Podcast
Questions and Answers
What is the most appropriate intervention for a patient who takes a second-generation antipsychotic for schizophrenia, has experienced weight gain, high BMI, high blood pressure, and elevated fasting glucose?
What is the most appropriate intervention for a patient who takes a second-generation antipsychotic for schizophrenia, has experienced weight gain, high BMI, high blood pressure, and elevated fasting glucose?
- Begin insulin therapy
- Stop antipsychotic medication
- Education regarding diet and exercise (correct)
- Begin a stimulant medication
Which diagnosis is most likely for a 23-year-old woman with symptoms of impulsivity, decreased need for sleep, excessive energy, rapid speech, grandiosity, and rhyming speech patterns, but no prior history of mood symptoms?
Which diagnosis is most likely for a 23-year-old woman with symptoms of impulsivity, decreased need for sleep, excessive energy, rapid speech, grandiosity, and rhyming speech patterns, but no prior history of mood symptoms?
- Bipolar I disorder (correct)
- ADHD combined presentation
- Bipolar II disorder
- Schizoaffective disorder
Which disorder is most likely in a 22-year-old woman who develops sudden stuttering triggered by a class discussion on sexual harassment related to a past sexual assault?
Which disorder is most likely in a 22-year-old woman who develops sudden stuttering triggered by a class discussion on sexual harassment related to a past sexual assault?
- Language
- Somatic symptom
- Conversion disorder (correct)
- Illness anxiety
What is the most appropriate treatment for a 52-year-old man with acute agitation, restlessness, headache, tremors, and a history of alcohol consumption who experiences a generalized tonic-clonic seizure during assessment?
What is the most appropriate treatment for a 52-year-old man with acute agitation, restlessness, headache, tremors, and a history of alcohol consumption who experiences a generalized tonic-clonic seizure during assessment?
Which of the following is the most appropriate measure for a 49-year-old man with a history of IV drug use and current good health?
Which of the following is the most appropriate measure for a 49-year-old man with a history of IV drug use and current good health?
Which of the following is the most appropriate diagnostic study for the patient with decreased visual acuity and sensitivity to painful stimuli over the skin of the right hand?
Which of the following is the most appropriate diagnostic study for the patient with decreased visual acuity and sensitivity to painful stimuli over the skin of the right hand?
What is the most likely diagnosis for the 50-year-old woman with unintentional weight loss, inability to find pleasure in life, and extreme fatigue?
What is the most likely diagnosis for the 50-year-old woman with unintentional weight loss, inability to find pleasure in life, and extreme fatigue?
Which treatment is most effective for the secondary prevention of drug use in high-risk adolescents?
Which treatment is most effective for the secondary prevention of drug use in high-risk adolescents?
What is the most likely diagnosis for the 28-year-old man with excessive hand washing and contamination fears?
What is the most likely diagnosis for the 28-year-old man with excessive hand washing and contamination fears?
What is the most likely diagnosis for the 37-year-old woman with hallucinations, dry mouth, tachycardia, and urinary retention?
What is the most likely diagnosis for the 37-year-old woman with hallucinations, dry mouth, tachycardia, and urinary retention?
What is most likely to be observed on the mental status examination of the 21-year-old man with elevated mood and grandiose thinking?
What is most likely to be observed on the mental status examination of the 21-year-old man with elevated mood and grandiose thinking?
Which symptom is most likely present in a patient in the withdrawal phase after heavy cocaine use?
Which symptom is most likely present in a patient in the withdrawal phase after heavy cocaine use?
Which element in the history of the 16-year-old boy suggests possible self-medication with marijuana?
Which element in the history of the 16-year-old boy suggests possible self-medication with marijuana?
What is the most appropriate initial intervention for a patient with acrophobia?
What is the most appropriate initial intervention for a patient with acrophobia?
In addition to psychotherapy, what is the most appropriate pharmaceutical therapy for the 16-year-old girl reporting depression symptoms?
In addition to psychotherapy, what is the most appropriate pharmaceutical therapy for the 16-year-old girl reporting depression symptoms?
What is the expected result of a Snellen Test for a patient with new onset left eye blindness and previous 20/20 vision?
What is the expected result of a Snellen Test for a patient with new onset left eye blindness and previous 20/20 vision?
What is the most likely side effect of the recommended pharmacologic therapy for ADHD disorder?
What is the most likely side effect of the recommended pharmacologic therapy for ADHD disorder?
Which factor is most likely to play a role in the etiology of autism spectrum disorder?
Which factor is most likely to play a role in the etiology of autism spectrum disorder?
For a 17-year-old girl with suspected anorexia nervosa, which condition poses the greatest risk?
For a 17-year-old girl with suspected anorexia nervosa, which condition poses the greatest risk?
