Psychiatry Flashcards
1
Q
Female patient with constant state of worry about most things (not specific trigger), during most days for > 6 months. She also has had sleep changes, change in weight, irritability, concentration issues.
Dx and tx?
A
Generalized anxiety disorder
Tx: Psychotherapy better than medications Meds: • Chronic SSRI/SnRI • Benzodiazepines ONLY for panic attacks
2
Q
Female patient in her 20s with no previous history that presents with acute shortness of breath, trembling, tachycardia, sweating, chest pain and nausea.
You have ruled out acute coronary syndrome (ACS), asthma, hypertiroidism.
Dx and tx?
A
Panic disorder
Benzodiazepines (e.g., Lorazepam IV or Alprazolam PO) to abort the attack and complement with cognitive behavioural therapy
3
Q
What is agoraphobia?
A
Fear of being in situations where escape might be difficult or that help wouldn’t be available if things go wrong
4
Q
Tx of phobias?
A
Cognitive behavioural therapy
- Flooding (less effective but done quickly): Performed by overwhelming the patient with the trigger
- Desensitization (more effective but takes longer): slowly increasing the stages of anxiety-provoking situations.
Benzodiazepines
5
Q
Tx of social phobia?
A
Non-selective beta blockers (e.g., atenolol, propranolol)
6
Q
Patient who was cut off when driving. The patient followed the car and severely hit the person.
Dx?
A
Intermittent explosive disorder
7
Q
Diference between theft and kleptomaniac?
A
Kleptomaniac:
- women > men
- Stealing things with little to none value
- Things that the patient can afford
- Gilt or remorse afterwards (gifting the object, hiding, returning it)
8
Q
Patient who constantly washes her hands to the point to make them bleed because of severe dermatitis.
Dx and tx?
A
Obsessive-Compulsive Disorder
Tx: Psychotherapy • Cognitive behavioural therapy • Better than meds SSRIs
9
Q
Patient who is unable to throwing things away.
Dx?
A
Hoarding disorder
10
Q
Patient who is doings lots of excersie to build muscle He has testicular atrophy and copper disorders.
Dx and risks?
A
Muscle dysphoria disorder
He is taking anabolic steroids. Risks: rhabdomyolysis, acute renal failure, roid rage
11
Q
Types of PTSD
A
- Intrusion (memories, flashbacks, nightmares)
- Mood change (depressed mood)
- Dissociation (depersonalization, amnesia)
- Avoidance (not talking about it)
- Arousal (hypervigilance, irritability)
12
Q
Difference between Post-Traumatic Stress Disorder and acute stress disorder
A
Duration:
- 3 days–1 month: acute stress disorder
- > 1 moth: PTSD
13
Q
Tx of PTSD?
A
1st: Psychotherapy (group therapy)
SSRIs may help
14
Q
4-y-o patient who was neglected/abused during. Doesn’t create bonds, depression, loneliness.
Dx, tx?
A
Reactive Attachment Disorder
Tx:
Rule out autism first, then coach caregiver
15
Q
4-y-o patient who was neglected/abused during childhood. Pairs too much, bonds with everyone
Dx, tx?
A
Disinhibited Social Engagement Disorder
Tx:
Rule out autism first, then coach caregiver
16
Q
Patient with changes in mood (depressive) after his girlfriend broke up with him. No suicidal ideation, no homicidal ideation. Duration < 6 months.
Dx, tx?
A
Adjustment Disorder
Tx: generally not needed, just reassurance
17
Q
Teen-early 20’s who after major stressor presents a change in behaviour and bizarre thought and is combative in the ER.
Dx, tx?
A
Psychotic break
Tx: haloperidol IM or Olanzapine IM
Note: Rule out drugs
18
Q
Dx of schizophrenia?
