Middle twist

A 34-year-old woman attends for a routine health check. She drinks four to five standard drinks on each of five evenings a week and has done so for three years.…

Psychiatry · Clinical rotations · middle twist

A 27-year-old man attends a community drug and alcohol service at 9 am asking to start buprenorphine. He has injected heroin daily for four years and last injec…

Psychiatry · Pre-internship · middle twist

A 47-year-old man completed inpatient alcohol withdrawal and has been abstinent for eight days. He wants medication to help him stay off alcohol and is attendin…

Psychiatry · Clinical rotations · middle twist

A 54-year-old man is admitted eighteen hours after his last drink, anxious, sweating and coarsely tremulous, with a pulse of 108/min and a blood pressure of 150…

Psychiatry · Pre-internship · middle twist

A 41-year-old woman stabilised on methadone 80 mg daily for opioid dependence has had open reduction and internal fixation of an ankle fracture. Four hours late…

Psychiatry · Pre-internship · middle twist

A 29-year-old man who has injected heroin daily for six years has completed a seven-day inpatient withdrawal. He is medically well and has declined both methado…

Psychiatry · Pre-internship · middle twist

You are the intern on a geriatric ward. An 84-year-old woman admitted six days ago with pneumonia was disorientated and inattentive for her first three days; sh…

Psychiatry · Pre-internship · middle twist

A 72-year-old woman who came to Australia from Vietnam forty years ago is brought to a memory clinic by her son, who describes two years of gradually worsening…

Psychiatry · Clinical rotations · middle twist

A 79-year-old man attends with his wife for the results of a memory assessment, which has confirmed mild Alzheimer disease. He lives at home, manages his own fi…

Psychiatry · Pre-internship · middle twist

A 78-year-old woman is brought by her daughter because over eighteen months she has become slower at finding words and repeatedly mislays her keys. She still dr…

Psychiatry · Clinical rotations · middle twist

A 74-year-old man is brought by his wife because for the past year he has described the small children who come into the lounge room most afternoons; he can say…

Psychiatry · Clinical rotations · middle twist

An 88-year-old man on a medical ward has a delirium precipitated by pneumonia and is receiving appropriate antibiotics. Overnight he is terrified by figures he…

Psychiatry · Pre-internship · middle twist

An 84-year-old woman was admitted three days ago with cellulitis, which is settling on flucloxacillin. Since yesterday she has been muddled at night, insists th…

Psychiatry · Clinical rotations · middle twist

A 79-year-old woman with moderate Alzheimer disease in residential care has become resistive over the past week. She shouts and pushes staff away during showeri…

Psychiatry · Pre-internship · middle twist

An 82-year-old man with Alzheimer disease diagnosed four years ago lives in residential care, where he usually plays cards each afternoon and needs help only wi…

Psychiatry · Clinical rotations · middle twist

A 34-year-old man with schizophrenia has relapsed twice in nine months, on each occasion a few weeks after stopping his oral risperidone. He is currently well,…

Psychiatry · Clinical rotations · middle twist

A 31-year-old woman is reviewed at home by the perinatal mental health team three weeks after the birth of her first child. She has not slept for four nights, h…

Psychiatry · Pre-internship · middle twist

A 19-year-old university student is in the emergency department six hours after her flatmate found her drowsy on the bathroom floor beside an empty blister pack…

Psychiatry · Clinical rotations · middle twist

An 86-year-old man who lives alone is brought to the emergency department by his daughter because he has been muddled for two days and twice called her by his l…

Psychiatry · Pre-internship · middle twist

A 72-year-old woman born in Vietnam attends with her daughter, who reports that over two years her mother has become repetitive, has twice left the stove burnin…

Psychiatry · Clinical rotations · middle twist