A 35-year-old male contacts his GP at 2PM to schedule his blood tests following a recent visit to his psychiatrist. The psychiatrist has raised his lithium dosage and requested that the GP arrange for lithium levels to be checked at the appropriate time after taking the medication. The patient took his first increased dose of lithium at 10AM (4 hours ago).
In how many hours should the GP schedule the blood test to be taken?
A 42-year-old accountant comes to see you for a follow-up review 2 weeks after presenting with symptoms suggesting low mood. He had felt ‘down’ for several weeks, no longer enjoyed work or seeing friends and was sleeping more than usual. Despite this, he had a normal appetite, a strong sense of self-worth, denied any thoughts of self-harm or suicide and came across as reasonably active and lively. He says that he feels very anxious on Sunday evenings before going to work on a Monday and is getting increasingly ‘short and snappy’ with his colleagues. However, he says that work is otherwise going well and he is managing to get through the day. He does not feel any better at today’s consultation and is requesting advice about treatment options. He says he is ‘not a tablet person’.
What should you advise?
A 19-year-old male presents to the Emergency Department after consuming eight paracetamol tablets, four cans of strong cider and two mouthfuls of bleach in an attempt to end his life. He reports feeling extremely anxious and low in mood for the past week following a recent argument with his girlfriend. He believes he has no worth in society and thinks he is ‘better off dead’, hoping his girlfriend will understand how low he has been recently now that he has almost succeeded in ending his own life. He takes no regular medication and has a history of depression for which he sees his GP. He has no relevant family history. He has been to the emergency department with suicide attempts eight times in the last six months. He has no history of deliberate self-harm otherwise.
What is the necessary feature required for a diagnosis of a personality disorder?
A person in their mid-30s has been taking an anti-psychotic medication for a few years. They have also recently begun taking fluoxetine. During a visit to their general practitioner, they reported experiencing troubling symptoms such as lip smacking, difficulty swallowing, and excessive blinking. What is the probable diagnosis?
A 50-year-old man with schizophrenia who is on chlorpromazine experiences a bilateral resting tremor. Which side effect of antipsychotic medication does this exemplify?
A 30-year-old woman, with a history of hearing voices, was brought to the Emergency Department by her family. She described the voices as telling her to kill her father as ‘he has the devil in him’. She also reported noting her intelligence being tapped through the Internet by a higher power. This has been going on for the past 6 months. Her family denies either depression or manic episodes. The patient was admitted to an inpatient Psychiatry Unit and started on haloperidol for her symptoms, after an evaluation and diagnosis of schizophrenia. Twelve hours after initiation of therapy, the patient started to have stiffness in the neck muscles and spine. Physical examination revealed muscular spasms in the neck and spine, a temperature of 37.2 °C, blood pressure 125/70 mmHg and a pulse of 80 bpm.
What is the most likely diagnosis?
A 56-year-old man presents to the community mental health team with a history of obsessive-compulsive disorder (OCD). He reports obsessive thoughts about his family members being in danger and admits to calling his wife and daughters 3-4 times an hour to ensure their safety. Despite undergoing cognitive behaviour therapy (CBT) with exposure and response prevention (ERP), he still experiences distressing symptoms. The patient has a medical history of hypertension, hypercholesterolaemia, unstable angina, and pre-diabetes. What would be the most appropriate course of action for managing this man’s OCD?
Sarah is a 35-year-old married woman with two children. She comes to you in distress and expresses suicidal thoughts, stating that she has considered taking an overdose. She has no history of self-harm or suicide attempts, and no psychiatric background. Despite having a loving family and enjoying her job, she is struggling. What is a risk factor for suicide in this case?
A 32-year-old man is referred by his general practitioner (GP) for counselling. He describes being incredibly happy with his long-time girlfriend, describing how they have been together for 10 years. They go out shopping together, own a successful business together, frequently host parties and are very outgoing and popular. But when his partner brings up marriage, he convulses with fear. ‘I know it’s ridiculous, but I really think if we get married, everything will suddenly be terrible.’
Which of the following best describes this patient?
A 36-year-old woman is admitted to the Emergency Department following taking approximately 18 paracetamol tablets three hours earlier. She had a row with her husband and took the tablets as she was angry and upset. She called her husband after she took the tablets, who rang for an ambulance.
This is the first time she has ever done anything like this, and she regrets the fact that she did it. She is currently studying at university, and only drinks recreationally. She is normally fit and well and has no history of mental health conditions.
Which of the following factors are associated with increased risk of a further suicide attempt in someone who has already made a suicide attempt?