A 22-year-old male was an unrestrained front seat passenger of a car traveling at 50 miles per hour. The driver swerved to avoid hitting a deer that darted in front of the car and hit a tree. EMS on the scene noted a stellate fracture of the windshield on the passenger side.

The patient was non-responsive at the scene when the paramedics arrived, and his pupils were unequal with the left pupil larger and sluggish to react to light. He was placed in a hard-cervical collar per the protocol and log rolled onto a long backboard.

He was breathing spontaneously at the scene, but pulse oximetry in the EMS unit revealed a SaO₂ of 78% on room air. He was intubated at the scene for airway protection and transported to a Level 1 trauma center. Glasgow Coma Scale=3

After a full trauma workup, the patient was diagnosed with an isolated traumatic brain injury with acute subdural hematoma secondary to the coup-contrecoup mechanism of injury.

He was emergently taken to the operating room for craniotomy after which he was taken to the Intensive Care Unit (ICU) for close monitoring. He had an intracranial bolt for measurements of his intracranial pressure (ICP).

Question:

Explain the differences between primary and secondary traumatic brain injuries (TBIs)? 

The APRN is called by the ICU staff because the patient’s ICP has risen to 22 mmHg. The APRN recognizes the urgent need to lower the ICP. The APRN institutes measure to decrease the ICP and increase the cerebral perfusion pressure (CPP). What are the factors that determine CPP?

CASE STUDY:

A 32-year-old white female presents to Urgent Care with complaints of blurry vision and “fuzzy thinking” which has been present for the last several weeks. She works as an executive for an insurance company and puts her symptoms down to the stress of preparing the quarterly report.

Today, she noticed that her symptoms were worse and were accompanied by some fine tremors in her hands. She has been having difficulty concentrating and has difficulty voiding. She remembers her eyes were bothering her a few months ago and she went to the optometrist who recommended reading glasses with a small prism to correct double vision. She admits to some weaknesses as well.

No other complaints of fevers, chills, upper respiratory tract infections, or urinary tract infections. Past medical and social history is non-contributory. The physical exam is significant for the 4^th cranial nerve palsy. The fundoscopic exam reveals edema of the right optic nerve causing optic neuritis. Positive nystagmus on positional maneuvers.

There are left visual field deficits. There was short-term memory loss with the listing of familiar objects. The APRN tells the patient that she will be referred to a neurologist due to the high index of suspicion for multiple sclerosis (MS).

Question:

What is multiple sclerosis and how did it cause the above patient’s symptoms? 

A 32-year-old Caucasian male presents to the office with complaints of back pain, stiffness, especially in the morning, interrupted sleep due to pain, and difficulty in leaning over to tie his shoes. The patient first noticed these symptoms about 6 months ago but attributed them to his weekend basketball team He said he is exhausted due to sleep interruption. He has taken acetaminophen with some relief but says the naproxen seems to be working better.

Married with 2 small children and works as a bank manager. Physical exam: Lungs clear but decreased chest excursion noted as well as decreased range of motion of hips and forward flexion, rotation, and lateral flexion restricted. Spine radiographs in the office revealed a slight kyphosis along with ankylosis at L5-S1. The APRN suspects the patient may have ankylosing spondylitis (AS). The APRN orders laboratory tests including an HLA-B27.

Question:

Why did the APRN order an HLA-B27 lab? How would that lab result assist in understanding what ankylosing spondylitis is?

The APRN tells the patient that the tender points are no longer used to diagnose FM. She suggests that the patient takes the Widespread Pain Index (WPI) and the Symptom Severity Inventory (SSI). The patient asks the APRN what these tests are for. What is the APRN’s best answer?

Should abnormal psychology continue its focus on identifying the causes of psychological distress, classifying different symptoms, and seeking effective treatment to reduce these symptoms, or should the field focus on improving knowledge of what goes right in happy people and trying to improve these techniques in the general population?

If you were to start a society from scratch and wanted to improve the lives of its members, would you focus on identifying what goes right in people or on identifying the abnormal?

How would approaches to treatment and intervention differ if society were to focus on positive psychology instead of abnormal psychology? Defend your position by replying to at least two of your peers.

Why is classification a necessary first step in developing an understanding of abnormal behavior?

Classification helps researchers identify populations with similar patterns of abnormal behavior. By classifying groups of people with a particular mental disorder, researchers might be able to identify common factors that help explain the origins of that mental disorder.

Why is classification important in abnormal psychology?