Psychiatry

Question 1

What is the diagnosis of major depressive disorder?

Answer 1

occurrence of at least two major depressive episodes that occurred at least 2 months apart

A major depressive episode is marked by symptoms in several domains, including mood (typically depressed), sleep (there may be insomnia or hypersomnia), appetite (either increases or decreases in it), cognition, and energy level.
Feelings of worthlessness and recurrent thoughts of death or suicidal ideation/planning are other core features that may be seen. In order for a diagnosis of major depressive episode to be made, significant functional impact must be present.

Question 2

What are the risk factors for depression?

Answer 2

• female (2x more common)
• incidence: peaks at 3rd -4th decade
• more common lower socioeconomic populations
• living in urban
• no differences in the occurrence of depression among different races

Question 3

Which of the following statements regarding the genetics of mood disorders is correct?

a. While depression may be a familial disorder, bipolar disorder is not (it is typically sporadic)
b. Most mood disorders have been linked to a single causative gene
c. Specific polymorphisms of a serotonin transporter have been associated with an increased chance of developing a mood disorder
d. Alcoholism is common among patients with mood disorders but their family members are not at risk for it
e. Mood disorders are entirely explained by genetic factors, and environmental factors have little role to play in the occurrence of mood disorders

Answer 3

c. Specific polymorphisms of a serotonin transporter have been associated with an increased chance of

Question 4

What are the neuroanatomic substrates for depression?

Answer 4

-dorsolateral prefrontal cortex (hypometabolism)
orbitofrontal cortex (hypermatabolic)- tagets for pharmacologic therapies
-subcallosal cingulate gyrus- potential targets for DBS
-frontal and subcortical circuits - metabolically overactive
-ventral portion of the internal capsule
-hypothalamic-pituitary-adreanal axis (HPA)

Question 5

It is characterized by extreme amnesia, far out of what would be considered normal forgetfulness. There is typically a loss of personal experiences. The information forgotten usually relates to a stressful event. Some patients regain memory of the event, whereas others remain chronically amnestic for it. Diagnosis?

Answer 5

Dissociative Amnesia

Question 6

It is another dissociative disorder in which there are intermittent or constant feelings of detachment from oneself as if a person is viewing him- or herself as an outside observer. Diagnosis?

Answer 6

Depersonalization disorder

Question 7

A person exists in two or more distinct identities or states, with these identities each unaware of the other and with each separately taking control of the person’s behavior over different time periods. Diagnosis?

Answer 7

Dissociative Identity Disorder

Question 8

Patient suddenly and unexpectedly travel away from their environment and are then unable to recall their past or their identity, and may assume a partial or completely
new identity.

Answer 8

Dissociative Fugue

Question 9

Serum concentrations of a medication do not necessarily reflect brain concentrations. True or false?

Answer 9

True

Question 10

How is blood-brain barrier formed?

Answer 10

It formed from continuous TIGHT junctions (not gap junctions) between brain capillary endothelial cells and also results from unique characteristics of pericapillary glial cells

Question 11

How is blood-CSF barrier formed?

Answer 11

It is formed from tight junctions between epithelial cells in the choroid plexus.

Question 12

Nonionized molecules and lipophilic (lipid-soluble) drugs have higher penetration into the CNS. True or False?

Answer 12

True

Question 13

What is the main difference of Brief Psychotic Disorder, Schizophreniform Disorder an Schizophrenia?

Answer 13

Brief Psychotic Disorder (up to 1 month)
Schizophreniform Disorder (1 - 6 months)
Schizophrenia (>6months)

Question 14

What are the predictors of good prognosis of Schizophreniform?

Answer 14

• occurrence of psychotic symptoms within 4 weeks of change in behavior or functioning
• presence of prominent positive symptoms (hallucinations, disorganized thought)
• disorganization of thought, confusion and good premorbid function

Question 15

What is the difference of Obsessive-Compulsive Disorder (OCD) and Obsessive Compulsive Personality Disorder?

Answer 15

definable obsessions and compulsions are absent in Obsessive Compulsive Personality Disorder

Question 16

What is General Anxiety Disorder?

Answer 16

It is CHRONIC EXCESSIVE anxiety and worrying that are difficult for the patient to control and negatively AFFECT FUNCTION.

Question 17

How to differentiate Post-Traumatic Stress Disorder with Acute Stress Reaction?

Answer 17

Post-Traumatic Stress Disorder occurs 1 month after the incident while Acute Stress Reaction occurs within 1 month after the incident.

Question 18

It is an occurrence of multiple recurrent symptoms, affecting various systems, and cannot be fully explained by physical factors.

Answer 18

Somatic Symptom Disorder

Question 19

It is characterized by acute loss of motor or sensory function that cannot be explained by a neurologic or other medical condition.

Answer 19

conversion disorder

Question 20

It is a chronic and pervasive preoccupation with physical symptoms and fear of having a serious disease, often resulting from misinterpretation of physical symptoms, even after diagnostic testing and exclusion of the condition of concern or any other identifiable medical condition.

Answer 20

Illness Anxiety Disorder (Hypochondriasis)

Question 21

What is the key point in distinguishing somatic symptom disorder from factitious disorder?

Answer 21

In somatic symptom disorder, symptoms are not intentionally feigned. While in factitious disorder, symptoms are voluntarily feigned for secondary gain.

Question 22

Which of the following medication has side effects of hemorrhagic pancreatitis?

A. Lithium
B. Quetiapine
C. Carbamazepine
D. Valproic Acid
E. Topiramate

Answer 22

D. Valproic Acid

Question 23

Which of the following medication has side effects of metabolic syndrome, weight gain and risk of diabetes?

A. Lithium
B. Quetiapine
C. Carbamazepine
D. Valproic Acid
E. Topiramate

Answer 23

B. Quetiapine

Question 24

Which of the following medication has side effects of aplastic anemia and agranulocytosis and dermatologic reactions?

A. Lithium
B. Quetiapine
C. Carbamazepine
D. Valproic Acid
E. Topiramate

Answer 24

C. Carbamazepine

Question 25

Which of the following medication has side effects of kidney stones and cognitive slowing?

A. Lithium
B. Quetiapine
C. Carbamazepine
D. Valproic Acid
E. Topiramate

Answer 25

E. Topiramate

Question 26

Which of the following medication has side effects of renal failure, hypothyroidism and cystic acne?

A. Lithium
B. Quetiapine
C. Carbamazepine
D. Valproic Acid
E. Topiramate

Answer 26

A. Lithium

Question 27

What are the indications for Electroconvulsive Therapy?

Give at least 2.

Answer 27

1. Patients with catatonia who do not respond to benzodiazepines
2. Patients with severe depressive symptoms despite medications (refractory depression)
3. Refractory Mania
4. Patient’s preference
5. Patients with severe psychotic depression

Question 28

Which of the following is not true with the definition of Major Depressive Disorder?

A. Depressed mood most of the day
B. Markedly diminished interest (anhedonia)
C. Insomnia or Hypersomnia
D. Feeling of worthlessness
E. At least 5 symptoms lasted for 2 months

Answer 28

E. At least 5 symptoms lasted for 2 months

AT LEAST 2 WEEKS

Question 29

Which of the following is not a risk for completed suicide?

A. Female Sex
B. Older Aga
C. White Race
D. Unemployed or unskilled workers
E. First degree relatives with suicide attempt

Answer 29

A. Female Sex