A 35‑year‑old patient presents with persistent low mood, loss of interest, and sleep disturbances for 8 weeks.

Determine whether the presentation meets criteria for major depressive disorder and develop an initial treatment plan.

Conduct a structured clinical interview using DSM‑5 criteria, administer the PHQ‑9, rule out medical causes with labs, and assess suicidal ideation. Discuss findings with the patient and outline therapy and medication options.

Accurate diagnosis of major depressive disorder, initiation of SSRI therapy, referral for CBT, and a safety plan that reduced depressive symptoms over the next month.

A 28‑year‑old male is brought to the emergency department with auditory hallucinations, disorganized speech, and agitation.

Stabilize the patient, ensure safety, and initiate appropriate acute psychosis management while respecting patient autonomy.

Perform rapid mental status exam, ensure a safe environment, administer IM antipsychotic (e.g., haloperidol) per protocol, obtain collateral history, and involve a psychiatrist for admission decision. Discuss treatment options with patient when possible and obtain consent for medication.

Patient’s agitation decreased within 30 minutes, was safely admitted to inpatient unit, and a comprehensive treatment plan including antipsychotic medication and psychoeducation was established.

A 45‑year‑old patient with chronic schizophrenia was skeptical of treatment after multiple relapses.

Establish trust to encourage medication adherence and participation in therapy.

Scheduled a brief, non‑judgmental conversation, used reflective listening, validated his concerns about side effects, and collaboratively explored dosing options. Offered a trial period with close follow‑up.

Patient agreed to a low‑dose trial, reported feeling heard, and attended the next three appointments, showing improved adherence.

A 30‑year‑old woman was diagnosed with early‑onset bipolar disorder after presenting with mood swings and a suicide attempt.

Communicate the diagnosis sensitively while providing hope and a clear treatment pathway.

Prepared a private setting, used the SPIKES protocol: set up interview, assessed perception, obtained invitation to discuss details, gave knowledge in clear terms, addressed emotions, and summarized a treatment plan including mood stabilizers and psychotherapy.

Patient expressed initial shock but later reported feeling supported, agreed to start lithium, and scheduled weekly therapy, leading to mood stabilization over three months.

A 22‑year‑old patient with severe depression expressed intent to overdose and refused antidepressant medication.

Ensure patient safety while respecting autonomy and legal obligations.

Conducted a thorough risk assessment, explained the consequences of refusal, explored alternative treatments (e.g., psychotherapy, short‑term inpatient stay). Initiated a safety contract, involved the hospital ethics committee, and, after obtaining consent from the patient’s legal guardian, arranged voluntary admission for close monitoring.

Patient agreed to a brief inpatient stay, received intensive therapy, and after 5 days demonstrated reduced suicidal ideation, later consenting to start medication.