Diagnoses - Part 2 of 4 Flashcards
LFT after 8 weeks is required in pts with alcohol dependence treated:
NALTREXONE AND DISULFIRAM
25 y/o pt has been Dx w/ ETOH dependence. Pt has neither had ETOH to drink nor met any of the criteria for alcohol dependence in the past 6 months. What remission specifiers would apply to the Dx of ETOH dependence?
EARLY FULL REMISSION
Individuals who consume ETOH at night usually develop:
DECREASED SLEEP LATENCY
In comparison to men, women who abuse ETOH are more likely to also have…
AXIS I DIAGNOSIS
An idiosyncratic, physiologic rxn to EtOH including rash, nausea, tachycardia, and hypotension occurs in what ethnic group?
ASIANS
Alcohol abuse in men commonly assoc w what comorbid mental D/O
ANTISOCIAL PERSONALITY
Priority of treatment: Marital problems, Depression, vs. Alcoholism.
ALCOHOLISM DETOX AND ABSTINENCE
Typical duration for alcohol detox using benzodiazepine withdrawal?
3 TO 5 DAYS
The role of the sponsor in AA characterized by:
AN AA MEMBER WHO PROVIDES 1:1 GUIDANCE IN WORKING THE AA PROGRAM.
84 y/o pt w hx of chronic alcoholism & amnesia will need, in addition to abstinence, the following intervention to prevent a progression to alcohol-related dementia:
ENSURING A GOOD NUTRITIOUS DIET
55 y/o pt presents for detox after alcohol binge. Pt reports “mild liver disease.” Labs reveal ALT is 80 and AST 70. What would be the preferred agent for detox?
CHLORDIAZEPOXIDE
Naltrexone is classified as? (Mechanism of action)
OPIATE ANTAGONIST
42yr old pt eval for depression, drinks 3 drinks/night, >3 on weekends, pt reports readiness to quit as “3/10”, what is the most helpful response for motivational interviewing?
WHY A 3 AND NOT A 0
Substantially increase rate of sustained abstinence a/w Disulfiram use?
INVOLVE PATIENTS PARTNER IN MEDICATION ADMINISTRATION
Psychotherapy for alcoholism that targets pt ambivalence
MOTIVATIONAL-ENHANCEMENT THERAPY
Which of the following should lead a psychiatrist to be concerned about benzodiazepine abuse or dependence?
HISTORY OF ABUSE OF OTHER DRUGS OR ALCOHOL.
Phenobarbital tolerance test is helpful in detox from what?
BENZODIAZEPINES
A nurse w/ 24 hr hx of anxiety and insomnia has a generalized tonic-clonic seizure. Dx?
LORAZEPAM WITHDRAWAL
A benzodiazepine reliably absorbed when administered PO or IM:
LORAZEPAM
25 y/o presents to ED c/o chest pain, SOB, and anxiety but appears NAD and calmly answers questions. Pt reports h/o panic attacks, requesting alprazolam by name, and reports “I usually need a prescription for at least 2mg 4x per day to get relief”. When asked to describe 1st panic attack, pt states, “I can’t remember when they started or the frequency”. Which d/o is likely present?
SUBSTANCE ABUSE
What is the mu opioid partial agonist approved by the FDA for the treatment of patients with opioid dependence? Administered sublingually: (3x)
BUPRENORPHINE
What drug is used to treat autonomic sxs associated with heroin withdrawal? (3x)
CLONIDINE
Pt who became addicted to codeine has a long h/o multiple relapses. Pt has completed a 2 wks detox and 2 wks following that, is about to start a court mandated maintenance on naltrexone. Prior to starting the maintenance therapy, psychiatrist should check for residual physical dependence by administering what? (2x)
NALOXONE
What term best describes buprenorphine’s action at the mu opioid receptor? (2x)
PARTIAL AGONIST
Withdrawal symptoms in chronic heroin users peak after what period of time (x2)
36 HOURS
opioid dependent offenders remain drug free with this intervention
METHADONE MAINTENANCE WHILE IN PRISON
What is reason that opioid antagonist naloxone can be co-administered with buprenorphine sublingually with no adverse effect?
POOR SUBLINGUAL ABSORPTION OF NALOXONE
Needle exchange is an example of what type of reduction strategies?
HARM
Miosis due to OD on:
HEROIN
Use of levomethadyl acetate hydrochloride (LAAM) for management of pt w/ opioid dependence allows for:
ELIMINATION OF NEED TO TAKE HOME DOSES
What is the advantage of buprenorphine compared to methadone taper in detoxification from opiate dependence?
LESS RISK OF RESPIRATORY SUPPRESSION
Opioid NOT detected in standard UDS:
FENTANYL
Pt in the ED is in withdrawal from a substance. Symptoms include muscle aches, lacrimation, yawning, and diarrhea. What substance withdrawn?
HEROIN
Lab to get prior to starting naltrexone
LFT’s
Chronic rx opioid use affects which hormone?
TESTOSTERONE
Healthcare professional has seizure as a result of drug addiction, seizure is not from withdrawal. What substance are they using?
MEPERIDINE
Which of the following produces best outcome in terms of drug consumption and criminal behavior for heroin-dependents?
MAINTAINING OF METHADONE
35 y/o pt with hx of opioid and alcohol dependence presents to the emergency department complaining of tremulousness, anxiety, nausea and vomiting. Used large amounts of heroin and alcohol the day prior. Initial preferred medication for opioid withdrawal?
METHADONE
Example of a harm reduction technique used in people with opioid dependence:
NEEDLE EXCHANGE
How should buprenorphine and the buprenorphine/naloxone combo be administered?
SUBLINGUALLY
15 y/o pt is found unresponsive by parents after pt returns from a party, friend confirms pt used heroin. What are signs?
PUPILLARY CONSTRICTION
Naltrexone prevents relapse of opioid dependency most effectively in which group?
PHYSICIANS
Check for residual physical dependence of opiates by administering:
NALOXONE
Patient in sustained opioid remission is now 10wk pregnant, how to manage?
