Psychiatry Flashcards
A 28-year-old female presents with obsessive-compulsive disorder (OCD) and is being treated with a selective serotonin reuptake inhibitor (SSRI). Which medication can be added as an adjunctive treatment if the SSRI is not effective?
A) Benzodiazepines
B) Atypical antipsychotics
C) Buspirone
D) Lithium
B) Atypical antipsychotics can be added as an adjunctive treatment in a patient with obsessive-compulsive disorder (OCD) who is not responding to treatment with a selective serotonin reuptake inhibitor (SSRI). Atypical antipsychotics such as risperidone, olanzapine, and quetiapine have been shown to be effective in reducing OCD symptoms.
A 55-year-old male presents with schizophrenia and is being treated with a typical antipsychotic. Which side effect is of greatest concern and should be monitored closely?
A) Tardive dyskinesia
B) Orthostatic hypotension
C) Diarrhea
D) Weight gain
A) Tardive dyskinesia is a side effect of greatest concern and should be monitored closely in a patient with schizophrenia being treated with a typical antipsychotic. Tardive dyskinesia is a movement disorder that can develop after prolonged use of antipsychotic medications. It is characterized by involuntary movements of the face, mouth, and tongue.
A 30-year-old female presents with bipolar disorder and is currently experiencing a manic episode. Which medication should be avoided in the treatment of her manic episode?
A) Lithium
B) Valproic acid
C) Carbamazepine
D) Chlorpromazine
D) Chlorpromazine should be avoided in the treatment of a manic episode in a patient with bipolar disorder. Chlorpromazine is a typical antipsychotic that is not commonly used for the treatment of bipolar disorder due to its potential to induce or worsen manic symptoms. Mood stabilizers such as lithium, valproic acid, or carbamazepine are typically used in the treatment of bipolar disorder.
A 23-year-old male presents with severe anxiety and panic attacks. He has a history of alcohol and drug abuse. Which medication should be avoided in the treatment of his anxiety?
A) Benzodiazepines
B) Selective serotonin reuptake inhibitors (SSRIs)
C) Buspirone
D) Beta blockers
A) Benzodiazepines should be avoided in the treatment of severe anxiety and panic attacks in a patient with a history of alcohol and drug abuse. Benzodiazepines can be habit-forming and may lead to addiction, especially in individuals with a history of substance abuse. Alternative treatments such as cognitive-behavioral therapy and selective serotonin reuptake inhibitors (SSRIs) may be considered.
A migraine sufferer has been prescribed zolmitriptan for his severe migraines. He takes the drug as directed upon experiencing a migraine, soon begins to experience debilitating symptoms, and is rushed to the emergency department. He is agitated, diaphoretic, and shivering, and exhibits tachycardia, dilated pupils, myoclonus, and hyperreflexia. Investigation reveals he has been taking another drug for some time prior to getting the zolmitriptan. What is the diagnosis?
The symptoms described suggest the possibility of serotonin syndrome, which can occur when a person takes medications that increase serotonin levels in the brain. The fact that the patient had been taking another drug prior to taking zolmitriptan suggests that there may have been an interaction between the two drugs that caused the serotonin syndrome.
Zolmitriptan is a medication used for the treatment of migraines, and it works by narrowing the blood vessels in the brain to relieve pain. It is also known to increase serotonin levels in the brain. Serotonin syndrome is a potentially life-threatening condition that occurs when there is too much serotonin in the brain, leading to a range of symptoms including agitation, sweating, shivering, tachycardia, dilated pupils, myoclonus (involuntary muscle contractions), and hyperreflexia (exaggerated reflexes).
A 31-year-old woman presents with a six-month history of bilateral headaches occurring once or twice per week. The headaches are moderate in intensity and improve with oral analgesia. She reports problems concentrating, fatigue, and inferior performance at work. The patient also mentions that for the last year, she has been experiencing an overwhelming feeling of being on edge, sleeping difficulty and that she recently started to drink more alcohol than usual. A urine drug screen is negative. ECG and MRI of the brain are unremarkable. Preventive medication is offered, but she is concerned about possible side effects. She leaves without a prescription but calls numerous times in the next couple of weeks. Which of the following medications is most appropriate for this patient’s condition?
zopiclone, flurazepam, or escitalopram?
