A 22-year-old college student presents with insomnia, anxiety, and flashbacks. She experienced a traumatic event two weeks ago when a young man demanded her phone and purse while she was walking home from a party. She was alone and feared for her safety. Since then, she has been struggling with nightmares and flashbacks, which have disrupted her sleep. She has also been avoiding going out alone. She is seeking medication to help her sleep. What is her response?
You are asked to see a 50-year-old woman who reports feeling down for several months. Upon further questioning, you discover that she has lost interest in activities she previously enjoyed, such as hiking and going to the theater. She has also been experiencing fatigue, causing her to miss work, and has had occasional thoughts of not wanting to be alive, although she denies any intention of harming herself. In the past month, her symptoms have worsened, with episodes of anxiety occurring at least once a week. These episodes last around five minutes and are characterized by hyperventilation, nausea, and a fear of having a heart attack. No physical abnormalities have been found. What is the most likely diagnosis?
A 20-year-old individual presents with obsessive thoughts about causing harm to others since moving away from home to attend college. They are particularly anxious about using the shared kitchen in their dormitory and tend to prepare and eat meals during the night to avoid contact with their roommates. After completing a Yale-Brown Obsessive Compulsive Scale (Y-BOCS), they are diagnosed with mild OCD. What treatment option would be most suitable for this individual?
A 28-year-old woman contacts her doctor seeking guidance on stopping all of her medications abruptly. She has a medical history of asthma, depression, and occasional tennis elbow pain, for which she takes a salbutamol inhaler, citalopram, and paracetamol, respectively. What is the most probable outcome if she discontinues her medications suddenly?
A 70-year-old homeless man is admitted to the hospital for osteomyelitis resulting from a diabetic foot ulcer. During his stay, it becomes evident that he is experiencing significant memory impairment. Despite being asked about the events of the day, he tells a believable story that is entirely different from what actually occurred. There is no indication that he is intentionally deceiving the medical staff. He is also unaware of his memory impairment and denies having any issues with his memory. According to his family, this memory impairment has been present for the past 5-6 months. He has a history of excessive alcohol consumption spanning 45 years. What is the most probable cause of his memory deficits?
A 65-year-old man is brought to the doctors by his son. Three weeks ago his wife passed away from metastatic breast cancer. He reports feeling sad and tearful every day, but his son is worried because he keeps getting into arguments with him over small things and bringing up past family issues. The son also mentions that his father has mentioned hearing his wife’s voice and even cooked a meal for her once. Despite this, he has started going for walks with his friends again and is determined to get his life back on track. What is the most probable diagnosis?
A 28-year-old man has been admitted to the psychiatric ward under section 2 of the mental health act for suspected first-episode psychosis. During his mental state examination, burns are observed on his arms and he claims that insects are burrowing into his skin. He suggests that the burns are caused by bleach. The evaluating psychiatrist could not detect any insects, and when questioned, the patient became agitated and insisted that his skin was infested. What is the most probable disorder being described?
A 26-year-old man is admitted to your psychiatric ward in a state of distress saying that he knows for certain that his colleagues are plotting to have him dismissed from work. He says they are spreading malicious rumours about his sexuality and, with the help of the CIA, have bugged his office. In the first week of his admission, he is observed to be responding to unseen stimuli when alone in his room. His family state that he is a lovely lad who never gets into any trouble with drink or drugs. They are very worried because in the last 3 months he has told them he can hear people talking about him to each other when he lies in bed at night. He has no significant medical history.
Which one of the following courses of action would be most appropriate?
A 29-year-old woman arrives at the Emergency Department in a state of distress. She admits to having lost a significant amount of money through gambling and then taking 4 packets of paracetamol. This is not the first time she has engaged in such behavior. She discloses that her partner of 3 years has been offered a job overseas and is considering accepting it. Despite her initial heartbreak, they had a major argument and she now claims to be indifferent about whether he stays or goes.
What is the most appropriate course of action based on the probable diagnosis?
A 38-year-old woman, who lived alone, scheduled a follow-up appointment with her GP. She had been self-isolating at home for several months due to the COVID-19 pandemic and continued to feel anxious about going out even after the lockdown was lifted.
Prior to the pandemic, she had experienced a traumatic event and was struggling with post-traumatic stress disorder (PTSD). She had also recently lost her job and was facing financial difficulties.
During a telephone consultation with her GP 4 weeks ago, she was diagnosed with moderate depression and referred for computerised cognitive behavioural therapy. She was also advised to increase her physical activity levels.
However, her mental health had since deteriorated, and she was experiencing difficulty sleeping, early morning awakening, and occasional thoughts of self-harm. She expressed reluctance to engage in one-to-one psychological treatments.
The GP discussed the next steps in managing her depression and PTSD.
What treatment options should be considered for this patient?