Psychiatry Flashcards
Gabriel is a healthy 2-year-old boy whose parents have taken him to the pediatrician. His problems started at 18 months of age, when he did not speak much. He does not have much attachment to his parents and seems aggressive toward other children.
What is the most likely diagnosis?
a. Deafness
b. Schizophrenia, childhood onset
c. Rett disorder
d. Autism spectrum disorder
e. Learning deficit
D. Autism spectrum disorder is seen more frequently in boys and usually starts by the age of 3. Children with autism tend to have problems with language and aggression, lack separation anxiety, and are withdrawn. Deafness should be ruled out if parents report that a child does not respond when his or her name is called.
What is the first line treatment of ADHD?
Methylphenidate and Dextroamphetamine
What are the side effects of Methylphenidate and Dextroamphetamine in the treatment of ADHD?
Insomnia, decreased appetite, GI disturbances, increased anxiety, and headache
ADHD is associated with lower/higher levels of dopamine
lower
A 10-year-old boy was seen by a school counselor after the teachers complained of his behavior in school. He frequently becomes angry towards others and loses his temper in class. His parents report that at home, he refuses to comply with house rules, often stays up later than he is supposed to, and frequently talks back to them.
What is the most likely diagnosis?
a. Conduct disorder
b. Tourette disorder
c. Adjustment disorder
d. Oppositional defiant disorder
e. Leaning disorder, not otherwise specified
D. Children with oppositional defiant disorder usually have problems with authority figures such as parents and teachers. Unlike children with conduct disorders, they do not break rules of society and do not commit crimes
You are asked to evaluate a 9-year-old boy who is having problems at home and school. His teachers report frequent temper tantrums in which he becomes physically aggressive toward his peers (biting and kicking). These usually occur after minor incidents, such as another child cutting in front of him in the cafeteria line. These outbursts have been occurring almost daily since the age of 8 and have worsened since school started 4 months ago, resulting in several weeks of disciplinary suspencion. His parents report the same problems at home (e.g. attacking his older brother when told he could not play outside). His general mood is irritable and angry, though his family noticed a slight improvement in his behavior during the summer months.
What is the most likely diagnosis?
a. Intermittent explosive disorder
b. Adjustment disorder with disturbances of conduct
c. Disruptive mood dysregulation disorder
d. Bipolar disorder
e. Oppositional defiant disorder
C. Disruptive mood dysregulation disorder. Children with intermittent explosive disorder are not aggressive on such a continuous basis; they have extended periods of good behavior. There is no mention of a stressor, ruling out diagnosis of bipolar disorder. There is no evidence of mood swings, ruling out diagnosis of biploar disorder. Children with oppositional defiant disorder mostly have problems with authority figures, not their peers.
This is characterized by the onset of multiple tics, lasting more than one year, and is seen before the age of 18. The motor tics most commonly involve the muscles of the face and neck, such as head shaking and blinking.
Tourette Disorder
What is the first line of treatment for Major Depressive Disorder?
SSRI (Fluoxetine, Paroxetine, Sertraline, Citalopram, or Escitalopram)
A 45-year-old woman was recently seen by her primary care physician due to complaints of depressed mood, lack of pleasure, sleep problems, decreased appetite and weight, decreased energy, and problems with concentration. She states that these symptoms started when she was fired from her job about 4 weeks ago, and that since then, she has been unable to function.
What is the most indicated treatment at this time?
a. Alprazolam
b. Paroxetine
c. Bupropion
d. Venlafaxine
e. Trazodone
f. Electroconvulsive therapy
B. She has a diagnosis of major depression and the first-line treatment is the use of an SSRI medication because of a better side-effect profile compared to the other therapies. All others, except alprazolam and electroconvulsive therapy, would be useful but usually are not based on side effect profile. Alprazolam is simply a benzodiazepine and acts as an anxiolytic, not an antidepressant. Electroconvulsive therapy might be useful if initial therapy did not work or the depression was far more severe and was associated with psychotic features.
