Psychiatry Assessment Techniques

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?

Postpartum depression (correct)

Major depressive disorder

Bipolar I disorder

Depression with psychosis

Bipolar II disorder

What is the infant's most likely medical complication associated with Down's syndrome when massive emesis begins on the second day of life?

Congenital hypothyroidism

Atrial septal defect

Duodenal atresia (correct)

Hypotonia of gastro-esophageal sphincter

Macroglossia

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?

Hippuric acid Signup and view all the answers

What is the major metabolite of cocaine?

Benzoylecgonine Signup and view all the answers

What psychiatric condition is most likely to develop in a patient hospitalized for major depressive disorder with psychotic features?

Bipolar disorder Signup and view all the answers

Which part of the limbic system is involved in anxiety?

Amygdala Signup and view all the answers

Based on the DSM-5, what is the complete delusional disorder sub-type diagnosis for a woman believing she is 'ant-infested'?

Somatic type Signup and view all the answers

What is a somatic type delusion?

Central theme of the delusion involves bodily functions or sensations. Signup and view all the answers

What is a mixed subtype of delusional disorder?

No one delusional theme predominates. Signup and view all the answers

What is formication?

Sensation of having insects crawling on or under the skin. Signup and view all the answers

What are some severe adverse effects associated with disulfiram?

Mood swings, psychosis, neuropathies, and fatal hepatitis. Signup and view all the answers

Which is an opioid receptor agonist that helps decrease cravings?

Naltrexone Signup and view all the answers

What is the appropriate treatment option for a patient with severe headache, chest tightness, and high blood pressure?

Labetalol Signup and view all the answers

Which medication is used in the management of serotonin syndrome?

Cyproheptadine Signup and view all the answers

Which drug is used in the management of malignant hyperthermia?

Dantrolene Signup and view all the answers

What should be monitored during the treatment of a patient prescribed olanzapine?

Lipid profile Signup and view all the answers

What is the most likely diagnosis for a man exhibiting charm, lack of remorse, and repeated physical fights?

Antisocial personality disorder Signup and view all the answers

Individuals with antisocial personality disorder show a pervasive pattern of empathy.

False Signup and view all the answers

Which of the following features is a poor prognostic feature in schizophrenia?

Blunted or flat affect Signup and view all the answers

What is the accurate statement regarding changes in sleep disturbance seen in neurocognitive disorder?

Decreased slow-wave sleep Signup and view all the answers

Which intervention is contra-indicated when providing grief therapy?

Warn patient against expressions of anger Signup and view all the answers

What important sexually transmitted infections should a patient sharing needles be screened for?

HIV and hepatitis B Signup and view all the answers

What is the mechanism of action of mirtazapine?

Alpha-2-adrenergic receptor antagonist Signup and view all the answers

What is the most likely diagnosis for a woman with low mood, hypersomnia, and significant weight loss?

Other Specified Depressive Disorder - Short duration depressive episode Signup and view all the answers

What pharmacokinetic drug-drug interaction should a patient be warned about when taking St. John's wort with fluoxetine?

St. John's wort can decrease OCP concentrations Signup and view all the answers

Which of the following instruments will be helpful in diagnosing the patient with PTSD and a mood disorder?

Minnesota Multiphasic Personality Inventory Signup and view all the answers

What medication had the 65-year-old man been prescribed for insomnia before his heart attack symptoms?

Alprazolam Signup and view all the answers

Which of the following is a risk factor for social anxiety disorder?

Parent with an anxiety disorder Signup and view all the answers

What is the diagnosis for the man who shouts during his sleep and appears to be scared?

Night terrors Signup and view all the answers

What is the most likely diagnosis for the woman who has intense anxiety when leaving the house?

Panic disorder and agoraphobia Signup and view all the answers

What is the most likely diagnosis for the 55-year-old man with rapid breathing and signs of tetany?

Hyperventilation syndrome Signup and view all the answers

What is the best treatment for the 17-year-old boy diagnosed with social anxiety disorder?

Cognitive restructuring and exposure therapy Signup and view all the answers

Which of the following is an appropriate treatment option for the woman with an insect phobia?

One-session exposure therapy Signup and view all the answers

What is the most likely diagnosis for the 22-year-old man with recurrent severe anxiety and chest pains?

Other specified anxiety disorder Signup and view all the answers

What is the most likely diagnosis for the woman excessively worried about her family?

Separation anxiety disorder Signup and view all the answers

What is the best treatment for the patient who fainted in a crowd?

Exposure therapy and reducing safety behaviors Signup and view all the answers

What is agoraphobia?

Marked anxiety caused by two or more specific situations. Signup and view all the answers

What is social anxiety disorder?

Fear of being judged in social situations. Signup and view all the answers

What should the patient prescribed lorazepam avoid?

Diphenhydramine Signup and view all the answers

Which psychotherapy can help in discontinuing medication for the patient diagnosed with panic disorder?

Cognitive behavioral therapy Signup and view all the answers

What substance can lead to hypervigilance, anxiety, and seizures?

Amphetamine Signup and view all the answers

What symptoms characterize panic disorder?

