Questions and Answers
What is the most likely diagnosis at present for the tearful mother who feels guilty for not taking care of her four-month-old baby?
What is the infant's most likely medical complication associated with Down's syndrome when massive emesis begins on the second day of life?
What are the clinical features of Down's syndrome?
Shortened palpebral fissures, macroglossia, iris white spots (Brushfield spots), deep palmar transverse creases, muscle hypotonia, incoordination, congenital hypothyroidism, GI atresias, cardiac atrial/ventricular septal defects.
Which substance will be positive in urinalysis of a patient who has been sniffing super-glue?
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What is the major metabolite of cocaine?
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What psychiatric condition is most likely to develop in a patient hospitalized for major depressive disorder with psychotic features?
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Which part of the limbic system is involved in anxiety?
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Based on the DSM-5, what is the complete delusional disorder sub-type diagnosis for a woman believing she is 'ant-infested'?
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What is a somatic type delusion?
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What is a mixed subtype of delusional disorder?
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What is formication?
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What are some severe adverse effects associated with disulfiram?
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Which is an opioid receptor agonist that helps decrease cravings?
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What is the appropriate treatment option for a patient with severe headache, chest tightness, and high blood pressure?
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Which medication is used in the management of serotonin syndrome?
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Which drug is used in the management of malignant hyperthermia?
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What should be monitored during the treatment of a patient prescribed olanzapine?
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What is the most likely diagnosis for a man exhibiting charm, lack of remorse, and repeated physical fights?
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Individuals with antisocial personality disorder show a pervasive pattern of empathy.
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Which of the following features is a poor prognostic feature in schizophrenia?
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What is the accurate statement regarding changes in sleep disturbance seen in neurocognitive disorder?
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Which intervention is contra-indicated when providing grief therapy?
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What important sexually transmitted infections should a patient sharing needles be screened for?
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What is the mechanism of action of mirtazapine?
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What is the most likely diagnosis for a woman with low mood, hypersomnia, and significant weight loss?
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What pharmacokinetic drug-drug interaction should a patient be warned about when taking St. John's wort with fluoxetine?
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Which of the following instruments will be helpful in diagnosing the patient with PTSD and a mood disorder?
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What medication had the 65-year-old man been prescribed for insomnia before his heart attack symptoms?
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Which of the following is a risk factor for social anxiety disorder?
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What is the diagnosis for the man who shouts during his sleep and appears to be scared?
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What is the most likely diagnosis for the woman who has intense anxiety when leaving the house?
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What is the most likely diagnosis for the 55-year-old man with rapid breathing and signs of tetany?
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What is the best treatment for the 17-year-old boy diagnosed with social anxiety disorder?
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Which of the following is an appropriate treatment option for the woman with an insect phobia?
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What is the most likely diagnosis for the 22-year-old man with recurrent severe anxiety and chest pains?
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What is the most likely diagnosis for the woman excessively worried about her family?
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What is the best treatment for the patient who fainted in a crowd?
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What is agoraphobia?
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What is social anxiety disorder?
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What should the patient prescribed lorazepam avoid?
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Which psychotherapy can help in discontinuing medication for the patient diagnosed with panic disorder?
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What substance can lead to hypervigilance, anxiety, and seizures?
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What symptoms characterize panic disorder?
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What investigation is required before switching a patient with panic disorder to imipramine?
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What is the diagnosis for the 20-year-old patient with extreme anxiety during presentations?
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What is the prevalence of anxiety disorders?
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What is the first-line management for a 50-year-old man with obstructive sleep apnea?
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What is OSA?
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What is the best initial treatment for a 33-year-old man with alcohol use disorder?
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What is Chlordiazepoxide?
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What is Disulfiram?
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Which organism is an example of a Group A beta-hemolytic streptococcus?
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What is the likely cause of the 16-year-old girl's symptoms after starting atomoxetine?
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Which antidepressants inhibit CYP 2D6 and are used to treat premenstrual difficulties?
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What is the appropriate treatment option for the 23-year-old man diagnosed with major depressive disorder?
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What type of medication is Bupropion?
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What type of medication is Buspirone?
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What is the risk associated with carbamazepine during pregnancy?
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What are the common side effects of carbamazepine?
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Which statement best describes the management of premenstrual dysphoric disorder?
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SSRIs have been found to have a _____ onset of therapeutic action in premenstrual dysphoric disorder, showing their effect within hours to days.
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This onset of action allows _____ dosing to be used for the treatment of premenstrual dysphoric disorder.
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What is the gold-standard pharmacologic treatment for PMDD?
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In which brain structure is damage most likely present in a patient with depression and cognitive decline?
