PSYCH REVIEW+ Quizes Flashcards by Ashley Ruehle

How long does anxiety have to be present for a diagnosis of GAD?

> 6 months

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What are the top treatments for GAD?

First line: CBT or Pharm therapy, if severe consider both

Pharm thx here: SSRI, SNRI

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How long for a specific fear out or proportion to actual danger to diagnostically become a phobia?

6 months

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How to treat phobias?

Desensitization

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How do you diagnose panic disorder?

At least one attack with 1 month of persistent concern of a second or a change in behavior to avoid attacks

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How to treat panic disorder

Desensitization, flooding, CBT, pharm, EMDR, psychotherapy

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Diagnostic Criteria of Bipolar I

Manic episode plus MAJOR depressive episode.

flight of ideas, grandiosity, fast speech, irritable (more common)

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What medications induce bipolar? (4)

Levadopa, corticosteroids (>50mg), antidepressants, stimulants

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What dose of corticosteroids can cause problems with mood?

> 50 mg / dose

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Treatment of Bipolar I (5)

Lithium, topiramate, valproic acid, lamotrigine, carbamazepine

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Bipolar II Disorder diagnostic criteria

Hypomania + MAJOR depressive episode

Depression: 2 weeks
Hypomania: 4-7 days of mania, no impairment, no psychosis
More time in depressive state
Rapid cycling

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How to treat Bipolar II

Lithium, Topiramate, valproic acid, lamotrigine, carbamazepine

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Diagnostic Criteria for Cyclothymic Disorder

hypomania plus MILD depression present HALF THE TIME for 2 years

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How long can you be without symptoms and still have cyclothymic disorder

Cannot be without symptoms for >2 months at one time

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How long do you have to show signs of depression to be diagnosed with Major Depressive Disorder (MDD)

2 weeks

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Brain changes for MDD seen on scans

small caudate nuclei, small frontal lobe

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Symptoms of MDD(3)

anhedonia (inability to experience pleasure), worthlessness, hopelessness,

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Seasonal pattern of MDD

MC in fall, winter over a 2 year period

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What is the treatment for seasonal pattern MDD

Bright artificial light

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How long after a death/catastrophic event do you need to have depression to diagnose Persistent complex bereavement disorder (adults vs children)

Adults: 1 year, children 6 months of grief beyond the norm

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Treatment for Persistent Complex Bereavement Disorder

No meds, talk therapy

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Disruptive Mood Dysregulation Disorder diagnostic criteria

Pattern of negative, hostile defiant behavior, WITHOUT serious violation of societal norms/rules

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How long to have symptoms to diagnose DMDD

6 months

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Diagnostic Criteria of Conduct Disorder

negative, hostile, defiant behavior with basic rights of others violated. Harm to animals, property. CHILDREN ONLY

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What does a diagnosis of conduct disorder manifest as in adulthood?

Antisocial Personality Disorder

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Dissociative Identity Disorder diagnostic criteria

Discontinuity in self, observer of actions, incomplete recovery, self mutilation common,

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What is the dissociative fugue specifier?

Wandering away from home or work unexpectedly

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Explain Dissociative Amnesia

selective or generalized amnesia, post emotional trauma or conflict, increased suicide and self harm risk

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Depersonalization/Derealization

Intact reality testing, detached from self
Egodystonic Episodes
Recognize Unreality
Altered sense of time
IF TRANSIENT, NOT A DISORDER
CLEAR ASSOCIATION WITH CHILDHOOD TRAUMA

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Depersonalization

outside observer of own thoughts, distorted sense of time and self, emotional and physical numbing

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Derealization

Unreality, detachment to surroundings, veil, fog, in a bubble, subjective visual distortions, auditory distortions

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Cluster A personality disorders

odd/eccentric, detached, distrustful, fantasy, projection
paranoid, schizoid, schizotypal

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Cluster B Personality Disorders

Dramatic, Erratic, Emotional

Histrionic Personality
Narcissistic Personality
Antisocial Personality
Borderline Personality

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Cluster C personality disorders

Anxious, fearful

avoidant, dependent, obsessive compulsive

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Paranoid personality disorder characteristics

so self absorbed they distort realtiy, projection of angry/sexual feelings on others towards them (they would want to have sex with me, they are in love with me), feel threatened, persecuted. Grudges, counter attacks, shame. PROJECTED SUPEREGO

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Schizoid Personality Disorder characteristics

No enjoyment of close relationships, little desire for sex, indifferent to praise, criticism, detachment from social relationships, restricted emotional expression

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Schizotypal Personality Disorder characteristics

eccentricities of behavior, odd beliefs, magical thinking, acute discomfort in close relationships, MICROPSYCHOTIC EPISODES, abnormal eye movement

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Avoidant Personality Disorder characteristics

NOT ASOCIAL, HAVE A DESIRE FOR COMPANIONSHIP
timid, intense sensitivity to rejection, inferiority complex, need for reassurance, fear of: criticism, disapproval, rejection, shame, ridicule, embarrassment