CONTINUE METHADONE CURRENT DOSE
What med is not used in tx of opioid maintenance and relapse prevention?
BUPROPION (NALTREXONE, METHADONE, BUPRENORPHINE AND CLONIDINE ARE USED)
26yo presents to ED due to PMR, slurred speech, constricted pupils. Intoxicated with…?
OPIOIDS
Contraindication to the use of clonidine in managing opiate withdrawal:
AORTIC INSUFFICIENCY
In long-term opioid therapy for management of chronic pain, the sign most indicative of addiction is?
ADMINISTRATION BY NON-PRESCRIBED ROUTES
22 y/o heroin dependent female discovers she is pregnant and wants to detox. What way would you recommend? (4x)
METHADONE MAINTENANCE UNTIL DELIVERY THEN DETOXIFICATION
What avg dose range of methadone yields best results in decreasing illicit use? (3x)
60-100MG
Pt in methadone tx earns number of take-home doses based on compliance with attendance and participation in groups. What kind of intervention is this? (2x)
CONTINGENCY MANAGEMENT
Pregnant pt dependent on heroin presents for treatment, wants to do what’s best for baby. What is safest treatment for both mother and unborn baby? (2x)
METHADONE MAINTENANCE FOR THE DURATION OF THE PREGNANCY
Med that has potential to decrease methadone blood level: (2x)
CARBAMAZEPINE
C&L psychiatrist sees a 20 y/o pt with cancer pain on methadone maintenance program. The staff feels that the pt’s request for additional narcotics represent drug-seeking behavior. Most appropriate recommendation: (2x)
THE PT SHOULD BE GIVEN MORE OPIOID MEDICATION TO ACHIEVE ADEQUATE PAIN CONTROL BECAUSE OF THE PT’S TOLERANCE.
Federal eligibility requirements for maintenance treatment with methadone specify that an individual must have been dependent on opioids for at least what length of time?
1 YEAR
35 yo pt stabilized on methadone maintenance tx 5 yrs is BIB family to ED bc pt is lethargic/confused. During assessment pt becomes obtunded/resp depression. Family reports pt recently began new med. Which med is likely responsible?
CARBAMAZEPINE
Adol attends a “pharm party”, takes 2 methadone tabs, later found to have decreased respirations and is rushed to the ED. Which med could cause an interaction which could cause this response?
SERTRALINE
Factor most predictive of effective methadone Tx
TOTAL DAILY DOSE
Due to its rate of oral absorption, what most enhances the euphoria produced by benzodiazepines with methadone?
DIAZEPAM
What is the lowest dose of methadone that suppresses opioid drug hunger and induces a cross tolerance of illicit opiates?
80-120mg
Methadone prescription in heroin dependence is called what kind of strategy?
HARM REDUCTION
Pt on methadone screen positive for alcohol, achieve abstinence of alcohol by co- administering what with methadone?
DISULFIRAM
Pt on methadone maintenance started taking a reflux drug and now is sedated. What med was recently added?
CIMETIDINE
The first symptom reported by patients with emerging amphetamine psychosis is: (2x)
PARANOID IDEATION
Tachycardia, HTN, excessive perspiration, pupils dilated in college student after attending a party. Drug? (2x)
COCAINE
Tachycardia, dilated pupils, hypervigilance, anger, HTN, psychotic sxs, and chills. UDS shows? (2x)
AMPHETAMINES
Maximum time cocaine metabolites detectable in urine? (2x)
4 DAYS
21-year-old male at ED is agitated, believes computers are flashing messages at him, and says “I need my knife to protect myself.” Which substance on UDS? (2x)
AMPHETAMINES
Which of the following areas of the brain is most associated with the reward effects of cocaine? (2x)
NUCLEUS ACCUMBENS
Phencyclidine induces psychosis by
INHIBITING NMDA-R
Aggressive pt, yelling and assaulting, vomit, HR 135, BP 155/80, T 101F. Utox neg. Suspect bath salts intoxication. tx?
LORAZEPAM
One year after achieving methamphetamine abstinence, these craving will most likely:
DECREASE IN INTENSITY
How many hours after ingestion do amphetamines reach peak levels?
2 HOURS
Formication, agitation, stereotypical oral movements, & paranoia?
STIMULANT INTOXICATION
The immediate phase of amphetamine withdrawal is characterized by dysphoria and anhedonia as well as euphoric recall of drug use and craving for the drug. The anhedonia and dysphoria are usually much improved in which of the following time frames?
2-4 MONTHS
Mechanism responsible for the euphoric effects of methamphetamine:
DOPAMINE RELEASE IN THE NUCLEUS ACCUMBENS
Which of the following is the primary mechanism through which amphetamine secret their stimulant effect?
RELEASE OF CATECHOLAMINES
A substance of abuse with powerful reinforcing effect:
COCAINE
How long after ingestion is amphetamine detectable in urine?
1-2 DAYS
Pt with a long history of substance abuse is admitted to the hospital for shortness of breath. The pt is found to have multiple granulomas in both lungs; a biopsy reveals the presence of talc within the granulomas. Pt most likely abusing what substance?
METHYLPHENIDATE
2 days s/p hospitalization dysphoric, fatigued, hypersomnic, vivid dreams, requesting double portions:
COCAINE
Stimulant-induced craving for drugs of abuse is most frequently mediated by which neurochemicals?
GLUTAMATE
32 y/o pt w cocaine dependence prescribed desipramine by another MD for withdrawal- assoc depression. Psychiatrist should warn pt of what adverse effects that might result from an interaction between desipramine and cocaine?
HYPERTENSION
Pt reports the continuing suspicion that the spouse is committing adultery, but acknowledges the possibility of being wrong since there is no evidence to support the pt’s belief: (3x)
OVERVALUED IDEA
Patient reports that an identical-appearing impostor has replaced his father. What is the name of this delusion? (2x)
CAPGRAS SYNDROME
Appropriate response when pt describes paranoid delusions
ACKNOWLEDGE THE PATIENT’S EMOTIONAL REACTION TO DELUSION
80 yo male tells PCP he thinks his wife of 55 years is having an affair, wife and two middle aged children disagree. Pt acknowledges no clear evidence of his belief. Pt is healthy, no psych history, no hallucinations, cognitive testing is normal for age. What is his most likely diagnosis?
