Psychiatry Formative Flashcards
Frequent cutting behaviour is more prevalent in:
= A. Borderline personality disorder - one of its features is ‘self harming behaviour under emotional distress’ (so wrist cutting is frequent).
Which remark made by a patient during a psychiatric interview most strongly suggests that he is suffering from a psychotic illness?
- A: I have heard my name called out, although there was no-one there
- B: My dead wife sometimes appears just before I go to sleep
- C: My thoughts keep repeating themselves and I can’t stop them
- D: The noise in my left ear is like the sea flowing over the roof
- E: They are taking the thoughts away from my mind and leaving it empty
= E. They are taking the thoughts away from my mind and leaving it empty
- Thought withdrawal, i.e. ‘they are taking the thoughts away from my mind etc’ is a first rank psychotic symptom. The other answers are not psychotic symptoms.
Aphasia can be defined as:
- A: A nearly continuous flow of continuous speech with abrupt changes from topic to topic that are usually based on understandable associations, distracting stimuli or play on words
- B: A pattern of speech in which a person’s ideas slip off one track and onto another that is completely unrelated or only obliquely related
- C: An impairment in the understanding or transmission of ideas by language in any of its forms that is due to injury or disease in any of the brain centres involved in language
- D: An impoverishment in thinking that is inferred from observing speech and language behaviour
- E: An inability to produce speech sounds that require the use of the larynx that is not due to a lesion in the central nervous system
= C: An impairment in the understanding or transmission of ideas by language in any of its forms that is due to injury or disease in any of the brain centres involved in language.
- Aphasia can be defined as impairment in the understanding or transmission of ideas by language in any of its forms that is due to injury or disease in any of the brain centres involved in language. This is a textbook description.
The definition of a delusion is:
- A: A fixed false belief not in keeping with the patient’s social, cultural and religious background
- B: A sensory perception in the absence of an external sensory percept
- C: An alteration in the perception or experience of the external world so that it seems strange or unreal
- D: Recurrent and persistent thoughts, impulses or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress
- E: The fleeting feeling that causal incidents and external events have a particular and unusual meaning that is specific to the person
= A: A delusion is a fixed false belief not in keeping with the patient’s social, cultural and religious background.
The definition of an hallucination is:
- A: A fixed false belief not in keeping with the patient’s social, cultural and religious background
- B: A sensory perception in the absence of an external sensory percept
- C: An alteration in the perception or experience of the external world so that it seems strange or unreal
- D: Recurrent and persistent thoughts, impulses or images that are experienced as intrusive and inappropriate, and that cause marked anxiety or distress
- E: The fleeting feeling that causal incidents and external events have a particular and unusual meaning that is specific to the person
= B: An hallucination is a sensory perception in the absence of an external sensory percept.
Which symptom is most consistent with akathisia?
- A: Constant pacing and walking
- B: Contraction of ocular muscles
- C: Excessive salivation
- D: Increased temperature
- E: Increased urinary sphincter tone
= A: Constant pacing and walking
- Constant pacing and walking is most consistent with akathisia. Akathisia is a subjective sensation of uncomfortable restlessness which is not relieved by movement but the person finds it difficult to resist movement so is observed to be constantly pacing or walking.
The main aetiological theory for schizophrenia is the:
- A: Melatonin hypothesis
- B: Monoamine hypothesis
- C: Neuro-developmental hypothesis
- D: Neuronal plaque model
- E: Serotonin dopamine (SDA) hypothesis
= C: Neuro-developmental hypothesis
- Main aetiological theory for schizophrenia is neuro-developmental hypothesis.
Flight of ideas can be defined as:
- A: A nearly continuous flow of speech with abrupt changes from topic to topic that are usually based on understandable associations, distracting stimuli or play on words
- B: A pattern of speech in which a person’s ideas slip off one track and onto another that is completely unrelated or only obliquely related
- C: An impairment in the understanding or transmission of ideas by language in any of its forms that is due to injury or disease in any of the brain centres involved in language
- D: An impoverishment in thinking that is inferred from observing speech and language behaviour
- E: An inability to produce speech sounds that require the use of the larynx that is not due to a lesion in the central nervous system
= A: A nearly continuous flow of speech with abrupt changes from topic to topic that are usually based on understandable associations, distracting stimuli or play on words.
- Flight of ideas can be defined as a nearly continuous flow of speech with abrupt changes from topic to topic that are usually based on understandable associations, distracting stimuli or play on words. This is a textbook description.
A 36 year old male presents with a nine month history of beliefs that his neighbours are attempting to prevent him from doing an extension to his house. He believes that they have plotted with government agencies to spy on him and have illegally accessed his tax records. His beliefs have been expanding and have become more complex over time. On questioning, he is unable to produce any evidence of his accusations. At no stage has he experienced perceptual abnormalities. What is the most likely diagnosis?
