A 26 year old woman has taken a significant overdose of antidepressant and antipsychotic medication. Which is the most appropriate next step?

Correct Answer: C

Rationale: The most appropriate next step in this scenario is option C, which is to compulsorily detain the patient for further assessment. When a person has ingested a significant overdose of medication, especially antidepressants and antipsychotics which can be potentially lethal in overdose, there is a high risk of harm to themselves. Compulsory detention allows healthcare professionals to closely monitor the patient, provide necessary medical interventions, and ensure their safety. Option A, arranging for home leave, is not appropriate in this situation as the patient is at high risk of harm and requires immediate medical attention. Allowing the patient to leave against medical advice, as in option B, is also not advisable as it could lead to serious consequences such as worsening of the overdose effects or even death. Referring the patient to a crisis and home treatment team, as in option D, may not provide the level of monitoring and intervention needed in this acute overdose situation. Compulsory detention ensures that the patient receives the urgent care and support required for their safety and well-being. In an educational context, it is crucial for healthcare providers to understand the gravity of psychiatric emergencies like overdoses and the importance of prompt and appropriate intervention to prevent harm to the patient. Understanding the rationale behind each option helps in developing critical thinking skills and making informed decisions in real-life clinical scenarios.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Labile affect. Labile affect refers to rapid and unpredictable changes in emotions, such as laughing one minute and crying the next without an apparent cause. This symptom is commonly seen in psychiatric emergencies and can indicate underlying mood instability or neurological conditions. Option A) Incongruent affect does not fully capture the rapid and fluctuating nature of the emotional changes described in the case. Incongruent affect typically refers to emotions that are not in line with the situation or context. Option B) Elation specifically denotes a state of intense happiness or joy, which does not encompass the wide range of emotions exhibited by the individual in the case. Option D) Flat affect is characterized by a lack of emotional expression and would not align with the alternating laughter and crying displayed by the 20-year-old male. Educationally, understanding psychiatric emergencies and associated symptoms like labile affect is crucial for healthcare professionals, especially in settings like emergency departments or mental health facilities. Recognizing and correctly identifying these symptoms can guide appropriate interventions and ensure the individual receives timely and effective care. By differentiating between terms like labile affect, incongruent affect, elation, and flat affect, healthcare providers can make informed clinical decisions to support patients in crisis.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Somatic passivity. Somatic passivity is a symptom commonly seen in psychiatric emergencies where individuals feel their bodily sensations are controlled by external forces, such as chemicals sprayed by colleagues in this case. This symptom is often associated with schizophrenia and other psychotic disorders. Option A) Automatic obedience refers to a phenomenon where a person follows commands without question, which is not described in the scenario. Option B) Visual hallucination involves seeing things that are not present, which is not mentioned in the patient's report of a tickling sensation. Option C) Delusion of persecution involves a false belief that one is being targeted or harmed, which is not directly related to the physical sensation described by the patient. Understanding psychiatric emergencies is essential for healthcare professionals to provide timely and appropriate care to individuals experiencing mental health crises. Recognizing symptoms like somatic passivity can aid in accurate assessment and intervention, leading to better outcomes for patients in distress. It is crucial to differentiate between various symptoms to provide targeted and effective support in psychiatric emergency situations.

Correct Answer: C

Rationale: The correct answer is C) Depression is a common comorbidity in obsessive-compulsive disorder (OCD). This is a true statement because individuals with OCD often experience co-occurring depression, with estimates suggesting that around 50% of individuals with OCD also have major depressive disorder. Option A is incorrect because atypical antipsychotics are not the first line of treatment for OCD. Instead, the first-line treatments for OCD typically include selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT). Option B is incorrect as the prevalence of OCD in the general population is estimated to be around 1-2%, not 7-10%. Option D is also incorrect as contamination is actually a very common obsession in individuals with OCD, alongside other common obsessions like fears of harming others or symmetry. Educationally, understanding the common comorbidities of OCD, such as depression, is crucial for healthcare providers to accurately diagnose and treat individuals with this disorder. Recognizing these patterns can help in developing comprehensive treatment plans that address both OCD symptoms and any co-occurring conditions like depression, leading to better outcomes for patients.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Promethazine. The patient presenting with upward rolling of the eyes is likely experiencing acute dystonia, which is a known side effect of antipsychotic medications like Risperidone. Promethazine is a first-line treatment for acute dystonia due to its anticholinergic effects, which can help alleviate the symptoms quickly. Option A) Lorazepam is used for anxiety, seizures, and alcohol withdrawal but is not the first-line treatment for acute dystonia. Option C) Olanzapine is another antipsychotic medication, so continuing or switching to it would not address the acute dystonia caused by Risperidone. Option D) Stopping antipsychotics abruptly can lead to a worsening of the patient's psychiatric condition and is not the appropriate management for acute dystonia. Educationally, this question highlights the importance of recognizing and managing common side effects of psychiatric medications. Understanding the side effect profile of medications is crucial in ensuring patient safety and adherence to treatment. It also emphasizes the need for prompt recognition and appropriate management of acute dystonia to prevent distress and discomfort for the patient.