DELUSIONAL DISORDER
Length of time criteria for delusional d/o
ONE MONTH
Body dysmorphic d/o vs. Delusional d/o somatic type:
INTENSITY W WHICH PT INSISTS ON PERCEIVED BODY DEFICITS
Complaints of skin infection with insects, negative medical w/u:
DELUSIONAL D/O, SOMATIC TYPE
Normal male, except that he is paranoid about wife cheating on him:
DELUSIONAL D/O
26yo pt thinks his brow bridge is too prominent and looks like a neanderthal. Physician finds brow bridge prominent but WNL. Pt wants plastic surgery consult. What best describes the pt’s belief?
OVERVALUED IDEA
Erotomania refers to which of the following conditions?
DELUSIONS OF A SECRET LOVER
Isolated erotomania is a form of what?
DELUSIONAL D/O
Pts complain of having lost not only possessions, status, and strength, but also heart, blood, and intestine suffer from which of the following syndromes?
COTARD
Pt believes he is the Son of God. This Sx is called:
DELUSION
Immediate intervention in case of a pt with paranoid delusion and idea of reference:
ASKING FOR DETAILS OF PERCEPTION THAT LED TO THIS DISTRESSING DISCOVERY.
20 yo Japanese American patient present of complaining of personal body odor that is offensive to other people. This is most often compared to this DSM diagnosis?
SOCIAL PHOBIA, BODY DYSMORPHIC DISORDER, DELUSIONAL DISORDER (SOMATIC TYPE)
A patient with somatic delusional disorder refusing to see a psychiatrist but sees a dermatologist regularly. What should the psychiatrist recommend the dermatologist do?
SUGGEST THAT THE DERMATOLOGIST ASK ABOUT DRUG USE
Belief that television is sending you special messages
DELUSION OF REFERENCE
A 20 y/o female patient reports menses stopped 4 months ago and she’s pregnant. Reports morning sickness and vomiting, bigger breasts. Pregnancy test negative, ultrasound negative, still thinks she’s pregnant. What’s the diagnosis
PSEUDOCYESIS
In learned helplessness model, the behavioral deficits in animals exposed to uncontrollable stress is reversed by? (5x)
ANTIDEPRESSANTS
65y/o had MDD but was treated w/ CBT to remission. Usually has 1 glass of wine w/ dinner. Same level of drinking for many years. Family h/o dementia in both parents. Advice? (3x)
CONTINUE THE ALCOHOL AS LONG AS THE PATTERN OF USE DOES NOT CHANGE
Which d/o is treated w/ light therapy? (3x)
SEASONAL AFFECTIVE DISORDER
WHO study in 1990, what is the 2nd worldwide leading source of years of healthy life lost to premature death/disability (#1 is ischemic heart disease): (x2)
UNIPOLAR MAJOR DEPRESSION
79y/o asks for eval for STD. Upset and guilty about an affair. Spouse says affair happened many years ago. Pt is sad but not confused. Dx? (2x)
MAJOR DEPRESSION WITH PSYCHOSIS
Which depressive symptom is a melancholic feature specifier in DSM-IV? (2x)
LACK OF PLEASURE
60 y/o w/ depressive syndrome has memory problems. Incorrect on date, messes up serial sevens, spells backwards, but slowly. After 4 wks of trazodone, both mood and cognition are improved. Dx? (2x)
PSEUDODEMENTIA
Depression increases risk of mortality from what disease? (2x)
ISCHEMIC HEART DISEASE
50 y/o PT w/ depression believes that he is responsible for the destruction of the world. This is an example of: (2x)
MOOD-CONGRUENT DELUSION
Depression, according to Beck’s model is a manifestation of: (2x)
DISTORTED NEGATIVE THOUGHTS (COGNITIVE DISTORTIONS)
Which of the following characteristics is considered particularly likely to be found in patients with MDD with atypical features? (2x)
INTERPERSONAL REJECTION SENSITIVITY
34 y/o F presents “unable to reach her potential” w mood switches frequently (day to day, sometimes within one day) from mildly to moderately. Depressed to happy in the morning. No episodes meeting criteria for mania. Hx suggests most likely Dx? (2x)
CYCLOTHYMIC DISORDER
Melancholia is characterized as (2x):
ANHEDONIA
Patient with depression on admission. Which risk factor suggests need for maintenance psychotherapy? (2X)
3 OR MORE EPISODES OF DEPRESSION IN A LIFETIME
21 y/o F hospitalized for excessive bleeding following elective first trimester abortion. Pt reports having anxiety about bleeding, but is relieved about abortion. Pt reports that baby’s father is abusive but does not want to leave him. What is the strongest predictor of depression? (3x)
HX OF PRE-PREGNANCY DEPRESSION
In cancer patients, what should you use to treat sub-threshold depression sx?
START AN SSRI
Screen for depression in primary care setting?
PHQ
Average # of yrs from start of mood d/o to dx?
6-8YRS
Finding from studies of neuroimmune mechanisms of depression
PRO-INFLAMMATORY CYTOKINES ARE OFTEN ELEVATED
Symptoms that may dominate picture of mood disorders w catatonia?
EXCESSIVE PURPOSELESS MOTOR ACTIVITY NOT INFLUENCED BY EXTERNAL STIMULI
35 year old woman reports history of recurrent depression always beginning in fall/early winter and remit by spring. She is trying to become pregnant, what’s best tx?
LIGHT THERAPY
40 y/o eats and sleeps too much, craves sweets, poor concentration, irritable, constant conflicts with husband. States “I always feel better in spring.” What is the treatment?
