Psychosis

A 45-year-old woman with bipolar I disorder, stable on lithium carbonate 1,000 mg nightly for six years with levels consistently 0.7–0.8 mmol/L, presents with t…

Pre-internship · middle twist

A 52-year-old man born in Vietnam, who has had schizophrenia for 25 years, comes to an emergency department with six hours of epigastric pain. He speaks limited…

Pre-internship · niche

A 44-year-old man with treatment-resistant schizophrenia has taken clozapine 400 mg at night for six years and smokes 30 cigarettes a day. He is admitted to a s…

Pre-internship · middle twist

A 49-year-old woman with schizophrenia has taken olanzapine for 12 years and attends a community clinic. Over three months she has become thirsty, gets up twice…

Clinical rotations · middle twist

A 22-year-old apprentice electrician has recovered from a first episode of psychosis and is well on aripiprazole. He lives with his parents, has no debts, showe…

Clinical rotations · common

A 31-year-old man with schizophrenia has had four admissions in 18 months. He lives alone in a boarding house, keeps about one clinic appointment in five, and e…

Pre-internship · middle twist

A 24-year-old man had a first episode of schizophrenia nine months ago and has remained well on risperidone. He lives with his mother, who gave up her part-time…

Clinical rotations · middle twist

A 27-year-old man with schizophrenia remains persistently deluded and hears voices for most of each day. He has completed eight weeks of risperidone 6 mg daily…

Pre-internship · middle twist

A 24-year-old man with schizophrenia has been taking clozapine for 17 days, titrated to 250 mg daily after two other antipsychotics failed. He reports three day…

Clinical rotations · middle twist

A 29-year-old woman is admitted with a first manic episode. She has not slept for four nights, has telephoned strangers at 3 am and has spent her rent money on…

Pre-internship · niche

A 23-year-old man with treatment-resistant schizophrenia started clozapine eighteen days ago and now takes 250 mg daily. He tells the nurse he feels as though h…

Clinical rotations · middle twist

A 46-year-old man with schizophrenia has taken clozapine 400 mg daily for four years without a dose change. Over the past ten days he has become drowsy in the a…

Pre-internship · niche

A 22-year-old man with a first psychotic episode has taken olanzapine 10 mg daily for six weeks. His delusional beliefs have largely resolved and he has returne…

Pre-internship · middle twist

A 27-year-old man with schizophrenia has taken amisulpride 1200 mg daily for ten weeks and, before that, olanzapine 20 mg daily for twelve weeks. Both were give…

Pre-internship · middle twist

A 24-year-old man with schizophrenia has been prescribed risperidone 6 mg daily for eight weeks since his first admission. He still hears two voices commenting…

Clinical rotations · middle twist

A 41-year-old man with bipolar I disorder is brought to a Perth community mental health clinic by his mother, who wants him put in hospital. He stopped lithium…

Pre-internship · middle twist

A 29-year-old woman is seen at home on day nine after the birth of her first child. Her husband says she has not slept for three nights, is talking rapidly abou…

Pre-internship · middle twist

A 17-year-old boy was assessed six weeks ago with four months of social withdrawal and fleeting suspiciousness, and was referred for psychological therapy. He r…

Pre-internship · middle twist

A 17-year-old girl is brought to her general practitioner by her father. Over eight months she has stopped seeing friends, dropped from an A to a D average, sle…

Clinical rotations · middle twist

A 19-year-old man is admitted with a four-week history of persecutory beliefs and voices commenting on his actions. He has used methamphetamine most days for a…

Clinical rotations · middle twist

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…

Pre-internship · middle twist

An 83-year-old woman in residential care has advanced Alzheimer disease. Over six weeks she has repeatedly struck staff during personal care and shouts that the…

Pre-internship · common

A 29-year-old man with bipolar I disorder is reviewed in the community mental health clinic. He was admitted at 22 with a manic episode and stopped lithium thre…

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…

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…

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…

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…

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…

Clinical rotations · middle twist

A 19-year-old man is admitted with a first episode of psychosis after eight weeks of persecutory beliefs and voices. He has never taken an antipsychotic. His bo…

Clinical rotations · common

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…

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…

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…

Clinical rotations · middle twist

A 26-year-old woman is reviewed at home on day 8 after the birth of her first child. Over three days she has slept about two hours a night, talks rapidly about…

Pre-internship · common

A 23-year-old apprentice has had persecutory beliefs and voices commenting on his actions continuously for three months. He has stopped attending work and rarel…

Clinical rotations · common

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…

Pre-internship · 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…

Pre-internship · middle twist

A 27-year-old man with schizophrenia is assessed at home in Perth after his sister contacted the community mental health team. He stopped his olanzapine six wee…

Pre-internship · niche

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,…

Clinical rotations · middle twist

A 78-year-old man admitted a fortnight ago with a first psychotic illness had his risperidone increased from 1 mg to 3 mg daily seven days ago. Since then he ha…

Pre-internship · middle twist

A 24-year-old man admitted with a first episode of psychosis started olanzapine six days ago and had the dose increased four days ago; he has also taken sertral…

Pre-internship · niche