A 26-year-old male comes to his doctor’s office at the request of his friends. Upon examination, he discloses that he thinks everyone can hear his thoughts, as if he were a radio station, and that he hears voices commenting on his actions. The doctor observes that he has a blunted affect, alogia, and avolition. Additionally, the doctor notes that the patient repeats the final word of any inquiry posed to him.
What term describes this phenomenon?
You’re on an acute take ward and you are asked to see a patient by your foundation doctor. The foundation doctor is concerned about this patient as he is uncertain of the next step in management and investigation.
The patient is a 46-year-old male who has been admitted with excess tearing. He has a past medical history of allergic rhinitis. He uses nasal saline rinses several times a day. His father recently died of lung cancer with brain metastases.
This patient has had extensive investigations in multiple other hospitals due to his concerns of a cancer diagnosis causing his excessively watery eyes. He has had three CT orbits in the last 12 months which have been reported as normal. On ophthalmic examination, he has some crusting and erythema of his lid margins, but it is a normal examination otherwise. The patient remains convinced that a cancer diagnosis still can’t be excluded.
What is the reason for this patient’s presentation?
A 20-year-old woman presents to her General Practitioner (GP) with a 2-year history of restricting food intake and self-induced vomiting. She attends her GP for the first time with her sibling reporting a recent worsening of her symptoms. The GP suspects anorexia nervosa.
Which is the most appropriate investigation to determine whether the patient requires urgent hospital admission?
A 32-year-old female presents to her primary care physician with her sister. The sister is worried that the patient may have a personality disorder due to her lack of interest in socializing and her preference for being alone. Upon further discussion, the patient admits to having no desire for romantic relationships, being unemployed, and lacking motivation to work. She denies any self-harm or suicidal thoughts and has no history of legal issues. During the consultation, she displays a flat and emotionless facial expression. What personality disorder is most likely present in this patient?
A 42-year-old woman presents to her GP with concerns about symptoms that have been affecting her for several years but are now becoming more disruptive to her daily life. She has been experiencing obsessive thoughts about her loved ones being harmed and feels compelled to perform certain rituals to prevent this from happening. She spends hours each day checking and rechecking that appliances are turned off and doors are locked. Her relationships are suffering, and she is struggling to maintain her job. She is hesitant to take medication but is open to exploring other treatment options.
What is the most appropriate psychological approach for managing OCD in this case?
A 25-year-old woman comes to her doctor with concerning symptoms. Ten weeks ago, she was in a serious car accident. Despite being physically fine, she has been experiencing flashbacks, heightened alertness when crossing the street, and difficulty concentrating at work. What characteristic would most strongly support the probable diagnosis?
A 28-year-old woman experiences chest pain following an argument with her 16-year-old daughter. She is brought to your clinic for evaluation. Upon examination, she appears anxious and is hyperventilating. She exhibits tenderness to light pressure on the front of her chest, but her oxygen saturation is 99% while breathing room air. An ECG reveals no abnormalities. What is the most suitable course of action for this patient?
A 28-year-old man presents to his GP with ongoing sleep issues due to tension in his relationship with his girlfriend. He feels she is distant and suspects she is spending time with her ex-boyfriend who works in the same office. Upon further questioning, he reveals a history of feeling uninterested in past relationships and struggles with mood swings. He expresses feeling alone in the world and that even his friends are against him. Although he self-harms, he denies any suicidal thoughts. A referral to psychiatry leads to a diagnosis of borderline personality disorder. What is the most appropriate treatment for this patient?
A 55-year-old man visits his GP clinic complaining of chronic constipation that has persisted for several years. He reveals that he has not had a bowel movement in ten days. The patient has a medical history of atrial fibrillation, type II diabetes mellitus, gastro-oesophageal reflux disease, and paranoid schizophrenia. He is currently taking apixaban, clozapine, digoxin, metformin, and lansoprazole. During the physical examination, the doctor notes a hard, non-tender abdomen and fecal impaction upon PR examination. Which of the medications listed above is likely contributing to his long-standing constipation?
A 28-year-old man presents to his primary care physician with concerns about recurring thoughts. He has been experiencing thoughts of needing to repeatedly check that his car is locked when leaving it, even though he knows he locked it. Sometimes he feels the need to physically check the car, but other times it is just thoughts. He denies any symptoms of depression or psychosis and has no significant medical or family history. He is not taking any medications. What is the recommended first-line treatment for his likely diagnosis?