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Borderline Personality Disorder Characteristics

Self image problems, frantic efforts to avoid real/imagined abandonment, recurrent suicidal, self mutilating, unstable/intense relationships, impulsivity in 2+ places, manipulative, transient paranoia,

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Antisocial Personality Disorder characteristics

-a pervasive pattern of disregard for, and violation of, the rights of others occurring since age 15 years
-don’t believe societies rules are made for them so are consistently irresponsible
-arrogant, self-centered, entitled
-exploit and seek power over others
-lack empathy and are unable to express human compassion

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Treatment for Borderline Personality Disorder

Dialectical Behavior Therapy (DBT)

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Histrionic Personality Disorder characteristics

Excessive emotionality, attention seeking, sexually seductive, uncomfortable when not the center of attention, uses physical appearance to get attention, considers relationships to be more intimate than they are, drama, theatherics, exaggerated expressions “I LOVE THIS, I HATE THAT”

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Narcissistic Personality Disorder characteristics

grandiosity, importance, fantasies of success, exploitative, lacks empathy, arrogant, believes they are special, chronic/intense envy

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PICA diagnosis

Eating non-food/non-nutritional substances, over 2 years old

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How long does PICA have to persist to be diagnostic?

1 month at least

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Rumination disorder

repeated regurgitation after feeding/eating, see weightloss and nutrient deficiencies

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Anorexia nervosa

high achievers, intake restriction, distorted self image, LOW BMI, arrhythmias, growth delay, osteoporosis, restricting

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How long does a person need to restrict nutrients to be given a diagnosis of anorexia

3 months at least

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Bulimia Nervosa

Difficulty with impulse regulation, binge eating plus vomiting/excessive laxative use

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How long does a person need to be bingeing / purging to have a diagnosis of bulimia nervosa?

At least 1 time per week for 3 weeks

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Obsessive compulsive disorder characteristics

true obsessions and true compulsions, perfectionism, orderliness, inflexibility, distrust of emotions, stiff, formal, rigid demeanor, lack of interpersonal skills, Good or fair insight that the actions are not helpful,

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Treatment for OCD

CBT, SSRIs, Clomipramine

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Body Dysmorphic Disorder Characteristics

any part of the body, preoccupation that is time consuming, ideas and delusions of reference

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Treatment for BDD

SSRIs, clomipramine

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Hoarding characteristics

distress to discard, an accumulation of possessions

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Trichotillomania characteristics

recurrent pulling of hair, repeated attempts to stop, vary in awareness,

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What is tonsure

almost completely bald from trichotillomania

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How to rule out alopecia in suspected trichotillomania?

Biopsy

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Excoriations

Recurrent skin picking, repeated attempts to stop, avoiding public and social events

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What treatments may you consider for excoriations?

Abx to treat infection

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What is Sydenham’s Criteria

neurological manifestation of rheumatic fever post strep A, OCD like sxs

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Autism Spectrum Disorder characteristics

impairment in social interactions, delayed speech is first sign, poor/absent eye contact, repetitive, restrictive behavior, resistance to change, fixated interests, self stimulating behavior

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Rhett’s Disorder

normal in first 6 months, then see regression, small head, slow brain growth, decreased motor skills, breathing issues, sudden odd facial expressions, epilepsy, scoliosis, irregular rhythms

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ADHD

inattention, hyperactivity, and impulsivity or any combo of the three, before age 12, 2 or more settings: Social, home, school,

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How long do sxs have to be present to diagnose ADHD and before what age

before age 12, 6 months or more of sxs

*in two or more settings

Primary insomnia

sleep-state misperceptions, idiopathic

Primary hypersomnia

Somnolence plus excessive daytime sleep

Narcolepsy

sleep paralysis, sleep attacks with REM, triggered by strong emotions

Sleep apnea mcc? tx?

MCC of excessive daytime sleepiness, tx with CPAP or BiPAP

Circadian rhythm disorders

societal expectations conflict with preferred rhythm (jet lag, shift work)

Tx for Periodic Limb movement disorder

dopamine agonists, benzos

Periodic limb movement disorder

contractions of the lower limbs

What are parasomnias

undesired activities during sleep

Parasomnia, slow wave (NREM 3-4)

Sleep walking aka somnambulism
Night terrors aka pavor nocturnus

Parasomnia, wake-sleep transition disorders

Sleep starts – hynogogic jerks involving involuntary contraction of legs/arms at starts of sleep
rhythmic movement disorder: banging head at sleep onset

Parasomnia, light sleep stage disorders (NREM 1-2)

Sleep talking aka somniloquism
Teeth grinding aka bruxism

Parasomnia, REM sleep disorders

Nightmare disorder
REM behavior disorder (acting out a dream)

Parasomnia diffuse sleep disrders

nocturnal enuresis
sleep related seizures

Post Traumatic Stress DIsorder characteristics

older than 6 years old, presence of one intrusion symptom, presistent avoidance of associated stimuli, negative alterations in cognitions and mood, marked alterations in arousal and reactivity,