What is the most likely diagnosis for a 23-year-old male who exposes his genitals to passersby for sexual arousal?
What is the most likely diagnosis for a 23-year-old male who exposes his genitals to passersby for sexual arousal?
Following the father's massive MI, what symptom is most likely experienced by the 6-year-old girl?
Following the father's massive MI, what symptom is most likely experienced by the 6-year-old girl?
For a 48-year-old man with paranoia and aggression, what is the most appropriate intervention?
For a 48-year-old man with paranoia and aggression, what is the most appropriate intervention?
Which medication requires an electrocardiogram prior to initiating high-dose therapy?
Which medication requires an electrocardiogram prior to initiating high-dose therapy?
Which substance is most likely responsible for a 15-year-old boy's intoxication with dysarthria, nystagmus, and confusion?
Which substance is most likely responsible for a 15-year-old boy's intoxication with dysarthria, nystagmus, and confusion?
For a 30-year-old woman seeking breast augmentation, what is the most appropriate next step in management?
For a 30-year-old woman seeking breast augmentation, what is the most appropriate next step in management?
For a patient who overdosed on a tricyclic antidepressant, which of the following is the most appropriate initial diagnostic study?
For a patient who overdosed on a tricyclic antidepressant, which of the following is the most appropriate initial diagnostic study?
Which of the following meds is most likely to be used to diminish compulsive behaviors identified in patients with exhibitionistic disorder?
Which of the following meds is most likely to be used to diminish compulsive behaviors identified in patients with exhibitionistic disorder?
Which of the following is a risk factor for attention-deficit/hyperactivity disorder?
Which of the following is a risk factor for attention-deficit/hyperactivity disorder?
Which of the following is recommended as an adjunct to the pharmacologic treatment for a patient with a diagnosis of GAD?
Which of the following is recommended as an adjunct to the pharmacologic treatment for a patient with a diagnosis of GAD?
A 28-year-old woman with difficulty sleeping and recurrent nightmares after being attacked by a dog 3 months ago is most likely diagnosed with:
A 28-year-old woman with difficulty sleeping and recurrent nightmares after being attacked by a dog 3 months ago is most likely diagnosed with:
More than half of all patients with a depressive disorder have an increase in levels of which of the following chemical mediators?
More than half of all patients with a depressive disorder have an increase in levels of which of the following chemical mediators?
Which of the following is a risk factor for the development of an anxiety disorder?
Which of the following is a risk factor for the development of an anxiety disorder?
Which of the following medications has the greatest risk of fetal abnormalities when used during pregnancy?
Which of the following medications has the greatest risk of fetal abnormalities when used during pregnancy?
A 22-year-old woman who exercises frequently and eats only one meal a day, with worries about gaining weight and other concerns, is at risk for which comorbid condition?
A 22-year-old woman who exercises frequently and eats only one meal a day, with worries about gaining weight and other concerns, is at risk for which comorbid condition?
A 22-year-old college student with symptoms of sadness, decreased appetite, and difficulty concentrating after a breakup should be intervened with:
A 22-year-old college student with symptoms of sadness, decreased appetite, and difficulty concentrating after a breakup should be intervened with:
A 5-year-old boy with hyperactivity, impulsivity, and inattention should have which of the following interventions recommended to the parents?
A 5-year-old boy with hyperactivity, impulsivity, and inattention should have which of the following interventions recommended to the parents?
Which of the following statements is most characteristic of persons with tobacco use disorder?
Which of the following statements is most characteristic of persons with tobacco use disorder?
Which of the following neurotransmitters is most involved in the etiology of anxiety disorders?
Which of the following neurotransmitters is most involved in the etiology of anxiety disorders?
Which of the following is recommended for the treatment of a patient with antisocial personality disorder with no comorbidities?
Which of the following is recommended for the treatment of a patient with antisocial personality disorder with no comorbidities?
A 12-year-old boy showing aggressive behavior, irritability, animal cruelty, and fire-setting is most likely affected by:
A 12-year-old boy showing aggressive behavior, irritability, animal cruelty, and fire-setting is most likely affected by:
Which of the following physical examination findings is expected for a patient with a history of alcohol use disorder?
Which of the following physical examination findings is expected for a patient with a history of alcohol use disorder?
An 8-year-old boy presenting with disruptive behavior may require an initial evaluation for ADHD with which diagnostic study?
An 8-year-old boy presenting with disruptive behavior may require an initial evaluation for ADHD with which diagnostic study?
A 22-year-old woman making multiple phone calls in the night, extravagant spending, and grandiosity may be diagnosed with:
A 22-year-old woman making multiple phone calls in the night, extravagant spending, and grandiosity may be diagnosed with:
A 49-year-old woman struggling to make daily decisions without reassurance, feeling hopeless, and fearing ridicule may have which personality disorder?
