Middle twist
One twist — a threshold, a comorbidity, an atypical presentation. 776 questions.
A 46-year-old woman has been fully well for eight months on sertraline 100 mg daily. This is her fourth depressive episode; the previous three, at 30, 34 and 39…
Psychiatry · Pre-internship · middle twist
A 79-year-old woman was started on sertraline three weeks ago for her first depressive episode. Her daughter brings her to the emergency department because over…
Psychiatry · Pre-internship · middle twist
A 64-year-old woman attends the general practice with six weeks of low mood, tearfulness, broken sleep and loss of interest in everything she used to enjoy. Fiv…
Psychiatry · Pre-internship · middle twist
A 27-year-old man is assessed in the emergency department short-stay unit with three weeks of low mood, waking at 4 am and hopelessness. He has had two similar…
Psychiatry · Pre-internship · middle twist
A 24-year-old woman is referred because of mood swings since her late teens. Twice in two years she has had six-day spells of sleeping three hours a night, talk…
Psychiatry · Clinical rotations · middle twist
A 71-year-old man is three months into rehabilitation after a left middle cerebral artery infarct. He eats little and has lost 4 kg. He wakes at 4 am and cannot…
Psychiatry · Clinical rotations · middle twist
A 22-year-old university student had her first episode of psychosis nine months ago and has been in full remission on aripiprazole for the past seven months. Sh…
Psychiatry · Pre-internship · middle twist
A 27-year-old man with schizophrenia took risperidone 6 mg daily for ten weeks and then olanzapine 20 mg daily for twelve weeks. His case manager supervises eac…
Psychiatry · Pre-internship · middle twist
A 24-year-old man has recovered from his first episode of schizophrenia and has been well on aripiprazole for four months. He has moved back in with his parents…
Psychiatry · Clinical rotations · middle twist
A 21-year-old man is brought to a regional emergency department at 2 am by police after he was found standing on a freeway overpass. He says a voice has been te…
Psychiatry · Pre-internship · middle twist
A 19-year-old man is brought to the emergency department by police after being found shouting at parked cars. He is guarded, gives his name and little else, and…
Psychiatry · Clinical rotations · middle twist
A 17-year-old is brought to the general practitioner by his father, whose own brother has schizophrenia. Over eight months the boy's grades have fallen, he has…
Psychiatry · Pre-internship · middle twist
A 25-year-old man has taken risperidone 4 mg at night for six months for schizophrenia, and his voices and persecutory beliefs have gone. His mother says he now…
Psychiatry · Clinical rotations · middle twist
An 81-year-old widow has told her general practitioner at three visits over four months that a neighbour lets himself into her flat at night and moves her furni…
Psychiatry · Pre-internship · middle twist
A 47-year-old woman, whose mother died six weeks ago, tells her general practitioner that she has three times seen and spoken with her mother in the family home…
Psychiatry · Clinical rotations · middle twist
A 24-year-old man is admitted at 11 pm with a first episode of psychosis. He has had six weeks of persecutory beliefs and voices commenting on his actions, and…
Psychiatry · Pre-internship · middle twist
A 21-year-old student is brought to the emergency department at 3 am by his housemates. He has slept two hours in three days and has drunk eight cups of coffee.…
Psychiatry · Pre-internship · middle twist
A 24-year-old man is brought to the emergency department at 2 am by police. He has been using methamphetamine for three days, and is pacing, sweating and shouti…
Psychiatry · Pre-internship · middle twist
A 29-year-old man is seen by the consultation-liaison team. Over the past twelve months he has needed steadily more alcohol for the same effect, has twice tried…
Psychiatry · Clinical rotations · middle twist
A 68-year-old woman is admitted after a fall at home. She says she takes 'a sleeping tablet now and then' and drinks 'a small sherry before bed'. Her speech is…
Psychiatry · Clinical rotations · middle twist