Secondary sleep disorders

anything–GAD, mood disorders, psychotic disorders, meds, drugs

How long to be characterized PTSD and not ASD

1 month

Timeline of Acute Stress Disorder

3 days to one month

How long does adjustment disorder

less than 6 months after symptoms start (which could be up to three months from stressor)

Example: you move on Jan 1, get symptoms April 1, have sx until October

Treatment for PTSD

SSRIs, SNRIs, CBT, EMDR
Prazosin for nightmares
SSRIs: Sertraline, paroxetine, fluoxetine

Adjustment Disorder characteristics

emotional and behavioral problems in response to identifiable stressor, not the same as bereavement, must start within 3 months of stressor

Neuroleptic Malignant Syndrome characteristics

idiosyncratic reaction to neuroleptic medications, fever, extreme muscle rigidity (lead pipe rigidity) =, AMS, elevated CK, tachycardia, HTN, rhabdo, DA agonist started or withdrawn within the past 72 hours

Treatment for NMS

lower temperature, fluids
if severe: dopamine agonists (bromocriptine) dantrolene, benzos

Serotonin Syndrome characteristics

Drug toxicity (SSRIs, SNRIs, MAOi, St Johns Wort, Triptans, buspirone, LSD, ondansetron, metoclopramide, linezolid, antivirals)
HA, seizures, arrhythmias, unconsciousness

TX for serotonin syndrome

cyproheptadine

Schizophrenia characteristics

idea of reference (false belief of being referred to by others)
echolalia
Grandiosity
Derealization
Positive Symptoms
Negative Symptoms
Disorganization of speech
Deterioration in social, occupational, interpersonal functioning

Must hve delusions or hallucinations in the absence of mood episodes,
If have mood episodes = schizoaffective

What are the postiive symptoms of schizophrenia

hallucinations, hyperactivity, hypervigilance, grandiosity, suspiciousness, hostility

What are the negative symptoms of schizophrenia

blunted affect, social and emotional withdrawal, poor rapport with others, difficulty with abstract thinking, loss of spontaneous conversation

How long is the duration of sxs to get a diagnosis of schizophrenia?

6 months

If have symptoms of schizophrenia but it’s been less than 6 months, what is the diagnosis?

Schizophreniform

If have schizophrenia like symptoms plus a mood disorder, what is the diagnosis?

Schizoaffective Disorder

Treatment of schizophrenia

CBT, Antipsychotics

Schizoaffective disorder characteristics

uninterrupted period of illness with a major mood episode (major depression plus schizophrenia for example)

TX for schizoaffective disorder

Antipsychotics, SSRIs, CBT

Diagnosis of Cushing’s Disease

24 hour urine cortisol, 11 pm salivary cortisol,

Dexamethasone Suppression Test: give DXM and see ACTH levels fall in a normal person, if don’t fall, have Cushing’s

Cushing’s Disease characteristics

hypercortisolims, pituitary tumor secreting ACTH, decreased libido, obesity, weight gain, round face, menstrual changes, lethargy, depression, buffalo hump

Thyroid Disease symptoms

Hypothyroidism: low thyroid, low mood, depression, fatigue, irritability, dry skin, memory less, muscle aches

Hyperthyroidism: anxiety, restlessness, exaggerated emotinoal responses, feelings of unhappiness and dissatisfaction, insomnia, weight loss, staring gaze

A therapeutic technique often used to treat anniversary and reactive depression is:
A. Expel the introject
B. Mobilization of rage
C. Mobilization of rage and expel the introject
D. None of these

A. Expel the introject

A 26-year-old woman presents to the emergency department accompanied by her sister, who reports episodes of sudden crying and dramatic shaking of the patient’s arms and legs. These episodes have been occurring frequently, especially in stressful situations. The patient appears distressed but fully alert and oriented upon examination. EEG monitoring does not show any epileptiform activity during an episode. What is the most likely diagnosis?

A Generalized tonic-clonic seizure
B Psychogenic non-epileptic seizure (PNES)
C Frontal lobe epilepsy
D Panic disorder
E Myoclonic seizure

B Psychogenic non-epileptic seizure (PNES)

A child who is diagnosed with conduct disorder is at high risk for developing which disorder as an adult?

A Mood disorder
B Narcissistic Personality Disorder
C Conduct disorder
D Antisocial Personality Disorder
E Psychopathy

D Antisocial Personality Disorder

To make a diagnosis of Bipolar Il Disorder:

A The diagnosis requires a history of a manic episode as well as a major depressive episode
B The depression is not nearly as deep as it may be in Bipolar Disorder Type I
C Patients must demonstrate impairment from the hypomanic episode
D There must be a history of at least one hypomanic episode and at least one major depressive episode
E Patients always exhibit depression as the first symptom.

