A patient is referred to an outpatient psychiatric clinic fo…
A patient is referred to an outpatient psychiatric clinic for evaluation of depressive episodes after bouts of overeating. Assessment reveals a five-year history of episodes of uncontrollable overeating precipitated by feelings of tension. This occurs about two to three times per week and for the past year has been associated with laxative use, self-induced vomiting, and periods of fasting to maintain body weight. The patient reports becoming increasingly depressed and has considered suicide in the past. The treatment plan first includes medical evaluation with electrolyte studies and:
Read DetailsA 32-year-old woman has a history of two acute episodes of p…
A 32-year-old woman has a history of two acute episodes of psychosis over the last 18 months. Her symptoms typically include paranoid delusions and auditory hallucinations. Her symptoms initially responded to treatment with risperidone, which was subsequently increased at the time of recurrence of symptoms. She did not have any significant mood disturbance during the initial six months. However, during the second acute episode of psychosis, she developed anhedonia, weight gain, psychomotor retardation, difficulty focusing, and suicidal ideation, which have persisted for the last year. She denies depressed mood, sleep difficulties, fatigue, and feelings of worthlessness or guilt. Which of the following is required for a diagnosis of schizoaffective disorder, depressed type in this case?
Read DetailsA patient has been prescribed olanzapine 15 mg daily for acu…
A patient has been prescribed olanzapine 15 mg daily for acute manic episodes associated with bipolar I disorder. Four days after beginning treatment, he has a sudden onset of fever (39 degrees C, 102 degrees F), tachycardia, and tachypnea. Oxygen saturation at rest is 93% and he exhibits muscular rigidity and some alteration is mental status. The most likely cause of these symptoms is:
Read DetailsA 3-day-old developed a rash 1 day ago that has continued to…
A 3-day-old developed a rash 1 day ago that has continued to spread. The perinatal history is unremarkable. On exam, she is well-appearing with macules, papules, and pustules 2-3mm in diameter generalized to her face, trunk and extremities. Which of the following is the most likely diagnosis?
Read DetailsA 13-year old boy presents for his annual physical. His is i…
A 13-year old boy presents for his annual physical. His is in the 98th percentile for weight and 50th percentile for height. On physical exam you note dark, velvety skin changes on his neck. You order a work up. His non-fasting glucose is 210 mg/dL and his hemoglobin A1c is 7%. What is the next best step?
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