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What are the characteristics of subcortical arteriosclerotic encephalopathy?
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Which antipsychotic is a partial D2 receptor agonist?
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What is usually the first step in cognitive behavioral therapy (CBT)?
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In Wernicke-Korsakoff syndrome, which feature is characteristic?
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What personality disorder is characterized by subservience and strong dependency on others?
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What is the most likely diagnosis for the man with heavy drinking and anxiety symptoms?
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Within what time frame after delivery should the onset of symptoms for major depressive disorder be to classify as postpartum onset?
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What strategy is likely to help decrease daytime sedation for a patient on mirtazapine?
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What is the most likely diagnosis for the woman with binge eating and mood fluctuations?
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How is cyclothymia defined?
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What should the clinician have done before diagnosing borderline personality disorder in the patient?
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What is a medical complication of anorexia nervosa - purging type?
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What are the electrolyte abnormalities associated with anorexia nervosa?
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What is the most likely diagnosis for the man with low mood and losing interest in life for the past week?
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What is defined as depressed mood and other symptoms present for 2-13 days at least once per month?
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What is the best treatment for the patient once stabilized, who presents with hoarding behavior?
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What is the likely diagnosis for the 30-year-old woman with low mood and suicidal ideation for a month?
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Study Notes
Psychiatric Assessment and Disorders
- PTSD and mood disorders can complicate diagnosis; tools like the Minnesota Multiphasic Personality Inventory are useful.
- Social anxiety disorder risk factors include having a parent with an anxiety disorder.
- Night terrors are characterized by fear during sleep, often without recall upon waking.
- Panic disorder often co-occurs with agoraphobia, leading to avoidance of places where panic attacks may occur.
Anxiety Disorders and Treatments
- Exposure therapy is effective for specific phobias; one-session exposure can be a time-efficient method.
- Generalized anxiety disorder features excessive worry and physical symptoms, but is differentiated from panic disorder which involves acute episodes of intense fear.
- Cognitive restructuring combined with exposure therapy is a key treatment for social anxiety disorder.
Physiological Symptoms and Diagnosis
- Hyperventilation syndrome presents with symptoms like rapid breathing and tetany; often misinterpreted as cardiac issues.
- Cardiac evaluations such as ECG are essential before changing medications, especially for patients with a history of panic disorders and familial heart issues.
- Obstructive sleep apnea (OSA) treatment includes lifestyle changes and CPAP, especially for patients with significant AHI scores.
Substance Use and Management
- Chlordiazepoxide is the first-line treatment for alcohol withdrawal due to its safety profile in tapering procedures.
- Naltrexone helps reduce cravings but is ineffective for immediate withdrawal symptoms.
- Disulfiram induces adverse reactions when alcohol is consumed, necessitating careful patient selection.
Other Notable Conditions and Treatments
- Serotonin syndrome requires prompt treatment like cyproheptadine to alleviate hypertensive symptoms.
- Malignant hyperthermia, characterized by elevated temperature and muscle rigidity, is managed with dantrolene.
- Amphetamine toxicity showcases severe anxiety and physical symptoms like tachycardia and can escalate to seizures.
Epidemiology and Risks
- Anxiety disorders have a 33.7% prevalence in the adult population over a lifetime and are associated with high suicide risk.
- Conditions are more common in females and often present with comorbid disorders.
Terminology Definitions
- Agoraphobia: Anxiety over being in situations where escape might be difficult, usually accompanied by panic attacks.
- Social anxiety disorder: Fear of judgment or embarrassment in social situations, leading to avoidance behaviors.
- Selective mutism: A childhood disorder where a child does not speak in certain social settings despite being able to communicate in familiar environments.### Olanzapine Treatment Monitoring
- Monitor lipid profile due to potential weight gain and metabolic effects associated with olanzapine usage.
Antisocial Personality Disorder
- Characterized by lack of remorse, disregard for societal norms, and impulsivity.
- Commonly shows irritability, aggressiveness, and a pattern of deceitfulness.
Prognostic Factors in Schizophrenia
- Blunted or flat affect is considered a poor prognostic indicator in schizophrenia.
Neurocognitive Disorder Sleep Disturbances
- Decreased slow-wave sleep is commonly observed in patients with neurocognitive disorders.
- Overall sleep disturbances include increased fragmentation and decreased total sleep time.
Treatment Options for Depression
- Electroconvulsive therapy (ECT) is beneficial for severe depressive symptoms, particularly in cases unresponsive to medications.
- Mirtazapine, an alpha-2-adrenergic receptor antagonist, may be effective in treating depression but can also affect sleep.