D There must be a history of at least one hypomanic episode and at least one major depressive episode

A 22-year-old college student is brought to the ED by her roommate. Approximately 3 weeks ago, she was diagnosed with major depressive disorder and started on fluoxetine. One week ago, the patient began acting strangely at her dormitory. She began staying up all night working on projects that were not required of her classes and despite only getting 2-3 hours of sleep per night, she reported feeling rested. She was speaking very rapidly and shifted rapidly between being excited, agitated, and tearful. She reports never having felt this way before and said that she has been taking the fluoxetine as prescribed. Which of the following is the most likely diagnosis?

A Schizoaffective disorder
B Bipolar I disorder
CBipolar Il disorder
D Mood disorder due to a substance
E Borderline personality disorder

B Bipolar I disorder

A 26-year old man is arrested for beating a motorist during a carjacking. The man has a history of repeated incarcerations for robbery, DUl, and credit card fraud. When he was 14 years old, he was expelled from school for fighting.

A Antisocial personality disorder
B Avoidant personality disorder
C Borderline personality disorder
D Dependent personality disorder
E Histrionic personality disorder

A Antisocial personality disorder

Characterized by periods of mild depression and hypomanic episodes.

A Bipolar I disorder
BBipolar Il disorder
C Cyclothymia
D Dysthymia

C Cyclothymia

Characterized by periods of major depression and manic episodes.

A Bipolar I disorder
B Bipolar II disorder
C Cyclothymia
DDysthymia

A Bipolar I disorder

A 27-year old man lives alone and works at night as a security guard. He ignores social invitations from coworkers, and he has no interests that involve interpersonal relationships and is content being at home.

A Narcissistic personality disorder
Obsessive-compulsive personality disorder
C Paranoid personality disorder
D Schizoid personality disorder
E Schizotypal personality disorder

D Schizoid personality disorder

A 30-year old woman has been sad for the past 2 weeks. She is fatigued and has a hard time concentrating at work. Just a few weeks ago, she was feeling energetic, enthusiastic, able to work 10-12 hours a day with little sleep and go dancing at night. Her husband states that he is tired from “those constant ups and downs” in the last several years. Her most likely diagnosis is:

A Major depressive disorder with seasonal pattern
B Dysthymia
C. Cyclothymia
D Recurrent major depressive disorder

C. Cyclothymia

An 11-year-old boy is brought to the office by his parents. He repeatedly steals, skips school, lies, gets in fights and is cruel to animals. The night before he was returned home by the police after her tried to run away from home. The police found him vandalizing a car. His parents are concerned not only because of his behavior, but also because he does not ever seem to have any remorse about his actions. Which of the following is the most likely DSM V diagnosis?

A borderline personality disorder
B conduct disorder
C oppositional defiant disorder
Dnarcissistic personality disorder

B conduct disorder

A 60-year old female presents to you complaining of blackouts. She states that she “wakes up” from her blackout periods not knowing the immediate preceding events. Her sister reports that over the years, her sister Elizabeth has often changed her name, at times going by Beth, Betty, Bet, Liz, or Elizabeth. Her sister also reports that the patient has frequent mood swings and often forgets previous conversations. Her sister says that sometimes Elizabeth “doesn’t even act like herself.” You note that she has a history of frequently missed appointments. Which of the following is an appropriate diagnosis and treatment?

A Bipolar disorder with initial treatment with a mood stabilizer
B Dependent personality disorder with initial treatment with a psychotherapy
C General anxiety disorder with initial treatment with an SSRI
D Conversion disorder with initial treatment with insight-oriented therapy
E Dissociative identity disorder with referral to a psychiatrist

E Dissociative identity disorder with referral to a psychiatrist

Characterized by periods of major depression and hypomanic episodes.

A Bipolar I disorder
B Bipolar II disorder
C Cyclothymia
D Dysthymia

B Bipolar II disorder

Reactive depression is:

A Exogenous and determined by events outside the body

B Endogenous and primarily determined by biological factors

C Best managed with medication and psychotherapy

D Often hereditary and usually has a first degree relative with the disorder

A Exogenous and determined by events outside the body

A 30-year-old woman has been sad for the past 2 weeks. She is fatigued and has a hard time concentrating at work. Just a few weeks ago, she was feeling energetic, enthusiastic, able to work 10-12 hours a day with little sleep and go dancing at night. Her husband states that he is tired from “those constant ups and downs” in the last several years. Her most likely DSM V diagnosis is:

A Major depressive disorder with seasonal pattern
B Mania
C Cyclothymia
DRecurrent major depressive disorder
E Histrionic personality disorder

C Cyclothymia

According to most traditional studies, the largest number of individuals who successfully suicide is found in which diagnostic category?

