Antipsychotics

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 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 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

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 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 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 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 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 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

A 24-year-old man with treatment-resistant schizophrenia is on day 18 of clozapine, now 250 mg at night. He is febrile at 38.4 degrees Celsius with a pulse of 1…

Pre-internship · niche

A 19-year-old man received his first ever dose of an antipsychotic 14 hours ago, having been admitted with psychosis. He calls the nurse because his neck has pu…

Pre-internship · middle twist

A 46-year-old man with schizophrenia becomes restless and confused two days after his haloperidol dose was increased. He is febrile at 39.8°C, has widespread mu…

Pre-internship · common

A 41-year-old woman has been stable on clozapine for 18 months but presents with fever, painful swallowing and malaise. Her temperature is 38.5°C and her absolu…

Clinical rotations · common

A 48-year-old man presents with severe persecutory psychosis and requires medication after verbal de-escalation has failed. He has no history of cardiac disease…

Clinical rotations · middle twist

A 38-year-old woman with bipolar disorder started haloperidol 10 days ago for a manic episode. She now reports that she cannot sit still, repeatedly walks aroun…

Clinical rotations · middle twist

A 32-year-old woman at 10 weeks’ gestation presents with four days of almost no sleep, excessive spending and increasingly intrusive plans to start several busi…

Clinical rotations · middle twist

A 28-year-old man with schizophrenia that failed to respond to two previous antipsychotics has been taking clozapine for four months with good effect. He presen…

Clinical rotations · common