A
At least 2, one must be 1–3 Positive sx: • 1. Delusions (persecution, grandiosity) • 2. Hallucinations (generally auditory) • 3. Disorganization of speech • Disorganization of behaviour
Negative sx:
• Flat affect, poverty of speech/movement, anhedonia, cognitive impairment
19
Q
Patient with delusions and disorganized behaviour. Duration of 2 weeks. No changes in mood.
Dx and tx?
A
Brief Psychotic Disorder
Atypical antipsychotics for 1 month
20
Q
Patient with auditory hallucinations and disorganized behaviour. Duration of 4 months. No changes in mood.
Dx and tx?
A
Schizophreniform
Atypical antipsychotics for 6 months
21
Q
Patient with delusions and disorganized behaviour. Duration > 6 moths. No changes in mood.
Dx and tx?
A
Schizophrenia
Atypical antipsychotics for 6 months
22
Q
Patient with dellutions, auditory hallucinations and depression.
Dx?
A
Schizoaffective
23
Q
Patient who is functional doesn’t have hallucinations or mood changes but believes that he is the illegitimate son of the Queen.
Dx and tx?
A
Delusional Disorder
Tx: gentle confrontation
24
Q
1st line of treatment in psychotic disorders
A
Atypicals (e.g., quetiapine, olanzapine, risperidone)
25
Patient with a psychotic disorder who is non-compliant. Tx option?
Depot forms (e.g., olanzapine, risperidone)
26
Patient with a pychotic disorder in whom all regimens have not worked. Tx?
Clozapine
27
Patient with a psychotic disorder who present at the ER with fever, rigidity, ↑CK.
Dx and tx?
Neuroleptic malignant syndrome
Tx: dantrolene
28
Patient with insomnia, lost interest, low energy, low concentration, low appetite, slow thoughts, and feeling guilt. No suicidal ideation
Dx, tx?
Typical major depressive disorder
Tx: SSRIs or SNRIs + psychotherapy
29
Patient with hypersomnia, lost interest, low energy, low concentration, high appetite, slow thoughts, and feeling guilt. No suicidal ideation
Dx, tx?
Atypical major depressive disorder
Tx: SSRRs or SNRIs + psychotherapy
30
Patient with suicidal ideation and a plan to achieve it.
| Next step?
Hospitalization against their will
31
Patient with suicidal ideation but no plan to achieve it.
| Next step?
Contract safety (they sign a document saying that they’ll call you before doing anything)
32
When to use electric convulsive therapy in tx for depression?
Used for refractory depression, if catatonia present, if psychosis present
33
Patient wtih hypomania + major depressive episode. No catatonia; no depression.
Dx?
Bipolar II
34
Patient who distracts easily, has insomnia, flight of ideas, agitation, talkative and racing thoughts.
Dx and tx?
Bipolar I (maniac disorder)
Tx:
Chronic tx (mood stabilizers):
• 1st: Lithium + quetiapine, or valproic acid + quetiapine
• 2nd: quetiapine if lithium/valproic acid are contraindicated
• 3rd: lamotrigine if none of above is possible
• 4th: carbamazepine
If psychosis present: quetiapine
35
Patient who is super agitated, maniac at the ER insomnia, flight of ideas, talkative and racing thoughts.
Tx?
BZDs
* Rule out drugs
36
Steps of grief
```
o Denial
o Depression
o Bargaining
o Anger
o Acceptance
```
37
Patient who lost a beloved one 6 months ago. He has dysphoria, guilt, and anhedonia, which comes and goes. When working he feels okay, but at home, he feels sad. He said he had seen his beloved one in the crowd, but he knows this is not possible.
Dx?
Normal grief (No tx necessary)
38
Patient who lost a beloved one 2 years ago. He has dysphoria, guilt, and anhedonia, which is persistent even when he is doing other activities.
Dx?
Depression
Treat with SSRIs, SNRIs
39
Female patient who after having her first baby is feeling dysphoric. However, she cares for the baby. Sx resolve 2 weeks after birth.
