Clinical Case 1

A 24-year-old female Sarah is brought into the ED by ambulance. She was found by her friends lying on her sofa with a bottle of vodka and 2 empty packets each of 16, 500mg paracetamol tablets. There was evidence of vomit around her.

On arrival at the department, she is very tearful. All her observations are normal and her GCS is 15/15. On further questioning by the ED doctor she states that she broke up with her boyfriend yesterday and decided to take an overdose on impulse 3 hours ago. She now regrets it. She states that she took all 32 tablets at once with about half the bottle of vodka and that she now regrets this act. She denies taking anything else. Her past medical history is unremarkable, as is her past psychiatric history. She says she has never previously self-harmed or attempted suicide. She states that she will never do this again. She is not on any regular medication and has no known allergies.

On mental state examination:

Appearance and behaviour: Slightly dishevelled, but otherwise clean and well dressed. Appropriate behaviour, although clearly tearful.

Speech: Normal volume, rhythm and rate.

Affect: She describes her mood as low since her boyfriend broke up with her. Objectively she is tearful and slightly low in mood.

Perception: She denies any hallucinations in any modality.

Thoughts: She feels her thoughts are her own. Objectively her thought processes seem normal.

Insight: She is regretful and understands the physical consequences of what she has done.

Cognition: She is orientated to time and place.

Her weight is 50 kg with a height of 165cm. Her BMI (body mass index) is 18.2 kg/m2

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