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Psychiatry: UWorld Flashcards

1
Q

What mature defense mechanism is characterized by the separating of a though from its emotional components, thereby making it tolerable?

A

Isolation

An example would be a bank teller who is calm and collected while foiling a robbery attempt

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1
Q

For a child whose parents both suffer from bipolar disorder, what is the lifetime risk of developing the condition?

A

60%

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1
Q

What condition/disorder is an absolute contraindication to the use of bupropion?

A

Seizure disorder.

An important side-effect of bupropion is decreased seizure threshold (usually seen in higher doses). Individuals with anorexia nervosa or bulimia nervosa frequently develop electrolyte abnormalities that can precipitate seizure and therefore, are also contraindications to the use of Bupropion.

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1
Q

What medication(s) can provide relief for for symptoms of dystonia secondary to antipsychotic therapy?

A

Antihistamines or Anticholinergics

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1
Q

Classification of psychiatric illnesses by phase is necessary to determine the appropriate pharmacotherapy. What phase is defined as the end of an episode of illness and the option of either discontinuing treatment or continuing maintenance therapy with the goal of preventing a new episode?

A

Recovery

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2
Q

Imaginary friends are a normal component of development for many young children in what age range?

A

2 to 6

Children usually outgrow imaginary friends by the early elementary school years

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2
Q

For an individual who has a monozygotic twin with bipolar disorder, what is the lifetime risk of developing the disorder?

A

70%

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3
Q

This disorder is characterized by the presence of symptoms of schizophrenia (hallucinations, delusions, disorganized speech, disorganized or catatonic behaviour, or negative symptoms such as flattened affect). These symptoms must be present for at least one month but less than six months.

A

Schizophreniform disorder

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4
Q

Antipsychotics cause hyperprolactinemia by blocking dopamine activity along what pathway?

A

The tuberoinfundibular pathway

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4
Q

For the general population, what is the lifetime risk of developing bipolar disorder?

A

1%

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4
Q

Stranger anxiety is a normal finding in children until what age?

A

3 years old

After that age, a persistent fear of strangers is generally attributable to other causes.

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4
Q

What is the treatment of choice for adjustment disorder?

A

Cognitive or psychodynamic psychotherapy

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5
Q

What are the diagnostic criteria for enuresis?

A

Occurrence of symptoms at least twice a week for 3 consecutive months or the development of marked functional impairment.

Enuresis = wetting the bed after age 5

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5
Q

Lithium should not be administered to a bipolar patient with what?

A

Renal dysfunction

Lithium is excreted through the kidneys.

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6
Q

When do patients with alcohol withdrawal siezures develop signs and symptoms of withdrawal?

A

12 to 48 hours after their last drink

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6
Q

What is one of the most common side effects of electroconvulsive therapy (ECT)?

A

Amnesia

Both retro- and anterograde

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6
Q

What is the treatment of choice for schizophrenic patients who suffer relapses due to treatment noncompliance with oral medications?

A

Depot antipsychotics (e.g. Fluphenazine, risperidone, paliperidone, and haloperidol)

These are long-acting injectable antipsychotics in depot form.

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7
Q

What immature defense mechanism is characterized by the failure to accept a disturbing aspect of external reality?

A

Denial

An example would be a patient diagnosed with a terminal illness who refuses to accept that he will likely die soon.

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7
Q

what disorder is characterized by the presence of 1 or more episodes of inability to recall important personal information that is too extensive to be considered ordinary forgetfulness and is usually related to a traumatic or stressful event?

A

Dissociative amnesia

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8
Q

What defense mechanism is characterized by the intense opposition to bringing unpleasant thoughts to conscious awareness?

A

Resistance

An example would be a woman who unconsciously realizes that her husband is a criminal but resists conscious assembly of the available evidence.

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9
Q

What mature defense mechanism is characterized by serving others in a positive manner to minimize internal fears?

A

Altruism

An example would be a patient with alcohol cirrhosis who has decided to sop drinking due to complications of cirrhosis. He wishes to help others and protect them from the dangers of alcoholism and has no desire to continue drinking alcohol.

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10
Q

What mature defense mechanism is characterized by intentionally postponing the exploration of anxiety-provoking thoughts by substituting other thoughts, thus allowing for the individual to cope with the present reality instead?

A

Suppression

An example would be a woman who focuses on her children’s needs instead of thinking about her father’s diagnosis of cancer.

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10
Q

What are the treament options for narcolepsy?