Dx and tx?
Baby blues (adjustment disorder)
No tx needed
40
Female patient who after having her second baby (1 moth ago) is feeling dysphoric, guilt, and less energy. She neglects the baby.
Dx and tx?
Post-partum depression
Tx: SSRIs
41
Female patient who after having her second baby (1 moth ago) fears her baby. She neglects the baby.
Dx and tx?
Post-partum psychosis (brief psychotic disorder)
Tx: antipsychotics (risk of her killing the baby)
42
Female patient in her 20s who is underweight. She has lanugo, amenorrhea, cold intolerance, and looks emaciated. Her BMI is 16, has electrolyte disorders, bradycardia and hypotension.
Dx and tx?
Anorexia Nervosa
Tx:
Hospitalize, IV fluids + electrolytes, antipsychotic + CBT
*If OCD/major depression, add SSRIs/SNRIs
43
Female patient who comes for a routine visit. On physical she has dental erosions and dorsal hand scars.
Dx? what do you expect to see in the labs? Tx?
Bulimia Nervosa
Labs
• ↓K, ↓Mg
• Metabolic alkalosis
Tx: SSRIs/SNRIs + CBT
44
Patient with bulimia who takes laxatives as purge method. What do you expect as her acid-base state?
Metabolic acidosis
45
Female patient who comes for a routine visit. On physical she has dental erosions and dorsal hand scars.
What antidepresant in contraindicated?
Bupropion (risk of seizure)
46
Patient who binge-eats but has no purge method.
Dx?
Binge eating disorder
47
Patient who is distrustful, suspicious, and interpret others are malicious.
Personality disorder?
Paranoid (Cluster A)
48
Loners, have no relationships but also are happy not having any relationships.
Personality disorder?
Schizoid (Cluster A)
49
Magical Thinking, borders on psychosis, bizarre Thoughts, Behavior, and Dress.
Personality disorder?
Schizotypal (Cluster A)
50
Unstable, Impulsive, Promiscuous, emotional emptiness, unable to control rapid changes in mood, suicidal gestures.
Personality disorder?
Borderline (Cluster B)
51
Theatrical, attention-seeking, hypersexual, use of physical appearance, dramatic, Exaggerated but superfluous emotions.
Personality disorder?
Histrionic (Cluster B)
52
Inflated sense of worth or talent, self-centered, fragile ego, uses eccentric dress to draw attention,
demands special treatment.
Personality disorder?
Narcissistic (Cluster B)
53
Criminal. No regards for rights of others, impulsive, lacks remorse, manipulative.
Personality disorder?
Anti-Social (Cluster B)
54
Fears rejection and criticism, wants relationships but does not pursue them, Passes on promotions.
Personality disorder?
Avoidant (Cluster C)
55
Unable to assume responsibility. Submissive, clingy, fears being alone.
Personality disorder?
Dependent (Cluster C)
56
Rigid, orderly perfectionist. Order, Control. Perfection at the expense of efficacy.
Personality disorder?
Obsessive-Compulsive (Cluster C)
57
Librarian who consumes drugs an has sex with a lot of people, but doesn't remember any of it.
Dx?
Dissociative Identity Disorder (multiple personalities)
Tx: Psychotherapy
58
Patient who was raped but doesn't remember any of the event.
Dx?
Dissociative amnesia without fugue
Tx: Psychotherapy
59
Patient who after his Dx of lung cancer walk during hours in the New Mexico desert and is found naked in a convenience store. He doesn't remember the event.
Dx?
Dissociative amnesia with fugue
Tx: Psychotherapy
60
Teenager who after having a C- on a test has an out-of-body experience.
Dx?
Depersonalization
61
Teenager whose girlfriend broke up with him. He has an episode of experiencing things as if in a dream
Derealization
62
Child with loss of cognitive skills and adaptative function.
Dx and tx?
