MLA Domain 5 · Presentation

Self-harm

9 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.

classic presentation · 5

Acute liver failure

Encephalopathy/cerebral oedema, hypoglycaemia, rising INR/lactate → transplant centre (King's College criteria)

Personality disorder

Recurrent self-harm and suicide attempts (esp. EUPD) — assess each episode on its merits

Salicylate (aspirin) overdose

Severe acidosis, very high levels, altered consciousness, seizures, renal failure → haemodialysis

Self-harm

High suicidal intent, ongoing plan, lethal method, or expressed wish to die → urgent psychiatric assessment

Tricyclic antidepressant overdose

QRS >100–120 ms, ventricular arrhythmia, seizures, hypotension, metabolic acidosis

recognised feature · 3

Body dysmorphic disorder

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

Depression

Active suicidal intent/plan, psychotic features, severe self-neglect → urgent specialist/crisis referral

Huntington disease

Suicide risk; juvenile (Westphal) variant with rigidity

differential of the above · 1

Wilson disease

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