A 49-year-old woman struggling to make daily decisions without reassurance, feeling hopeless, and fearing ridicule may have which personality disorder?
A 17-year-old boy showing academic decline and behavioral changes related to marijuana use could benefit most from which intervention?
A 17-year-old boy showing academic decline and behavioral changes related to marijuana use could benefit most from which intervention?
A 28-year-old woman presenting with chronic abdominal pain and worries of cancer likely has a history of:
A 28-year-old woman presenting with chronic abdominal pain and worries of cancer likely has a history of:
A woman with depressed mood, suicidality, anhedonia, and hypersomnia alongside a history of psychosis is likely diagnosed with:
A woman with depressed mood, suicidality, anhedonia, and hypersomnia alongside a history of psychosis is likely diagnosed with:
Which factor is most likely found in the history of a high school patient with anorexia nervosa?
Which factor is most likely found in the history of a high school patient with anorexia nervosa?
A 30-year-old man with a history of repeated arrests and use of an unregistered firearm would benefit from which diagnostic study to assess comorbid disorders?
A 30-year-old man with a history of repeated arrests and use of an unregistered firearm would benefit from which diagnostic study to assess comorbid disorders?
A 12-year-old boy exhibiting bullying, fighting, and destruction of property is most likely diagnosed with:
A 12-year-old boy exhibiting bullying, fighting, and destruction of property is most likely diagnosed with:
Which medication is the treatment of choice for a patient with an initial presentation of hypomania?
Which medication is the treatment of choice for a patient with an initial presentation of hypomania?
A 22-year-old man showing restlessness, disorientation, and symptoms of drug use most likely has signs and symptoms due to:
A 22-year-old man showing restlessness, disorientation, and symptoms of drug use most likely has signs and symptoms due to:
A patient with a stiff neck and musculoskeletal symptoms after starting haloperidol would benefit most from which intervention?
A patient with a stiff neck and musculoskeletal symptoms after starting haloperidol would benefit most from which intervention?
A 28-year-old woman with chronic pain and headaches may benefit from which medication in addition to psychotherapy?
A 28-year-old woman with chronic pain and headaches may benefit from which medication in addition to psychotherapy?
A 16-year-old girl presenting with fever, abdominal pain, and blood-tinged diarrhea is most likely affected by:
A 16-year-old girl presenting with fever, abdominal pain, and blood-tinged diarrhea is most likely affected by:
Which of the following is the most appropriate pharmacologic treatment for a patient with normal physical findings and laboratory results?
Which of the following is the most appropriate pharmacologic treatment for a patient with normal physical findings and laboratory results?
What is the most likely diagnosis for a 23-year-old man who is experiencing declining grades, self-care, hears voices, and refuses meals believing they are poisoned?
What is the most likely diagnosis for a 23-year-old man who is experiencing declining grades, self-care, hears voices, and refuses meals believing they are poisoned?
Which of the following medications is most appropriate for treating a 60-year-old man with headache, palpitations, and agitation related to heavy alcohol use?
Which of the following medications is most appropriate for treating a 60-year-old man with headache, palpitations, and agitation related to heavy alcohol use?
What should be included in patient education regarding atypical antipsychotics?
What should be included in patient education regarding atypical antipsychotics?
What is the most likely diagnosis for a 19-year-old woman with symptoms of waxy flexibility, no eye contact, and fear of being killed?
What is the most likely diagnosis for a 19-year-old woman with symptoms of waxy flexibility, no eye contact, and fear of being killed?
Which diagnostic test is indicated to evaluate a patient with symptoms of an undiagnosed anxiety disorder?
Which diagnostic test is indicated to evaluate a patient with symptoms of an undiagnosed anxiety disorder?
Functional neurologic symptoms of vision loss, paralysis, seizures, or abnormal movements are most consistent with which of the following?
Functional neurologic symptoms of vision loss, paralysis, seizures, or abnormal movements are most consistent with which of the following?
What is the most appropriate initial diagnostic study for a 28-year-old man with symptoms of agitation, restlessness, and palpitations after consuming an energy drink?
What is the most appropriate initial diagnostic study for a 28-year-old man with symptoms of agitation, restlessness, and palpitations after consuming an energy drink?
Which neurotransmitter is associated with positive symptoms in patients with schizophrenia?
Which neurotransmitter is associated with positive symptoms in patients with schizophrenia?
What is the most likely diagnosis for a 16-year-old girl with weight loss, excessive exercise, distorted body image, and fear of gaining weight?
What is the most likely diagnosis for a 16-year-old girl with weight loss, excessive exercise, distorted body image, and fear of gaining weight?
