A 28-year-old woman presents to the emergency department with a decreased level of consciousness. Upon evaluation, her blood sugar is found to be 1.2 and is treated accordingly. The paramedics report finding her next to an insulin syringe, despite her not having diabetes. This is the third occurrence of such an event, and the patient denies any suicidal ideation. What is the diagnosis for this woman’s condition?
A 14-year-old boy comes to the clinic with complaints of sudden jerking movements of his neck, causing his head to move involuntarily from left to right. He has been experiencing these symptoms for a few years, but lately, he has been feeling embarrassed as he involuntarily utters swear words in social situations. These symptoms worsen when he is under stress. What is the most probable diagnosis for this patient?
A 21-year-old woman comes to your clinic for an appointment scheduled by her father, who is worried about her lack of sleep. During the consultation, the patient reveals that she no longer feels the need to sleep for more than 2-3 hours. She appears talkative and mentions that she has been working on an online business that will bring her a lot of money. She is annoyed that people are questioning her, especially since she usually feels down, but now feels much better. There are no reports of delusions or hallucinations. What is the most probable diagnosis?
A 22-year-old man with a history of hearing voices is brought to the Emergency Department by his family. He describes these voices as telling him to kill himself, ‘as he has a demon in him’. He also reports noting his intelligence being tapped through the television by a higher power. This has been going on for the past 3 months. His family denies either depression or manic episodes. The patient was admitted to the inpatient Psychiatry Unit and, after an evaluation, a diagnosis of schizophreniform disorder was made. He was started on Haldol (haloperidol) for his symptoms. Two days after initiation of therapy, the patient’s temperature rose to 41 °C, blood pressure 150/85 mmHg and pulse 110 bpm. Physical examination revealed muscular rigidity and delirium.
What is the most likely diagnosis?
A 50-year-old man visits his GP in a state of distress. He recently returned from a vacation and forgot to renew his prescriptions, resulting in him not taking his medications for the past week. The patient is currently experiencing general discomfort, nausea, and excessive diarrhea. Upon conducting a thorough examination and reviewing his medical history, the GP suspects that his symptoms are due to the discontinuation of one of his medications. The patient has a medical history of depression, gout, hypothyroidism, and type two diabetes mellitus. He also occasionally uses zopiclone to treat his insomnia. Which medication withdrawal is likely causing the patient’s symptoms?
A 70-year-old man comes in for his routine psychiatric follow-up appointment. He has a history of schizophrenia that has been difficult to manage, but has been stable for the past 5 years on various antipsychotic medications. He also has type II diabetes. During the appointment, he reports experiencing repetitive, involuntary movements of his lips and tongue, including lip smacking and grimacing. Which medication is the most likely culprit for these symptoms?
A 23-year-old woman is scheduled for a routine phone consultation. Her father is worried about her well-being, but she insists that she is fine and has no issues. Her father believes that she is socially withdrawn as she does not have any friends and spends most of her time indoors using her phone. Upon further inquiry, you discover that this woman has a strong belief that her phone is being monitored by the government, which is contributing to her isolation. She does not exhibit any psychotic symptoms, and her speech, tone, and mood are all normal. What is the most probable diagnosis?
A 35-year-old man is brought to his GP by his partner who is concerned he may have developed bipolar disorder over the last few months.
The man experiences periods of elevated mood, where he spends a lot of money and sleeps very little. He denies having any delusions of grandeur. These episodes usually last for a few days, and he has never put himself or others in danger.
The man also has episodes of severe depression, where he feels suicidal, loses interest in his hobbies, and sleeps excessively. He is referred to a psychiatrist for further evaluation.
What is the most probable diagnosis?
A 56-year-old man is brought to the emergency department by ambulance, after being found confused by members of the public for the fifth time in the past month. Upon review, he tells you that he came here by bicycle after spending the afternoon with his friends doing shopping, and then later tells you he spent today in the pub with his new dog. He smells strongly of alcohol and you notice a near-empty bottle of unlabelled spirit with him.
On examination, he has an ataxic gait, dysdiadochokinesia and horizontal nystagmus.
When you go back later to see him, he has forgotten your previous interaction.
Which of the following explains his signs and symptoms?
A 50-year-old man has been admitted to a psychiatric ward for a fourth time. He is withdrawn, irritable, restless and afraid. He says that he has been depressed for about 8 weeks. He has insomnia, loss of appetite and weight loss. He also has suicidal ideation with a plan to overdose on medicine, which he has done in the past under the influence of commanding auditory hallucinations. He hears voices often even when he is not depressed, but they only talk of suicide when he is depressed. He was divorced 5 years ago and has trouble holding jobs due to his paranoia and odd behaviour.
What is the most likely diagnosis?