Bright Light Therapy for Seasonal Affective Disorder
- Sessions should ideally occur in the morning for effective treatment of seasonal affective disorder.
- Phototherapy involves exposure to light at a minimum intensity of 10,000 lux over 30-90 minutes.
Screening and Assessment Recommendations
- Conduct suicide screening, especially in older adults experiencing grief and loss.
- In pediatric populations with special educational needs, healthcare providers should actively participate in the Individualized Education Program (IEP) meetings.
Substance Use and STIs
- Screen individuals who share needles for HIV and hepatitis B due to high-risk behaviors.
Drug Interactions and Pharmacokinetics
- St. John’s Wort may decrease the efficacy of oral contraceptives and should be monitored in patients using both.
- Atomoxetine levels may be increased by concurrent antidepressant therapies that inhibit CYP 2D6.
Major Depressive Disorder Characteristics
- Symptoms include depressed mood, sleep disturbances, weight changes, and suicidal ideation.
- Effective pharmacotherapy options include Bupropion, which is less likely to affect sexual function compared to SSRIs.
Risks of Antiepileptic Drugs during Pregnancy
- Carbamazepine can cause craniofacial and neural tube defects in neonates if taken during pregnancy, making valproate a safer alternative for women planning pregnancy.
Common Side Effects of Carbamazepine
- Includes nausea, vomiting, drowsiness, diplopia, blurred vision, and ataxia.### Hematological and Dermatological Side Effects
- Mild anemia, leukopenia, and thrombocytopenia are common hematological side effects of certain treatments.
- Electrolyte disturbances, including hyponatremia, are often observed.
- Hepatotoxicity may also occur, posing risks to liver function.
- Development of a rash within the first 6 months can indicate serious dermatological reactions, such as Stevens-Johnson syndrome (SJS), prompting potential discontinuation of medication.
Premenstrual Dysphoric Disorder (PMDD)
- PMDD is characterized by severe mood swings, irritability, and distress beginning before menstruation, affecting personal and professional life.
- Oophorectomy with hormone replacement therapy may effectively treat PMDD.
- SSRIs are established as the gold-standard pharmacological treatment for PMDD.
- SSRIs show a rapid onset of action within hours to days, allowing for intermittent dosing.
Neurological Assessment
- Signs of subcortical arteriosclerotic encephalopathy include dysmnesia, dysexecutive syndrome, slowness, and apathy.
- Patients may exhibit a "frontal" or "magnetic" gait and pseudobulbar palsy due to damage along corticobulbar tracts.
- Brain damage in related conditions is most likely present in the periventricular white matter.
Antipsychotic Management
- Aripiprazole is identified as a partial D2 receptor agonist among common antipsychotics.
Cognitive Behavioral Therapy (CBT)
- The initial step in CBT for conditions like generalized anxiety disorder involves educating patients about symptoms, treatment processes, and goal setting.
Wernicke-Korsakoff Syndrome
- Characterized by specific ocular changes (e.g., abducens nerve paralysis, nystagmus), this syndrome is associated with heavy alcohol use and thiamine deficiency.
Personality Disorders
- Dependent personality disorder is marked by excessive reliance on others for emotional support and decision-making.
- Behavior indicative of this disorder includes seeking approval and prioritizing others' needs over one’s own.
Diagnosis in Depressive Disorders
- Generalized anxiety disorder can coexist with alcohol use disorder; identifying comorbid conditions is crucial for proper diagnosis.
- Major depressive disorder with postpartum onset requires symptom onset within four weeks of delivery.
- Other Specified Depressive Disorder-Recurrent brief depression involves depressive symptoms occurring for 2-13 days at least once per month over a year.
Down's Syndrome Complications
- Infants with Down's syndrome are at risk of duodenal atresia, presenting in early life with severe emesis.
- Common clinical features include short palpebral fissures, macroglossia, hypotonia, and various organ abnormalities.
Substance Use Disorders
- Sniffing glue can lead to the detection of hippuric acid in urinalysis, indicating toluene use.
- Cocaine metabolite, benzoylecgonine, is associated with cocaine use.
Delusional Disorder
- Occurrence of one or more delusions lasting over a month is classified as a delusional disorder with specific subtypes, such as somatic type.
- Symptoms do not significantly impair functioning and behavior remains relatively normal aside from delusions.
Formication
- Formication is the sensation of insects crawling on or under the skin, often linked with certain psychiatric conditions.
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Description
This quiz focuses on various psychological assessment instruments used in psychiatry. It evaluates your knowledge of different diagnostic tools that may assist in refining a diagnosis for patients with mood disorders and PTSD. Test your understanding of these essential evaluation methods.