What is the leading hypothesis for the etiology of schizophrenia?
What is the leading hypothesis for the etiology of schizophrenia?
Which neurotransmitter has been implicated in the etiology of manic disorders?
Which neurotransmitter has been implicated in the etiology of manic disorders?
In a patient with obsessive-compulsive personality disorder, which of the following is most likely to be revealed as part of the patient’s history?
In a patient with obsessive-compulsive personality disorder, which of the following is most likely to be revealed as part of the patient’s history?
Which laboratory study is most appropriate to order when evaluating a patient with depression?
Which laboratory study is most appropriate to order when evaluating a patient with depression?
What is the most likely diagnosis for a 25-year-old woman who believes she is pregnant despite negative tests and extensive workup?
What is the most likely diagnosis for a 25-year-old woman who believes she is pregnant despite negative tests and extensive workup?
Children with separation anxiety disorder are at increased risk for which of the following?
Children with separation anxiety disorder are at increased risk for which of the following?
Which disorder is characterized by a history of sexual pleasure resulting from self-abuse?
Which disorder is characterized by a history of sexual pleasure resulting from self-abuse?
Which of the following is a risk factor for the development of ADHD?
Which of the following is a risk factor for the development of ADHD?
During the active phase of schizophrenia, first-line medications are used to reduce which of the following symptoms?
During the active phase of schizophrenia, first-line medications are used to reduce which of the following symptoms?
Which parental recommendation has been found to reduce the risk of feeding or eating disorders for high-risk individuals?
Which parental recommendation has been found to reduce the risk of feeding or eating disorders for high-risk individuals?
What is likely on the history of an 8-year-old boy with difficulty at school, distractibility, and worsening grades?
What is likely on the history of an 8-year-old boy with difficulty at school, distractibility, and worsening grades?
What is the expected disease course for a 32-year-old man diagnosed with bipolar II disorder?
What is the expected disease course for a 32-year-old man diagnosed with bipolar II disorder?
Which diagnosis is most likely for a 37-year-old man with recent onset of palpitations, agitation, and depressed mood following personal stressors?
Which diagnosis is most likely for a 37-year-old man with recent onset of palpitations, agitation, and depressed mood following personal stressors?
What is the most appropriate initial intervention for a disorder characterized by a paralyzing fear of social embarrassment?
What is the most appropriate initial intervention for a disorder characterized by a paralyzing fear of social embarrassment?
What medication may benefit a 40-year-old woman who believes she can read other people's minds and engages in unusual behavior?
What medication may benefit a 40-year-old woman who believes she can read other people's minds and engages in unusual behavior?
Which diagnostic study is most beneficial for evaluating an alternate source for anxiety in a 48-year-old woman with fatigue, weight loss, and treatment-resistant generalized anxiety disorder?
Which diagnostic study is most beneficial for evaluating an alternate source for anxiety in a 48-year-old woman with fatigue, weight loss, and treatment-resistant generalized anxiety disorder?
What is the most appropriate first step in the management of the patient who denies suicidal and homicidal ideation but admits to inability to sleep, stomachaches, and palpitations?
What is the most appropriate first step in the management of the patient who denies suicidal and homicidal ideation but admits to inability to sleep, stomachaches, and palpitations?
What is the most appropriate first step in the management of the 14-year-old girl experiencing irritability, angry outbursts, and rule-breaking behavior?
What is the most appropriate first step in the management of the 14-year-old girl experiencing irritability, angry outbursts, and rule-breaking behavior?
Which additional symptom is most likely present in the 24-year-old woman experiencing palpitations and diaphoresis when entering an elevator?
Which additional symptom is most likely present in the 24-year-old woman experiencing palpitations and diaphoresis when entering an elevator?
What needs to be closely monitored in a patient taking valproic acid (Depakene)?
What needs to be closely monitored in a patient taking valproic acid (Depakene)?
Which finding is consistent with a diagnosis of schizophrenia?
Which finding is consistent with a diagnosis of schizophrenia?
What is the most likely diagnosis for the 40-year-old woman complaining of various symptoms and frequent visits to the Emergency Department?
What is the most likely diagnosis for the 40-year-old woman complaining of various symptoms and frequent visits to the Emergency Department?
What physical examination finding is most likely in the 22-month-old boy with sleeping and behavioral issues?
What physical examination finding is most likely in the 22-month-old boy with sleeping and behavioral issues?
What is the most likely diagnosis for the 35-year-old man with a snake-related injury due to his lifelong fear of snakes?
What is the most likely diagnosis for the 35-year-old man with a snake-related injury due to his lifelong fear of snakes?
Which personality disorder is the most likely diagnosis for the 35-year-old man with increased anxiety and work-related concerns?
