Psychiatry Flashcards
How long does excessive worrying and anxiety need to be present before the diagnosis of generalized anxiety disorder can be made?
Excessive worry needs to be present for >6 months.
What is the treatment of choice for panic disorder?
SSRIs are the treatment of choice. However, benzodiazepines can be used as bridge therapy until SSRIs kick in.
Are patients with phobias aware of their fears?
Yes, they are aware of their fears AND they know their fears are irrational.
A 36 year old male patient was held up at gun point 2 weeks ago. The patient is relieving the event and avoiding the place at which it happened. The patient is coming to you because it has been affecting his daily living. What is the most likely diagnosis?
The most likely diagnosis is acute stress disorder. The only thing that separates this from post traumatic stress disorder is going to be the duration of symptoms. If symptoms are present
A 3 year old is diagnosed with ADHD. What is the treatment of choice?
The treatment of choice is dextroamphetamine. This medication can be started at 3 years of age. Methylphenidate can be started >6 years of age.
A 20 year old patient is brought in to your office by her friend because she is worried about her weight. The patient is 90 pounds. She admits to a history of purging after meals and using laxatives to keep her weight down. What is the treatment of choice?
The diagnosis is anorexia and the treatment of choice is CBT. SSRIs are useful ONLY in bulimia, not anorexia. The differentiating factor between anorexia and bulimia is the weight difference. Those under weight have anorexia. Those whos weight is normal or over weight have bulimia. Purging is present in both.
A 40 year old male patient was arrested after trying to rob a liquor store. Hospitalization was deemed necessary due to his behavior while incarcerated. The patient also admits he had maxed out his credit cards and has not slept for the past couple of days. Symptoms began 4 days ago. What is the most likely diagnosis?
Although symptoms have only been present for 4 days, the diagnosis is bipolar 1 disorder. The patient was having a manic episode by the mere fact he was hospitalized. If the patient has to be hospitalized, by default, this is a manic episode. If hospitalization was not required, we could not call this a manic episode, because symptoms need to have been present >7days.
What labs should be ordered during the initial workup of depression?
A CBC and TSH should be ordered to rule out anemia and hypothyroidism.
How long does it take for SSRIs to work?
Patients should start to feel the effect after 2 weeks, but won’t get maximal improvement until 4 weeks have passed.
What is first line treatment for post partum psychosis?
Patients should be hospitalized and started on antipsychotics.
A 30 year old male was brought in to the ED by his brother due to increasingly odd behavior. The brother found the patient boarded up in his own home. For the past 3 months, the patient had secluded himself from others due to fear of being attacked. The patient feels as if everyone is out to get him. He even states that aliens are after him, and that their mission is to unscrew his head to take his soul.
The voice of “GOD” has been telling him that he should board up his house and never go outside so that he can stay safe from those who are after him. Urine toxicology screen was negative. What is the most likely diagnosis?
This patient is presenting with schizophreniform disorder. Again, time duration is important here. Symptoms are the same for brief psychotic disorder, schizophreniform disorder, and schizophrenia.
Duration
6 months = schizophrenia.
What is circumstantial speech?
This is seen in patients with schizophrenia. Patients will answer a question in a round about manner.
Describe the obsessions and compulsions seen in OCD.
Obsessions are involuntary intrusive thoughts or urges. Compulsions are rituals or acts the patient must do to alleviate the obsession.
