Comportamiento Flashcards
An otherwise healthy 55-year-old woman comes to the physician because of a 7-month history of insomnia. She has difficulty initiating sleep, and her sleep onset latency is normally about 1 hour. She takes melatonin most nights. She avoids consuming alcohol and caffeine before bedtime and has begun to exercise every other afternoon. She also does not watch TV or use her phone shortly before she goes to bed. The physician gives the following recommendations: when unable to fall asleep within 20 minutes, leave the bedroom to read or listen to music; return only when sleepy; use the bed only for sleeping and having sex. These recommendations are best classified as which of the following?
Relaxatin
Stimulus control therapy
Improved sleep hygiene
Cognitive behavioral therapy
Sleep restriction
Stimulus control therapy
The physician’s recommendation of rising from bed after 20 minutes of being unable to sleep and returning only when sleepy is an example of stimulus control therapy, a common behavioral treatment for insomnia. The goal is to reestablish the bed as a strong cue for sleep by strengthening sleep-compatible associations with the bedroom environment and removing sleep-incompatible ones.
A 5-year-old boy is brought to the physician by his mother because he claims to have spoken to his recently-deceased grandfather. The grandfather, who lived with the family and frequently watched the boy for his parents, died 2 months ago. The boy was taken out of preschool for 3 days after his grandfather’s death but has since returned. His teachers report that the boy is currently doing well, completing his assignments, and engaging in play with other children. When asked about how he feels, the boy becomes tearful and says, “I miss my grandpa. I sometimes talk to him when my mom is not around.” Which of the following is the most likely diagnosis?
Normal grief
A senior medicine resident receives negative feedback on a grand rounds presentation from his attending. He is told sternly that he must improve his performance on the next project. Later that day, he yells at his medical student for not showing enough initiative, though he had voiced only satisfaction with the student’s performance up until this point. Which of the following psychological defense mechanisms is he demonstrating?
Displacement
Displacement is a neurotic defense mechanism in which an individual redirects negative emotions from its real target to a neutral third party. The neutral third party is often a subordinate or less threatening entity. The senior resident is displacing his anger at his attending to his medical student.
A 58-year-old man with hypertension and dyslipidemia comes to the physician for a routine health maintenance examination. He says he feels well. He is 180 cm (5 ft 11 in) tall and weighs 103 kg (227 lb); BMI is 32 kg/m2. His BMI last year was 27 kg/m2. When asked about his diet, he says, “Being overweight runs in my family. Rather than fight it, I just try to enjoy myself and eat what I want.” Which of the following defense mechanisms best describes the patient’s response to the physician?
Rationalization
Rationalization is a neurotic defense mechanism that involves offering excuses or rational explanations in an attempt to justify behaviors, attitudes, or beliefs to avoid self-blame. The way in which this patient uses his family history of obesity as a rationale for overeating and his own weight is, therefore, an example of rationalization.
A 40-year-old woman comes to the therapist for weekly psychotherapy. She was diagnosed with major depressive disorder and anxiety after her divorce 1 year ago. During last week’s appointment, she spoke about her ex-husband’s timidity and lack of advancement at work; despite her urging, he never asked for a raise. Today, when the therapist asks how she is doing, she replies, “If there’s something you want to know, have the courage to ask me! I have no respect for a man who won’t speak his mind!” The patient’s behavior can be best described as an instance of which of the following?
Transference
Transference is a phenomenon in which a patient projects feelings (positive and/or negative) about important persons onto the clinician. This woman projects her frustrations about her ex-husband’s timidity onto the therapist. Transference is not a type of defense mechanism.
Countertransference is a similar phenomenon in which clinicians project feelings about important persons onto patients (e.g., by viewing patients as their children).
This patient has _______, a condition that manifests with neurologic symptoms that are inconsistent with neurologic disease. A characteristic finding in patients with said disorder is a neurologic deficit that manifests inconsistently during an examination, such as this patient’s transient inability to plantarflex the ankles. This condition is more common among young women and typically develops after an acute stressor (e.g., trauma, interpersonal conflict). The diagnosis of conversion disorder requires thorough evaluation and ruling out of other possible diagnoses, such as a cerebrovascular accident in this patient with unilateral weakness and an unsteady gait after a loss of consciousness.
conversion disorder
A 42-year-old man comes to the physician because of a 3-year history of urinating up to 20 times each day. He has not had any dysuria and nocturia. He has been evaluated by several urologists but has not received a specific diagnosis despite extensive diagnostic testing. Various pharmacologic treatments have not improved his symptoms. He quit his job 1 year ago and stopped attending social events because his frequent urination has been disruptive. He spends most of his time at the library trying to learn what could be causing his symptoms. He would like to undergo a CT scan of his entire body to evaluate for cancer. Physical examination and laboratory studies show no abnormalities. Mental status examination shows a depressed mood and constricted affect. There is no evidence of suicidal ideation. Which of the following is the most likely explanation for this patient’s symptoms?
This patient has somatic symptom disorder, a condition characterized by ≥ 6 months of excessive thoughts, feelings, and/or behaviors related to a somatic symptom (e.g., heartburn, fatigue, headache, pain). His previous diagnostic workup did not reveal any known medical etiology of his frequent urination. Patients with this condition typically show a preoccupation with their health and develop significant distress, anxiety, and fear of severe illness.
A 38-year-old man comes to the physician because of persistent sadness and difficulty concentrating for the past 6 weeks. During this period, he has also had difficulty sleeping. He adds that he has been “feeling down” most of the time since his girlfriend broke up with him 4 years ago. Since then, he has only had a few periods of time when he did not feel that way, but none of these lasted for more than a month. He reports having no problems with appetite, weight, or energy. He does not use illicit drugs or alcohol. Mental status examination shows a depressed mood and constricted affect. Which of the following is the most likely diagnosis?
Persistent depressive disorder
_____ can be used to treat GAD. While SSRIs or SNRIs are generally considered first-line for treatment of GAD, ____ is an effective anxiolytic drug with no potential for dependence and its favorable side effect profile makes it the best option for this patient with sexual dysfunction. Pharmacologic treatment should be continued for several months to minimize the risk of relapse. Because the time to onset of clinical response to buspirone is commonly delayed, a trial with this drug should be continued for several weeks.
Buspirone
A 21-year-old man comes to the physician because of nervousness and difficulty sleeping over the past 2 weeks. Three months ago, he started a new team project at his job. He says that he has trouble falling asleep at night because he thinks about the project. He insists on checking the work of his teammates and spends several hours each week making elaborate lists and schedules. He refuses to let others take on more tasks because he thinks that only he can complete them satisfactorily. The project deadline has already been postponed once. He says, “My teammates never understand how important it is to do things the right way.” Ever since high school, he has used the majority of his time to plan out assignments and does not have time to regularly participate in social activities. Which of the following is the most likely diagnosis?
Obsessive-compulsive personality disorder
