Core
Clinical
Cases in
Psychiatry
ND
2 EDITION
,Contents
Series preface vi
Preface vii
Abbreviations ix
Chapter 1 Psychosis 1
Chapter 2 Mood disorders 23
Chapter 3 Anxiety disorders 37
Chapter 4 Chronic disorders 53
Chapter 5 Older people 65
Chapter 6 Young people 79
Chapter 7 Psychiatry in general medical settings 97
Chapter 8 Substance misuse 113
Chapter 9 Psychiatry and aggression 127
Index 141
, Psychosis
Questions
Clinical cases 2
OSCE counselling cases 4
Key concepts 5
Answers
Clinical cases 8
OSCE counselling cases 19
Revision panel 21
, 2 Psychosis
Questions
Clinical cases
For each of the case scenarios given, consider the following:
Q1: What is the likely differential diagnosis?
Q2: What information in the history supports the diagnosis, and what other information
would help to confirm it?
Q3: What might the important aetiological factors be?
Q4: What treatment options are available?
Q5: What is the prognosis in this case?
CASE 1.1 – Gradual onset of paranoid symptoms
A 24-year-old biology graduate is referred to the outpatient department by his general practitioner (GP).
He attends with his mother, who has been becoming increasingly concerned about him for some time.
He tells you that he is feeling fine in himself. Objectively, you notice that he has reduced spontaneous
movements, his tone of voice is monotonous and soft in volume. There is some suggestion that he is
defensive or suspicious as he often asks you the reason for your questions and refuses to answer some
personal questions. His mood is flat, showing little reactivity during the course of the interview, but he
denies feeling depressed. He denies any psychotic symptoms and you are unable to detect any thought
disorder.
His mother tells you that she began to worry 2 years ago after he finished his university degree
course. He had previously been a high achiever, both academically and socially, with many friends and a
hectic social life. However, since returning from university with a disappointing third class degree, he had
made no efforts to gain any job and seemed to have lost contact with all of his friends. He was spending
all of his time alone, often remaining upstairs in his bedroom for hours on end and interacting less and
less with his family. More recently, he had begun to express some odd ideas, suggesting that someone
was watching him and that other people knew where he was and what he was doing. His personal
hygiene has begun to deteriorate, and he now refuses to allow his mother to clean his bedroom, which
is becoming increasingly cluttered and dirty.
CASE 1.2 – Acute-onset florid psychosis
You are asked urgently to assess a 24-year-old woman who has recently moved to a large city to find
work. She previously lived in a small rural community, and has had difficulty adapting to city life and
finding employment. She gave up her job 2 weeks ago because it was not the sort of thing she was used
to. Her boyfriend describes her as becoming ‘increasingly anxious’ throughout the last week, and her
conversation increasingly confused and difficult to follow. She has not been sleeping well at night, often
staying up doing housework all night and then sleeping during the day. For the 2 days prior to admission
her behaviour had become extremely bizarre. She began to talk about people being hidden in the roof
of her flat, saying that she could hear them sneezing and coughing, and could smell them as they
passed in and out of the building. At one stage she said that she was a goddess who had been chosen
to rid the world of evil. Sometimes she seemed happy, sometimes sad, and often very anxious and tense.
Clinical
Cases in
Psychiatry
ND
2 EDITION
,Contents
Series preface vi
Preface vii
Abbreviations ix
Chapter 1 Psychosis 1
Chapter 2 Mood disorders 23
Chapter 3 Anxiety disorders 37
Chapter 4 Chronic disorders 53
Chapter 5 Older people 65
Chapter 6 Young people 79
Chapter 7 Psychiatry in general medical settings 97
Chapter 8 Substance misuse 113
Chapter 9 Psychiatry and aggression 127
Index 141
, Psychosis
Questions
Clinical cases 2
OSCE counselling cases 4
Key concepts 5
Answers
Clinical cases 8
OSCE counselling cases 19
Revision panel 21
, 2 Psychosis
Questions
Clinical cases
For each of the case scenarios given, consider the following:
Q1: What is the likely differential diagnosis?
Q2: What information in the history supports the diagnosis, and what other information
would help to confirm it?
Q3: What might the important aetiological factors be?
Q4: What treatment options are available?
Q5: What is the prognosis in this case?
CASE 1.1 – Gradual onset of paranoid symptoms
A 24-year-old biology graduate is referred to the outpatient department by his general practitioner (GP).
He attends with his mother, who has been becoming increasingly concerned about him for some time.
He tells you that he is feeling fine in himself. Objectively, you notice that he has reduced spontaneous
movements, his tone of voice is monotonous and soft in volume. There is some suggestion that he is
defensive or suspicious as he often asks you the reason for your questions and refuses to answer some
personal questions. His mood is flat, showing little reactivity during the course of the interview, but he
denies feeling depressed. He denies any psychotic symptoms and you are unable to detect any thought
disorder.
His mother tells you that she began to worry 2 years ago after he finished his university degree
course. He had previously been a high achiever, both academically and socially, with many friends and a
hectic social life. However, since returning from university with a disappointing third class degree, he had
made no efforts to gain any job and seemed to have lost contact with all of his friends. He was spending
all of his time alone, often remaining upstairs in his bedroom for hours on end and interacting less and
less with his family. More recently, he had begun to express some odd ideas, suggesting that someone
was watching him and that other people knew where he was and what he was doing. His personal
hygiene has begun to deteriorate, and he now refuses to allow his mother to clean his bedroom, which
is becoming increasingly cluttered and dirty.
CASE 1.2 – Acute-onset florid psychosis
You are asked urgently to assess a 24-year-old woman who has recently moved to a large city to find
work. She previously lived in a small rural community, and has had difficulty adapting to city life and
finding employment. She gave up her job 2 weeks ago because it was not the sort of thing she was used
to. Her boyfriend describes her as becoming ‘increasingly anxious’ throughout the last week, and her
conversation increasingly confused and difficult to follow. She has not been sleeping well at night, often
staying up doing housework all night and then sleeping during the day. For the 2 days prior to admission
her behaviour had become extremely bizarre. She began to talk about people being hidden in the roof
of her flat, saying that she could hear them sneezing and coughing, and could smell them as they
passed in and out of the building. At one stage she said that she was a goddess who had been chosen
to rid the world of evil. Sometimes she seemed happy, sometimes sad, and often very anxious and tense.