A Social Anxiety Disorder
B Personality Disorders
C Adjustment Disorder with depressed mood
D. Cyclothymia
E Major Depressive Disorder

E Major Depressive Disorder

A 34-year old single man who lives with his mother and works as an accountant presents because he is very unhappy after his recent break-up with his girlfriend. He feels like he was forced to choose between his mother and his girlfriend and because “blood is thicker than water,” he decided to heed his mother’s wishes and end the relationship. His mother “wears the pants in the family” and he is afraid of disagreeing with her for fear that she will not be supportive of him and that he will have to fend for himself. He feels that his own judgment is poor. He has lived at home his whole life, having commuted to college.

A Antisocial personality disorder

B Avoidant personality disorder

C Borderline personality disorder

D Dependent personality disorder

E Histrionic personality disorder

D Dependent personality disorder

A 19-year old woman presents for a gynecological exam and reports that she has been feeling sad lately. Further inquiry reveals that she also has lack of energy, lack of enjoyment of usual activities, trouble concentrating, and she has been sleeping and eating more than usual. She was well until these symptoms began over 2 months ago. She notes her father died 8 months ago. You notice on her clinic record that her PCP checked her TSH level 1 month ago that was WNL. She reports occasional alcohol use of 1-2 drinks per week. The most likely diagnosis is:

A Dysthymic disorder
B Major depressive disorder
Bipolar I| disorder
DCyclothymia

B Major depressive disorder

A 45-year old man dreads the upcoming office Valentine’s party because he believes that he is incapable of making social conversations or dancing. He thinks he will become an object of pity or ridicule if he tries. He anticipates another lonely Valentine’s Day as a result.

A Antisocial personality disorder
B Avoidant personality disorder
C Borderline personality disorder
D Dependent personality disorder
E Histrionic personality disorder

B Avoidant personality disorder

A 45-year-old woman reports intense fear of being in places where escape might be difficult. She avoids crowded markets and has not taken public transportation in years. Which disorder best fits her description?
A. Social Anxiety Disorder
B. Panic Disorder
C. Specific Phobia
D. Generalized Anxiety Disorder
E. Agoraphobia

E. Agoraphobia

All are true of Panic Attack EXCEPT:

A Sometimes nocturnal
B. Has its own diagnosis code
C. Feelings of choking
D. Experience depersonalization
E. Numbness can occur

B. Has its own diagnosis code

Which of the following is the most significant predictor of suicide?

A past history of suicide attempt
B family history of suicide
C cluster A personality disorder
D female gender

A past history of suicide attempt

A 40-year old woman seeks psychotherapy because of her impending divorce. She says that she has driven her spouse away with her demands that the house is kept spotless, that extremely detailed work and recreational schedules are maintained, and that rigid dietary habits are maintained.

A Narcissistic personality disorder
B Obsessive-compulsive personality disorder
C Paranoid personality disorder
D Schizoid personality disorder
E Schizotypal personality disorder

B Obsessive-compulsive personality disorder

A 59-year old man living in a condominium complex constantly accuses his neighbors of plotting to avoid paying their share of maintenance.
He writes angry letters to other owners and has initiated several lawsuits. He lives alone and does not socialize.

A Narcissistic personality disorder
B Obsessive-compulsive personality disorder
C Paranoid personality disorder
D Schizoid personality disorder
E Schizotypal personality disorder

C Paranoid personality disorder

Which is TRUE regarding individuals with Dissociative Identity Disorder?

A The individual’s personality transitions gradually to another personality and another
B Usually all of the personalities are aware of one another (pretreatment)
C Rarely have an associated depression
D May have a manifestation of Borderline Personality Disorder
E Most commonly have an incomplete recovery

E Most commonly have an incomplete recovery

A 43-year-old male presents for a routine exam. You have seen him three other times and he has always appeared withdrawn. He says he has felt this way his whole life. He is on his 10th job in the last 3 years and feels like he can never do anything right. If something goes wrong at work he feels like it is his fault. He says he has no social life and stays in his apartment most of the time. He doesn’t like being bothered by others and becomes irritable when pressed to join the group. He has no hobbies or interests outside of his home and spends most of his leisure time watching television although he doesn’t recall what programs he watches. He denies any changes in his appetite, but admits he feels worse when he wakes from sleep. What is the most likely diagnosis?

A Depressive disorder
B Persistent depressive disorder (dysthymia)
C Social phobia
D Antisocial personality disorder
E Bipolar II disorder

B Persistent depressive disorder (dysthymia)

A 21-year old college female who is “madly in love” with her new boyfriend. She “absolutely hates” her biology class, but loved her communications class last week when she gave her presentation. She is in the drama club and is happiest with the lead role.

A Antisocial personality disorder
B Avoidant personality disorder
C Borderline personality disorder
D Dependent personality disorder
E Histrionic personality disorder

E Histrionic personality disorder

A 40-year-old man is brought to the clinic by his wife. Approximately 6 weeks before, the patient was fired from his job of 20 years due to
“down-sizing”
. Since then, he has been constantly sad, does not want to go out, or have anyone come in to visit. He appears preoccupied constantly with the loss of his job. He admits to having trouble concentration, poor appetite, and waking before the alarm goes off at 6:30 a.m.
He denies any suicidal ideation but admits he just does not care about doing much. Which of the following is the most likely diagnosis?