Which personality disorder is the most likely diagnosis for the 35-year-old man with increased anxiety and work-related concerns?
For which of the following is there the greatest evidence of positive correlation to antisocial personality disorder?
For which of the following is there the greatest evidence of positive correlation to antisocial personality disorder?
What is the most likely additional finding on physical examination for the 13-year-old girl with hair loss and thinning?
What is the most likely additional finding on physical examination for the 13-year-old girl with hair loss and thinning?
What is the most likely diagnosis for the 49-year-old woman experiencing tearfulness, fatigue, and hopelessness following a breakup?
What is the most likely diagnosis for the 49-year-old woman experiencing tearfulness, fatigue, and hopelessness following a breakup?
Which diagnostic study would help distinguish an exacerbation of schizophrenia from an organic etiology for the psychosis in the 47-year-old man?
Which diagnostic study would help distinguish an exacerbation of schizophrenia from an organic etiology for the psychosis in the 47-year-old man?
Which personality disorder is most likely to lead a patient to refuse immunizations?
Which personality disorder is most likely to lead a patient to refuse immunizations?
What characterizes CBT in the treatment of alcohol use disorder?
What characterizes CBT in the treatment of alcohol use disorder?
What is the most likely pathophysiology causing irritability, anxiety, and insomnia in the 28-year-old man?
What is the most likely pathophysiology causing irritability, anxiety, and insomnia in the 28-year-old man?
What is most likely to be found on ultrasound in a patient taking lithium?
What is most likely to be found on ultrasound in a patient taking lithium?
Which medication is most likely causing the rash and ulcerations in the 22-year-old woman with bipolar disorder?
Which medication is most likely causing the rash and ulcerations in the 22-year-old woman with bipolar disorder?
After correcting caloric deficiencies in a patient with anorexia nervosa, what is indicated to stimulate bone anabolism?
After correcting caloric deficiencies in a patient with anorexia nervosa, what is indicated to stimulate bone anabolism?
What is the most likely diagnosis for the 34-year-old woman convinced she has breast cancer despite no physical findings?
What is the most likely diagnosis for the 34-year-old woman convinced she has breast cancer despite no physical findings?
Which medication is an anxiolytic but is not a benzodiazepine?
Which medication is an anxiolytic but is not a benzodiazepine?
What is the most appropriate medication for the 53-year-old woman experiencing palpitations associated with public speaking?
What is the most appropriate medication for the 53-year-old woman experiencing palpitations associated with public speaking?
What is the most likely diagnosis for the 26-year-old woman with insomnia and persistent worries leading to disrupted sleep?
What is the most likely diagnosis for the 26-year-old woman with insomnia and persistent worries leading to disrupted sleep?
Which of the following is the most appropriate treatment for the 15-year-old boy with angry outbursts, lying, and kicking his dog?
Which of the following is the most appropriate treatment for the 15-year-old boy with angry outbursts, lying, and kicking his dog?
What is most important to screen for when evaluating a patient with depression?
What is most important to screen for when evaluating a patient with depression?
Which of the following has been most closely associated with borderline personality disorder?
Which of the following has been most closely associated with borderline personality disorder?
A 26-year-old woman 2 weeks postpartum with signs of depression is at greatest risk for which of the following with a future pregnancy?
A 26-year-old woman 2 weeks postpartum with signs of depression is at greatest risk for which of the following with a future pregnancy?
Which intervention would be most beneficial for the 67-year-old man preoccupied with rearranging everything in the kitchen?
Which intervention would be most beneficial for the 67-year-old man preoccupied with rearranging everything in the kitchen?
Which disorder is most consistent with the presentation of the 35-year-old man with constant fatigue, irritability, and worrying?
Which disorder is most consistent with the presentation of the 35-year-old man with constant fatigue, irritability, and worrying?
Which of the following is the most commonly experienced type of hallucination?
Which of the following is the most commonly experienced type of hallucination?
What is a common negative symptom of schizophrenia?
What is a common negative symptom of schizophrenia?
Which disorder is the most likely diagnosis for a 23-year-old man with acute, self-limited episodes resembling a heart attack?
Which disorder is the most likely diagnosis for a 23-year-old man with acute, self-limited episodes resembling a heart attack?
What is the pharmacologic treatment of choice for a 21-year-old woman with bulimia nervosa?
What is the pharmacologic treatment of choice for a 21-year-old woman with bulimia nervosa?
What is most likely present in the history of a man with frotteuristic disorder?
What is most likely present in the history of a man with frotteuristic disorder?
What is most important in the evaluation of a patient with a seizure and a history of factitious disorder?
What is most important in the evaluation of a patient with a seizure and a history of factitious disorder?
