Management plan and formulation
Management plan
Differential diagnosis





The correct diagnosis may be glaringly obvious, but in most cases there will be three or four realistic alternative differential diagnoses, with one favourite. There will often be more than one correct diagnosis present at the same time (Fig. 1).
Investigations
Investigations should start with information gathering from psychiatric and medical case notes and the GP. Relatives or friends may be interviewed with the patient’s consent. If possible, the patient should not be present at these interviews in order to give the informant an opportunity to speak freely. They should be asked for their view of the patient’s problems, and may be able to clarify or confirm aspects of the history you are uncertain about. It is helpful to engage the family at an early stage as they may have an important role in the later management of the patient. Psychological and physical investigations may be helpful if abnormalities are found in routine cognitive testing or physical examination (Fig. 2).
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