A
  1. Scheduled daytime naps
  2. Psychostimulants (Modafinil, Methylphenidate tc.)
  3. Combination of antidepressants and psychostimulants
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11
Q

Patients with Tourette syndrome have a significantly increased risk of developing what two other conditions?

A
  1. Attention deficit hyperactivity disorder
  2. Obsessive-compulsive disorder

There is also an increased incidence of conduct disorder, oppositional defiant disorder, and antisocial personality disorder in patients suffering from Tourette syndrome.

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12
Q

Buspirone is used to treat what?

A

Generalized anxiety disorder

Buspirone is not considered an antidepressant.

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12
Q

What is the timeframe for the diagnosis of schizophreniform disorder?

A

Symptoms lasting longer than 1 month but less than 6 months

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13
Q

What immature defense mechanism is characterized by substituting a less disturbing view of the world in place of reality as a means of resolving conflict?

A

Fantasy

An example would be a mother interpreting the appearance of an angel in her dream as meaning her son with a terminal disease will live a long time.

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13
Q

Patients who develop acute dystonia from the use of antipsychotics should be treated with what?

A

Anticholinergics (Benztropine) or antihistamines (diphenhydramine)

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13
Q

Which atypical antipsychotic is most likely to cause extrapyramidal side effects?

A

Risperidone

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13
Q

What disorder is characterized by persistent or recurrent feelings of detachment from one’s own physical or mental processes in the context of an intact sense of reality (like observing one’s own body and thoughts from afar, as in a dream)?

A

Depersonalization disorder

This condition usually results in significant occupational or functional impairment.

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13
Q

What immature defense mechanism is characterized by the attribution of unacceptable internal thought or emotions to other individuals?

A

Projection

An example would be an unfaithful husband who accuses his wife of infidelity.

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14
Q

Which antidepressant is the most appropriate for treating a smoker with depressive symptoms?

A

Bupropion

This is the best option becuase it is useful both as an antidepressant and may be beneficial for smoking cessation.

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14
Q

What disorder is characterized by manic episodes and may or may not include depressive episodes?

A

Bipolar I disorder

A key difference between DSM-IV and DSM-V is that patients with bipolar I disorder are, now, by definition, not required to have had a depressive episode.

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15
Q

What are the first-line drugs in the management of patients with social phobia?

A

SSRIs

Often used in combination with assertiveness training

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16
Q

The sudden onset of neurologic symptoms and a normal neurologic examination consistent with what?

A

Conversion disorder

These symptoms are not intentionally produced and occur more commonly in females

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17
Q

What thought process is characterized by abrupt, permanent deviation from the current subject?

A

Tangentiality

The new thought process is minimally relevant at best and never returns to the original subject.

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18
Q

For the diagnosis of major depressive disorder, patients should have at least how many of eight depressive symptoms and for what period of time?

A

5 of 8 symptoms for at least 2 weeks

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19
Q

Buspirone is used to treat what?

A

Generalized anxiety disorder

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20
Q

Generalized anxiety disorder is characterized by excessive worry or anxiety over many aspects of one’s life for at least how long?

A

6 months

Patients with generalized anxiety disorder have a hard time keeping these worries out of their mind and find them to be very distressing They also frequently have symptoms such as fatigue, restlessness, difficulty concentratin, irritability, and sleep disturbance.

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21
Q

Amantadine is used to treat what?

A

Parkinson’s disease

Amantadine is a dopamine agonist that has been shown to delay the onset and minimize the severity of dementia in patients with Parkinson’s disease.

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22
Q

What are the first line treatments for obsessive-compulsive disorder

A

Selective serotonin reuptake inhibitors or Clmipramine

Medications approved by the FDA include: Clomipramine, Fluoxetine, Fluvoxamine, Paroxetine, and Sertraline

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23
Q

Can a patient with a psychiatric diagnosis give informed consent?

A

Yes, unles their judgment and decision-making abilities are determined to be compromised

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25
Q

This is the repetition of words or ideas during a conversation.

A

Perseveration

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26
Q

What class of medication is Desipramine?

A

Tricyclic antidepressant

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26
Q

Psychotherapy and a trial of antidepressants thould be considered for a bereaved patient who has at least 2 weeks of symptoms of depression how long after the inciting event (major loss etc)?

A

6-8 weeks after

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27
Q

Gender dysphoria is considered to be an incongruence between a patient’s expressed gender and assigned gender for how long?

A

At least 6 months

Patients with this condition may wish to be treated as the other gender or to be rid of their sexual characteristics

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28
Q

What is diagnosed in a person that derives satisfaction from making another person ill?

A

Munchausen syndrome by proxy

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28
Q

Chlordiazepoxide is predominantly used for the treatment of what?

