Psychobehavioural

A 25-year-old man presents to the emergency department after his housemate expressed concern about his wellbeing. He describes low mood, anhedonia, unintentional weight loss of 4 kg, early morning waking and pervasive feelings of hopelessness for the past three months, coinciding with redundancy from his job. He reports fleeting thoughts that 'everyone would be better off without me' but denies any plan, intent or access to means, and has never attempted self-harm. He has no past psychiatric history, denies alcohol or illicit drug use, and takes no regular medications. Observations are unremarkable: HR 78 bpm, BP 118/76 mmHg, afebrile, normal glucose. Mental state examination reveals a dysphoric, tearful affect, slowed psychomotor activity, intact orientation, and no evidence of delusions, hallucinations, thought disorder or cognitive impairment. He denies psychotic symptoms and has good insight into his low mood. What is the most appropriate first-line management for this presentation?

A 19-year-old woman is brought to the emergency department by her flatmate after ingesting an unknown but reportedly large quantity of paracetamol tablets approximately 6 hours ago, following an argument with her partner. She reports mild nausea but no abdominal pain, vomiting or jaundice. She denies co-ingestion of alcohol or other drugs and has no significant past medical history. On examination she is alert and orientated, BP 118/76 mmHg, HR 88 bpm, RR 16/min, temperature 36.7°C, and there is no right upper quadrant tenderness or hepatomegaly. She becomes tearful and admits the overdose was intentional. What is the MOST appropriate next step in management?

A 50-year-old man with a 20-year history of heavy daily alcohol use is brought to the emergency department by paramedics after his partner witnessed a 90-second generalised tonic-clonic seizure at home. He stopped drinking abruptly two days ago after being admitted briefly for an unrelated injury. On arrival he is post-ictal but rousable, with a heart rate of 118 beats/min, blood pressure 158/94 mmHg, temperature 37.4°C, and a fine tremor of both hands. He is diaphoretic and mildly agitated, denying any prior seizure history, head injury or fever. Glucose is 6.1 mmol/L and there is no focal neurological deficit. Which of the following represents the most appropriate initial management?

A 25-year-old primiparous woman is brought to the emergency department by her partner 5 days after an uncomplicated vaginal delivery. Over the past 48 hours she has become increasingly agitated, is not sleeping, and has been overheard talking about the baby being 'possessed' and needing to be 'saved'. She has no past psychiatric history but her mother had a psychiatric admission after childbirth. On examination she is afebrile, tachycardic (HR 110/min), and appears distressed and fearful, with disorganised speech, paranoid delusions about hospital staff, and auditory hallucinations. She denies alcohol or illicit drug use, and her partner confirms no access to medications. Abdominal and pelvic examination reveal no uterine tenderness and lochia is normal. Basic bloods, CRP, TSH and a urine drug screen are unremarkable. What is the most appropriate next step in management?

A 34-year-old man is brought to the emergency department by police after his partner called triple-zero, reporting that he had told her he was going to 'kill her ex-boyfriend, Michael Reyes, for ruining our relationship.' He has a known history of borderline personality disorder and methamphetamine use, and appears agitated with pressured speech. On mental state examination he is not psychotic, has no evidence of delirium, and repeatedly and specifically states his intent to locate and harm Mr Reyes, whose address he says he already knows. He refuses voluntary admission and denies any current suicidal ideation. Observations are BP 142/88 mmHg, HR 104 bpm, RR 18, SpO2 99% on room air, temperature 36.8°C. Which of the following BEST describes the appropriate next step in management?

A 40-year-old woman is brought to the emergency department by her family after several days of escalating involuntary movements and vocal outbursts, including one episode where she blurted an inappropriate phrase during triage. Her family report she has had intermittent eye blinking, facial grimacing and throat-clearing since primary school, previously dismissed as a 'nervous habit', with periods of remission and exacerbation over the years. Since her teens she has had intrusive checking rituals and contamination fears consistent with obsessive-compulsive symptoms. Over the past month, coinciding with the stress of losing her job, her tics have markedly worsened and she has had several episodes of explosive anger out of proportion to triggers. Her father and paternal uncle reportedly had similar tics and temper outbursts. On examination she is afebrile with normal vital signs, has no signs of pharyngitis or recent infection, and displays repetitive shoulder shrugging, eye blinking and intermittent throat-clearing during the consultation; the remainder of her neurological examination, including gait, tone and reflexes, is normal. There is no history of recent streptococcal infection. Which of the following is the most appropriate next step in management?