Psiquiatria General Flashcards
25.1.
Why was the term, “psychosomatic medicine” deleted from
the DSM and changed to the term, “consultation–liaison
psychiatry”?
A. Insurance companies mandated the change
B. It implied the disorders were all in the individual’s head
C. It included religious connotations
D. It separated psychological factors from physical ones
E. The focus was more so on the body, rather than the mind
25.1. B. It implied the disorders were all in the individual’s
head
The term psychosomatic is derived from the Greek words for psyche
(soul) and soma (body). It refers to how the mind affects the body.
The term psychosomatic ended up having a negative connotation in
those with medical complaints where no physical cause could be
found, implying that they were crazy, and the symptoms were all in
their head. In 2018, the Academy of Psychosomatic Medicine
changed its name to the Academy of Consultation–Liaison
Psychiatry and the American Board of Psychiatry and Neurology
(ABPN) changed the name of psychosomatic medicine as a specialty
to consultation–liaison psychiatry.
25.2.
Rates of suicide are typically highest in which of the following
populations?
A. Late adolescent females
B. Young adolescent males
C. Females over 60 years old
D. Males over 45 years old
E. Midadolescent males
25.2. D. Males over 45 years old
Suicide rates are highest in males over 45 years of age. Other risk
factors include those with medical illnesses, a history of alcohol
dependence, decreased social support, severe pain, and previous
suicide attempts
25.3.
Which treatment is thought to be safest and most beneficial
for hospitalized patients with excessive agitation due to
substance use?
A. Antipsychotic medications
B. Mechanical restraints
C. Physical restraints
D. Sedation with opioids
E. Sleeping medications
25.3. A. Antipsychotic medications
Antipsychotic medication may be beneficial for excessive agitation in
hospitalized patients with various disorders, including cognitive
disorders, or those withdrawing from substances. Physical restraints
should be used as a last resort. While sedation is typically safer than
physical restraints, opioids should be avoided in a patient with a
history of substance use.
25.4.
Benzodiazepines can often cause sundowner syndrome in a
patient with delirium, resulting in which of the following
symptoms?
A. Ataxia
B. Fever
C. Hypertension
D. Lethargy
E. Tachycardia
25.4. A. Ataxia
Benzodiazepines and other sedatives can worsen delirium, leading to
sundowner syndrome. Symptoms include ataxia and disorientation,
along with agitation, anxiety, and confusion. While benzodiazepines
are sedatives and can cause lethargy, often when used in patients
with delirium, they can worsen confusion and lead to agitation
25.5.
A son takes his elderly father to neuropsychiatry clinic for a
follow-up appointment and mentions that his father has had
worsening memory problems and falls and that he is
struggling with taking care of him due to him constantly
wetting himself. He is afebrile with a normal urinalysis, blood
urea nitrogen, and creatinine levels. Which of the following
diagnoses is highly suspected?
A. Hydronephrosis
B. Hyperthyroidism
C. Normal pressure hydrocephalus (NPH)
D. Subdural hematoma
E. Urinary tract infection
25.5. C. Normal pressure hydrocephalus (NPH)
Central nervous system disorders, such as NPH can cause delirium
and is an urgent medical issue that surgery may cure. The classic
triad for presentation of NPH is gait disturbance, incontinence, and
dementia. Normal renal labs and a uranalysis would rule out a
urinary tract infection and hydronephrosis, which might also cause
confusion in the elderly. While a subdural hematoma and
hyperthyroidism could also cause some confusion and memory
impairment, incontinence is not typical for those disorders
25.6.
A landmark study found that women with metastatic breast
cancer receiving which treatment survived an average of 18
months longer compared to control patients?
A. Family based
B. Group therapy
C. Individual cognitive behavioral therapy
D. Individual dialectical behavioral therapy
E. Selective serotonin reuptake inhibitor
25.6. B. Group therapy
A study by David Spiegel showed that women with breast cancer
receiving weekly group psychotherapy lived an average of 18 months
longer, compared to control patients. Other studies on those with
cancer show increased activity of NK cells in those receiving a group
behavioral intervention for breast cancer and also for patients with
malignant melanoma.
25.7.
Which of the following is the most common comorbid
psychiatric disorder among cancer patients?
A. Adjustment disorder
B. Delirium
C. Generalized anxiety disorder
D. Major depressive disorder
E. Substance use disorder
25.7. A. Adjustment disorder
About half of all cancer patients have a psychiatric disorder, with an
adjustment disorder being the most common, at around 68%. Major
depressive disorder is the next most common comorbid diagnosis
(i.e., around 13%), followed by delirium (8%).
25.8.
Which best describes the incidence of suicidal thoughts, or
suicide rates, among cancer patients compared to the general
population?
A. A comparable rate of completed suicides
B. A comparable risk of suicidal thoughts
C. A decreased risk of completed suicides
D. A decreased risk of suicidal thoughts
E. A slightly higher risk of completed suicides
25.8. E. A slightly higher risk of completed suicides
Though suicidal thoughts are frequent in cancer patients, compared
to the general population, the risk of suicide is only slightly higher.