PHOTOTHERAPY
Clinical circumstance that best warrants consideration of psychotherapy as the sole treatment for mild to moderate depression:
PREGNANCY, LACTATION, OR WISH TO BECOME PREGNANT
Which is NOT common in patients >65: depression, cog d/o, phobias, ETOH d/o, psychotic d/o
PSYCHOTIC D/O
Pts w late-life depression compared w early onset depression more likely to report:
PSYCHOTIC SXS
52 y/o with h/o unipolar depression is brought to ED with a first episode of catatonia. Pt is on no meds, UDS is neg. Further w/u should initially focus on what factor?
METABOLIC DISORDERS
Pt with MDD 4-wks into sertraline 200mg trial without improvement. Duloxetine 90mg added for an additional 6 weeks followed by 4-weeks on phenelzine 90mg. Pt cont to be depressed. What would be the most definitive treatment:
ECT
Pt with low mood, middle insomnia, impaired concentration and memory x 3 months, onset shortly after adult child was convicted with felony and imprisoned x 10 years. Most likely Dx?
ADJUSTMENT D/O WITH DEPRESSED MOOD
Blunted response to TRH stimulation test correlates with …
DEPRESSION
Most common psych d/o that occurs in pts s/p organ transplant
MAJOR DEPRESSION
The mood disturbance of PMDD is characterized by …
IT CAN BE AS SEVERE AS IN MDD
Defining feature of mood in atypical depression
REACTIVE
27 y/o F, 1 week postpartum, has sudden emotional outbursts; not sad, wants the baby. What’s going on?
MATERNITY BLUES
Implantation of DBS electrodes has been shown to lead to remission in about half of patients with treatment-refractory depression. To obtain this effect, the electrode is placed in the:
SUBGENUAL CINGULATE CORTEX
Important distinction between depressive symptoms in pts with cancer as compared to those patients with depression but no cancer is that the patients w cancer?
USUALLY MAINTAIN INTACT SELF-ESTEEM
17 y/o with depressed mood, low self esteem and poor concentration possibly has dysthymia. Which feature would support the Dx?
SYMPTOMS >1 YEAR
27 y/o M seen in ED c/o insomnia, hopelessness, anorexia, decreased concentration for 2 weeks and is now acutely suicidal. Pt has hx of ETOH use daily for the past 3 months. The most likely Dx?
SIMD
65 y/o morbidly obese pt with new onset of depression endorses fatigue and hypersomnia. He is not on meds and has no PMH. What test?
POLYSOMNOGRAPHY
40 y/o M reports long hx of continuous dysphoria and insomnia (dysthymia). Recently he feels worse and reports poor energy, hopelessness and SI. Dx:
DOUBLE DEPRESSION
Dx for 40yo male w/ mild chronic dysphoria, insomnia, fatigue, and lessened job performance, now with despondency, tearfulness, lack of energy, skipping work, hopelessness, psychomotor agitation, and SI
DOUBLE DEPRESSION
Strongest predictor in pt following MI (ever stronger than EF):
DEPRESSION
59 y/o ER physician with alcohol problem and depressed mood, less tolerant to day and night shift. In addition to abstinence from ETOH, what is next step?
RECOMMEND RELIEF FROM THE NIGHT SHIFT
Women at highest risk of MDD during:
REPRODUCTIVE YEARS
Man w/ HTN and MI, has stressors and depression, Tx?
RELAXATION TRAINING
60 y/o w/ depression & paranoia treated with 50mg Zoloft and 6mg risperidone. On follow up pt c/o slow thinking & excessive salivation. On PE masked faces and cogwheel rigidity present. Mood and paranoia have greatly improved. What is the next step?
LOWER DOSE OF ANTIPSYCHOTIC MEDS
What is a characteristic of atypical depression?
LEADEN PARALYSIS
Dexamethasone suppression test for diagnosing mood disorders:
NOT USEFUL IN ROUTINE CLINICAL PRACTICE
77 y/o F whose husband died 6 wks ago, complains about the length of time it took for her to dress. She sounds irritable, looks fatigued. “I can’t accept he is gone…. I should have been able to save him”. She says “When the real darkness descends on me specially in the middle of the night I don’t want to call anyone.” What is more indicative of MDD rather than uncomplicated bereavement:
HAVING THOUGHTS OF SUICIDE.
Cognitive triad of depression: negative self-perception, experience the world as self- defeating, AND?
EXPECTATION OF CONTINUED FAILURE
What augmentation strategies for treatment-refractory depression has shown the highest efficacy and replicability?
ELECTROCONVULSIVE THERAPY (ECT)
Tx for worsening depression, severe weight loss, dehydration, catatonia.
ELECTROCONVULSIVE THERAPY (ECT)
Presence/severity of depressive Sx in MS is correlated with:
CEREBRAL INVOLVEMENT
50 y/o pt is being treated for sadness, anorexia, poor energy, and difficulty concentrating. Fluoxetine 20mg is prescribed and the pt achieves full remission. Later pt admits that she had visual and auditory hallucinations. This improved with treatment and pt currently denies any hallucinations. Dx?
MDD WITH PSYCHOTIC FEATURES
25 y/o pt reports experiencing intense periods of profound tiredness over the past 2-3 weeks. During these periods she has increased need for sleep and spend much of day in bed. Pt also reports increased appetite. These episodes often occur in setting of interpersonal discord. Dx?
MDD WITH ATYPICAL FEATURES
Pt is initiating light therapy for seasonal depression. What statement accurately represents what is known about the type, dose, and timing of effective treatment?
MORNING LIGHT TREATMENT APPEARS TO BE MORE EFFECTIVE THAN MID-AFTERNOON EXPOSURE.
Characterizes depression in pt with MS:
RESPONDS TO ANTIDEPRESSANTS
How many symptom-free weeks must be between two episodes of depression for them to be considered separate and therefore recurrent according to DSM-IV?
8 SYMPTOM-FREE WEEKS
Which of the following functions is most likely to normalize in an 80 y/o pt successfully treated for depression?
INFORMATION PROCESSING SPEED
In pts with recurrent depression, successful treatment with antidepressants should be followed by which treatment strategy?
CONTINUING ANTIDEPRESSANTS AT THE SAME DOSAGE
Associated with improved outcome in late-life depression?
