Psych Station 6

Setting:

You are a junior doctor in a general outpatient clinic. Your next patient is a 16 year old girl, who has been brought in by her mother due to concerns about her mood and behaviour over the past few weeks.

Name: Aisha Khan

Tasks:

1. Take a patient history.

2. Give 3 differential diagnoses to the examiner.

2. Discuss the intial management plan with the patient and her mother.

You are not required to examine the patient or explain the diagnosis.

Briefing

Diagnosis: Bipolar
You are Aisha Khan, age 16
You have been brought to the GP by your mother due to her concerns over your mood swings.

Appearance and Behaviour

Enter the room quietly, avoid eye contact, and sit down slowly. You might look around the room nervously or fidget with your hands. Start with a soft, somewhat hesitant tone of voice. You might speak in short sentences, pausing often as if unsure of what to say.

Opening statement

“I guess I’m just a bit up and down really.”

Information to Give Freely

Most days I just feel really down and have absolutely no energy. (do not reveal manic states unless asked)

Presenting Complaint

Usually I feel depressed and low, however I have spikes of high energy where everything feels better and I feel I can do anything. At the moment I'm definitely at a low point.

Mood - usually very low and i just want to be left alone, but sometimes I feel really really high like everything is going great. I'm elated.
Sleep - I usually want to sleep all the time. When I'm in a really good mood I don't need any sleep at all, maybe just 3 hours a night.
Concentration - School has been hard, my grades have slipped. At times I think i'm much smarter than my teachers and I don't need their help but at the moment I'm struggling to keep up with my friends grades. I can't focus.
Psychomotor - nil
Anxiety - nil
Mania - Usually no symptoms. However during certain "episodes" I spend a lot of money online buying clothes and stuff that I don’t really need. I even had a huge arguement with my mom about it, because I used her credit card. I didn’t really care at the time but now it makes me sad. (If asked you spent $10,000). My friends say when I'm in a very good mood I can be a bit too much and I can't concentrate on one thing.
Psychosis - No visual/auditory hallucinations.
Obsessions/compulsions - nil
Risk Assessment - No thoughts of suicide or self harm.

Past Medical History

Previous similar episodes - 3 manic episodes in the past year with symptoms above of excess spending and communicating manically at school (saying you know more than teachers)
Other medical conditions - none

Forensic History

None

Drug History

Prescribed - None
Over the counter - None
Allergies - None

Family History

Father - has mental health problems but you're not in contact so you're not sure of the exact nature.

Social History

Smoking - none
Alcohol - none
Drugs - never used drugs
Job - student
Home - live with my mum. My mum and I used to be really close, but we’ve been arguing a lot lately. She doesn’t understand what I’m going through, and it’s frustrating.

Systems Review

No systemic upset

Ideas / Concerns / Expectation

Ideas - I'm worries this will never get better and i'm stuck like this forever?
Concerns - You’re scared of what these changes mean and worried that you might have to take medication or go to the hospital.
Expectations - You hope the doctor can explain what’s happening and provide some kind of reassurance or solution, but you’re also nervous about what that might be.

Discussion / Questions

The doctor will explain a management plan to you and your mother. You should be receptive. If the doctor starts to explain the diagnosis say you've heard of it and would like to know about management.