25.9.
Which demographic group is thought to have the highest rate
of suicide?
A. Young African American males
B. Elderly Caucasian females
C. Elderly Caucasian males
D. Middle-aged Caucasian males
E. Middle-aged Hispanic females
25.9. C. Elderly Caucasian males
The prevalence of major depressive disorder is lower in the elderly
compared to younger age groups. However, the incidence of suicide
is the highest among elderly persons, in particular, for elderly white
males.
25.10.
Which is the most common cause of disability among adults
65 years and older?
A. Arthritis
B. Alcoholism
C. Chronic obstructive pulmonary disease
D. Diabetes
E. Dementia
25.10. A. Arthritis
Only arthritis is a more common cause of disability among those
aged 65 years and older than dementia. Dementia increases with age,
with about 20% having severe dementia by 80 years old
25.11.
Depression with which of the following features is more
common in the elderly population compared to younger
patients with depression?
A. Atypical
B. Increased appetite
C. Insomnia
D. Manic
E. Melancholic
25.11. E. Melancholic
Elderly patients with depression present differently from that seen in
younger patients. Typically, there is more of an emphasis placed on
somatic complaints in the elderly. Depression with melancholic
features is common in the elderly. Some common features of
depression with melancholia include hypochondriasis, low selfesteem,
worthlessness, self-accusatory trends, paranoia, and suicidal
ideation.
25.12.
Which is the most common type of delusion?
A. Grandiose
B. Jealous
C. Mixed
D. Persecutory
E. Sexual
25.12. D. Persecutory
While delusional disorder is most common between 40 and 55 years
old, it can occur at any time, including in the elderly. Delusions can
be seen with medical issues such as Alzheimer disease and can occur
with psychiatric illnesses, including schizophrenia and depression.
Persecutory delusions are the most common type.
25.13.
Which is the single most important factor associated with an
increased prevalence of sleep disorders?
A. Advanced age
B. Being in college
C. Depression
D. Malnutrition
E. Psychosis
25.13. A. Advanced age
Advanced age is the single most important factor associated with an
increased prevalence of sleep disorders. Daytime sleeping, napping,
and use of hypnotic drugs are commonly found in the elderly. Higher
rates of breathing-related sleep disorders are also found in the
elderly.
25.14.
Which medication can be helpful in the treatment of vertigo
in the elderly?
A. Clonazepam
B. Diphenhydramine
C. Lorazepam
D. Meclizine
E. Propranolol
25.14. D. Meclizine
Vertigo, or dizziness, is a common complaint in the elderly. Various
medical causes include anemia, cardiac arrhythmias, Meniere
disease, etc. Most cases have a psychological component as well.
Anxiolytics and other medications that cause dizziness and daytime
somnolence should be avoided. Meclizine 25 mg to 100 mg daily can
be helpful in treating vertigo in the elderly.
25.15.
Dose adjustments in psychiatric medications should be
made in the elderly for many reasons, including which of the
following?
A. Decreased presence of lean body mass
B. Lower rates of orthostasis
C. Higher hepatic clearance
D. Increased metabolism
E. Increased gastric secretions
25.15. A. Decreased presence of lean body mass
Dose adjustment should be made in the elderly when utilizing
psychiatric meds due to increased renal and hepatic clearance, along
with decreased cardiac output and decreased gastric secretions and
absorption. Orthostasis is common, especially from psychotropic
meds in the elderly, and often necessitates a decrease in the dose. In
general, pretreatment medical clearance and an electrocardiogram
(EKG) are recommended before starting psychiatric medications in
the elderly
25.16.
Which factor is correlated with an increased risk of suicide
and should be included in emergency room (ER) screens for
suicide?
A. Anhedonia
B. A family history of bipolar disorder
C. Increased sleep
D. Psychomotor retardation
E. Pervasive hopelessness
25.16. E. Pervasive hopelessness
A clinician evaluating a patient in a psychiatric ER setting should
always ask the patient about suicidal ideation and assess suicide risk.
Some examples of factors that increase the risk of suicide include
pervasive hopelessness or pessimism, along with family history of
suicide, verbalization of suicidal ideation, and previous attempts
25.17.
A patient with a history of schizophrenia and depression,
currently on psychotropic medication, is seen in the
emergency room for evaluation of a high fever. Vital signs are
also significant for tachycardia. The physical exam is
significant for pharyngitis and ulcers in the oral and perianal
area. Which psychiatric medication is the most likely culprit
of these symptoms?
A. Carbamazepine
B. Clozapine
C. Selegiline
D. Thioridazine
E. Venlafaxine
25.17. B. Clozapine
The patient described above with a high fever, pharyngitis, and oral
and perianal ulceration likely has clozapine-induced agranulocytosis.
