Case Discussion
Clinical teaching and practical ideas for your next study session.
Stimulant-Associated Psychotic Agitation: Treat Both Targets
When psychosis and methamphetamine exposure overlap, rapid tranquilization should not become a one-drug reflex. This case shows how to address acute arousal and psychotic symptoms as separate treatment targets while keeping medical evaluation active.
Suicide Risk After Alcohol Intoxication: Reassess, Don’t Use a BAC Cutoff
A suicidal patient’s later denial after intoxication is new data, not an all-clear. Learn how to structure serial assessment, check the timeline against collateral, and make disposition from the whole picture—not a BAC or screening score.
Why PMDD SSRIs Can Work in Days: The Allopregnanolone Hypothesis
An illustrative patient with a prospectively charted cyclic pattern reports improvement after several days of an SSRI. Learn why rapid benefit is plausible in PMDD, what the allopregnanolone–GABA-A model proposes, and why neither the model nor early response establishes a diagnosis or mechanism.
IPV Disclosures in the ED: Planning a Safe Exit When a Partner Is Waiting
PTSD symptoms do not answer whether a patient can leave safely. Learn an ED approach to privacy, immediate danger, child safety, monitored communication, and a patient-led disposition.
OCD Family Accommodation: How to Reduce Reassurance Without Losing Support
When a partner is drawn into repeated checking, simply saying “stop reassuring” can turn treatment into a standoff. Learn to reduce ritual participation collaboratively while preserving emotional support and ordinary safety.
When a Psychotic Teen Refuses Psychiatric Admission
A psychotic adolescent’s refusal raises three separate questions: whether inpatient care is needed, who may authorize admission, and what process permits admission over objection.
Psychosis After Seizures: Lucid Interval or Nonconvulsive Status?
After a seizure cluster, psychosis may emerge after a lucid interval—but ongoing nonconvulsive seizures can look psychiatric too. Learn how chronology, serial attention checks, and EEG should shape urgent care and disposition.
When Gambling Predates a Dopamine Agonist: Assessing Worsening
When gambling starts before a dopamine agonist but worsens after it is added, distinguish the onset of the behavior from its escalation. That timeline can sharpen the differential without delaying steps to reduce financial and safety harms.
Adolescent Aggression: Breaking the Coercive Family Cycle
When a teen’s outburst ends a caregiver’s demand, immediate relief may reinforce both sides. Learn to map the cycle and plan safer, more consistent responses without blaming the family.
After No Acute MI Is Identified: Discussing Panic-Like Chest Symptoms
Repeated reassuring emergency evaluations do not necessarily make a patient feel safe—or establish a psychiatric diagnosis. This case discussion shows how to validate chest symptoms, explain what prior tests do and do not establish, and build a shared follow-up plan without dismissing medical risk.
One Patient, Two Episodes: Reassessing FND After Intentional Illness Induction
Documented intentional insulin induction may support a later factitious-disorder formulation if the full criteria are met. It does not, by itself, prove that earlier functional weakness was deliberate.
Self-Injury in Borderline Traits: Function, Intent, and Treatment
A patient self-injures after a relationship rupture and says she wanted to feel real, not die. Learn to assess the function of that episode without confusing it with suicidal intent or diagnosing borderline personality disorder from self-injury alone.