The most appropriate medication for this patient’s condition is escitalopram, which is a selective serotonin reuptake inhibitor (SSRI) used to treat anxiety and depression. Based on the patient’s symptoms, she may be experiencing generalized anxiety disorder (GAD) and depression, which can both be effectively treated with SSRIs. Zopiclone and flurazepam are both benzodiazepines that are commonly used to treat insomnia but are not effective in treating anxiety and depression. Additionally, benzodiazepines have a higher risk of dependence and addiction and are not recommended as a first-line treatment for GAD.
A 34-year-old woman is brought to the emergency department by her husband, who reports that she has been feeling “jittery” and “on edge” for the past few days. She reports feeling like she can’t sit still, has difficulty concentrating, and has been having trouble sleeping. She has no prior psychiatric history. Which of the following is the most likely diagnosis?
a. Generalized anxiety disorder
b. Panic disorder
c. Adjustment disorder with anxiety
d. Post-traumatic stress disorder
Answer: a. Generalized anxiety disorder
Explanation: The patient’s symptoms are consistent with generalized anxiety disorder, which is characterized by excessive worry and anxiety about a variety of events or activities. Panic disorder is characterized by recurrent panic attacks, which the patient does not report. Adjustment disorder with anxiety can occur in response to a stressor, but the patient does not report a specific stressor. PTSD can also present with anxiety symptoms, but it is typically associated with a specific traumatic event.
A 16-year-old boy is brought to the emergency department by his parents, who report that he has been refusing to eat for the past month. He has lost a significant amount of weight and appears emaciated. He denies any concerns about his weight or body image. Which of the following is the most likely diagnosis?
a. Anorexia nervosa
b. Bulimia nervosa
c. Avoidant/restrictive food intake disorder
d. Body dysmorphic disorder
Avoidant/restrictive food intake disorder.
Explanation: The patient’s symptoms of refusing to eat and significant weight loss suggest a diagnosis of an eating disorder. However, the patient denies any concerns about his weight or body image, which would rule out a diagnosis of anorexia nervosa or bulimia nervosa. Avoidant/restrictive food intake disorder is characterized by a persistent failure to meet nutritional needs, which may be due to a lack of interest in food or avoidance based on sensory characteristics of food, but without a disturbance in body image. Body dysmorphic disorder involves preoccupation with perceived flaws in appearance, but this is not present in the patient’s history.
A 52-year-old woman is referred to psychiatry for evaluation of persistent sadness and anhedonia. She reports feeling “down” for the past year and has lost interest in activities she used to enjoy. She denies any suicidal thoughts or plans. She has no significant medical history. Which of the following is the most likely diagnosis?
a. Major depressive disorder
b. Dysthymia
c. Adjustment disorder with depressed mood
d. Bipolar disorder
Answer: a. Major depressive disorder
Explanation: The patient’s symptoms are consistent with major depressive disorder, which is characterized by persistent sadness, anhedonia, and a loss of interest in activities that were once enjoyable. Dysthymia is a chronic form of depression that lasts for at least two years, but the patient reports symptoms that are severe enough to meet the criteria for major depressive disorder. Adjustment disorder with depressed mood can occur in response to a stressor, but the patient does not report a specific stressor. Bipolar disorder is unlikely, as the patient does not report any symptoms of mania.
A 60-year-old man presents to his psychiatrist with complaints of hearing voices that are telling him to harm himself. He reports feeling very anxious and depressed, and has had difficulty sleeping and eating. He denies any history of psychotic symptoms in the past. What is the most appropriate next step in management?
a. Hospitalize the patient for safety reasons
b. Increase the patient’s dose of antidepressant medication
c. Start the patient on an antipsychotic medication
d. Refer the patient for psychotherapy
e. Monitor the patient closely and continue with the current treatment plan
Answer: a. Hospitalize the patient for safety reasons
Explanation: The patient’s report of auditory hallucinations with command features to harm himself indicates a significant risk of harm to himself. Hospitalization is the most appropriate next step to ensure the patient’s safety and initiate treatment. Antipsychotic medication and psychotherapy may also be indicated, but ensuring the patient’s safety is the first priority.
