Reference no: EM132850628

A 25-year-old female was brought to the ER by her family after experiencing sudden neurologic symptoms. She had been delivering food while working in a local retiree resident facility when she reported "suddenly passing out for a couple of seconds while on the elevator." She stated that she woke up with blurred vision that developed into loss of vision in both eyes. She also reported an inability to stand due to weakness in her left leg.

• While in the emergency department, the patient described seeing only shadows. She stated that she was generally in good health without significant medical issues or any history of chronic medical conditions or surgeries, which was confirmed by her mother. The patient had no reported mental health history and no history of aversive childhood experiences (i.e., abuse or neglect). She had never been seen by a psychiatrist or been on any psychiatric medications. There was also no reported use of tobacco, alcohol, herbal supplements, or over-the-counter or illicit drugs. The patient's family history was not significant for medical or psychiatric diseases, including anxiety, depression, or psychosis; however, the patient's mother reported that her daughter was experiencing significant situational stressors from working 2 jobs, attending school, being a single parent to a 4-year-old child, experiencing significant financial difficulties, and having a difficult relationship with her child's father.
• On physical examination, the patient was alert, awake, and oriented to person, time, and place. Her vital signs were stable with a blood pressure of 120/80 mm Hg and no orthostatic changes, a heart rate of 80 beats per minute, and a temperature of 97.6ºF. A thorough systemic examination was normal, including of her cardiovascular system, with no abnormalities detected on her electrocardiogram.
• On neurologic examination, her speech was normal, her pupils were slightly sluggish but reactive, she was able to see light that was shined into her eyes, and she demonstrated a full range of eye movement, but there was no visual acuity to hand motion or finger counts. The patient had no facial asymmetry and had normal strength in her upper extremities. She had some trouble lifting her left leg off the bed but was able to walk with assistance. No sensory deficits were noticed. A Mini-Mental State Examination yielded a score of 30, indicating normal cognition.
• All laboratory work was normal, including a complete blood count, comprehensive metabolic panel, blood glucose test, and drug screening. Imaging studies-including CT scan, contrast-enhanced CT angiogram of the brain, MRI, and magnetic resonance angiography of the head and neck-were normal.
• The patient was admitted to the hospital and observed for 24 hours, during which time neurology and ophthalmology consultants examined her. Their evaluation revealed no clear anatomical cause for her vision loss or left leg weakness, prompting consultation with the psychiatry department. The psychiatrist who examined her made a diagnosis of CD based on the findings of unexplained vision loss (i.e., it was not associated with an identifiable lesion in her visual pathway); normal physical examination and patient history; and observations of the patient and her family. Following the diagnosis, the psychiatrist engaged the patient in a brief session of cognitive behavioral therapy and supportive therapy, to which she responded well. The following day, she reported feeling less stressed, was able to walk normally, and her eyesight gradually improved but was still blurry. The patient was referred for outpatient psychotherapy. After a few days, she was in complete remission per a follow-up visit with her primary care physician.

Discussion 1. What is the diagnosis of this patient?

Discussion 2. What is the (la belle indifference)?