects of James' life that make you concerned about access to medical care? How might you address the issues presented here in a meaningful and successful way with James?

Please take just a few minutes to examine these questions, referring back to earlier material as appropriate before moving on the some discussion of this scenario.

Discussion: There are two important pieces of information in the scenario as presented that may be relevant to possible medical problems. First, James engaged in a number of activities that may have resulted in some potential head injury. It would be very important to examine if there was any trauma to his head that may have been responsible for mental or mood impairments.

James is at an age where he is not as likely to be closely supervised by adults who may have awareness of the need for medical attention for even seemingly minor head trauma. Additionally, he is at an age where there is a certain sense of invulnerability. He may have had a trauma that he decided to shrug off, without considering the possible consequences of such a decision. This should be discussed with some sensitivity and respect for his burgeoning independence.

The next area of concern has to do with the location of the camp and the amount of time that James spent outdoors. That part of the country is near the epicenter of the original outbreak of Lyme Disease, and the ticks that cause Lyme Disease were certainly present in that area. The development of flu-like symptoms at the end of the summer suggests the need to consider that possibility for James.

At the very least, the mental health clinician should gather some information about whether the camp James worked at provided some education about Lyme Disease risks, and whether James took precautions to protect himself from it.

Likewise, the possibility of mononucleosis must be examined. This disease, called the "kissing disease", is spread through contact with saliva from an infected party. Some education about this medical issue might be accompanied by delicate gathering of information about sexual activity, as it may also be helpful to consider the possibility of a sexually transmitted disease. Clearly, substance use for a college age student must also be considered.

The age and life stage where James is at must be taken into consideration as these judgments are being examined. While at home and in preparation for college, James may have had consistent and regular medical care, including blood work and regular physicals.

Depending upon the college James attends and the conscientiousness of his parents, there may be less external support for thorough medical care at this point in his life. Depending upon the level of maturity James possesses, there may also be inadequate understanding on his part about what risks he faces, and less motivation to include good health care in his overall life balance.

This is where it becomes important for the mental health clinician to remain flexible in the assessment process, and to consider the full range of possibilities that may explain the array of symptoms James presents.

This completes the course on medical conditions that mimic mental health problems. Following the references page, you may move to the test section.