Intellectual disability disorder
Tx:
- Special education
- Develop social skills
- Special care
63
Child who can't understand other people's emotions, doesn't make eye contact, can't interpret gestures, does repetitive actions, can't stand changes in routines and focus his attention to a single object.
Dx and tx?
Autism spectrum disorder (ASD)
Tx:
- Special education
- Training in social interaction
64
Child who Blurts out answers, Interrupts, Fidgets, Can’t wait, Talks fasts, Easily distracted, Fails to complete tasks.
Dx?
Think about ADHD if sx are present in 2 or more settings, not only at school.
65
Child who Blurts out answers, Interrupts, Fidgets, Can’t wait, Talks fasts, Easily distracted, Fails to complete tasks. This happens both at home and at school.
Dx, tx?
Attention deficit hyperactivity disorder (ADHD)
Tx:
- Stimulants/amphetamines (e.g., methylphenidate)
- Special education
- Train the parents
F/U: Could present with absence seizures (Tx: ethosuximide or valproate)
66
Patient with a tic (vocal or physical).
| Tx?
D2-antagonists (e.g., olanzapine, clozapine)
| Cognitive behavioural therapy
67
5 y-o kid who wets the bed.
Tx?
Positive reinforcement
Water restriction and void before going to bed
Alarm blankets
68
8 y-o kid who wets the bed and didn't do that before.
Next step?
Uroanalysis and ultrasound
69
8 y-o girl who wets the bed and didn't do that before.
Uroanalysis +
In addition to treating UTI what else is needed?
Educate kid on who to wipe and rule out STI/abuse
70
8 y-o kid who wets the bed and didn't do that before.
Uroanalysis: normal
U/S: normal
Next step?
Evaluate stressor (new sibling, abuse)
71
Teenager who hurts animals, starts fire, steals, doesn't go to school and has run away from home twice.
Dx and tx?
Conduct Disorder
Tx: juvenile detention
72
Teenager who lies, cheats, steals, and is defient. Always hangs out with his friends and has never hurt an animal.
Dx, cause and tx?
Oppositional Defiant Disorder
Cause: incongruent parenting
Tx: coach parents (display one message so kid learns the concept of authority)
73
Patient with ↓alertness and response to stimuli, patient can be put in any position, motionless, resistance to instructions, Stereotyping, echolalia and echipraxia.
Not taking any meds
Dx, tx?
Catatonia: not a Dx but a modifier of an underlying disease (generally mood disorder > schizophrenia)
Tx: lorazepam
F/U:
- Malnutrition
- DVT (LMWH)
- Rhabdomyolysis: ↑ CK
74
Patient with schizophrenia with lead pipe rigidity, ↑CK, ↑HR, ↑BP, ↑temp.
The patient is on antipsychotics.
Dx, tx?
Neuroleptic malignant syndrome
Tx: stop antipsychotics
75
Patient with depression with lead pipe rigidity, ↑CK, ↑HR, ↑BP, ↑temp.
The patient is on SSRIs.
Dx, tx?
Neuroleptic malignant syndrome
Tx: stop SSRIs
76
Patient who was exposed to halothane gas as anestetic before a surgery. Now the patient has lead pipe rigidity, ↑CK, ↑HR, ↑BP, ↑temp.
Dx, tx?
Malignant hyperthermia
Tx: dantrolene
77
How to recognize substance abuse disorder?
```
Control
• Consuming more than intended
• Difficulty cutting down or stopping
• Waste time obtaining it
• Craving
Social impairment
• Failed responsibilities at work
• Impact on personal relationships
• Impact on everyday activities
Risk-taking
• Putting themselves in hazardous situations (sex, driving)
• Use despite previous consequences or complications
Health effects
• Tolerance: needing more to feel the same
• Withdrawal: physical sx when stopped
```
78
Screening of sustance abuse disorder?
