Psychiatry

A 28-year-old woman has depressed mood, anhedonia, insomnia, impaired concentration, and guilt for 6 weeks; denies mania; no substances; functioning impaired.

A 21-year-old man has 4 days of elevated mood, decreased need for sleep, pressured speech, and increased goal-directed activity with marked impairment; no substances.

A 32-year-old woman has 6 days of elevated mood, decreased need for sleep, talkativeness, and increased productivity, no psychosis, no impairment; partner notes “great week at work.”

A 24-year-old man has auditory hallucinations, delusions, disorganized behavior for 3 weeks; no mood symptoms; functioning declined.

A 19-year-old woman has psychosis for 2 months without mood symptoms; prodrome with social withdrawal.

A 30-year-old man has 1 year of delusions of infidelity without hallucinations or disorganization; normal functioning aside from relationship.

A 34-year-old woman has ≥7 months of psychosis with significant negative symptoms and functional decline; no prominent mood episodes.

A 29-year-old woman with 3 weeks of insomnia, weight loss, psychomotor agitation, and depressed mood after job loss; meets MDD criteria; requests fastest relief.

A 48-year-old with MDD improved partially on sertraline 200 mg/day; still anergia and sexual dysfunction.

A 37-year-old woman with MDD started on citalopram develops agitation, hyperreflexia, clonus, fever after adding linezolid for infection.

A 25-year-old man with panic attacks avoids crowded buses; has unexpected panic episodes and worries about new attacks.

A 19-year-old student has excessive worry for 9 months about multiple domains, fatigue, muscle tension, and insomnia.

A 26-year-old has intrusive thoughts of harming her infant and repetitive checking rituals to reduce anxiety; insight preserved.

A 30-year-old man fears public speaking with marked blushing, avoids presentations despite career cost.

A 8-year-old refuses school with nightmares about being away from mother; physical complaints before school; symptoms 3 months.

A 5-year-old selectively speaks at home but stays silent at school despite understanding language; symptoms >1 month.

A 24-year-old soldier has nightmares, flashbacks, hypervigilance, and avoidance 3 weeks after an IED blast.

A 36-year-old assaulted 5 months ago has intrusive memories, avoidance, sleep disturbance, and irritability; wants therapy.

A 22-year-old dancer restricts calories, has BMI 15, amenorrhea, bradycardia, lanugo, and distorted body image.

A 20-year-old woman binge eats with compensatory vomiting twice weekly for 4 months; weight normal; metabolic alkalosis and hypokalemia.

A 26-year-old man with MDD and past bullimia asks about bupropion.

A 42-year-old with insomnia, low appetite, and weight loss due to depression; needs a medication that improves sleep and appetite.

A 55-year-old man on phenelzine develops severe headache and HTN crisis after red wine and aged cheese.

A 63-year-old with schizophrenia on haloperidol develops sustained painful neck contraction and oculogyric crisis after dose increase.

A 27-year-old on risperidone develops akathisia (can’t sit still).

A 54-year-old man with schizophrenia has months of chewing and tongue movements; wants management.

A 35-year-old man on clozapine develops fever and sore throat; WBC 1.8K with ANC 0.4K.

A 38-year-old on clozapine has chest pain, dyspnea, and low EF 2 weeks after initiation.

A 58-year-old with schizoaffective disorder on olanzapine gains 12 kg; fasting glucose 178 mg/dL, triglycerides high.

A 46-year-old man on haloperidol develops fever, rigidity, confusion, CK 12,000, leukocytosis, and autonomic instability.

A 40-year-old man with bipolar disorder on lithium has tremor, polyuria/polydipsia; creatinine rising; TSH elevated.

A 28-year-old woman on lithium becomes pregnant (first trimester).

A 27-year-old man on valproate for bipolar disorder has abdominal pain and markedly elevated AST/ALT; ammonia elevated; platelets low.

A 31-year-old woman started on lamotrigine develops a painful, spreading morbilliform rash with mucosal involvement after dose escalation.

A 45-year-old with severe psychotic depression and food refusal needs rapid, safe treatment.

A 72-year-old man becomes acutely confused post-op; fluctuating attention, disorganized thinking, sleep-wake reversal; vitals stable; meds include opioids and diphenhydramine.

A 77-year-old with visual hallucinations, parkinsonism, cognitive fluctuations, and REM sleep behavior disorder.

A 58-year-old with stepwise cognitive decline, focal neurologic deficits after multiple strokes.

A 62-year-old with profound personality change, disinhibition, hyperorality; memory relatively preserved early.

A 35-year-old woman has somatic preoccupation with “defective nose” despite normal appearance; repeated mirror checking; significant distress.

A 29-year-old man presents repeatedly with dramatic neurologic symptoms (non-epileptic seizures) after stress; exam shows positive Hoover sign; no secondary gain.

A 33-year-old woman persistently worries about having cancer despite multiple negative exams; misinterprets normal sensations; frequently seeks reassurance.

A 50-year-old presents intoxicated, with slurred speech, ataxia, nystagmus, and respiratory depression; empty pill bottle of alprazolam found.

A 34-year-old with diaphoresis, tremor, tachycardia, anxiety, and seizures 36 hours after last drink; BP 170/100.

A 25-year-old with pinpoint pupils, respiratory depression, bradycardia after heroin use.

A 27-year-old with yawning, lacrimation, piloerection, myalgias, abdominal cramping, diarrhea, dilated pupils after stopping oxycodone.

A 19-year-old comes to ED with tachycardia, hypertension, diaphoresis, hypervigilance, mydriasis, and chest pain after “lines” at party; ECG shows ischemia.

A 22-year-old daily cannabis user presents with cyclic vomiting relieved by hot showers; normal workup.

A 16-year-old with poor grades, inattentiveness, forgetfulness, and fidgeting across school and home; onset before age 12.

A 6-year-old has repetitive motor and vocal tics for 1 year; impairment at school.

A 3-year-old avoids eye contact, lacks joint attention/pointing, has restricted interests, and language delay; hearing normal.

A 10-year-old bullies peers, steals, and tortures animals; truancy; no remorse.

A 9-year-old argues with adults, deliberately annoys, and blames others; grades okay; no aggression or theft.

A 32-year-old with chronic instability of relationships, impulsivity, self-injury, and intense fear of abandonment; mood lability.

A 40-year-old with long-standing distrust, reads hidden meanings in benign remarks, holds grudges; no psychosis.

A 28-year-old with perfectionism, rigidity, and control; preoccupied with rules; relationships strained; sees traits as desirable.

A 24-year-old presents with mutism, posturing, negativism, and waxy flexibility; medical workup negative.

A 67-year-old widower admits to passive wish to “join my wife,” denies plan/intent; has protective factors and agrees to safety plan; MDD treated.

A 30-year-old with schizophrenia threatens to kill a named coworker; you believe the threat is serious and imminent.

A 41-year-old intoxicated patient refuses laceration repair; he cannot state risks/benefits or a rational choice.