FAMILY HISTORY OF DEPRESSION
Strongest risk factor for postpartum depression:
UNTREATED DEPRESSION DURING PREGNANCY
Why would you not test breast milk or baby’s blood for sertraline levels in a breast feeding patient?
EVIDENCE SHOWS THAT INFANTS ARE HARMED MORE BY HAVING A DEPRESSED MOTHER THAN BEING EXPOSED TO SERTRALINE
What risk factor distinguished 42-52yo women w/ persistent or recurrent depressive sx from those w/ a single depressive episode?
SLEEP PROBLEMS
Began bright light therapy for seasonal mood change, now experiencing undesirable later sleep onset and awakening time. What is the most likely reason.
LIGHT EXPOSURE WAS TOO LATE IN THE DAY
The Patient Health Questionnaire-9 is a validated tool to assess the severity of what disorder?
MAJOR DEPRESSIVE
Focused attention, altered consciousness usually seen in pts w dissociative D/O (2x)
TRANCE
This symptom is essential to support a diagnosis of dissociative identity disorder (2x)
EXTENSIVE INABILITY TO RECALL PERSONAL INFORMATION
A feeling of being outside oneself or detached (x2)
DEPERSONALIZATION
Which OTC drug causes a dissociative feeling
DEXTROMETHORPHAN
Childhood environmental factor in dissociative ID d//o?
PHYSICAL ABUSE
Psychiatrist asks, “Do you find things in your possession that you cannot explain?” Trying to elicit:
DISSOCIATION
Detachment of emotional component from perception
DEREALIZATION
44 y/o pt reports hx of repeated episodes of self-mutilation and sudden changes in relationships. After several months of psychotherapy, the pt speaks in unusual accent, is irritable, and has little awareness of in-session discussions. Psych MD has past records that state pt has been Dx with borderline personality disorder and has a sexual trauma history. Dx?
DISSOCIATIVE IDENTITY D/O
Pts with dissociative identity disorder are also most likely to meet the diagnostic criteria for which of the following disorders?
PTSD
20 y/o in MVA, no injuries – speaks softly, feels calm, dim vision, mechanical movements, feels detached:
DEPERSONALIZATION
Psychiatrist and patient move from the day room to an interview room where they have met on several occasion. The patient states, “the room looks weird and different today; it doesn’t feel right.” This statement is an example of:
DEREALIZATION
Depersonalization is classified as disturbance of which of the following?
PERCEPTION
Newly married 22-year-old pt is strongly encouraged by husband to seek eval due to abrupt changes in pt’s attitudes and behaviors. Pt denies awareness of this, but does acknowledge “missing time” that made her feel like her life is “scattered on the floor of a film editor’s studio after pieces were cut and the ends spliced back together.” Old gf of husband has threatened to file charges 2/2 hostile telephone messages that have been traced to pt’s phone. Pt denies memory of making calls. What is the d/o?
DISSOCIATIVE IDENTITY D/O
Patient presents with complain “I think I’m going crazy.” Reports that she has no self and thoughts are not her own. Feels like a robot and is unable to control her body. States she has feelings and is not able to feel them. Feels emotionally numb. Feels head is “full of cotton.” Recently started having “out of body experiences.” Diagnosis?
DEPERSONALIZATION / DEREALIZATION DISORDER
Distinguishing dissociative identity disorder from PTSD?
AMNESIA FOR EVERYDAY EVENTS
What diagnosis is associated high hypnotizability potential
DISSOCIATIVE DISORDER
Most reversible type of amnesia
DISSOCIATIVE AMNESIA WITH MDD
Episodes of unrestrained eating w/o compensatory behaviors of bulimia. Dx? (5x)
BINGE-EATING DISORDER
Metabolic abnormality commonly found w anorexia nervosa/purging subtype? (4x)
DECREASED SERUM POTASSIUM
Dehydrated bulimic w/ BP 100/60 and orthostasis HR 60. Stat lab test: (3x)
POTASSIUM
What med has shown some efficacy in reducing binging and purging in bulimia nervosa? (x3)
FLUOXETINE
A plastic surgeon asks the psychiatrist to evaluate a 15 yo pt who is requesting rhinoplasty. The surgeon is willing to perform the operation but is concerned by the pt’s young age. The pt is with her parents. The pt explains “I broke my nose playing hockey 2 years ago and it has bothered me ever since” On exam, her nose is noticeable asymmetrical. Patient shows no obvious psychological distress other than concern for her appearance. Pt states “I just want to look normal again”. Parents report child has had poor self esteem since the injury and they are hoping the operation will help her self confidence. Which of the following is the most likely psychological outcome for this pt following cosmetic surgery? (x2)
AN IMPROVEMENT IN QUALITY OF LIFE
Complication of anorexia nervosa LEAST likely to resolve after restoring weight is? (2x)
OSTEOPOROSIS
A diagnosis of anorexia nervosa requires that the patient has maintained a weight below what percentage of a minimally normal weight for age and height? (2x)
85%
Pt with significant medical hx admitted to inpatient psych unit. Labs show: low K and Cl, elevated HCO3 and amylase, and normal lipase. Dx: (2x)
BULIMIA NERVOSA, PURGING TYPE
23 y/o pt w/ excessive preoccupation with body shape. Pt is in no apparent distress, but admits to binge eating episodes followed by purging twice weekly for past 6 months, Body weight: normal. Dx: (x2)
BULIMIA NERVOSA
Enlarged parotid glands in a pt being treated for anorexia nervosa would suggest which of the following? (2x)
SELF-INDUCED VOMITING
During the acute initial refeeding phase of tx for pt w/ severe anorexia nervosa, which is most helpful focus of psychotherapeutic interventions with the pt? (4x)
COACHING, SUPPORT, AND POSITIVE BEHAVIORAL REINFORCEMENT
Risk factor for developing bulimia?
CHILDHOOD SEXUAL ABUSE
What differentiates bulimia from binge eating disorder?
