For my first H&P, I presented a case of a 24 y/o male with a PMHx of HIV and substance abuse presenting for evaluation of auditory hallucinations and paranoia for several weeks. He reports voices saying “lets mess with him” and feeling that people are watching and following him. Additionally, reported methamphetamine use, but could not specify whether these symptoms occur when he is not using substances. I decided to present this case because it was a classic case of substance induced psychosis vs early onset schizophrenia; however, schizophrenia cannot be diagnosed in the setting of psychosis with substance abuse. I also selected this H&P because up until this point it was the only intake evaluation where perhaps there was a differential diagnosis, as the rest were very straightforward depression, anxiety, bipolar, ect. 

My second H&P was a 24 y/o transgender female with a PMHx of severe abuse (multiple sexual assaults), PTSD, and chronic depression/anxiety presenting with dissociation since 2016/2017. She reports that she views herself as the country of Germany and described an elaborate internal framework in which different aspects of her identity are organized as parts of a symbolic “country” called Germany. I selected this case because dissociative identity disorder is a subject I knew little about and I felt that I could create a more robust differential diagnosis than my previous H&P. It is easy to label a patient like this a psychotic; however, the resident doctor I was working with said that her symptoms didn’t fit into psychosis because she was aware that she was not actually from the country of Germany. I found this fascinating, so I also decided to find a journal article on this subject.