When the number of absolute neutrophil count (ANC) is low, it can
cause life-threatening infections.
25.18.
After discontinuing the medication in the patient above,
administration of which of the following treatments is the
most appropriate measure?
A. A blood transfusion
B. Chlordiazepoxide
C. Cyproheptadine
D. Granulocyte colony-stimulating factor
E. Lorazepam
25.18. D. Granulocyte colony-stimulating factor
The first step in the treatment of Clozaril-induced agranulocytosis, as
described in the previous case, is discontinuing the medication
immediately. After that, administration of granulocyte colonystimulating
factor may be helpful. Though it is similar to a blood
infusion, granulocytes, not red blood cells, can be infused in rare
cases of agranulocytosis.
25.19.
A patient presents to the emergency room (ER) intoxicated
with an unknown substance. He presents with ataxia and is
highly somnolent on mental status examination, with low
blood pressure, heart rate, and respiratory rate. Which of the
following substances is the toxicology screen most likely to
come back positive for?
A. Amphetamines
B. Benzodiazepines
C. Lithium
D. Lysergic acid diethylamide (LSD)
E. Phencyclidine (PCP)
25.19. B. Benzodiazepines
Benzodiazepine intoxication can present with sedation, somnolence,
and ataxia, as described in the case above. Risks of intoxication
include suppression of blood pressure, heart rate, and respiratory
rate. LSD and PCP are hallucinogens that can affect perception. LSD
intoxication can present with hypertension, mydriasis, and
diaphoresis. PCP intoxication presents with nystagmus,
hypertension, and dissociative symptoms and agitation. Unlike
benzodiazepines, which are sedatives, amphetamines and stimulants,
can cause agitation, tachycardia, hypertension, and dilated pupils.
Lithium toxicity causes nausea, vomiting, confusion, and tremors
25.20.
Administration of which of the following treatments is the
most appropriate measure in the case above?
A. Charcoal
B. Flumazenil
C. N-acetylcysteine
D. Naloxone
E. Naltrexone
25.20. B. Flumazenil
Supportive measures and administration of Flumazenil can be
helpful in reversing benzodiazepine overdoses, if skilled personnel
are delivering it and resuscitation equipment is nearby
25.21.
A patient had a recent gastrointestinal illness and has had
poor appetite for the past few days. He remained compliant
with psychiatric medication and now presents in the
emergency room (ER) with acute worsening of diarrhea, gait
instability, and a tremor and is noted to be confused on
mental status examination and has a seizure. Which
psychiatric medication is the most likely culprit?
A. Divalproex sodium
B. Fluoxetine
C. Lithium
D. Methylphenidate
E. Venlafaxine
25.21. C. Lithium
The patient described in the case has lithium toxicity, which can
often occur with dehydration, such as that caused by the recent
sickness in the case above, given Lithium has a small therapeutic
window and fluid shifts can lead to toxicity. Sings of toxicity include
vomiting, ab pain, diarrhea, tremor, ataxia, and in more severe cases,
seizures, focal neurologic signs, and a coma.
25.22.
Which of the following treatments is most appropriate to
reverse the medication toxicity noted in the previous case?
A. Outpatient dialysis
B. Outpatient neuro follow-up and benztropine
C. Intensive care unit (ICU) transfer and benzodiazepines
D. ICU transfer and charcoal administration
E. ICU transfer and osmotic diuresis
25.22. E. ICU transfer and osmotic diuresis
The previous case describes lithium toxicity. Lithium toxicity can be
deadly and often requires an ICU admission. Osmotic diuresis and
lavage with a wide-bore tube can help reverse the toxicity.
25.23.
A 25-year-old female presents with hot flashes and reports
feeling shaky and tingling in her fingers. She reports a rapid
heartbeat, lasting a few minutes at a time, multiple days a
week for the past few months. She presents to the emergency
room after another episode. Which medical test should be
obtained to rule out an organic cause for this disorder?
A. Chest x-ray
B. Complete blood count
C. Electrocardiogram (EKG)
D. Magnetic resonance imaging of the brain
E. Urinalysis
25.23. C. Electrocardiogram (EKG)
Mitral valve prolapse can be associated with panic disorder, as it can
cause heart palpitations, dyspnea, fear, and anxiety. An EKG should
be obtained to rule out mitral valve prolapse in cases of panic
disorder
25.24.
Which of the following medication strategies is the best
long-term treatment for the patient in the previous case,
provided her medical tests are all normal?
A. Alprazolam
B. Fluoxetine
C. Gabapentin
D. Lorazepam
E. Propranolol
25.24. B. Fluoxetine
While short-acting benzodiazepines might be useful for short-term
management of panic disorder, the best long-term management
medication wise is an antidepressant, such as fluoxetine, which is
U.S. Food and Drug Administration (FDA) approved to treat panic
disorder. In cases of mitral valve
prolapse-induced panic symptoms,
propranolol could be helpful
