Pre-internship
The harder call — the unwell patient, escalation, prioritisation, prescribing detail, ethics and law. 456 questions.
A 74-year-old woman is referred with six months of worry, restlessness and broken sleep. She has never been anxious before and can point to no trigger. She has…
Psychiatry · 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…
Psychiatry · Pre-internship · middle twist
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 47-year-old farmer is brought to a regional emergency department by his brother. Over three months he has withdrawn from the family, stopped eating with them…
Psychiatry · Pre-internship · common
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 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 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 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 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 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 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 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…
Psychiatry · Pre-internship · 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…
Psychiatry · 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…
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 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 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