A

Alcohol withdrawal

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30
Q

Lithium therapy for single manic episode in a patient with bipolar disorder should be continued for how long?

A

Long-term maintenance for a period of at least one year

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31
Q

This disorder is characterized by at least four pain symptoms involving multiple sites; at least two GI symptoms; sexual or reproductive symptoms other than pain; and one pseudoneurological symptom such as blindness, deafness, weakness, seizures, loss of consciuosness, or impaired balance. The symptoms persist for several years yet medical assessment is normal. The condition presents before the age of 30 and most frequently occurs in females

A

Somatization disorder

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31
Q

What immature defense mechanism is characterized by the assimilating of another person’s attitude into one’s own perspective.

A

Introjection

An example would be a battered woman who believes her husband is right when he says she is worthless.

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32
Q

What thought process is characterized by loosely associated thoughts that rapidly move from topic to topic?

A

Flight of ideas

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33
Q

How long after recieving antipsychotic medication can parkinsonian symptoms manifest?

A

4 days to 4 months after beginning treatment

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35
Q

All depressed patients must be screened for what?

A

Suicidal ideation

Actively suicidal patients will often need to be hospitalized for stabilization and to maintain their safety.

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36
Q

Alcoholic hallucinosis is a type of alcohol withdrawal syndrome that typically develops and resolves at what time periods following the last drink?

A
  1. Develops within 12-24 hours of last drink
  2. Resolves within 24-48 hours of last drink
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38
Q

What is the first-line treatment for specific phobias?

A

Cognitive behavioral therapy

Medication is considered second-line treatment for specific phobias. If medication is needed, beta-blockers and SSRIs are the best initial pharmacologic choices.

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40
Q

What is the treatment of choice for obsessive-compulsive disorder?

A

Selective serotonin reuptake inhibitors (SSRIs) such as Paroxetine, Sertraline, Fluvoxamine, Fluoxetine

If a patient fails to respond to initial treatment with a SSRI, a trial of a different SSRI or Clomipramine is recommended.

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41
Q

What immature defense mechanism is characterized by the altered perception of disturbing aspects of external reality in an effort to make it more acceptable?

A

Distortion

An example would be an intravenous drug abuser who contracts hepatitis C and blames his condition on inadequate control of hepatitis C within the community.

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41
Q

Dystonia is characterized by muscle spasms/stiffness, tongue protrusion/twisting, opisthotonus, and oculogyric crisis.Hou long after recieving antipsychotic medication can it occur?

A

4 hours to 4 days after starting antipsychotic medication

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42
Q

What change is seen on CT scan of the brain of schizophrenic patients?

A

Increased ventricular size

Decreased cerebral mass, hippocampal mass, and temporal mass are also changes seen in schizophrenic patients.

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43
Q

Lithium exposure in the first trimester of pregnancy causes a twenty-fold increase int he risk of what?

A

Ebstein’s anomaly

  • This is a cardiac malformation characterized by a malformed and inferiorly attached tricuspid valve that causes atrialization of the right ventrical and a decrease in the size of the functional right ventricle. Despite a twenty-fold increased risk, the incidence nevertheless remains very low (1/1,000) because this congenital malformation is quite rare in the general population.*
  • Lithium exposure during the later trimesters may cause goiter and transient neonatal neuromuscular dysfunction.*
44
Q

What disorder is characterized by episodes of major depression and hypomania (manic-like symptoms that are milder, do not require hospitalization, and do not cause psychosis)?

A

Bipolar II disorder

45
Q

What disorder is characterized by the development of unexplained serious neurological symptoms preceded by an obvious emotional trigger (e.g a tragic event or argument)?

A

Conversion disorder

The symptoms are not artificially produced, are unexplained by any medical condition, and can be severe enough to cause social and functional impairment.

47
Q

Classification of psychiatric illnesses by phase is necessary to determine the appropriate pharmacotherapy. What phase is characterized by significant improvement, generally defined as a 50% reduction in the baseline level of severity?

A

Response (acute phase)

48
Q

What disorder is characterized by the state of experiencing familiar persons and surroundings as if they were strange or unreal?

A

Derealization disorder

49
Q

Which personality disorder is characterized by a pattern of distrust and suspiciousness of others?

  1. A tendency to negatively interpret the actions, words, and intentions of others
  2. The suspicion that others intend to harm or deceive them, though there may be little evidence supporting such concerns
  3. Long-held grudges
  4. Reluctance to confide in others
A

Paranoid personality disorder

Cluster A (odd, eccentric)

49
Q

What disorder is characterized by sudden and unexpected travel, the inability to remember the past, confusion about personal identity, and sometimes the assumption of a new identity?