HISTORY OF LAXATIVE ABUSE
13 yo seen for therapy has lost weight and is now 20th %ile for weight and 60th %ile for hight. Decided to eat healthy, wants to lose 5-10 lbs, spending time researching food. Diagnosis?
ANOREXIA NERVOSA
Abdominal pain, diarrhea, hypokalemia, weight loss, steatorrhea, skin pigmentation. Possible laxative abuse. Measure:
PHENOLPHTHALEIN
Patient with anorexia nervosa is admitted to inpatient unit and has begun treatment with high caloric oral feedings; 2 days after admission an EKG shows ventricular tachycardia. Which tests would best determines the likely cause of arrhythmia?
PHOSPHATE
The primary focus of behavior therapy in the treatment of anorexia nervosa is to :
RESTORE WEIGHT
Bulimia is comorbid with:
MDD
Frequently a medical sx/sign in pts with anorexia:
REPRODUCTIVE HORMONE DYSFUNCTION
What electrolyte abnormality is most seen in bulimics?
HYPOCHLOREMIC ALKALOSIS WITH HYPOKALEMIA
32 y/o pt reveals a long-standing preoccupation with the shape of her mouth and teeth, though she says that her friends and spouse have assured her that her feelings are inappropriate. Pt reports that she often spends an hour cleaning her teeth, so that the abnormality will be less noticeable. At times she avoids social contact, fearing that people will silently criticize the appearance of her mouth. She has no other obsessions on cleaning rituals. Best dx for pt’s long-standing preoccupation?
BODY DYSMORPHIC DISORDER
25-year-old pt with no previous psych history has a new preoccupation with imagined defects in appearance, which is a cause of excessive concern. The pt has a normal medical workup and, other than the distress over appearance, the pt does not have other psych sx. Which of the following meds is most appropriate?
FLUOXETINE
In overcoming the resistance to treatment often encountered with patients who have anorexia nervosa, what is it most useful for the psychiatrist to emphasize?
EMPHASIZE HOW TREATMENT WILL ALLOW THE PATIENT TO FOCUS ENERGY ON OTHER MATTERS.
Bulimia and depression. Contraindicated:
BUPROPION
What is associated with flattening of T waves and development of U waves on EKG?
PURGING BEHAVIOR
What test findings are associated with anorexia and bulimia?
BRADYCARDIA, AMENORRHEA, HYPOKALEMIA, AND ELEVATED SERUM AMYLASE
Bulimia nervosa presents in which personality d/o?
BORDERLINE
Which enzymes can be increased in serum of pt’s with bulimia?
AMYLASE
At 30 years after presentation for treatment, mortality rates for anorexia nervosa are:
0.20%
EKG finding in pt with bingeing and purging bx:
QT AND T WAVE CHANGES
Psychotherapy that has been shown to be effective in bulimia nervosa:
CBT
Evidence for efficacy of family therapy as treatment for eating disorders?
IS SUPERIOR TO INDIVIDUAL THERAPY FOR ADLESCENTS 6-12 MONTHS AFTER TREATMENT
18 yo f avoiding food for 4 months with low BMI, regular menstruation, obsessing about being fat, trying to lose weight, sometimes vomits after large meals. Diagnosis?
ANOREXIA NERVOSA
What condition shows motivation to assume the sick role? (3x)
FACTITIOUS DISORDER
What factor differentiates malingering from factitious disorder? (2x)
HAVING EXTERNAL INCENTIVE
25 y/o prisoner claiming to be depressed is hospitalized after he swallowed some razor blades. Razor blades were carefully wrapped with surgical tape before swallowing. Confesses he wanted some time out of prison. Dx? (x2)
FACTITIOUS DISORDER
Which EMG findings in pt complaining of involuntary myoclonic movements supports dx of conversion disorder?
RISING PRE-MOVEMENT POTENTIALS
Psychiatrist is evaluating frequent liar. Pt’s lies are grandiose and extreme. Pt appears to believe the stories. This is called:
PSEUDOLOGIA FANTASTICA
In contrast to pts with factitious disorder, pts with malingering are characterized by having:
MOTIVATION FOR SECONDARY GAIN.
Pt complaining of an inability to move his arm. Pt is becoming enraged at his wife and, on several occasions, feared he might strike her. Shortly after one argument, his arm became limp. Dx:
PRIMARY GAIN
25 y/o prisoner who claims to be depressed is hospitalized after he swallowed some razor blades. The razor blades are found to have been carefully wrapped in surgical tape before the pt swallowed them. Later, the pt confesses he swallowed the blades because he wanted some time out of prison:
MALINGERING
Psych MD is asked to recommend treatment interventions for a 16 y/o pt with a presumptive diagnosis of conversion disorder. Which of the treatments is most likely to be both accepted by the pt and result in functional improvement:
REHABILITATIVE TREATMENT
24 y/o M seen in ED with chest pain claims to have a rare connective tissue d/o and said he required a recent heart transplant due to aorta dissection. He provides the MD with a list of immunosuppressive meds and requests that a transesophageal echo be done. He has no sternotomy scar and outside records indicate his story is false. Is this likely factitious d/o or malingering?
FACTITIOUS D/O (MALINGERERS USUALLY AVOID INVASIVE TESTS)
Hallucinations in patients with conversion disorder are characterized by?
HAVING A CHILDISH, FANTASTIC QUALITY
What key factor distinguishes factitious disorder from malingering
MOTIVATION TO BE IDENTIFIED AS ILL
A 35 yo F patient has discoid lupus which has long been controlled with a stable dose of oral prednisone. She abruptly develops increased fatigue, inflamed joints, and diffuse myalgias. Pt also exhibits depressed mood and cognitive impairment. She has no prior psychiatric history and no focal neurological signs. Which of the following is the most likely etiology? (x2)
DISEASE INDUCED CEREBRITIS
A C&L psychiatrist sees a sick patient with AMS. Has persecutory delusions and AH/VH. Malar rash and proteinuria, fever, pancytopenia present. What is cause of AMS?
