Physician's Assistant

Patient Details

Refined clerking (152 days ago 16:15)

Refined clerking Wed 05 November 2025 16:15

Last Modified: 152 days ago

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Content:

Medical ST5 Miller Clerking

Presenting Complaint:
Psychiatric crisis

History of Presenting Complaint:
Patient presented in the early hours requiring urgent psychiatric assessment. Seen by psychiatry at 02:00. She reports struggling at home with paranoid ideation, feeling she is being watched by AI through cameras and receiving messages via the television. No physical health concerns.

Past Medical History:
• Paracetamol overdose - September 2025
• Hypertension
• Mixed anxiety and depressive disorder
• Alcohol dependence
• Borderline personality disorder
• Asthma
• Bipolar disorder

Drug History:
• Valproic acid 500mg PO BD (total 1g daily) with or just after food
• Olanzapine 10mg PO nocte

Allergy History:
• NKDA

Social History:
Alcohol dependence previously treated with acamprosate.

On Examination:
No physical health concerns identified.

Investigations:
• FBC: Normal with mild microcytosis likely secondary to alcohol
• Renal function: Normal
• Paracetamol level: <10
• LFTs: Normal
• CK: Normal
• Urea: Normal
• AST: Normal
• B12 and folate: Normal
• Ferritin: Normal
• TSH: Normal
• Bone profile: Normal
• Magnesium: Normal

Impression:
Psychiatric crisis with manic episode in context of bipolar disorder
No physical health concerns

Management Plan:
1. Admit to medical bed while awaiting psychiatric placement
2. Continue management plan as per psychiatry team
3. Medications as prescribed by psychiatric team

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Patient Details

Refined clerking Wed 05 November 2025 16:15

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