For each of the following clinical situations, select the most appropriate pharmacological treatment. Options: A Amitriptyline - ~H Olanzapine B_ Aripiprazole 1 perdal consta © Chlorpomazine J idone D Clozapine K Sertraline E Haloperidol L Sodium valproate F Lithium M = Zuclopenthixol decanoate G__ Mirtazapine Questions: 6. A 25 year old single male on a disability pension, living in supported accommodation has been diagnosed with chronic paranoid schizophrenia since age 17. Multiple medications have not been effective in preventing ongoing psychotic symptoms. He has partial insight and has been compliant with his treatment by the continuing care team. You have been asked to review his antipsychotic medications. 7. 80 year old married female lawyer has presented with her second manic episode. She has been diagnosed with bipolar affective disorder. Her medical history includes diabetes complicated by renal impairment and obesity. 8. A221 year old single male is on a disability pension and living alone. He has a two year history of disorganized schizophrenia complicated by polysubstance abuse, poor insight and non-compliance. He is currently an inpatient treated with oral olanzapine. Investigations reveal an elevated prolactin level of 2000 ng/l. He is about to be discharged into the community. 9. A30 year old single male living with his elderly parents is referred by his GP to the continuing care unit with a 5 year history of increasing psychosocial decline and social isolation. On mental state examination, he displays a blunted affect, poverty of thought and speech but not clear delusions or hallucinations. He currently spends his time lying on his bed, not sleeping. His parents find it hard to motivate him to do anything including attending to his personal hygiene.For each of the following patients select the most appropriate next speci: investigation. Options: ‘A blood lipids H__ full blood examination B__ blood sugar 1 LFTs © calcium J phosphate D CSF studies K serum lithium EC. brain L serum troponin F serum electrolytes M syphilis serology G__ echocardiogram N___ thyroid function tests Questions: 10. A285 year old man with treatment resistant schizophrenia presents with fever and mouth ulcers twenty weeks after commencing clozapine. 41. A.50 year old man with treatment resistant schizophrenia presents with shortness of breath on exertion and ankle swelling twelve months after commencing clozapine. 12. _A45 year old woman on lithium for 10 years with stable blood levels complains of feeling cold, forgetful and slowed down. 13. _A70 year old woman with dementia, living in a nursing home, presents with progressive right sided weakness and aphasia several weeks after falling and striking her head 14. _A.40 year old man, known to be on maintenance treatment for bipolar disorder, is brought to E.D. semi-comatose, dysarthric and ataxic. His family report that he has recently been commenced on an anti-hypertensive by his GP.Which diagnosis best fits the following scenario, when reviewed in the context of consultation liaison psychiatry? Options: A ‘Adjustment disorder with H_ Munchausen syndrome by proxy depressed and anxious mood B Borderline personality disorder. 1 Panic disorder C Conversion disorder J Post traumatic stress disorder D Delusional disorder K Primary insomnia E Factitious disorder L_ Pseudoseizures F Generalized anxiety disorder M_— Temporal lobe epilepsy G__Major depressive disorder Questions: 22. A 24 year old student has been crying frequently and complains of being unable to sleep or eat since being told she has Crohn's Disease three days ago. 23. A337 year old woman in an unhappy marriage develops an inability to walk and is admitted to a neurology ward. No abnormalities are found on physical examination or other assessments. 24. _A.28 year old woman has frequent episodes in which she falls to the floor of the neurology ward and thrashes about with her arms and legs while screaming. She is never injured during these episodes, which occur more frequently during visiting hours. 25. A 4year old girl is admitted repeatedly for weight loss and recurrent infections, but no cause is found. Her mother is very solicitous, always stays in her daughter's room, and gets on well with the staff. The visiting liaison psychiatrist discovers that the girl's mother has a history of childhood ‘emotional abuse and neglect. 26. _A.24 year old female student presents with the episodic experience of strong smells which she thinks are emanating from her body. She wonders if this might indicate that she has cancer. Her grandmother was diagnosed with advanced breast cancer two years ago, and recently died with a suppurating ulcerative breast lesion. The student has a history of head injury when aged 6 years old, which resulted in her being in a coma for 3 days. Following this injury she temporarily lost her ability to talk and required intensive speech therapy.