Case 13 Upson Pratt, a 52-year-old janitor smelled of strong disinfectant on examination. He said that he was worried about contracting diseases like HIV, so he washed his hands incessantly with bleach. On average, he washed his hands up to 30 times a day. He also avoided touching practically anything outside of his home, but if he felt contaminated, he would wash it.

Mr. Pratt also had intrusive images of hitting someone and fears that he might offend or disturb the neighbors. He often apologized for fear he might have sounded rude. When he showered, he made sure that the water in the tub only reached a certain level for fear he could flood his neighbors. He recognized that his fears and urges were "kinda crazy," but he felt they were out of his control.

Case 10 Larry Gorbachovwas a 57-year-old single unemployed white man who was in weekly psychotherapy. He found it "humiliating" that he was forced to see trainees who rotated off his case every year or two. He frequently found that the psychiatry residents were not especially educated, cultured, or sophisticated and felt they knew less about psychotherapy than he did. He preferred to work with female therapists because men were "too competitive and envious."

He enjoyed fine restaurants and "five-star hotels," but he added that he could no longer afford them. He wore clothing that appeared to be by a hip-hop designer generally favored by men in their 20s.

Case 7

Jason Todda 60-year-old businessman, returned to see his longtime psychiatrist 2 weeks after the death of his 24-year old son. The young man was tragically killed in a car accident.

Mr. Todd was very close to his son and he immediately felt crushed, like life had lost its meaning. In the ensuing 2 weeks, he felt constantly sad, withdrew from his usual social life, and was unable to concentrate on his work. His psychiatrist told him he was struggling with grief and that such a reaction was normal. Mr. Todd was to return for ongoing assessment.

By the sixth week of visiting the psychiatrist, his symptoms had worsened. He started to become preoccupied that he should have been the one to die, not his son. He had trouble falling asleep, but he also tended to wake up at 4:30 A.M. and just stare at the ceiling, feeling overwhelmed with fatigue and sadness.

Case 7,13 and 10 Question

1. What is your Diagnosis?

2. What led you to that diagnosis? (Don't forget to highlight/underline).