```
CAGE
o Cut down: trying to quit the substance
o Anger or annoyed by criticism
o Guilty about use
o Eye opener: substance needed to start the day
```
79
Stages of addiction attitutes towards addiction?
```
o Pre-contemplative: Denial
o Contemplative: Accepted
o Preparation: 1st step
o Action: Behaviour change
o Maintenance: Sustain
```
80
53 y-o patient who has already had 3 normal colonoscopies and wand another because he is afraid he might have colon cancer.
Dx, tx?
Illness anxiety disorder (hypochondriac)
Tx
- Psychotherapy
- Setting boundaries like having only one provider and limit of visits
81
Female patients who complain of pain in several articulations over the past 6 months. After multiples visits to different doctors and many tests everything in negative.
Dx, tx?
Somatic symptom disorder (sx are not intentionally produced)
Tx
- Psychotherapy
- Setting boundaries like having only one provider and limit of visits
82
Patient who after breaking up with her boyfriend goes blind. All tests are normal.
Dx, tx?
Conversion disorder (sx are not intentionally produced)
Tx
- Psychotherapy
83
Patient who intentionally injects himself fecal matter to be kept in the hospital for a few more days and keep attention.
Dx?
Factitious
Note: attentions seeking is the motive and differentiation from malingering
84
Patient who after his Dx of lung cancer walks during hours in the New Mexico desert and is found naked in a convenience store. He doesn't remember the event.
You dx Dissociative amnesia with fugue and start psychotherapy, but in one of the sessions the patient confesses that he faked everything to avoid confronting his wife and the police.
Dx?
Malingering
Note: secondary gain (e.g., money, freedom) differentiate it from factitious in which the patient only seeks attention
85
reversible cerebellar dysfunction secondary to alcohol use?
Wernike’s encephalopathy
o Tx: thiamine + folate
86
Dementia secondary to EtOH presenting with confabulation
Korsakoff’s
87
Patient who is found in coma a no one knows what happened.
Tx?
Thiamine + D50 (in the case it's alcohol intoxication)
+
Naloxone (in case the cause of coma is opioids)
88
Tx of alcholism?
Group therapy (AA) better than disulfiram
89
Patient with diastolic hypertension, tachycardia, tremor, diaphoresis. agitation, and confusion (delirium tremens)
Dx and tx?
Alcohol withdraw
o Tx: Long-acting BDZ and taper (e.g., diazepam) + rapid-acting BDZ (e.g., alprazolam, lorazepam)
90
Patient with euphoria, coma, constrictive pupil, ↓respiratory rate, and constipation.
Dx and tx?
Opioid intoxication
Tx: Naloxone
91
Tx of opioids addiction?
Narcotic anonymous
Opioid substitution therapy
o Methadone
o Subloxone
92
Patient with psychomotor agitation, HTN, dilated pupils, and psychosis.
Dx, tx?
Cocaine intoxcication
Tx: supportive care, benzos, Alfa blockade then beta-blockade
93
Patient with aggressive psychosis, vertical horizontal nystagmus, and impossible strength.
Dx, tx?
PCP intoxication
Tx: haloperidol, acidify urine to enance excretion
94
Patient with respiratory depression, coma, delirium and amnesia.
Dx, tx?
BZD intoxication
Tx: flumazenil (use only if sure that it's BZD as it lowers the seizure threshold)
95
Patient with tachycardia, hypertension, pressured speech, flight of ideas, fever and water intoxication.
Dx?
Amphetamine intoxication
Tx: Supportive care
96
Rule of 6s for depression treatment
* ≥ 6 weeks of single dose to determine if med if effective
* ≥ 6 months of treatment after effective dose
* ≥ 3–6 weeks of washout
* Combination (≥2 meds + psychotherapy) better than psychotherapy or monotherapy alone
97
Examples of SSRIs and their side effects?
Escitalopram, fluoxetine, paroxetine, sertraline
Side effects: ↓libido, delayed eyaculation
98
Examples of SNRIs and their side effects?
