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?
A 45-year-old man with a history of schizophrenia no longer reports hallucinations or delusions. However, he spends many hours doing nothing, has trouble reading a book or watching a film and rarely speaks spontaneously or fluently. His grooming is poor and he is socially withdrawn.
What is a positron emission tomography (PET) scan most likely to show?
A 24-year-old man is brought into the emergency department by his friends. They report that for the past 6 days, he has not slept or eaten, and he believes that aliens are communicating with him through his phone.
During the examination, he speaks rapidly and loudly. When asked about his condition, he describes in detail what the aliens have been telling him, including the frequency and duration of the calls, as well as the tone and pitch of their voices. He also expresses feelings of anxiety and paranoia.
What type of thought disorder is present in this man?
A 30-year-old female with a diagnosis of bipolar disorder visits her doctor to discuss a headache. She starts explaining her issue with the following statement:
I came here to talk about this headache, but I can’t stop thinking about the dream I had last night where I was flying over a rainbow. It’s funny because I haven’t eaten pizza in a week, and I really miss it.
What sign of thought disorder is evident in the patient’s speech?
A 78-year-old man is admitted with new-onset confusion. He is usually independent and enjoys gardening in his spare time. When he didn’t show up for his weekly gardening club meeting, a friend went to his house. The friend noticed that the patient appeared disoriented and was speaking nonsensically, prompting them to call for medical assistance.
What distinguishes delirium from dementia?