You saw a 55-year-old male in your office today complaining of depressed mood for over 2 months, along with lack of energy, decreased appetite, inability to concentrate, and poor sleep. He stated that his sleep problems and inability to focus in the morning are impairing his work.
Which of the following is most indicated at this time?
a. Imipramine
b. Venlafaxine
c. Bupropion
d. Zolpidem
e. Mirtazapine
E. Although any antidepressant can be used, mirtazapine is preferable in this patient for both its antidepressant and sedative effects. Imipramine would have too many side effects and is not a first-line agent. Venlafaxine might be considered if the patient had depression alone; since insomnia is a major concern, mirtazapine is the better option. Bupropion tends to cause problems with sleep, so is not indicated. Zolpidem would help this patient sleep but would not treat his depression.
A 21-year-old college student is taken to the emergency department and admitted after she was noted to be acting bizarrely in class. She is talking fast and giggling, and she reports that she has not slept for over 4 days. She appears to be paying little attention to her surroundings. Her roommate reports that she has been drinking alcohol excessively over the last few days and has had many sexual contacts with unknown men.
What is the most likely diagnosis?
a. Alcohol-induced mood disorder
b. Biploar disorder type I
c. Bipolar disorder type II
d. Major depression with psychosis
e. Cyclothymia
B. The patient is exhibiting mania, as shown by her pressured speech, decreased sleep, increased libido, and inappropriate behavior. The symptoms are severe enough that her level of functioning is affected. Bipolar disorder occurs more frequently in young individuals.
A 33-year-old man was taken to the emergency room by the police after neighbors complained about his behavior. His family informed the doctor that he has been diagnosed with biploar disorder and was recently started on lithium. While in the emergency room, he became combative and punched a nurse on the mouth.
What is the next step in the management of this patient?
a. Obtain lithium level
b. Admit to psychiatric unit
c. Refer to psychiatry
d. Add valproic acid
e. Olanzapine
E. The patient is exhibiting mania and you do not need to verify the lithium level given that his symptoms are acute. He apparently has been noncompliant with medications and obtaining a level is not the correct answer. He needs to be medicated and antipsychotics are considered first-line treatment for bipolar patients presenting with acute mania. Admitting an agitated patient to the psychiatric unit is not as important as administering adequate treatment.
A 65-year-old man was brought to the office by his daughter after she became concerned about him. He has been hopeless and helpless since his wife died 3 months ago. His daughter is worried about his isolative behavior and lack of appetite, and he expresses feelings of worthlessness. He has lost over 30 pounds. He does not seem interested in getting better and believes he should have died with his wife.
What is the most likely diagnosis?
a. Bereavement
b. Persistent depressive disorder
c. Major depressive disorder
d. Adjustment disorder
e. Bipolar disorder
C. Although it has been less than 6 months since his wife died, his symptoms are severe enough to warrant a diagnosis of major depression. He has no interest in things, has lost weight, feels hopeless and helpless, and believes he should have died as well. He needs to be treated with antidepressants, and you must ensure that he is not suicidal since he is at high risk.
What is the single most effective treatment for depression?
a. Electroconvulsive therapy
b. Fluoxetine
c. Venlafaxine
d. Imipramine
e. Phenelzine
A. Although electroconvulsive therapy (ECT) is usually used for suicidal patients or those who do not respond to treatment, it is considered the best treatment for depression. All others are equally efficacious, but the SSRIs are used more frequently due to side-effect profiles
A 22-year-old woman was recently diagnosed with schizophrenia. She is 30 pounds overweight and suffers from type 2 diabetes. She is concerned about her medications and asks for your advice.
Which of the following would be most indicated in this patient?
a. Aripiprazole
b. Olanzapine
c. Quetiapine
d. Clozapine
e. Risperidone
A. Aripiprazole and ziprasidone are the least likely to cause weight gain, diabetes, and metabolic syndrome. Olanzapine and clozapine have the highest risk of metabolic abnormalities. Quetiapine and risperidone have medium risk.
