Middle twist
One twist — a threshold, a comorbidity, an atypical presentation. 776 questions.
A 24-year-old man with schizophrenia has had three admissions in eighteen months. He receives paliperidone palmitate by monthly injection at the clinic and ever…
Psychiatry · Pre-internship · middle twist
A 44-year-old man has adjustment disorder with anxious mood following a workplace investigation. Over eight weeks he has completed six sessions of cognitive beh…
Psychiatry · Pre-internship · middle twist
A 14-year-old boy is brought in by his mother because of his behaviour over the past two months. Since his parents separated he has sworn at teachers, walked ou…
Psychiatry · Clinical rotations · middle twist
A 34-year-old woman has been treated for adjustment disorder with depressed mood for ten months, since her only son sustained a spinal cord injury and she becam…
Psychiatry · Pre-internship · middle twist
A 79-year-old woman lives alone in the house she owns. She tells the general practice registrar that her grandson shouts at her when he visits and has twice sho…
Psychiatry · Pre-internship · middle twist
An 83-year-old man with moderate Alzheimer disease has a large symptomatic inguinal hernia and the surgeon has recommended repair. He lives in a hostel, cannot…
Psychiatry · Clinical rotations · middle twist
A 78-year-old retired farmer is brought in by his wife with four months of tiredness, vague upper abdominal discomfort and aching legs. He has lost 5 kg. He sto…
Psychiatry · Clinical rotations · middle twist
A 79-year-old woman is an inpatient on a psychiatric ward being treated for a depressive episode. She is oriented, gives a coherent account of her illness and i…
Psychiatry · Pre-internship · middle twist
A 79-year-old man was prescribed temazepam 10 mg at night when his wife died four months ago, to help him sleep for a few nights. He has taken it every night si…
Psychiatry · Pre-internship · middle twist
A 77-year-old woman is brought to the emergency department by her daughter because she has become confused and unsteady over three days. Five weeks ago her gene…
Psychiatry · Clinical rotations · middle twist
A general practice in a regional Western Australian town is auditing its patients aged 65 years and over as part of a suicide prevention programme. None of the…
Psychiatry · Clinical rotations · middle twist
An 80-year-old woman with moderate Alzheimer disease in residential care has been agitated and wandering at night for five days, and is drowsy during the day. S…
Psychiatry · Pre-internship · middle twist
A 73-year-old woman presents with four months of worry, restlessness and difficulty sleeping. She has never been an anxious person and nothing in her circumstan…
Psychiatry · Clinical rotations · middle twist
An 82-year-old woman with mild dementia is admitted from home with three days of confusion that fluctuates and is worse at night. She is drowsy but rousable and…
Psychiatry · Pre-internship · middle twist
An 84-year-old woman is referred for assessment of memory loss. Her daughter says she has become withdrawn at family gatherings and often answers questions inap…
Psychiatry · Clinical rotations · middle twist
An 84-year-old man with mild Alzheimer disease is brought to the emergency department by his daughter. For two days he has been drowsy after lunch and then agit…
Psychiatry · Pre-internship · middle twist
An 81-year-old woman who came to Australia from Viet Nam at the age of 55 is brought by her son because of two years of gradually worsening memory. She left sch…
Psychiatry · Clinical rotations · middle twist
A 15-year-old girl has lost 12 kg over five months and eats about 600 kcal a day. She is alert, has attended school all week, and her parents can start family-b…
Psychiatry · Pre-internship · middle twist
A 16-year-old girl has had major depression for five months. She has completed 10 sessions of cognitive behavioural therapy but still cannot attend school, has…
Psychiatry · Pre-internship · middle twist
A 12-year-old boy with autism spectrum disorder and moderate intellectual disability has been banging his head on walls and biting his forearms several times a…
Psychiatry · Clinical rotations · middle twist