A Major depressive disorder
B Bipolar I disorder
C Midlife crisis
D Dysthymic disorder
E Dependent personality disorder

A Major depressive disorder

Depersonalization:

A Is the alteration of one’s perception about oneself as being unreal or strange
B Is the sensation that one’s surroundings have altered
C Is when a patient loses control and becomes psychotic
D Is a type of an anxiety disorder
E Is never seen in PTSD

A Is the alteration of one’s perception about oneself as being unreal or strange

A 19-year old male who takes an overdose of aspirin when his girlfriend leaves him. He has been using cocaine and visiting prostitutes as well. His moods change rapidly and he continually makes superficial cuts on his forearms.

A Antisocial personality disorder
B Avoidant personality disorder
c Borderline personality disorder
D Dependent personality disorder
E Histrionic personality disorder

c Borderline personality disorder

A 30-year old man is completely preoccupied with studying and brewing herbal teas. He associates many peculiar powers with consumption of these teas, and he says that plants sometimes whisper to him. He spends all of his time alone, often taking walks in the wilderness for days to collect plants for teas. He has no history of disorganized behavior.

A Narcissistic personality disorder
B Obsessive-compulsive personality disorder
C Paranoid personality disorder
D Schizoid personality disorder
E Schizotypal personality disorder

E Schizotypal personality disorder

Each of the following are symptoms of mania EXCEPT

A Euphoric and expansive mood
B Hypersomnia
C Irritable mood
D Increased talkativeness
E Inflated self esteem

B Hypersomnia

A 41-year old woman is seen in an outpatient psychiatrist’s office complaining of long-term (defined as “years”) feelings of sadness, low self-esteem, and low motivation. She has never been hospitalized and has never made a suicide attempt. She recently got divorced. While she thinks that her symptoms may have contributed to her difficulties in her relationship, she is not particularly distressed about the divorce itself and continues to have an active social life. Her most likely diagnosis is:

A Major depressive disorder
B Schizoid personality disorder
C Dysthymic disorder
D Avoidant personality disorder

C Dysthymic disorder

A 40-year-old man is brought to the clinic by his wife. Approximately 6 weeks before, the patient was fired from his job of 20 years due to
“down-sizing”.
‘. Since then he is constantly sad, does not want to go out, or have anyone come in to visit. He appears preoccupied constantly
with the loss of his job. He admits to having trouble concentration, poor appetite, and waking before the alarm goes off at 6:30 a.m. He denies any suicidal ideation but admits he just does not care about doing much. Which of the following is the most likely diagnosis?

A Major depressive disorder
B Bipolar I disorder
C Midlife crisis
D Dysthymic disorder

A Major depressive disorder

A 49-year-old female is expected to attend a work event with her husband. She does not want to go because she doesn’t feel comfortable in crowds because of her weight and that she is embarrassed when people stare at her. Just thinking of going gives her palpitations, diaphoresis, and nausea. The last event she attended she became jittery, had palpitations and vomits in the driveway of the house. Which of the following is the most likely diagnosis?

A Panic disorder
B General anxiety disorder
C Avoidant personality disorder
D Social anxiety disorder
E histrionic personality disorder

D Social anxiety disorder

A 44-year old man with palpitations and tension most of the time without recognizable triggers. Most likely diagnosis?

A Acute stress disorder
B General anxiety disorder
C Adjustment disorder
D Panic disorder

B General anxiety disorder

A 34-year-old male is referred to a neurology clinic after multiple emergency room visits for seizure-like episodes characterized by asymmetric arm movements and head turning from side to side. Despite being treated with antipileptic drugs, his episodes have not improved. He has a history of childhood trauma. Which of the following features is most consistent with his diagnosis of PNES?

A Symmetrical limb movements during episodes
B Eyes open with direct eye contact during episodes
C Waxing and waning course of the episode
D. Rapid response to anticpileptic drugs
E Elevated serum prolactin levels post episode

C Waxing and waning course of the episode

Which of the following is INCORRECT about Depersonalization/derealization Disorder?

A. With regard to the association between this disorder and childhood traumas, sexual abuse is a less commen stressor than physical abuse.

B Individuals experience subjective difficulty vividly recalling past memories:

C Symptoms may be transient (lasting hours days):

D This disorder occurs commonly in individuals who abuse dextromethorphan.

E Salvia, ketamine, MDMA (ecstasy) may precipitate this disorder.

D This disorder occurs commonly in individuals who abuse dextromethorphan.

A 42-year old divorced man who continually harasses his ex-wife about how she is raising his children. He forces her to comply with his demands or he will take her back to court. He often will refuse to take the children to their sporting events as a means to “teach his ex-wife a lesson.” He maintains the belief that the children would be better off living with him full-time and often force the children to tell him that.