Desvenlafazina, duloxetine
Side effects: more expensive. More secure than SSRIs
99
Examples of tricyclics and their side effects?
Imitryptiline, imipramine, desipramine, doxepin
Side effects: Anti-ach (dry mouth, sedation, urinary retention, constipation), convulsions, coma, arrhythmias
100
Examples of MAO-Is and their side effects?
Phenelzine, tranycypromine
Side effects: HTN crisis when mixed together or eating red wine/cheese
101
Side effects of lithium?
Teratogen, nephrotoxic, nephrogenic diabetes insipidus
102
Side effects of valproate?
Teratogen, thrombocytopenia, agranulocytosis, pancreatitis
103
Tx of BZD withdrawal?
Diazepam or chlordiazepoxide
104
Patient with dx of schizophrenia and dysphagia. How to tx?
Oral dissolving table form (olanzapine, risperidone)
105
Side effects of typical antipsychotics?
Extrapyramidal sx
↑Prolactin:
- Gynecomastia
- Amenorrhea
- Galactorrhea
Anti-Ach sx: dry mouth, constipation, urinary retention
106
Side effects of quetiapine (atypical)?
QTc prolongation, anti-ach, somnolence (use to treat insomnia, bipolar/mania)
107
Side effects of olanzapine (atypical)?
QTc prolongation, anti-ach, Metabolic syndrome
108
Side effects of risperidone (atypical)?
QTc prolongation, anti-ach, extrapyramidal sx
109
Side effect of clozapine?
Agranulocytosis
*That's why although it's the best treating psychotic symptoms, it's the last choicce
110
Examples of extrapyramidal symptoms?
Akathisia, acute dystonia, dyskinesia, tardive dyskinesia
111
Patient who is on antipsychotics and feels restless.
Dx, tx?
Aktahisia
Tx: ↓ dose, beta blockers, anti-ach (benztropine)
112
Patient on antipsychotics who has involuntary muscle contractions, torticollis, and cant' move his eyes.
Dx, tx?
Acute dystonia (with oculogyroc crisis)
Tx: anti-ach (benztropine)
113
Patient on antipsychotics who has slow movement and an impaired ability to move the body swiftly on command.
Dx, tx?
Dyskinesia
Tx: anti-ach (benztropine)
114
Patient on antipsychotics who has grimacing and repetitive movements of the jaw.
Dx, tx?
Tartdive dyskinesia
Tx: Stops drug, but it's irreversible. Sx may initially worsen
115
EEG findings during NREM sleep stage 1
theta waves, absence of alpha waves
116
EEG findings during NREM sleep stage 2
K-complexes, sleep spindles
117
EEG findings during NREM sleep stage 3
Delta waves
118
EEG findings during REM sleep
awake pattern, atony of EMG, saccadic eyes, erections
119
Parents bring their kid because he is having episodes of screaming while sleeping, he doesn't remember any of it when he wakes up.
Dx, Sleep stage when this happens and tx?
Night terrors
NREM sleep stage 3
Tx: Reassurance
120
Patient with daytime somnolence the partner says the patient snores. On physical, he is obese and has a short neck.
Dx, next step, tx?
Obstructive sleep apnea (OSA)
sleep study: ≥ 15 apneas/hour or ≥ 5 apneas/hour + snoring
Tx:
- CPAAP = PEEP
- Lose weight
121
Patient with daytime somnolence. Partner says it is as if he forgets to breathe while sleeping.
Sleep study shows central sleep apnea.
Tx?
BIPAP
122
Patient who after a startle lose tone and pass out. He wakes up refreshed. Has happened more than 3 times in 3 moths.
Dx, next step, Tx?
Narcolepsy
Dx:
- Sleep study
- CSF hypocretin-1
Tx:
- Schedule naps
- Stimulants (e.g., amphetamines)
123
Patient who has trouble sleeping. He says he works night shifts.