LUPUS CEREBRITIS
28 y.o. hospitalized with paranoid delusions, AH, and agitation, tx w/Haldol 5, pt becomes rigid & mute, in days gets choreoform mvmt, has seizures, gets resp problems leading to ICU admit. Exam shows ovarian mass, CSF will show antibodies to:
NMDA RECEPTORS
Patient presents with paranoia and auditory hallucinations, found to have waxing and waning confusion. Anti-NMDA receptor antibody was positive. Which neoplasam is associated for her symptoms
OVARIAN TERATOMA
Which Sx is most common in pts with SLE?
DEPRESSION AND/OR COGNITIVE DYSFUNCTION
72 w/ recent behavior/memory problems. Disrobing, not sleeping, irritable. Waxing and waning consciousness. Dx? (8x)
DELIRIUM
52 y/o pt w/ hx of depression & HTN hospitalized, being evaluated by psych resident. His family reports he had severe HA & “has not been himself” for 10 days. On exam, pt has poor eye contact and is inattentive, muttering, picking at his clothes, occasionally dozing off although it is midday. Dx: (4x)
DELIRIUM
Pt with ICU psychosis most likely has what condition? (2x)
DELIRIUM
52 y.o. With delirium – eeg
GENERALIZED THETA AND DELTA ACTIVITY (SLOWING)
75 y/o F pt is 8 days s/p total hip replacement and has delirium. Her diazepam and doxepin were discontinued just prior to surgery. She is getting meperidine for pain, diphenhydramine for sleep and a renewed prescription for doxepin. Her confusion is likely due to which of the following: medication toxicity, diazepam WDRL, electrolyte imbalance, atypical depression, UTI.
MEDICATION TOXICITY, DIAZEPAM WITHDRAWAL, ELECTROLYTE IMBALANCE, ATYPICAL DEPRESSION, OR UTI. (ALL OF THE ABOVE)
21 y/o pt is hospitalized w/ 4 wk hx of progressive paranoia, irritability, confusion and sleep disturbance. Psych MD elicits pt hx of viral illness preceding the onset of psychiatric Sx and mental status changes. No family psych hx. Benadryl markedly make Sx worsened. Dx:
DELIRIUM SECONDARY TO VIRAL ENCEPHALITIS
Alcoholic p/w 2 days confusion, AH/VH, disorientation, distractibility, with fever, tachycardia, and tremor. EEG shows low-voltage fast waves superimposed on slow waves. Long-term olanzapine treatment for schizoaffective d/o. Dx?
DELIRIUM A/W ETOH WITHDRAWAL
Best recommendation for pt with delirium? Minimize contact with family members or limit sleep meds to diphenhydramine, or maximize staff continuity assigned to pt?
MAXIMIZE STAFF CONTINUITY ASSIGNED TO PT
Delirium in HIV patients treated with what parenteral agent?
LOW DOSE OF A HIGH-POTENCY ANTIPSYCHOTIC
Pt w/ hx of Central Pain Syndrome presented to ED with high temp, tachycardia, dilated and poorly reactive pupils, VH, agitation, constipation, and dry skin. Dx:
ANTICHOLINERGIC DELIRIUM
This major symptom of delirium may require that the pt receive pharmacological treatment:
INSOMNIA
57 y/o w AMS over several hours, followed by abrupt return to normal. No recollection, patient observed to be confused, oriented. Pt keeps asking same question, otherwise neuro exam normal, no weakness, loss of balance, speech impairment. What is typical of this condition?
RECURRENT EPISODES RARE
Doctor examines 81-year-old pt twice daily, mid morning and late afternoon. Comparing the two assessments, what findings suggest that the patient is delirious?
LOGICAL AND COHERENT SPEECH ON THE FIRST EXAM, DISORGANIZED SPEECH ON THE SECOND
8 days after hip surgery a 75 y/o pt has episodes of disorientation, sleeplessness, and crying especially at night. Also little frogs in her room. In mid morning she is ok. Was Dx w/ MDD several months ago and taking doxepin 25 mg tid and diazepam 5 mg tid were d/c before surgery. Currently on meperidine, diphenhydramine. The recent confusion is NOT caused by:
ATYPICAL DEPRESSIVE DISORDER
What is the easiest scale to use for initial assessment of delirium in geriatric patients?
CONFUSION ASSESSMENT METHOD
In a likely delirious patient, in addition to orientation questions, which part of the MMSE is most helpful to confirm the diagnosis?
SERIAL 7S
35 y/o pt presents with severe depression with episodes of anxiety for 9 months that have become so bad he can no longer leave the house, has severe weight loss, hyperpigmentation of exposed skin, and cold tolerance. Dx? (2x)
ADDISON’S DISEASE
36 yo F w/ fatigue, weight loss, salt craving, nausea, hyperpigmentation, and muscle cramps, depressed mood, and apathy? Dx?
ADRENOCORTICAL INSUFFICIENCY
58 yo depression and psychomotor retardation on SSRI. Tx augmented by?
LIOTHYRONINE
73 y/o M w/ onset of fatigue, weight gain, constipation, cold intolerance, depressed mood. Which organic caused needs to be ruled out?
THYROID
Physical finding associated with hypothyroidism:
SLOW RELAXATION OF DEEP TENDON REFLEXES
32 y/o s/p thyroidectomy presents c/o frequent panic attack, progressive cognitive inefficiency, perceptual disturbances, severe muscle cramps, and carpopedal spasm. PE: alopecia and absent DTR. Dx?
HYPOPARATHYROIDISM
55yo p/w depression, fatigue, wt gain, & somnolence x1 mo. Hx MI 3mo ago (VTach), on amiodarone, HCTZ, & metformin. Management?
TSH & T4 level
Irregular asymmetric small (1-2mm) pupils which reacts to accommodation but not to light.
DIABETIC AUTONOMIC NEUROPATHY
Hyperthyroidism should be ruled out as part of the DDx of what psychiatric d/o
PANIC D/O
The most common psychiatric symptom associated with pheochromocytoma?
PANIC ATTACKS
What stage of development occurs first in female physical development?