A 32-year-old man presents to the emergency department with chest pain, shortness of breath, and palpitations. He reports feeling like he is “going to die” and is extremely fearful. On examination, he appears agitated and anxious, with tachycardia and diaphoresis. What is the most likely diagnosis?
a. Panic disorder
b. Generalized anxiety disorder
c. Obsessive-compulsive disorder
d. Social anxiety disorder
e. Post-traumatic stress disorder
Answer: a. Panic disorder
Explanation: The patient’s symptoms of sudden onset of extreme fear and physical symptoms such as chest pain, shortness of breath, and palpitations are highly suggestive of a panic attack. Panic disorder is characterized by recurrent panic attacks and persistent fear of future attacks. The absence of other anxiety disorders such as social anxiety disorder or PTSD make these diagnoses less likely.
A 20-year-old college student comes to the student health center with complaints of difficulty concentrating and staying focused. He reports that he often feels “fidgety” and restless, and has trouble sitting still in class. He also reports a history of difficulty with impulsivity and disorganization. What is the most likely diagnosis?
a. Attention-deficit/hyperactivity disorder (ADHD)
b. Major depressive disorder
c. Generalized anxiety disorder
d. Obsessive-compulsive disorder (OCD)
e. Schizophrenia
Answer: a. Attention-deficit/hyperactivity disorder (ADHD)
Explanation: The patient’s symptoms of difficulty concentrating, restlessness, and impulsivity are suggestive of ADHD. While other diagnoses such as anxiety or OCD may also involve difficulty concentrating or restlessness, the history of lifelong symptoms and a lack of obsessions or compulsions make these diagnoses less likely.
A 68-year-old man with a history of chronic alcohol abuse presents with confusion, memory impairment, and hallucinations. His blood alcohol level is within normal limits, and a CT scan of the brain is unremarkable. What is the most likely diagnosis?
a. Alcohol-induced persisting dementia
b. Wernicke-Korsakoff syndrome
c. Delirium tremens
d. Vascular dementia
Answer: b. Wernicke-Korsakoff syndrome
Explanation: The patient’s history of chronic alcohol abuse and symptoms of confusion, memory impairment, and hallucinations are highly suggestive of Wernicke-Korsakoff syndrome, which is caused by thiamine deficiency. Alcohol-induced persisting dementia is a chronic cognitive disorder that can occur in individuals with a history of heavy alcohol use, but it typically develops over a longer period of time. Delirium tremens is a medical emergency characterized by hallucinations, confusion, and autonomic instability, and typically occurs during alcohol withdrawal. Vascular dementia is a type of dementia caused by cerebrovascular disease, and would not be the most likely diagnosis in this case.
A 45-year-old man presents with a two-month history of excessive worry and anxiety, with difficulty controlling his worry and associated physical symptoms such as muscle tension and restlessness. He reports a past history of similar symptoms. Which of the following is the most likely diagnosis?
a. Generalized anxiety disorder
b. Panic disorder
c. Social anxiety disorder
d. Obsessive-compulsive disorder
Answer: a. Generalized anxiety disorder
Explanation: The patient’s symptoms of excessive worry and anxiety, difficulty controlling worry, and associated physical symptoms are suggestive of generalized anxiety disorder. Panic disorder involves recurrent panic attacks with associated fear of future attacks, while social anxiety disorder involves fear of social situations.
A 32-year-old man presents with a two-week history of fluctuating symptoms of elevated, expansive mood, irritability, decreased need for sleep, increased talkativeness, and grandiosity. He reports a past history of similar episodes. What is the most likely diagnosis?
a. Bipolar I disorder, current episode manic
b. Bipolar I disorder, current episode hypomanic
c. Bipolar II disorder, current episode hypomanic
d. Cyclothymic disorder
Answer: a. Bipolar I disorder, current episode manic
Explanation: The patient’s symptoms of elevated, expansive mood, grandiosity, decreased need for sleep, and increased talkativeness are suggestive of a manic episode. The presence of past episodes of similar symptoms and the absence of a recent history of major depression make bipolar I disorder, current episode manic, the most likely diagnosis.