Dx, tx?
Jet-lag
Tx: phototherapy
124
Patient who has trouble sleeping. He says he sleeps around 4-5 hours/night.
Next step?
Treat sleep hygene: avoid stimulants, have a sleep schedule, phototherapy, routine, bed only for sex and sleep, and avoid exercise, meals, fluids or naps
125
Patient who has trouble sleeping. He says he sleeps around 4-5 hours/night. After treating sleep hygiene, he continues having trouble sleeping.
Dx and next step?
Might be primary insomina. Assess for other disorders (e.g., mood disorders)
```
You could treat with:
o Diphenhydramine (don't give it to elderly)
o Trazadone
o Quetiapine
o Zolpidem
```
126
First-line pharmacotherapy for depression.
SSRIs.
127
Antidepressants associated with hypertensive crisis.
MAOIs
128
Galactorrhea, impotence, menstrual dysfunction, and
| ↓ libido.
Patient on dopamine antagonist.
129
A 17-year-old girl has left arm paralysis after her boyfriend
dies in a car crash. No medical cause is found.
Conversion disorder.
130
Name the defense mechanism:
A mother who is angry at her husband yells at her
child.
Displacement
131
Name the defense mechanism:
| A pedophile enters a monastery.
Reaction formation
132
Name the defense mechanism:
| A woman calmly describes a grisly murder.
Isolation
133
Name the defense mechanism:
| A hospitalized 10-year-old begins to wet his bed.
Regression
134
Life-threatening muscle rigidity, fever, and rhabdomyolysis.
Neuroleptic malignant syndrome.
135
Amenorrhea, bradycardia, and abnormal body image in a
| young female.
Anorexia.
136
A 35-year-old man has recurrent episodes of palpitations, diaphoresis, and fear of going crazy.
Dx?
Panic disorder.
137
The most serious side effect of clozapine.
Agranulocytosis.
138
A 21-year-old man has three months of social withdrawal, worsening grades, flattened affect, and concrete thinking.
```
Schizophreniform disorder (diagnosis of schizophrenia
requires ≥ 6 months of symptoms).
```
139
Key side effects of atypical antipsychotics.
Weight gain, type 2 DM, QT prolongation.
140
A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways.
Diagnosis?
Treatment?
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine.
141
Medication to avoid in patients with a history of alcohol withdrawal seizures.
Neuroleptics.
142
A 13-year-old boy has a history of theft, vandalism, and violence toward family pets.
Conduct disorder
143
A five-month-old girl has ↓ head growth, truncal dyscoordination, and ↓ social interaction.
Rett’s disorder.
144
A patient hasn’t slept for days, lost $20,000 gambling,
is agitated, and has pressured speech. Diagnosis?
Treatment?
Acute mania. Start a mood stabilizer (e.g., lithium).
145
After a minor fender bender, a man wears a neck brace and requests permanent disability.
Malingering.
146
A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C-peptide.
Dx?
Factitious disorder (Munchausen syndrome).
C-peptide (a product of insulin production)
- If ↑, excess production of endogenous insulin
- If normal or ↓, patient is faking hypoglycemia by injecting exogenous insulin
147
A patient continues to use cocaine after being in jail,
| losing his job, and not paying child support.
Substance abuse.
148
A violent patient has vertical and horizontal nystagmus.
Phencyclidine hydrochloride (PCP) intoxication.
149
A woman who was abused as a child frequently feels outside of or detached from her body.
Depersonalization disorder.
150
A man has repeated, intense urges to rub his body against unsuspecting passengers on a bus.
Frotteurism (a paraphilia).
151
A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Diagnosis?
Treatment?
Tardive dyskinesia. ↓ or discontinue haloperidol and consider another antipsychotic (e.g., risperidone, clozapine).
152
A man unexpectedly fl ies across the country, takes a new name, and has no memory of his prior life.
Dissociative fugue.
