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Depression in ICD-10

CASE STUDY, PSYCHIATRY

       WHAT CAN BE THE DIAGNOSIS?

       At the age of 25, D.A.K., a postgraduate student in chemistry, found himself at the emergency department (ED) of the university hospital, where the campus police had brought him. He had been working late at the laboratory alone when the police came. He had been awake for the past 4 days working on an experiment that he believed would save the world.

       D.A.K.’s professors had voiced concerns as the often quiet and well-mannered student had recently begun to take over the class discussions and interrupt lectures. More remarkable than the behavior itself was the change it represented. In the preceding semester, D.A.K. had been uncharacteristically quiet and withdrawn. Many suspected that he was depressed, but they could find no apparent reason for his behavior. Then he isolated himself from friends and family and stopped seeing his girlfriend of 2 years.

       D.A.K. had a family history of depression on his mother’s side, with a grandmother who had received electroconvulsive therapy (ECT) years ago in a state hospital. On his father’s side, his uncle had received lithium and had been diagnosed with manic depression. A vague history of colorblindness was also noted. D.A.K. had a younger sister who was often described as moody.

    

       In the ED, D.A.K. was belligerent, talked rapidly but coherently, and demanded to return to the laboratory so that he could save his experiment and thus the world. He wanted a lawyer and denied being suicidal but threatened those who, he claimed, were standing in his way. He accused the faculty of being against him, threatened legal action against those incarcerating him, denied hallucinations but clearly saw himself in highly grandiose terms, was orientated times 3, had good recall, and was colorful and verbose in his response to proverbs.

       No history of drug or alcohol use was noted, except for a large consumption of coffee in the preceding several weeks. He had no obvious medical problems.

       D.A.K. kept demanding to leave and return to the laboratory to save everyone. He was a huge challenge to the emergency physicians, who could not wait for the psychiatric resident to arrive