Case #3 Ken Ken Waldron, is a 20-year-old, cisgender male, caucasian, college sophomore, was referred by his resident advisor (RA) to the school's mental health care clinic after he appeared sad in the weeks following a breakup with his girlfriend. Mr. Waldron did not attend the evaluation session, telling his RA that "everybody gets bummed after a breakupI'll be fine." When Mr. Waldron seemed "strange and out of it," his RA made another appointment and then accompanied Ken to the meeting In that initial session, Mr. Waldron was hesitant but revealed that he had been crushed by the breakup. While he had previously been an excellent student, he'd quit doing homework and just looked out the window during class. He noticed that his grades had declined markedly, but "I don't seem to care." Although he said he felt lonely, he also admitted to steadily deleting incoming texts, so that he rarely communicated with his friends and family. When asked to describe other symptoms of sadness, Mr. Waldron replied that he didn't have anything to say. He said that his mind felt blank, "as usual." He added that he also felt increasingly detached from his physical body, going about his daily activities "like a robot." He stated feeling like he has no control over his body at times and that he is just witnessing things as they happen. He said he felt so disconnected that he often wondered if he were dead or living in a dream, or just had "no self." Mr. Waldron said that he'd been "down" for a few weeks after the breakup. He said he'd never been in love before and was shocke when Jill told him she needed "time apart." For weeks afterward, he felt sad and a little desperate, but he'd continued to see friends and go to class; however, at some point, things began to change. He said he started feeling numb, unreal, and disconnected, but it was all a little fuzzy. Mr. Waldron described a time-limited bout of extreme anxiety in tenth grade. At that time, panic attacks had begun and then escalated in severity and frequency over 2 months. During those attacks, he had felt very detached, as if everything around him was unreal. The symptoms sometimes lasted for several hours and were reminiscent of his current complaints. The onset appeared to coincide with his mother's entry into a psychiatric hospital. When she was discharged, all of his symptoms cleared rapidly. He did not seek treatment at that time. Mr. Waldron also described experiencing transient feelings of unreality in elementary school, just after his parents divorced and his father left him and his mother, who had a diagnosis of paranoid schizophrenia. His childhood was significant for pervasive loneliness and the sense that he was the only adult in the family. His mother was only marginally functional, with a few actively psychotic episodes. His father rarely visited but did provide enough money for them to continue to live in reasonable comfort. Ken often stayed with his grandparents on weekends, but in general, he and his mother lived a very isolated life. He did well in school and had a few close friends, but he largely kept to himself and rarely brought friends home. Jill would have been the first girlfriend to meet his mother. Mr. Waldron denied using any drugs, in particular cannabis, hallucinogens, or ketamine, and his urine toxicology was negative. Although his home life featured emotional neglect by both parents and emotional abuse when his mother was actively psychotic, he denied physical or sexual abuse. He denied any psychiatric history of mania, psychosis, or other past psychiatric symptoms, except as described above. He also specifically denied hallucinations, paranoia, and other unusual thoughts. Results of routine laboratory tests. a blood toxicology screen, and a physical examination were normal, as were a brain magnetic resonance imaging scan and an electroencephalogram. Consultations with an otorhinolaryngologist and a neurologist were noncontributory. 99 Q Search PRE a 6:23 PM 2/1/2024