A 25-year-old woman with schizophrenia visits you with her caregiver on a Monday morning. She informs you that she was out of town over the weekend and misplaced her prescribed clozapine, which she takes at a dosage of 200 mg in the morning and 400 mg at night. She hasn’t taken any since Friday evening and seems to be experiencing psychotic symptoms. Her caregiver mentions that this is the first time she has ever lost her medication.
What course of action should you take?
A 28-year-old unemployed man is evaluated by the Community Psychiatry Team due to a decline in his schizophrenia. The patient was initiated on medication two months ago after being diagnosed with the condition. However, he was unable to tolerate the initial treatment prescribed, and the patient’s mother reports that her son’s psychotic symptoms have persisted and may have even slightly worsened, despite starting a different type of medication. What is the most potent antipsychotic for stubborn psychotic symptoms?
Sarah is a 38-year-old female who was diagnosed with post-traumatic stress disorder (PTSD) following a car accident two years ago. Similar to Steven, Sarah has been experiencing difficulty with sleep since the accident. She frequently wakes up in the middle of the night due to nightmares and struggles to fall back asleep. This has been affecting her daily life as she no longer has the energy to keep up with her young children.
Sarah has undergone several sessions of cognitive behavioural therapy (CBT), but unfortunately, she has not seen any significant improvement in her symptoms.
What would be the appropriate medication to manage Sarah’s condition?
A 30-year-old man is exhibiting changes in mental status. He has been staying up most nights for the past month, working on four different novels simultaneously. He has not left his home or eaten in the last week and refuses to do so. Additionally, he has started gambling. During the consultation, he appears easily distracted and responds to questions with nonsensical sentences made up of random words. A collateral history was necessary to gather information. There is no evidence of drug misuse, and he is currently being treated for depression. When his family attempts to understand his behavior, he accuses them of trying to hold him back from achieving fame. What is the most likely diagnosis?
A 27-year-old woman comes to the GP for a mental health check-up. She had previously sought help 9 months ago for a major depressive episode that was successfully treated with fluoxetine, which she has now discontinued. Presently, she reports feeling fantastic. She has only slept for 4 hours each night over the past 5 days and has been busy renovating her entire house while still managing to attend work, where her boss has commended her on her newfound confidence and productivity. You observe that she speaks rapidly and that her thoughts are occasionally difficult to follow. There are no indications of self-neglect. What is the probable diagnosis?
A 26-year-old man presents with complaints of hearing voices named ‘Tommy and Timmy’ who talk to him constantly. Initially, they would inquire about his activities, but lately, they have become derogatory, urging him to end his life and calling him worthless. Sometimes, they converse with each other about him, but he can still hear their unpleasant remarks. He seems frightened and bewildered. He is now convinced that Tommy and Timmy are the spirits of deceased children searching for another body to possess. The man’s concerned sibling, who has accompanied him, reports that he has been experiencing these symptoms consistently for the past eight months. He is typically a reserved individual who never gets into trouble or uses drugs.
What is the most probable diagnosis for this man?
A 45-year-old woman is brought in by her daughter because ‘she is acting wild again’. She drinks moderately about once a week. She is not sleeping much, talks incessantly about plans to travel the world and has made many impulsive and irrational purchases. She reports hearing voices but refuses to discuss this issue when questioned by the admitting psychiatrist. She begins a task but does not complete it, all the while making lists of things to be done. She has been starting tasks and not finishing them. She had a similar episode 3 years ago. She also has depressive episodes several times over the last few years and recovered in between them.
What is the most likely underlying diagnosis?
A 32-year-old office worker presents to the Emergency Department after taking a handful of various tablets following an argument with her current partner. She has a history of tumultuous relationships and struggles to maintain friendships or romantic relationships due to this. She also admits to experiencing intense emotions, frequently oscillating between extreme happiness and anger or anxiety. In the past, she has engaged in self-harm and frequently drinks to excess. A psychiatry review is requested to evaluate the possibility of a personality disorder. What personality disorder is the most probable diagnosis for this patient?
A 25-year-old woman comes to the emergency department with suicidal ideation after a fight with her partner. She has a history of relationship problems and frequently argues with loved ones. She denies having any paranoid thoughts or unusual beliefs but reports hearing a voice in her head that describes her negative thoughts. Upon examination, you observe several superficial scars on her forearms. There is no evidence of delusions or abnormal speech. What is the most probable diagnosis?
A 28-year-old man who works as a software engineer has recently been terminated by his supervisor, citing missed deadlines and a decline in the quality of his work. He disputes this and claims that his supervisor has always had a personal vendetta against him. He has confided in his family and close friends, but despite their reassurances, he believes that some of his colleagues were colluding with his supervisor to oust him. During his mental health evaluation, he appears to be generally stable, except for his fixation on his supervisor and coworkers conspiring against him. His family reports that he is easily offended and has a tendency to believe in conspiracies. What is the most probable diagnosis?