Pediatric, geriatric, and perinatal psychiatry — where age changes everything.
12 cases
A 31-year-old woman who is 8 weeks pregnant stopped sertraline 150mg abruptly after a positive pregnancy test and is now experiencing depressive relapse — raising the question of how to navigate the risk-benefit conversation when both treating and not treating carry real consequences.
A 9-year-old boy is brought by his mother to outpatient child psychiatry after she read online that his explosive temper outbursts might be bipolar disorder. His father has Bipolar I. He has comorbid ADHD. The clinical question: Is this pediatric bipolar disorder or the chronic irritability pattern that DSM-5 now calls Disruptive Mood Dysregulation Disorder? The answer determines everything — from medication choices to long-term prognosis to what this mother needs to hear.
A 13-year-old male referred by juvenile probation after his third shoplifting charge presents with a history of ODD, escalating antisocial behavior, animal cruelty, and a chilling absence of remorse. His mother is exhausted and afraid. Walk through the diagnostic evolution from ODD to Conduct Disorder, learn to assess callous-unemotional traits in context, and develop a treatment plan grounded in evidence rather than fear.
A 14-year-old girl referred by her school counselor for increasing absences presents with raw, cracked hands, 90-minute showers, and a mother who has rearranged her entire life to accommodate rituals she believes are 'just anxiety.' This case walks through the diagnosis of contamination OCD in an adolescent, the critical role of family accommodation in maintaining symptoms, first-line treatment with ERP and SSRIs, and the nuances of pediatric prescribing when a parent wants medication to be the whole answer.
A 78-year-old man is two days post hip surgery and 'not making sense' according to the surgical team. They want you to start an antipsychotic so he'll stop pulling at his IV lines. His daughter says he was 'a little forgetful' before admission but nothing like this. You're the psychiatry consult. The surgical team wants a quick fix. The family wants to know if this is Alzheimer's. Neither question has the answer they're hoping for.
A 30-year-old woman is brought in by her husband 4 weeks postpartum with persistent crying, insomnia, intrusive thoughts about the baby, and a statement that alarms everyone: "The baby would be better off without me." Navigate the timeline-based differential, risk assessment, and the medication-in-breastfeeding conversation that every perinatal clinician must master.
A 74-year-old retired ICU nurse hasn't left her house in three months. She says it's because of her knees, her vertigo, and the ice outside. Her PCP thinks it's anxiety. She has a PRN alprazolam prescription she's been using daily. Everyone is treating pieces of this — nobody is seeing the whole picture.
A 72-year-old retired schoolteacher is brought in by her daughter who suspects Alzheimer's disease. Cognitive symptoms emerged suddenly after the death of her husband. Can you distinguish pseudodementia from true dementia — and give this patient the diagnosis she actually deserves?
A 15-year-old male expelled for fighting arrives with a school-assigned ODD label. But underneath the defiance is a teenager who's stopped sleeping, lost interest in everything he loved, and has a family history no one thought to ask about. Walk through the full evaluation — from referral to treatment plan — and learn why behavior is never the whole story.
A 15-year-old on four medications from three different providers presents with worsening function, significant weight gain, and daytime sedation, prompting a careful reassessment of diagnoses, medication rationale, and a rational deprescribing approach.
An 81-year-old widow with mild cognitive impairment wants to sell her house and give the proceeds to her church. Her adult children are convinced she's being manipulated and want you to declare her incompetent. She's sitting in front of you, sharp-eyed and annoyed, telling you this is her money and her decision. This case teaches what capacity actually means — and what it doesn't.
An 11-year-old girl with ADHD and anxiety is brought by her mother for an initial psychiatric evaluation. Her parents are divorced with joint legal custody. Mother wants medication started; father is firmly against it. The clinician must navigate parental disagreement, protect the child from triangulation, and determine a path forward -- all while recognizing that legal and institutional requirements vary significantly by jurisdiction and setting.
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