Cases

Question 1

45y/o woman presents with a 1mth history of poor sleep and irritable mood, in the setting of a recent divorce and ongoing custody battle with her former husband over their 2 teenage children. She has also just had a bad performance review at work due to her inability to meet deadlines and she is fearful of losing her job.

Answer 1

Depression

• Sertraline; first line in this patient due to associated anxiety.

Question 2

20y/o man presents to A&E accompanied by his parents, owing to a change in mental state and behaviour, marked by uncharacteristic argumentativeness, eruptions of laughter, excessive talking and unusual thoughts. He is being treated for depression and insomnia, and has recently been drinking more alcohol.

Answer 2

Bipolar affective disorder

• Onlanzapine; initially to deal with manic state.
• Lithium carbonate; used as a long-term mood stabiliser.

Question 3

25y/o female presents to her GP with complaints of muscle tension, especially in her shoulders and neck, contributing to tension headaches. She describes having trouble sleeping, chronic fatigue and constant restlessness in addition to poor concentration at work. She admits to being a worrier since she was a child, but is currently struggling to manager her worry.

Answer 3

Generalised anxiety disorder

• Sertraline
• Diazepam; may be required during acute attack.

Question 4

38y/o man presents to A&E for the 2nd time in 4wks with sudden-onset chest pain, tachycardia, SOB, dizziness and sweating. He says he is afraid of having a heart attack and is afraid of “losing his mind”. Cardiac testing during both admission is normal.

Answer 4

Panic disorder

• Sertraline
• Diazepam; may be required during acute attack.

Question 5

40y/o man experiences intense worry several weeks before scheduled airline travel. However, he is required to fly several times each year with his work. His fear developed 2yrs ago following an extremely turbulent flight.

Answer 5

Specific phobia

• Sertraline; due to several flights a year BZDs would want to be avoided so as to reduce likelihood of addiction.

Question 6

32y/o man presents describing an intense fear of germs. He continually experiences thoughts about contracting an illness by coming into contact with things in the environment, such as doorknobs or sears in public places. He finds himself washing his hands for hours a day.

Answer 6

OCD

• Sertraline

Question 7

25y/o woman presents to A&E complaining of sad mood, nervousness, difficulty falling asleep and disinterest in her friends for the past 2mths. She notes these symptoms started following a rape by a former male friend at a party.

Answer 7

PTSD

• Paroxetine

Question 8

24y/o filing clerk at the local library is referred for assessment as a result of increasing tearfulness. He has recently graduated in computer science at university and was offered this job as he knows the librarians well, having spent most weekend at the library. It is difficult to establish a rapport with him as he is quite distance, that is until he start discussing AI in computer technology.

Answer 8

Autism

• Risperidone; can be used in the short term for significant aggression/tantrums.
• Methlyphenidate; can be used to combat ADHD symptoms.
• NO TREATMENT FOR CORE SYMPTOMS.

Question 9

15y/o girl accompanied by her mother, presents to her GP complaining of fatigue which has lasted 6mths. She appears quite petite and is wearing an oversized, baggy dress. During the examination the patient mentions how fat she has become. Her mother is concerned as her daughter has been eating little and exercising daily, and seems disinterested with her friends.

Answer 9

Anorexia

• Input from nutritionist and psychotherapy team.
• Sertraline; often co-morbid OCD and/or depression.

Question 10

25y/o woman complains that she is obsessed with eating and weight. During the consultation you notice calluces on the back of her hands.

Answer 10

Bulimia nervosa

• CBT, with nutritional and meal support.
• Fluoxetine; preferred in bulimia.

Question 11

22y/o unmarried white man presents to the clinic with his mother. He spends most of his time in the house and refuses to go out at night alone. He used to lived independently and worked until a few months ago. The patient states he made an error on his income tax statement and is convinced that the tax authorities have hired detectives to gather information about his whereabouts.

Answer 11

Schizophrenia

• Lorazepam/Diazepam; used to manage acute psychosis.
• Risperidone; used as long term mangaement, any atypical could be used here.