You are evaluating a 22-year-old male with depression who has had limited success with various antidepressants and counseling. You opt to initiate a trial of mirtazapine. What side effect of this antidepressant can you advise him is a common feature?
A 31-year-old woman presents to her general practitioner 7 days after giving birth to her first child. The patient has been complaining of feeling ‘down’ for the last 4 or 5 days. She also describes being tearful and tired. She denies loss of interest in her hobbies, difficulty concentrating, guilt, change in appetite, sluggishness and suicidal thoughts. She also denies hallucination.
Which of the following statements concerning this patient’s likely condition is most accurate?
A 21-year-old man is brought to the psychiatrist by his father. He expresses concern for his son’s mental health, as he has noticed him talking to himself frequently over the past 6 months. The patient is hesitant to speak with the psychiatrist and insists that his father stay in the room with him. During the psychiatric evaluation, it is revealed that the patient has been hearing a voice in his head for the past year, but denies any thoughts of self-harm or harm to others. The psychiatrist recommends a referral for further treatment, which causes the father to become emotional and question if he did something wrong as a parent. Which factor from the patient’s history is a poor prognostic indicator for his condition?
A 48-year-old woman with a history of manic-depressive psychosis, diagnosed at the age of 23, presents to her General Practitioner with polydipsia and polyuria. Current medication includes lithium and a steroid inhaler for bronchial asthma. Examination reveals a blood pressure (BP) of 110/75 mmHg, with a pulse of 80 bpm and regular. There are normal fasting sugar levels and there is no postural drop on standing.
What are the investigation findings most likely to help diagnose this condition?
A 25-year-old female has been discharged from hospital after being diagnosed with schizophrenia. She is now being seen in the GP clinic and is concerned about her prognosis. Prior to her illness, she was a high-functioning accountant. Her symptoms began gradually and mainly involved auditory hallucinations and persecutory delusions, which are currently under control. What factor in her case suggests a poor prognosis?
You are part of the mental health team assessing a 65-year-old woman in the emergency department who has presented with an intentional paracetamol overdose. She is a retired teacher and a devout Christian. She lives alone in a house and her two adult daughters live in a different state. When you ask her, she says that she regrets taking the paracetamol, but is not sure if she would try to do it again.
What factor decreases her likelihood of carrying out another attempt in the future?
A 28-year-old man is brought to the Emergency Department by ambulance after his partner reported he ingested multiple tablets of paracetamol after an argument. The patient is currently medically stable and can give a history to the attending emergency physician. He reports that he regrets taking the tablets and that this is the first time he has committed such an act. He claims that he acted in a moment of anger after the argument and never planned for this to happen. He suffers from moderate depression which has been managed by his general practitioner with sertraline. He consumes a moderate amount of alcohol and denies any abuse of recreational drugs. He has no family history of mental illness.
Which one of the following is an important dynamic risk factor to consider when managing this patient?
Sarah is a 20-year-old woman who has just started her first year at university. She is described by others as quite a reserved character. She has one friend but prefers solitary activities and has few interests. Sarah has never had a boyfriend and does not seem to be interested in companionship. When she is praised or criticised by others, she remains indifferent to their comments. There is no history of low mood or hallucinations.
What is the most probable diagnosis for Sarah’s condition?
A 25-year-old man arrives at the emergency department following his fifth suicide attempt in the past two years. He was discovered by his ex-girlfriend, who ended their relationship the day before due to his intense mood swings and overwhelmingly negative emotions. He has no communication with his family and appears unkempt. When questioned, he expresses feelings of worthlessness and a belief that everyone will eventually leave him. What is the probable diagnosis?
A 76-year-old man visits his doctor with his wife, who is concerned about his recent memory decline and difficulty concentrating. She also notes that he has become incontinent of urine and is walking with smaller steps. The patient’s medical history includes a myocardial infarction one year ago, as well as hypertension and diabetes. There is no family history of similar symptoms. What is the probable diagnosis?