Behaviour/ personality change

Early-onset dementia with personality change — often misattributed to a psychiatric disorder

ALL cases are emergencies — risk of suicide and infanticide; admit, ideally to a Mother and Baby Unit

High suicide risk; repeated requests for cosmetic surgery (rarely satisfying)

Delusions driving harmful behaviour (e.g. morbid jealousy, persecution)

Loss of skills (REGRESSION) at any age → neurodegenerative/metabolic or ASD — urgent

Reduced GCS, status epilepticus, raised ICP; delay in aciclovir worsens outcome

Acute food-bolus impaction unable to swallow own saliva → urgent endoscopic disimpaction (do NOT push the bolus blindly

Do not miss genuine organic disease; assess depression/anxiety and suicide risk

Increased risk of breast cancer (gynaecomastia), osteoporosis, venous thromboembolism

NEUROLEPTIC SENSITIVITY — antipsychotics can cause severe rigidity/irreversible deterioration; recurrent falls

A persistent, firm, fixed neck lump in an ADULT (especially with smoking/alcohol, dysphagia, hoarseness, or an HPV risk)

UNILATERAL persistent OME in an ADULT → examine the postnasal space to exclude a nasopharyngeal carcinoma obstructing th

Early falls/postural instability, vertical gaze palsy, early autonomic failure, or symmetry/poor levodopa response → a P

Risk to self/others, command hallucinations → urgent assessment

Do not miss genuine organic disease — somatic symptom disorder can coexist

Acute (fulminant) liver failure in a young person → consider Wilson's (may need transplant)

Rapid decline, focal signs, early gait/falls, fluctuation or early hallucinations → reconsider the dementia subtype or a

Symptoms persisting >2 weeks or worsening (postnatal depression); abrupt severe disturbance, confusion or delusions abou

Suicide risk; the genetic/reproductive implications for relatives (predictive testing + counselling)

Thoughts of harming the baby, psychotic features, or marked functional decline → urgent perinatal mental health referral