What is the most likely predisposing factor for a 30-year-old man with symptoms of anxiety after witnessing a traumatic event?
What is the most likely predisposing factor for a 30-year-old man with symptoms of anxiety after witnessing a traumatic event?
What must be monitored weekly for a 34-year-old man starting on clozapine?
What must be monitored weekly for a 34-year-old man starting on clozapine?
What is the most likely diagnosis for a 20-year-old man with bizarre behaviors, talking to himself, and paranoid thoughts?
What is the most likely diagnosis for a 20-year-old man with bizarre behaviors, talking to himself, and paranoid thoughts?
What is the most likely diagnosis for a 7-year-old girl with social withdrawal, intense focus, and refusal to be re-directed?
What is the most likely diagnosis for a 7-year-old girl with social withdrawal, intense focus, and refusal to be re-directed?
What is expected to decrease over time for patients with bipolar II disorder?
What is expected to decrease over time for patients with bipolar II disorder?
What factor is most likely associated with the onset or exacerbation of obsessive-compulsive personality disorder?
What factor is most likely associated with the onset or exacerbation of obsessive-compulsive personality disorder?
In addition to cognitive-behavioral therapy, which medication is the appropriate treatment for a man with sexual urges towards girls near his workplace?
In addition to cognitive-behavioral therapy, which medication is the appropriate treatment for a man with sexual urges towards girls near his workplace?
Which disorder is most likely present in a woman with panic attacks in the lobby of her apartment building?
Which disorder is most likely present in a woman with panic attacks in the lobby of her apartment building?
What is the most appropriate screening test for a 45-year-old man with a long history of alcohol use disorder?
What is the most appropriate screening test for a 45-year-old man with a long history of alcohol use disorder?
Which finding is most likely in the history of a patient diagnosed with paraphilic disorder?
Which finding is most likely in the history of a patient diagnosed with paraphilic disorder?
What is the most likely diagnosis for a 72-year-old woman with sadness, insomnia, poor appetite, and weight gain after the death of her husband?
What is the most likely diagnosis for a 72-year-old woman with sadness, insomnia, poor appetite, and weight gain after the death of her husband?
What physical examination finding would be consistent with the likely diagnosis of a stressed-out graduate student?
What physical examination finding would be consistent with the likely diagnosis of a stressed-out graduate student?
What is the most appropriate treatment for a patient diagnosed with somatic symptom disorder and a 6-month history of abdominal pain?
What is the most appropriate treatment for a patient diagnosed with somatic symptom disorder and a 6-month history of abdominal pain?
What is the most likely diagnosis for a 19-year-old woman with fear of public speaking and social interactions?
What is the most likely diagnosis for a 19-year-old woman with fear of public speaking and social interactions?
Which medication is contraindicated in a woman with panic disorder who is trying to conceive?
Which medication is contraindicated in a woman with panic disorder who is trying to conceive?
Voyeuristic disorder is characterized by sexual arousal through which of the following?
Voyeuristic disorder is characterized by sexual arousal through which of the following?
What is most likely revealed in the history of a woman who avoids social interactions and views herself as inept and inferior to others?
What is most likely revealed in the history of a woman who avoids social interactions and views herself as inept and inferior to others?
A man brought to the ED after an argument is goal-oriented and sad due to his grandmother's recent passing. What is his likely condition?
A man brought to the ED after an argument is goal-oriented and sad due to his grandmother's recent passing. What is his likely condition?
Study Notes
Tricyclic Antidepressant Overdose
- For a patient who overdosed on a tricyclic antidepressant, the most appropriate initial diagnostic study is an electrocardiography (ECG).
Exhibitionistic Disorder
- Fluoxetine (Prozac) is most likely to be used to diminish compulsive behaviors identified in patients with exhibitionistic disorder.
Attention-Deficit/Hyperactivity Disorder (ADHD)
- Risk factors for ADHD include:
- Lead exposure
- Secondhand smoke exposure after birth
- Not birth order or obesity
- Charts and checklists to remember tasks, and essential fatty acid supplementation are potential interventions for managing ADHD.
Generalized Anxiety Disorder (GAD)
- Mindfulness meditation is recommended as an adjunct to the pharmacologic treatment for a patient with GAD.
Post-Traumatic Stress Disorder (PTSD)
- A patient who experiences difficulty sleeping, recurrent nightmares, and avoidance of areas that may trigger memories of a traumatic event is likely to be diagnosed with PTSD.
Depression
- More than half of all patients with a depressive disorder have an increase in levels of cortisol.
- A patient who has a history of depression, and an inability to express themselves due to fear of being ridiculed, is likely to be diagnosed with avoidant personality disorder.
