A 28-year-old man visits his General Practitioner on the advice of the Community Psychiatric Nurse. He has been experiencing a fever and sore throat lately. He is currently on clozapine for treatment-resistant schizophrenia.
What would be the most crucial investigation to conduct, considering his recent symptoms?
You are considering prescribing an antidepressant to a 75-year-old woman who has been experiencing low mood and difficulty maintaining her weight due to low appetite. Which psychiatric medication could potentially improve both her mood and appetite?
A client under your care has been prescribed imipramine for depression. What combination of side-effects is most probable in an individual taking this type of antidepressant?
A patient with a known history of schizophrenia presents to the Emergency Department with nausea, diarrhoea, coarse tremor and unsteadiness on her feet. She is taking the following prescribed medications: clozapine 150 mg mane and 300 mg nocte, lithium carbonate 200 mg bd and sertraline 50 mg od. Blood results are as follows:
Investigation Result Normal Value
Clozapine level 444 ng/ml 250 to 350 ng/ml
Lithium level 2.3 mmol/l 0.4–1.2 mmol/l
Blood glucose 6.1 mmol/l < 7 mmol/l
White cell count (WCC) 8.0 × 109 4–11 × 109/l
Neutrophils 4.5 × 109 2.5–7.58 × 109/l
What is the most likely diagnosis for a patient in their 30s with these symptoms and medication history?
A 30-year-old woman is in a car accident. Another car collided with a truck and she swerved to avoid them, hitting a tree. Two weeks later, she still experiences flashbacks, nightmares, and difficulty sleeping. Her brother reports that she startles easily and seems disoriented at times. The woman denies any chest pain or dizziness.
What is the probable diagnosis?
A 20-year-old female has presented to the emergency department with a history of diarrhoea for the past week. She denies any blood in her stool or exposure to infectious agents. The patient reports feeling more fatigued and sleeping more than usual.
The patient has a history of depression and was prescribed sertraline. However, she stopped taking the medication two weeks ago as she felt she no longer needed it. Her mental state is currently stable and euthymic.
During the general examination, the patient’s pupils are noted to be bilaterally dilated, which was also observed during her childhood. What is the most likely feature in this patient that is a result of discontinuing her medication?
A 28-year-old man visits his GP with complaints of poor memory. He works in a consulting company and recently faced trouble at work after missing a flight to a client in Tokyo. He has difficulty falling asleep and wakes up feeling exhausted. Sometimes he wakes up in the middle of the night screaming. When awake, he cannot relax and appears to be constantly on edge.
The patient has a history of attention-deficit hyperactivity disorder during childhood and one major depressive episode during his university years. He has not had any mental health-related complaints since then. He drinks one bottle of wine on Saturdays with his wife and admits to occasional past cocaine use. However, he stopped using cocaine after being ambushed and stabbed while dealing with a dealer during his last vacation in Thailand two months ago. His wife has recently complained that he appears emotionally unavailable.
Upon physical examination, no abnormalities are found. However, during the mental state examination, the patient exhibits low mood and an increased startle response. What is the most likely diagnosis?
A mental state examination is conducted on a 30-year-old individual. When asked about their activities during the week, they begin discussing their job, then transition to their passion for writing, followed by reminiscing about their favorite literature teacher from school, and finally discussing the death of their childhood dog and how it relates to their current writing project. Although their speech is at a normal pace, they never fully answer the question about their recent activities. What can be said about this individual’s behavior?
A 40-year-old man presents to his General Practitioner with symptoms, including chorea, incoordination, personality changes and psychiatric symptoms such as depression. His father died at the age of 55. You suspect this may be a case of Huntington’s disease.
Which of the following investigations would be the most useful to confirm this diagnosis?
A mental state examination is conducted on a 32-year-old individual. When asked about their breakfast, they start by describing their morning routine, then talk about their favourite recipes, followed by a story about a cooking competition they participated in, and finally mention having cereal for breakfast. Their speech is at a regular pace and flow.
What type of thought process is demonstrated in this scenario?