A 33-year-old man who is a driver-by-profession presented to you with decreased appetite, loss of sleep, and irritability for the last three months. There is no past or family history of psychiatric conditions. He is the only earning member of his family and must go to work every day to make a living. On physical examination, his pulse is 90 beats per minute with an irregular rhythm. a) Outline your assessment and management plans. b) What precautions you will take while prescribing psychotropic medications in this case? c) Enumerate all possible differential diagnoses in this case.

  Assessment of Treatment Resistance   Reconsider the diagnosis, especially considering bipolar depression and hypothyroidism.   Identify comorbidities.   Ensure that adequate dosages for adequate durations have been given   Confirm adherence to treatment   Evaluate for maintaining factors and repeated experiences of stressful circumstances.

(Mnemonic: GINPH) ● Delusions of Guilt ● Delusions of Impoverishment (can also be considered as a type of nihilistic delusion. ● Nihilistic delusions, including Cotard syndrome ● Persecutory delusions* ● Hypochondriacal delusions Patients with Psychotic depression  consider these thoughts well-deserved unlike in schizophrenia where patients feel remorse towards them and mania where patients consider them a response to the great position they have earned.  When these delusions occur against a background of depressed mood, they are mood-congruent and favor the diagnosis of psychotic depression. When patients with depression have delusions of grandeur or even neutral delusions e.g. delusions of reference, they are mood-incongruent delusions" and favor the diagnosis of schizophrenia (ICD-10).

Psychosis Versus Neurosis What is psychosis? A psychiatric disorder in which the thoughts, affective-response, ability to recognize reality, and ability to communicate and relate to others shows impairment sufficient to interfere grossly with the capacity to deal with reality. The classic characteristics of psychosis are. Impaired reality testing Hallucinations Delusions Disorganization. Psychosis Insight is absent in patients with psychosis.  In patients with psychosis, there is an impairment in judgment and reasoning.  They lose contact with reality. For example, they believe in the voices they hear.  Delusions are often present. Delusions are psychotic features and are never normal (if a belief meets any criteria of normality, it's not a delusion).  True hallucinations are present, even though hallucinations, especially hypnagogic and hypnopompic hallucinations, also occur in normal people.   Patients with psychosis may exhibit changes in personality, es...

What are the factors known to improve effective communication? The following is a list of the factors that contribute to effective communication with patients during clinical assessment.  Use Minimal Prompts Interrupting your patient during a clinical assessment prohibits them from explaining their concerns. Points that are important for you as a clinician are often less important for the patient.  Knowing whatever is important to the patients and addressing their concerns is immensely important from a holistic and biopsychosocial model of health care. Using minimal prompts helps patients to communicate their concerns so you can address them.  Sit squarely in relation to the patient Open body position in relation to the patient Leaning slightly towards the client Eye contact maintained Relax while listening Listen to the message content Listen for feelings Respond to feelings Note all non-verbal cues