Anxiety Disorders
- Risk factors for anxiety disorders include:
- History of childhood abuse
- Poor school performance
- Not high SES, older age, or male gender
- Serotonin is the neurotransmitter most involved in the etiology of anxiety disorders.
Substance Use Disorders
- Nicotine activates the brain's reward centers, increasing serotonin levels.
- A patient who experiences difficulty making routine daily decisions without reassurance, and has a history of marijuana use, is likely to require counseling and behavioral interventions.
Psychosis
- A patient who has a history of psychosis, and experiences a decline in academic performance, is likely to be diagnosed with schizophrenia.
Personality Disorders
- A patient who is brought to the clinic due to unusual behavior, and has a history of making dozens of phone calls in the middle of the night, is likely to be diagnosed with bipolar I disorder.
Antisocial Personality Disorder
- A patient who has a history of multiple incarcerations, and an inability to conform to societal norms, is likely to be diagnosed with antisocial personality disorder.
Conduct Disorder
- A patient who has a history of frequent bullying, fighting, and destruction of school property, is likely to be diagnosed with conduct disorder.
Hypomania
- Lithium is the treatment of choice for a patient with an initial presentation of hypomania.
Atypical Antipsychotics
- Patient education regarding atypical antipsychotics should include monitoring weight.
Conversion Disorder (Functional Neurological Symptoms Disorder)
- Functional neurologic symptoms of vision loss, paralysis, seizures, or abnormal movements are most consistent with conversion disorder.
Schizophrenia
- The leading hypothesis for the etiology of schizophrenia focuses on excess or deficiency of specific neurotransmitters.
Other Disorders
- Children with separation anxiety disorder are at increased risk for social anxiety disorder.
- An increase in gamma-aminobutyric acid (GABA) has been implicated in the etiology of manic disorders.### Adjustment Disorder
- Adjustment disorder is a likely diagnosis for a 37-year-old man who recently experienced a divorce and a missed promotion, and is now experiencing depression, agitation, and work impairment.
- Adjustment disorder is an appropriate diagnosis when a person's reaction to a stressful event is more severe than expected.
Social Anxiety Disorder
- Exposure therapy is a recommended treatment for a patient with a disorder characterized by a paralyzing fear of being embarrassed by one's actions in social situations.
Borderline Personality Disorder
- A 40-year-old woman with a history of intense, unstable relationships, inability to maintain a job, and suicide attempts may have borderline personality disorder.
- Borderline personality disorder is characterized by a pattern of unstable relationships, emotions, and self-image.
Eating Disorders
- Bulimia nervosa is associated with a risk of developing complications such as electrolyte imbalance, gastrointestinal problems, and tooth decay.
- A 40-year-old woman who unintentionally lost 15 pounds in the last 6 months, is unable to find pleasure, and is too fatigued to do daily activities may have major depressive disorder (MDD).
Substance Use Disorders
- A 56-year-old man who presents with anxious and diaphoretic appearance, tachycardia, tremor, and hyperreflexia, and experiences tonic-clonic seizure activity, is likely experiencing withdrawal from alcohol.
- A 34-year-old woman who comes to the clinic with hallucinations, dry mouth, tachycardia, and urinary retention, and has dilated pupils and photophobia, may have anticholinergic intoxication.
Psychotic Disorders
- A 40-year-old woman who believes she can read other people's minds, lives alone, and has a disheveled appearance, may have a psychotic disorder, such as schizophrenia.
- A 20-year-old man who has a 1-week history of elevated mood, grandiose thinking, and decreased need for sleep, may have a manic episode.
Anxiety Disorders
- A 16-year-old boy who is afraid of heights and has a history of self-medicating with marijuana may have an anxiety disorder, such as acrophobia.
- A 28-year-old man who washes his hands at least 20 times a day, has unwanted thoughts about contamination, and has a fear of being contaminated by other people's germs, may have obsessive-compulsive disorder (OCD).
Mood Disorders
- A 16-year-old girl who reports difficulty getting out of bed, irritability, fatigue, and increased appetite, and has a history of talking to a school counselor, may have a mood disorder, such as depression.
- A 45-year-old woman who comes to the office with fatigue, insomnia, loss of interest in activities, and feelings of hopelessness, and has a history of narcissistic personality disorder, may have a mood disorder, such as depression.
Schizophrenia
- A 20-year-old man who is brought to the clinic by his mother for bizarre behaviors, such as talking to himself, and believes that people are talking about him and tracking his whereabouts, may have schizophrenia.
- A patient with schizophrenia who is taking clozapine should have their CBC monitored regularly.
Somatic Symptom Disorder
- A 29-year-old woman who is evaluated for a 3-month history of abdominal pain, and is persistently worried about the pain, and has a history of being raised in an orphanage, may have somatic symptom disorder.
