A 22-year-old woman comes to the surgery, distressed that her midwife has advised her to stop taking sertraline at 10 weeks of pregnancy. She had taken it during her previous two pregnancies and had two healthy children. She insists on knowing the potential risks associated with sertraline use during the first trimester. What are the increased risks during this period?
A 28-year-old woman comes to her General Practitioner (GP) with her partner, concerned about her recent behavior. She has been having trouble sleeping for the past week and has been very active at night, working tirelessly on her new art project, which she believes will be a groundbreaking masterpiece. When questioned further, she admits to feeling very energetic and has been spending a lot of money on new materials for her project. Her partner is worried that this may be a recurrence of her known psychiatric condition. She is currently taking olanzapine and was recently started on fluoxetine for low mood six weeks ago. She has no significant family history. The couple has been actively trying to conceive for the past six months.
What is the most appropriate next step in managing this patient?
A 27-year-old man presents with a 6-month history of depressed mood. He reports feeling fatigued and having suicidal thoughts on a daily basis. His appearance is disheveled and he has made multiple suicide attempts in the past few months. The psychiatrist decides to initiate electroconvulsive therapy (ECT) for his depression, scheduled to begin in a week. The patient is currently taking 100 mg of sertraline daily. What is the appropriate course of action regarding his medication prior to ECT treatment?
A 52-year-old man presents to his GP with a 6-month history of erectile dysfunction. He reports a weaker morning erection and difficulty maintaining an erection during sexual activity. He feels depressed about his symptoms. Upon further questioning, he mentions that his morning erection is still present but weaker than usual. He also admits to consuming approximately 50 units of alcohol per week and gaining weight recently. Despite his symptoms, he remains hopeful for improvement. What signs would indicate a psychological origin for his condition?
A 25-year-old man has just been diagnosed with schizophrenia. His family is concerned about the long-term outlook of the illness. What factor is linked to the poorest prognosis for poorly managed schizophrenia?
A 35-year-old divorced man gives a history of moderately heavy drinking for 10 years. In the 2 years since his divorce, he has experienced disrupted sleep, fatigue, irritability and cynicism. He typically drinks excessively. For example, he consumes a case of beer in a weekend and now drinks before work.
Which is the most appropriate initial form of psychotherapy?
An older woman was discovered collapsed in a stairwell of a parking lot. A card from an outpatient psychiatry department was discovered in her coat pocket, along with a bottle of procyclidine tablets. She was running a fever (38.2°C), conscious but not responding to instructions. Her blood pressure was 160/105 mmHg, and she had significant muscle rigidity. What is the probable diagnosis?
A young man seeks counselling because of marital discord. He and his wife have been having problems because he is uninterested in doing anything but playing video games. He has neglected his responsibilities at home and his work performance is beginning to suffer as well.
Which one of the following best describes his behaviour?
A 27-year-old woman has been experiencing a pattern of tumultuous endings in all of her relationships. She confides in you that she seems to have a knack for choosing friends and romantic partners who ultimately reveal themselves to be awful people.
What defense mechanism is most likely at play in this patient?
A 40-year-old mid-level manager is referred by his company after a recent incident. He had been working on a major project that would secure his promotion and position in the firm. After months of hard work, he was just about to finalize the project when his team member made a mistake that caused a setback. Frustrated by the setback, your patient began yelling, stomping on the floor and throwing objects until he broke a window.
Which one of the following ego defences best describes his behaviour?