You are referred a 23-year old gentleman who was brought to the emergency department by the police after he punched a group of men in the coffee shop where he was having a drink. The emergency care team found that he had a fever of 40 degrees celcius and a raised creatine kinase (CK) and he was admitted to the medical ward and given intravenous fluids. He appeared apprehensive and was mute. He became agitated when the nurse came to change his IV fluids. Later in the evening he pulled out his IV cannula and attempted to run from the ward.

Q1. State the emergency condition that you suspect this gentleman may have and list down its core features.

Q2. Name a group of medication that can be used to treat agitation in this gentleman at this point and give two (2) examples.

Q3. State the group of medication that is contraindicated in this patient.

Q4. You treat this patient with the medication in Q2 and becomes more engaging the next day however his speech is incoherent. How will you ascertain the history?

Q5. You are able to contact his father. List three (3) questions that you will ask the father regarding patients history and state your reasons.

Q6. Patients fever resolves and his CK normalises. History from the father reveals that he has well until a year back when he started talking to himself and saying that there were people watching him. For the past month he has been staying locked up inside his room most of the time. He does not bathe unless instructed to but still goes to the nearby coffee shop for an espresso once in a while. His parents had brought him to religious healers but denied giving him any oral medication or herbs. They had planned to bring him for medical consultation if his condition did not improve in another week.

How will you treat the patient with this information?

Q7. The patient improves significantly after one week with the new treatment in Q6 and is able to talk relevantly. He tells you that the men he hit were members of a demonic cabal that wanted to catch him for their evil purposes.

State your working diagnosis.

Q8. Describe how you will psychoeducate his family about his condition, focusing on his diagnosis, course of illness and management plan.

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