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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please take a history from Marcus and then request appropriate examination findings from the facilitator. Outline your diagnostic impressions and problem list to the facilitator. Negotiate your management plan with Marcus.

Scenario

Marcus Petrovic is 28-year-old man who moved to your practice six months ago. He has a 10-year history of schizophrenia with frequent hospital admissions. In the last year he has been relatively stable on fortnightly Zuclopenthixol (Clopixol) depot injections and nightly quetiapine (Seroquel).

He is obese, has borderline hypertension and is not very physically active. He has a family history of diabetes, heart disease and dyslipidaemia. He smokes but does not drink alcohol. He is unemployed and is on a disability support pension.

Your previous impression has been that he seems quite blunted in affect and you suspect he has at least some moderate intellectual and/or developmental delay, which gives him a child-like manner. Six months ago, he moved to your town to live with his parents but he has recently moved into a flat with friends. He is on the waiting list to see a local psychiatrist but has yet to engage with local mental health services.

He takes his medication, recognising that it has probably contributed to his good run in recent years. He presents today in between his scheduled fortnightly appointments.

The following information is on his summary sheet:

  • Past medical history

  • Chronic schizophrenia

  • Intellectual disability

  • Gastro-oesophageal reflux disease

  • Medication

  • Zuclopenthixol (Clopixol) depot injection IMI 300 mg/mL every two weeks

  • Quetiapine (Seroquel) XR 300 mg nocte

  • Gaviscon tabs po prn

  • Allergies

  • Nil known

  • Immunisations

  • Unknown

  • Social history

  • Smokes 15 cigarettes per day

  • Non-drinker

  • Lives with friends.

INSTRUCTIONS FOR THE PATIENT, MARCUS PETROVIC

The area of redness and soreness in your right elbow began a couple of days ago and is getting bigger each day. Early on in the discussion you say, ‘I think I must’ve used a dirty needle’.

You readily volunteer information about your drug use and are not embarrassed about it. You’ve been using either ice or heroin (‘Harry’) for the past month, initially irregularly but now daily. You have never used drugs before but have been introduced to them by your new group of friends. You have never paid anything as your new friends (from the motorcycle gang) supply them for free along with the needles and injecting equipment. If specifically asked, your friends sometimes get you to ‘do a Sydney run’—to ride your bike to Sydney and back with a package, or to carry packages around town. You have no idea what you are carrying on these trips.

You have limited understanding about safe injecting or bloodborne viruses. You are not concerned about the risks of IV drug use but don’t like this infection because it is painful and you ...

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