Niche but important
Rare, but missing it harms. 109 questions.
An 81-year-old woman has a severe depressive episode with nihilistic delusions. She has refused all food and fluid for four days and is dehydrated, saying that…
Psychiatry · Pre-internship · niche
An 80-year-old woman is admitted for assessment of cognitive decline. Her daughter says her memory 'fell off a cliff' in the five months since her husband died.…
Psychiatry · Pre-internship · niche
A 16-year-old Aboriginal boy is brought to a regional clinic by his aunt six weeks after his grandmother died. He says he hears his grandmother calling his name…
Psychiatry · Pre-internship · niche
A 29-year-old woman with borderline personality disorder has been in dialectical behaviour therapy for four months. Her self-harm has fallen from weekly to once…
Psychiatry · Pre-internship · niche
A 26-year-old woman is assessed by a community mental health team. She has a lifelong pattern of unstable relationships, impulsive self-harm and chronic emptine…
Psychiatry · Clinical rotations · niche
A 16-year-old boy with anorexia nervosa weighing 39 kg was admitted three days ago and nasogastric feeding was commenced and increased daily. He has received th…
Psychiatry · Pre-internship · niche
A 26-year-old woman with a two-year eating disorder is admitted with cramps and profound weakness. She weighs 58 kg and has not lost weight. She denies vomiting…
Psychiatry · Pre-internship · niche
A 26-year-old woman with a history of childhood sexual abuse collapses in the emergency department waiting room and develops generalised shaking. Twelve minutes…
Psychiatry · Pre-internship · niche
A 36-year-old woman was abused by a relative between the ages of six and sixteen. She has nightmares about it, avoids the suburb where it happened and startles…
Psychiatry · Pre-internship · niche
At a hospital grand round on mental health funding, a registrar is asked how much Australia spends on mental health. She finds several different figures in circ…
Psychiatry · Clinical rotations · niche
A 74-year-old woman has been an inpatient for five weeks with a severe depressive episode. She has completed adequate trials of sertraline and then venlafaxine…
Psychiatry · Pre-internship · niche
A 62-year-old man is reviewed in the cardiology clinic eight weeks after an anterior myocardial infarction. He meets criteria for a moderate depressive episode…
Psychiatry · Pre-internship · niche
A 22-year-old woman is admitted after three weeks of increasingly odd behaviour. Her mother says she had a flu-like illness a month ago, then became convinced h…
Psychiatry · Clinical rotations · niche
A 63-year-old woman has taken slow-release morphine for eighteen months for pain from vertebral metastases, prescribed and reviewed monthly by her oncologist. S…
Psychiatry · Pre-internship · niche
A 76-year-old man with dementia with Lewy bodies has become convinced that his son is stealing from him and has started accusing and shoving care staff. Over th…
Psychiatry · Pre-internship · niche
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…
Psychiatry · Pre-internship · niche
A 78-year-old woman is on day six after an elective right hemicolectomy. Since the second postoperative day she has had episodes lasting about twenty minutes in…
Psychiatry · Pre-internship · niche
You are the intern on a geriatric medicine ward in Perth. An 84-year-old woman who developed a hyperactive delirium during her admission for pneumonia is being…
Psychiatry · Clinical rotations · niche
A 23-year-old woman is brought in by her partner with three weeks of escalating persecutory beliefs, agitation and rambling speech. Over the past week he has no…
Psychiatry · Clinical rotations · niche
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…
Psychiatry · Pre-internship · niche