A Narcissistic personality disorder
B Obsessive-compulsive personality disorder
C Paranoid personality disorder
D Schizoid personality disorder
E Schizotypal personality disorder

A Narcissistic personality disorder

A 22-year-old college student experiences unexpected, intense surges of panic, including palpitations, sweating, shaking, and fears of dying that peak within minutes. These episodes are followed by ongoing worries about having another attack. What is the most likely DSM V diagnosis?
a. Social Anxiety Disorder
b. Generalized Anxiety Disorder
c. Panic Disorder

c. Panic Disorder

Which of the following describes a delusion?

A fixed false beliefs that are not shared by the individual’s cultural group and are resistant to rational argument

B a general sense of suspiciousness, hyper-vigilance, and a tendency to misinterpret environmental cues as dangerous

C misinterpretation of commonplace events, believing them to be special messages for the individual

D false sensory impressions that originate in the patient

A fixed false beliefs that are not shared by the individual’s cultural group and are resistant to rational argument

The 67-year-old husband of a psychiatric patient presents to the emergency department with total body stiffness, a temperature of 104°F, and a heart rate of 120. His wife states that he has a habit of taking her medications to make him feel better. She takes fluoxetine, haloperidol, and lorazepam. Which of the following is the most appropriate next step in management?

A Administer dantrolene
B Obtain blood and cerebrospinal fluid cultures
C Administer flumazenil
D Administer naloxone
E Administer ethaline glycol

A Administer dantrolene

A 40-year-old woman complains of the obsessional need to check her doors in the morning repeatedly to make certain they are locked before she leaves home for work. In addition, she washes her hands at least ten times per hour. Which of the following categories of medication holds the most promise for the management of her condition?

A Benzodiazepines
B Barbiturates
C Selective serotonin reuptake inhibitors
D Phenothiazines
E Antipsychotics

C Selective serotonin reuptake inhibitors

A 19-year-old girl is brought to the emergency room by her parents because of sudden blindness. The patient is from an intensively religious background. She states that she cannot see anything, and she believes that her condition is divine punishment for her sinful behavior. She also states that she “gracefully accepts God’s will”. Physical examination shows intact visual reflexes. What is the most likely diagnosis?

A Conversion disorder
B Delusional disorder
Hypochondriasis
D Malingering
E Factitious disorder

A Conversion disorder

The act of a 42-year old female who checks 5 times to be sure her front door is locked every time she leaves her home is called what?

A delusion
B obsession
C both delusion and obsession
D neither delusion or obsession

D neither delusion or obsession
This is compulsions

A patient believes that her neighbors are spying on her and they have a camera in her bathroom and are watching her. Because of this, she refuses to shower. Assuming that there really isn’t a camera in her room, these thoughts are considered:

A delusions
B obsessions
C both delusions and obsessions
D neither delusions and obsessions

A delusions

A 23-year-old man patient reports that he washes his hands 40-60 times a day. He also has a fear of contamination. He knows that his handwashing is excessive and his fear of contamination is unrealistic yet he continues his behavior. Which of the following best describes this condition?

A Major depression
B Bipolar disorder
C Obsessive-compulsive disorder
D Dysthymia
E Obsessive compulsive personality disorder

C Obsessive-compulsive disorder

A 38-year-old woman complains of persistent headaches, intermittent lower abdominal cramps, neck pain, “carpal tunnel” pain, food allergies, nausea, sexual aversion, and persisting tingling in her extremities upon awakening. According to her medical records, extensive physical and laboratory assessments have been unremarkable. The woman says that she has been in severe physical distress for more than 9 years and does not know how much longer she can bear these symptoms. What is the most likely diagnosis?

A Body dysmorphic disorder

B Conversion disorder

C Hypochondriasis

D Pain disorder

E Somatization disorder

As of today, a 58-year-old lawyer who was working in the World Trade Center has recurrent flashbacks of his experiences after 9/11.

A Post-traumatic stress disorder
B Acute stress disorder
C Adjustment disorder
D General anxiety disorder

A Post-traumatic stress disorder

A 17-year-old female who is 5’2” and 135 pounds (unchanged from her last visit) is seen in your office for frequent use of antacids and weakness. Her mother is concerned because she can hear her daughter in her locked bathroom sometimes vomiting after she eats a large meal. She also has found empty bottles of laxatives. She fears she may have an ulcer. She is a popular cheerleader at school who is “a little heavier than the rest of the girls on the squad”. You examine the girl and find the following: erosion of the enamel on her teeth, a rapid irregular, irregular pulse, decreased deep tendon reflexes, and a generalized muscle weakness. The labs you draw come back with a potassium level of 2.5 mEq/L. Her other electrolytes are also abnormal. What is the most likely diagnosis?