Recurring episodes of intense fear. Signup and view all the answers

What investigation is required before switching a patient with panic disorder to imipramine?

Electrocardiogram Signup and view all the answers

What is the diagnosis for the 20-year-old patient with extreme anxiety during presentations?

Social anxiety disorder Signup and view all the answers

What is the prevalence of anxiety disorders?

They are estimated to be found in 33.7% of the adult population during a lifetime. Signup and view all the answers

What is the first-line management for a 50-year-old man with obstructive sleep apnea?

Weight loss and CPAP Signup and view all the answers

What is OSA?

Obstructive Sleep Apnea. Signup and view all the answers

What is the best initial treatment for a 33-year-old man with alcohol use disorder?

Chlordiazepoxide Signup and view all the answers

What is Chlordiazepoxide?

A benzodiazepine used in mild to moderate withdrawal symptoms. Signup and view all the answers

What is Disulfiram?

An alcohol sensitizing agent. Signup and view all the answers

Which organism is an example of a Group A beta-hemolytic streptococcus?

Group A beta-hemolytic streptococcus Signup and view all the answers

What is the likely cause of the 16-year-old girl's symptoms after starting atomoxetine?

Patient is taking a medication that is increasing the levels of atomoxetine Signup and view all the answers

Which antidepressants inhibit CYP 2D6 and are used to treat premenstrual difficulties?

Fluoxetine or paroxetine Signup and view all the answers

What is the appropriate treatment option for the 23-year-old man diagnosed with major depressive disorder?

Bupropion Signup and view all the answers

What type of medication is Bupropion?

Norepinephrine and dopamine reuptake inhibitor Signup and view all the answers

What type of medication is Buspirone?

Non-benzodiazepine anxiolytic Signup and view all the answers

What is the risk associated with carbamazepine during pregnancy?

Craniofacial defects Signup and view all the answers

What are the common side effects of carbamazepine?

Nausea, vomiting, drowsiness, diplopia, blurred vision, ataxia Signup and view all the answers

Which statement best describes the management of premenstrual dysphoric disorder?

Oophorectomy followed by hormone replacement therapy may be effective Signup and view all the answers

SSRIs have been found to have a _____ onset of therapeutic action in premenstrual dysphoric disorder, showing their effect within hours to days.

short Signup and view all the answers

This onset of action allows _____ dosing to be used for the treatment of premenstrual dysphoric disorder.

intermittent Signup and view all the answers

What is the gold-standard pharmacologic treatment for PMDD?

SSRIs Signup and view all the answers

In which brain structure is damage most likely present in a patient with depression and cognitive decline?

Periventricular white matter Signup and view all the answers

What are the characteristics of subcortical arteriosclerotic encephalopathy?

The 4 D's: dysmnesia, dysexecutive syndrome, delay, and depletion Signup and view all the answers

Which antipsychotic is a partial D2 receptor agonist?

Aripiprazole Signup and view all the answers

What is usually the first step in cognitive behavioral therapy (CBT)?

Educating patients about their symptoms, the treatment process, and setting goals Signup and view all the answers

In Wernicke-Korsakoff syndrome, which feature is characteristic?

Ocular changes may include abducens nerve paralysis and nystagmus Signup and view all the answers

What personality disorder is characterized by subservience and strong dependency on others?

Dependent personality disorder Signup and view all the answers

What is the most likely diagnosis for the man with heavy drinking and anxiety symptoms?

Generalized anxiety disorder with comorbid alcohol use disorder Signup and view all the answers

Within what time frame after delivery should the onset of symptoms for major depressive disorder be to classify as postpartum onset?

4 weeks Signup and view all the answers

What strategy is likely to help decrease daytime sedation for a patient on mirtazapine?

Increase the dose Signup and view all the answers

What is the most likely diagnosis for the woman with binge eating and mood fluctuations?

Bulimia nervosa; bipolar II disorder with rapid cycling Signup and view all the answers

How is cyclothymia defined?

Low-grade hypomanic and depressive symptoms over two years Signup and view all the answers

What should the clinician have done before diagnosing borderline personality disorder in the patient?

Excluded possibility that these behaviors occurred in the context of another psychiatric disorder Signup and view all the answers

What is a medical complication of anorexia nervosa - purging type?

Cardiac arrhythmias Signup and view all the answers

What are the electrolyte abnormalities associated with anorexia nervosa?

Hypochloremia, hyponatremia, hypomagnesemia, hypokalemia, hypophosphatemia Signup and view all the answers

What is the most likely diagnosis for the man with low mood and losing interest in life for the past week?

Other Specified Depressive Disorder-Recurrent brief depression Signup and view all the answers

What is defined as depressed mood and other symptoms present for 2-13 days at least once per month?

Other Specified Depressive Disorder-Recurrent brief depression Signup and view all the answers

What is the best treatment for the patient once stabilized, who presents with hoarding behavior?

Depot antipsychotic medication Signup and view all the answers

What is the likely diagnosis for the 30-year-old woman with low mood and suicidal ideation for a month?

Major depressive disorder Signup and view all the answers

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.