- A: Brief psychotic disorder
- B: Delusional disorder
- C: Major depression
- D: Schizophrenia
- E: Schizophreniform disorder
= B: Delusional disorder
A middle-aged female presents with a three year history of recurring depressed mood with inability to cope, reduced talkativeness and loss of self-confidence. Periods of normal mood have lasted for less than a few weeks and there have been no episodes of hypomania. There have been no changes in energy, activity, sleep, concentration, agitation or retardation. What is the most likely diagnosis using DSM 5?
- A: Adjustment disorder with depressed mood
- B: Bipolar affective disorder
- C: Depressive disorder-chronic and unremitting
- D: Persistent depressive disorder (Dysthymia)
- E: Reactive depression
= D: Persistent depressive disorder (Dysthymia)
Which medication has been shown to be most useful in improving cognition in mild to moderate Alzheimer’s disease?
- A: Diclofenac
- B: Donepezil
- C: Memantine
- D: Oestrogens
- E: Vitamin E
= B: Donepezil
- Cholinesterase inhibitors such as Donepzil have an evidence base and so Donepzil is the first choice. Others on the list have been investigated with various results. Memantine may have a modest benefit and might be used if side effects mean Donepzil needs to be discontinued.
Which medication will increase lithium carbonate levels?
- A: Diazepam
- B: Ibuprofen
- C: Paracetamol
- D: Propanolol
- E: Vitamin C
= B: Ibuprofen - will increase lithium carbonate levels.
Which medication can be safely administered with moclobemide (MAO inhibitor)?
- A: Amitryptiline
- B: Citalopram
- C: Diazepam
- D: Selegiline
- E: Tramadol
= C: Diazepam - Diazepam can be safely administered as it has no serotonergic agonist activity. Others do.
Which statement does not describe the Diagnostic and Statistical Manual (DSM 5) classification of mental health disorders?
- A: Describes the manifestations of the mental disorders and rarely attempts to account for how the disturbances come about
- B: Developed to improve consistency in the diagnosis of mental disorders
- C: Has a decision tree system of isolating the diagnosis to one category to facilitate treatment planning
- D: It is sufficient to just check off symptoms in the diagnostic criteria to make a mental disorder diagnosis
- E: Uses the global assessment of functioning (GAF) scale to report a clinician’s judgement of a patient’s overall level of functioning
= C: Has a decision tree system of isolating the diagnosis to one category to facilitate treatment planning.
The following is not a DSM 5 classification for mental health disorders - Has a decision tree system of isolating the diagnosis to one category to facilitate treatment planning.
Which factor is not associated with an increase in completed suicide?
- A: Access to lethal means
- B: Female gender
- C: Medical illness with chronic pain
- D: Past history of self harm
- E: Psychiatric disorder
= B: Female gender - Female gender is not associated with this. All others are risk factors for completed suicide.
Derailment can be defined as:
B: Derailment = A pattern of speech in which a person’s ideas slip off one track and onto another which is completely unrelated or only obliquely related.
- Derailment can be defined as a pattern of speech in which a person’s ideas slip off one track and onto another which is completely unrelated or only obliquely related. This is a textbook definition.
The definition of idea of reference is:
= E: The fleeting feeling that causal incidents and external events have a particular and unusual meaning that is specific to the person
A 64 year old retired accountant presents to his GP. He has been feeling irritable, anxious, has marked loss of energy, poor sleep with waking at 02:00, decreased appetite and very poor concentration. He is ruminating about his past decisions and worried that he is bankrupt and is wanted by the Australian Taxation Office. The family are very concerned about his state of mind. They refute all of his worries and are wondering why he has recently made a new will.
- What are the two most likely differential diagnoses? (2 marks)
- List the four most important treatment priorities. (2 marks)
- What additional services should be suggested? (1 mark)
- Name two management alternatives which may be appropriate in this case and give reasons for your answer(s)? (2 marks)
1) Classic features of major depressive disorder with psychotic features - Does not have either of the two essential symptoms of Major Depressive Disorder with melancholic features viz Loss of pleasure in all or almost all activities; Lack of reactivity to usually pleasurable stimuli so leave this qualifier out.
2) Dementia- mood symptoms and delusional interpretations may occur in dementia. (Total 2 marks)
You are an intern in the emergency department on Monday morning. You have been asked by your Registrar to see a patient who has presented with drowsiness last night and is now in the overnight observation ward. While you are examining the patient she tells you she has thoughts of self harm and last night took an overdose. Given what the patient has just told you, what history should you now obtain to conduct a risk assessment? List the 20 most important points from the history you should obtain relevant to this case. (10 marks)
- Age of the patient - Is she a minor?
- HxPC - what exactly did she take to overdose? How much did she take? When did she take it?
Did she take anything else (eg. alcohol)? - Collateral history - anyone else observe the patient taking anything?
- Was the intention to harm herself or to end her life?
- Was there a specific triggering event yesterday?
- Previous suicide attempts? Previous self-harm attempts?
- Formal suicide plan in place?
- Access to lethal means?
- History of substance use - alcohol, illicit drugs?
- Past medical history - any medical conditions that may impact on treatment?
- Past psychiatric history - is there a known psychiatric diagnosis? Does the patient meet the criteria for depression? Mania? OCD? PTSD？
