Charlie

• 16 years old
• Tall and slim
• Was brought to the emergency room because he fainted at school
• Blood pressure value is 90/50, blood sugar is 65
• ALT-AST high
• Amphetamine in urine
What do you think?
• Examinations are being carried out, but the reason cannot be
understood
• Fluid replacement is performed (to balance blood pressure and blood
sugar)
• He is transferred to the pediatry for further examination
• Inspections are being carried out in the service, but no disease can be
found
• No explanation for positive amphetamine test in urine
• He eats very little (the nurse finds the food in the garbage)
• BMI: 16.8
• Psychiatry consultation
• A psychologist and a social worker ought to be in charge of
the case
Story
• Bullyied, being outed, and has a secret relationship with a
boy
• Charlie mentioned how he used to self harm to deal with the
pain
• Wanting the need to control something in his life, and it often
flares up when he is stressed or upset
• Ask the social worker to visit his school and talk to the
school administration and the teachers. If the social
worker is not covinced that Charlie’s situation is likely
to improve, transfer to another school should be
considered.
• Using Concerta to suppress appetite
• When he looks in the mirror, he finds himself very ugly and
overweight
• His family does not know about his eating problems and his sexual
orientation
• Ask the psychologist and the social worker to have sessions with
the parents and the siblings. It is very likely that there are
problems (material, social, emotional, behavioral,
interactional…) in the family. How and to what extent can they
be supported?
Should we talk to his parents?

About his eating disorder and school problems, yes. These need immediate intervention.
About his sexual orientation, not without Charlie’s consent.
• What else should we ask?
Suicide
Evaluation for other psychiatric diseases
How is treatment motivation?
Social support
• After evaluation, Charlie is diagnosed with anorexia nervosa, OCD and
depression
• How should we manage the treatment process?
Consent from the patient and family and plan the treatment process
together
Collaboration with dietician and pediatric endocrinologist
Medicine
Psychotherapy
Social work: Collaboration with family, school and peers