A Anorexia nervosa
B Peptic ulcer disease
C Bulimia nervosa
D Adjustment disorder
E Eating disorder NOS

C Bulimia nervosa

A 17-year-old high school senior, who is 168 cm (66 inches) tall and weighs 31.8 kg (70 pounds), is admitted to the hospital. She talks a great deal about fears of “losing control” and becoming fat. She diets rigorously and exercises regularly and though emaciated in appearance, she insists that her cheeks, abdomen, hips, and thighs are too heavy. She is unconcerned that her menstrual periods have ceased. The clinical stuff notes that she orders dietary food, spreads it about her plate, and eats little. Her parents are concerned about her weight but are not sure she should be hospitalized. What is the most likely diagnosis?

A Bulimia nervosa
B Anorexia nervosa
C Body dysmorphic disorder
D Conversion disorder
E Schizoaffective disorder

B Anorexia nervosa

Larry is a friend of yours, who has thought he is Elvis Presley for the past two months ever since he sang karaoke at the local bar. Now he wears a bright costume and believes he is Elvis Presley. So much does he believe it, that he goes to the bar every night to sing Elvis’s songs.
He sounds terrible and the crowd boos him and even throws things at him. He thanks them for their appreciation and always ends with,
“Thank you, Thank you very much” and a lip curl. When Larry is not on stage, he functions normally as “Larry, the quiet accountant”.
- What is
the most likely diagnosis?

A Schizophrenia
B Delusional disorder
C Schizoid personality disorder
D Adjustment personality disorder
E Psychotic disorder

B Delusional disorder

A 21-year-old woman patients sees you in your office. The patient states that she has recurrent dreams of sexual abuse by her father when she was a child. She also has recurrent intrusive thoughts and vivid “movies” that replay the events in her head. She avoids the home where she grew up and any thoughts, conversation, places that remind her of this past. Sometimes she feels that she has no future. At night, she ha difficulty falling asleep and she always feels on-edge. Which of the following is the most likely diagnosis?

A Major depression
B Social phobia
C Post-traumatic stress disorder
D Panic disorder
E Acute stress disorder

C Post-traumatic stress disorder

A 30-year-old woman becomes angry and bitter after her husband of 5 years leaves her to live with his female business partner. One week the woman quit her job without giving notice, began drinking heavily, and made threatening calls to her husband’s new girlfriend.

A Post-traumatic stress disorder
B Acute stress disorder
C Adjustment disorder
D General anxiety disorder

C Adjustment disorder

A 28-year-old physician from Europe comes to the office complaining “I am just tired and anxious. I don’t have a job yet and I miss my family, my collages and friends back home. I am having problems with my pregnancy and was recently diagnosed with hypothyroidism. In addition, my husband lost his job. I am trying to adjust to the new system and language and culture and don’t know what is going on with me. Since I come to the U.S. 3 months ago, I am just having a hard time.” What is the most likely diagnosis?

A Adjustment disorder
B Cultural difference issue
C Posttraumatic stress disorder
D General anxiety disorder
E Major depressive disorder

A Adjustment disorder

A 40-year-old man refuses to cut his shoulder-length hair, and his employer threatens to dismiss him. The man hesitantly admits that t his hair long to cover what he considers are extremely prominent ears. He believes that if his ears were visible, his colleagues would ri him. The man has very mildly prominent ears that would not attract attention. What is the most likely diagnosis?

A Body dysmorphic disorder
B Hypochondriasis
C Malingering
D Somatization disorder
E Obsessive compulsive personality disorder

A Body dysmorphic disorder

Mrs. D is a patient of yours that you have been treating for major depressive disorder for several years. Her daughter brings her in to see you today because she has been acting “strange” for the past month. Today she reports her mother has been seeing things in the house that just aren’t there and reports that she also has been hearing her husband talking to her even though he has been dead for 5 years. Her speech is nonsensical as well and she is not aware of the date or even where she is located. What is the most likely diagnosis?

A Schizophrenia
B Delusional personality disorder
C Schizoaffective disorder
D Borderline personality disorder
E Bipolar disorder

C Schizoaffective disorder

A 32-year-old student survivor of the earthquake in Haiti returns to the US and is constantly reminded of the catastrophic events for 2 weeks following the earthquake.

A Post-traumatic stress disorder
B Acute stress disorder
C Adjustment disorder
D General anxiety disorder

B Acute stress disorder

A 44-year old man with palpitations and tension most of the time without recognizable triggers.

A post-traumatic stress disorder
B Acute stress disorder
C Adjustment disorder
D General anxiety disorder

D General anxiety disorder

essica, who is 8 years old, is brought to your clinic by her concerned mother who says Jessica doesn’t want to go to school. They have just moved here last month from out of state. Jessica seems depressed when she is home and becomes angry and combative when she is told she has to go to school. She has even been caught skipping school. They live in a nice neighborhood with lots of girls Jessica’s age but Jessica hasn’t made any friends here yet either because she doesn’t want to go outside. Mom fears that Jessica may commit suicide. What is the most likely diagnosis?

A Adjustment disorder
B Social phobia
C Paranoid personality disorder
D Panic disorder
E Oppositional defiant disorder

A Adjustment disorder

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