A patient with a history of major depressive disorder is started on a new antidepressant medication. What are the most common side effects of antidepressant medication, and how can they be managed?
The most common side effects of antidepressant medication include gastrointestinal upset, dry mouth, dizziness, and sexual dysfunction. Serotonin syndrome can also occur in rare cases, which can cause symptoms such as agitation, fever, and muscle rigidity. Side effects can be managed by adjusting the dose of medication and monitoring symptoms.
A patient presents with sudden-onset fear and panic symptoms, including rapid heart rate, sweating, and difficulty breathing. What is the most likely diagnosis, and what is the first-line treatment?
The most likely diagnosis is panic disorder. The first-line treatment is typically cognitive-behavioral therapy (CBT) and/or medication, such as a selective serotonin reuptake inhibitor (SSRI) or benzodiazepine.
A patient with a history of bipolar disorder is started on lithium therapy. What are the most common side effects of lithium, and how can they be managed?
The most common side effects of lithium include gastrointestinal upset, fine tremor, polyuria, and weight gain. Lithium toxicity can also occur, which can cause symptoms such as confusion, lethargy, and tremors. Side effects can be managed by adjusting the dose of lithium and monitoring blood levels.
A patient with a history of substance abuse presents with anxiety, irritability, and difficulty sleeping. What is the most likely diagnosis, and what is the first-line treatment?
The most likely diagnosis is substance-induced anxiety disorder. The first-line treatment is typically abstinence from the substance and/or medication to manage withdrawal symptoms. Additionally, therapy, such as cognitive-behavioral therapy (CBT), may be beneficial in managing anxiety symptoms.
A patient with a history of borderline personality disorder presents with self-harm behaviors and suicidal ideation. What is the most effective treatment for this patient, and what are some potential challenges in treating this condition?
Dialectical behavior therapy (DBT) is the most effective treatment for borderline personality disorder. Potential challenges in treating this condition include difficulty establishing a therapeutic relationship, high rates of treatment dropout, and self-destructive behaviors.
A patient with a history of obsessive-compulsive disorder (OCD) presents with a new onset of symptoms, including intrusive thoughts and compulsive behaviors. What is the most likely diagnosis, and what is the first-line treatment?
The most likely diagnosis is a relapse of OCD. The first-line treatment is typically a combination of medication, such as a selective serotonin reuptake inhibitor (SSRI), and cognitive-behavioral therapy (CBT), specifically exposure and response prevention (ERP).
A 23-year-old primigravid woman at 8 weeks’ gestation is brought to the emergency department by her husband because of increasing confusion and high-grade fever over the past 16 hours. Three days ago, she was prescribed metoclopramide by her physician for the treatment of nausea and vomiting. She has a history of depression. Current medications include fluoxetine. She is confused and not oriented to time, place, or person. Her temperature is 39.8°C (103.6°F), pulse is 112/min, and blood pressure is 168/96 mm Hg. Examination shows profuse diaphoresis and flushed skin. Muscle rigidity is present. Her deep tendon reflexes are decreased bilaterally. Mental status examination shows psychomotor agitation. Laboratory studies show:
Which of the following drugs is most likely to also cause the condition that is responsible for this patient’s current symptoms?
- Atropine
- Succinylcholine
- Phenelzine
- Haloperidol
- Dextroamphetamine
- Amitriptyline
High-potency antipsychotics such as haloperidol are the most common cause of neuroleptic malignant syndrome (NMS), but low-potency or atypical antipsychotics, as well as antiemetics like metoclopramide, have also been associated with NMS. While symptoms usually develop during the first 2 weeks of therapy, as seen in this patient, NMS may also develop after years of continuous therapy and without any associated increase of dose. Nonetheless, higher doses or switching antipsychotics are risk factors for the development of NMS.
The most important therapeutic measure is the discontinuation of the triggering substance. This patient should be transferred to the intensive care unit for supportive treatment including fluid resuscitation, cardiorespiratory management, and measures to lower body temperature. Administration of dopamine agonists (e.g., bromocriptine) and/or dantrolene can be considered.