INCREASE IN ADRENAL ANDROGEN PRODUCTION
This is a necessary characteristic for symptoms that qualify for DSM diagnosis of premenstrual dysphoric disorder
MUST BE PRESENT DURING THE FINAL WEEK OF LUTEAL PHASE
Developmental disability assoc w triple repeat genetic abnormality (4x)
FRAGILE X SYNDROME
4 y/o child that was hypotonic as an infant is now demonstrating developmental delays, foraging for food and having many temper tantrums. Dx? (4x)
PRADER-WILLI SYNDROME
13 y/o w developmental delay, stereotyped behaviors, impaired social interactions, hyperactive behavior, large anteverted ears, hyperextensible joints, macroorchidism. Dx? (3x)
FRAGILE X SYNDROME
27 y/o F has multiple brown popular lesions on the face, neck, shoulders that have developed over years. Has b/l hearing loss, b/l limb and gait ataxia. MRI w/ gadolinium shown on test and has b/l enhancing masses. Pt is a carrier of a mutation in which gene? (3x)
NF-2 (NEUROFIBROMATOSIS 2 GENE)
Most common inherited mental retardation: (2x)
FRAGILE X
Child presents w/ moderate intellectual disability, deficits in visual-spatial processing, high levels of anxiety, a phobia, and is highly sociable. Which genetic d/o? (2x)
MICRODELETION ON CHROMOSOME 7q11.23 (WILLIAMS SYNDROME)
Metachromatic leukodystrophy associated w/ mutation in gene for which enzyme? (2x)
ARYL SULFATASE
Apoptosis of cortical neurons differs from necrosis in that it: (2x)
INVOLVES EXPRESSION OF SPECIFIC GENES
40 y/o M developed gradually progressive dementia and abnormal involuntary movements. Older brother and father have similar illness. Best Dx. test (2x)
EXCESS CAG TRIPLETS IN DNA ANALYSIS
Genetic anticipation refers to: (2x)
EARLIER ONSET OR WORSENING OF ILLNESS WITH EACH SUCCEEDING GENERATION IN A PEDIGREE (WITH EACH TRANSMISSION OF UNSTABLE DNA)
Adol pts with velcardiofacial syndrome (chromosome 22q11 deletion syndrome) are at substantially increased risk for developing which psychotic d/o? (2x)
SCHIZOPHRENIA
Karyotyping is a method of genetic analysis characterized by which techniques? (2x)
ANALYZING CHROMOSOMAL STRUCTURES
Methodological advantage of a genome wide association study in comparing individuals with schizophrenia to demographically matched controls.
CAN DETECT COMMON GENE VARIANTS THAT HAVE SMALL EFFECT ON DISEASE RISK
What is the diagnosis of pt with FTT in infancy, hyperphagia, obesity, hypogonadism, OCD? Pt has short stature and small hands/feet.
PRADER-WILLI
Chromosomal microdeletions in q11.2 of chromosome 22
SCHIZOPHRENIA
Which genetic abnormality presents with macroorchidism, intellectual disability, and frequent hand flapping in teenager?
TRINUCLEOTIDE REPEAT IN FMR1 GENE
Clinical exome sequencing helps detect which genetic abnormalities
SINGLE NUCLEOTIDE SUBSTITUTIONS
Gene mapping strategy to detect rare genetic variants of large effect
PEDIGREE LINKAGE ANALYSIS
breakage and removal of seg of chromosome and moved to another
TRANSLOCATION
Genetic technique to analyze chromosomes for a disorder
LINKAGE ANALYSIS
Which method examines the consistency that genetic variants are passed from parent to offspring within different families? (recombination, linkage analysis, DNA sequencing, Genome-wide association studies)
LINKAGE ANALYSIS
Analyzing genetic markers in a diseased population and comparing it to the norm
GENOME WIDE ASSOCIATION STUDIES
What does acetylation of lysine residues in histone proteins do?
RELAXES CHROMATIN STRUCTURE
What is the similarity between copy number variation and single nucleotide polymorphisms?
ARE COMMONLY FOUND IN HEALTHY INDIVIDUALS
What type of genetic variation is most commonly investigated in genome wide association studies?
SINGLE NUCLEOTIDE POLYMORPHISMS
What syndrome has pathogenic copy number variants affecting DNA base pairs?
PRADER-WILLI
Pts w/ PTSD have higher frequency of a specific genotype, this refers to what gene identification approach
CANDIDATE-GENE APPROACH
Animal licking/ grooming affects offspring stress. Mechanism?
IS DUE TO DNA METHYLATION AFFECTING GLUCOCORTICOID RECEPTOR EXPRESSION
Molecular mechanism explaining how early life development contributes to psychiatric disorders
DNA METHYLATION
Which is the most common mitochondrial disorder?
MITOCHONDRIAL ENCEPHALOPATHY, MYOPATHY, LACTIC ACIDOSIS, AND STROKE-LIKE EPISODES (MELAS)
Which is seen in 90 – 100% of pt w/ narcolepsy (genetics)
HLA-DR2
Mutations in the gene that codes for the parkinson protein are most commonly associated with which parkinsonism?
EARLY-ONSET PARKINSON’S DISEASE
Adrenogenital syndrome, Down syndrome, Hurler’s syndrome, Tay-Sachs disease and phenylketonuria all cause mental retardation. Which one does NOT have autosomal recessive inheritance pattern?
DOWN SYNDROME
What neurological syndromes is the result of trisomy 21?
DOWN SYNDROME
Process of gene expression
DNA TRANSCRIBED TO MRNA AND PRODUCES PROTEINS
Individuals carrying inactive alleles of the CYP2A gene have increased coniine levels per unit of drug ingested and are relatively protected from addiction to:
TOBACCO
Psych comorbidities in individuals w mental retardation vs general population:
SAME TYPES OF PSYCHOPATHOLOGY
Strongest genetic contribution
CYCLOTHYMIC DISORDER
Genetic linkage studies investigates what in medico-psychiatric research:
CO-SEGREGATION OF GENES DURING MEIOSIS