- A 35-year-old man who is evaluated for constant lower back pain, and refuses diagnostic tests, may have somatic symptom disorder.
ADHD
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A 58-year-old man who comes to the office with headaches and dizziness, and has a history of CNS injury, may have ADHD.
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A comprehensive diagnostic evaluation for autism spectrum disorder must include assessments of cognitive function, social interaction, and communication.### Mental Health Disorders
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Depression:
- A 25-year-old woman experiencing difficulty sleeping, concentrating, feeling numb, and having recurring nightmares related to a past rape is likely to receive fluoxetine as the next step in management.
- A 28-year-old woman with a history of depression, who refuses to feed her infant and stays away from the infant, is likely suffering from postpartum depression.
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Anxiety Disorders:
- Panic Disorder:
- A 32-year-old woman experiencing anxiety, rapid pulse, and clammy hands after stopping therapy 3 months ago is likely to receive lorazepam and then escitalopram.
- A 23-year-old man experiencing self-limited, recurrent episodes of chest pain, palpitations, and shortness of breath with no abnormal physical exam or diagnostic study findings is likely suffering from panic disorder.
- Generalized Anxiety Disorder (GAD):
- A 35-year-old man experiencing constant fatigue, irritability, difficulty concentrating, and excessive worry about his job, the health of his neighbor's dog, and the possibility of something bad happening to his parents is likely suffering from GAD.
- Social Anxiety Disorder:
- A 19-year-old woman experiencing fear of public speaking and curtails social interactions due to fear of saying something embarrassing is likely suffering from social anxiety disorder.
- Panic Disorder:
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Psychotic Disorders:
- Schizophrenia:
- A 20-year-old man experiencing bizarre behaviors, talking to himself, and believing people are talking about him and tracking his whereabouts is likely suffering from schizophrenia.
- Bipolar Disorder:
- A 24-year-old man experiencing an elevated, expansive mood for 9 days after a depressive episode is likely suffering from bipolar disorder.
- Schizophrenia:
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Personality Disorders:
- Narcissistic Personality Disorder:
- A person is more likely to develop narcissistic personality disorder due to genetic factors.
- Borderline Personality Disorder:
- Borderline personality disorder is closely associated with abnormal cholinergic activity.
- Narcissistic Personality Disorder:
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Substance-Related Disorders:
- Alcohol Use Disorder:
- A 68-year-old man experiencing anxiety, headache, and nausea after abruptly stopping the consumption of 12 beers daily is likely suffering from alcohol withdrawal.
- Alcohol Use Disorder:
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Trauma- and Stressor-Related Disorders:
- Post-Traumatic Stress Disorder (PTSD):
- A 35-year-old man experiencing signs and symptoms of depression 2 weeks postpartum is at greatest risk of acute psychotic episode, major depressive disorder with peripartum onset, panic disorder, and gestational diabetes in a future pregnancy.
- A 30-year-old man experiencing irritability, anxiety, and flashbacks after witnessing a traumatic event is likely suffering from PTSD.
- Post-Traumatic Stress Disorder (PTSD):
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Dissociative Disorders:
- Dissociative Amnesia:
- A patient diagnosed with factitious disorder and experiencing tonic-clonic seizure-like symptoms is likely to have a normal prolactin level, indicating pseudoseizure.
- Dissociative Amnesia:
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Eating Disorders:
- Bulimia Nervosa:
- A 16-year-old girl hiding food wrappers and engaging in self-induced vomiting is likely suffering from bulimia nervosa.
- Bulimia Nervosa:
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Sleep-Wake Disorders:
- Insomnia:
- A patient experiencing difficulty sleeping, irritability, and excessive worry about his job, the health of his neighbor's dog, and the possibility of something bad happening to his parents is likely suffering from insomnia.
- Insomnia:
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Screening Tests:
- Liver Function Studies:
- A 45-year-old man with a 20-year history of alcohol use disorder should have liver function studies performed.
- Gamma-Glutamyl Transferase:
- A patient with a history of alcohol use disorder should have gamma-glutamyl transferase levels monitored.
- Liver Function Studies:
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Medications:
- Clozapine:
- A patient started on clozapine 150 mg twice a day must have their absolute neutrophil count monitored weekly.
- Fluoxetine:
- A 25-year-old woman experiencing difficulty sleeping, concentrating, feeling numb, and having recurring nightmares related to a past rape is likely to receive fluoxetine as the next step in management.
- Risperidone:
- A 22-year-old woman with pedophilic urges and fantasies should receive risperidone as part of her treatment plan.
- Clozapine:
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Test your knowledge of psychology and psychiatry with these questions on tricyclic antidepressants and treatment options for compulsive behaviors.