A

Dissociative fugue

This is the only condition within the group of dissociative disorders that is associated with travel.

51
Q

What differentiates acute stress disorder from post-traumatic stress disorder?

A

Acute stress disorder lasts < 1 month

54
Q

What is the acute treatment for panic attacks?

A

Benzodiazepines

56
Q

Grief is the specific emotional response to a loss and includes pain, destress, and physical/emotional suffering. When does a normal grief reaction typically subside?

A

6 months after initial loss

Although symptoms can recur for up to 1 year and on particular days, such as anniversaries, the patient generally has overall improvement.

57
Q

Severe symptoms of Tourette syndrome are best treated with what?

A

Typical antipsychotics

e.g. haloperidol or pimozide

59
Q

Adolescents presenting with behavioral changes should be evaluated for what?

A

The use of illegal and illicit substances

In addition to substance use, other considerations include partner violence, date rape, physical or sexual abuse, and pregnancy.

60
Q

What is the most suitable therapy for the initial treatment of a patient with bipolar disorder and elevated creatinine?

A

Valproate with or without an atypical antipsychotic

Lithium is contraindicated in renal failure due to its renal excretion.

62
Q

Which atypical antipsychotic is least likely to cause extrapyramidal side effects?

A

Clozapine

It is still considered to be a medication of last resort because it can cause agranulocytosis. A complete blood count should be done before starting clozapine and throughout treatment to monitor for possible agranulocytosis.

62
Q

Trazodone is used primarily for the treatment of what?

A

Insomnia related to depression

Trazodone has antidepressant properties and sedation as a side effect. Priapism is another potential side effect.

63
Q

This thought content is the belief that one’s thoughts can control events in a manner not explained by natural cause and effect. It also includes the attribution of casual incidents to supernatural forces.

A

Magical thinking

65
Q

Dysthymia can is also known as what?

A

Persistent depressive disorder

67
Q

If parents refuse to consent to treatment of their child for a non-emergent but potentially fatal medical condition, the physician should do what?

A

Seek a court order mandating treatment

If a delay in obtaining consent would be imminently life threatening, the physician is legally authorized to provide the emergency treatment for the child, regardless of the parent’s wishes.

67
Q

The likelihood of a schizophrenic patient relapsing is decreased by what?

A

Keeping conflicts and stressors in the home environment to a minimum

69
Q

What medication can be given to provide some relief for a patient with symptoms of akathisia (subjective feeling of restlessness) secondary to antipsychotic therapy?

A

Beta-blockers

70
Q

Adjustment disorders are characterized by increased anxiety, depression, or disturbed behavior. These aberrations must develop within how many months of an identifiable stressor while lasting no longer thanhow many months after the stressor ends?

A

Must develop within 3 months of a stressor and last no longer than 6 months

71
Q

What disorder is characterized by non-bizarre (i.e. can occur in real life) false beliefs in an otherwise high-functioning individual?

A

Delusional disorder

73
Q

Anticonvulsive medications such as Carbamazepine and Valproate are mood stabilizers known to cause what birth defects when taken during pregnancy?

A
  1. Craniofacial defects
  2. Neural tube defects
  3. Genital anomalies
74
Q

Do not share patient information with a third party without first obtaining what?

A

Written consent from the patient

75
Q

What mature defense mechanism is characterized by channeling unacceptable or negative impulses into more acceptable or positive activities? The individual does not feel guilty about his/her behavior but finds a more socially acceptable way to channel it rather than change the actual behavior.

A

Sublimation

An example would be a man with a fiery temper who channels his anger into athletic pursuits.

76
Q

What is an anticholinergic medication useful in controlling the extrapyramidal side effects of antipsychotics (eg dystonia, tardive dyskinesia)?

A

Benztropine

78
Q

What is the non-pharmacological treatment of choice for social phobia?

A

Assertiveness training

This is a component of cognitive-behavioral psychotherapy.

80
Q

Classification of psychiatric illnesses by phase is necessary to determine the appropriate pharmacotherapy. What phase is defined asminimal symptoms or the absence of symptoms, with a return to the patient’s premorbid functioning or wellness?

A

Remission (acute phase)

81
Q

This is a sensory perception in the absence of any external stimulus.

A

Hallucination

An example would be a patient who envisions bugs climbing the walls in a hospital room.

82
Q

What is the antidepressant of choice for depressed patients who do not respond to first-line treatment with a selective serotonin reuptake inhibitor?

A

Another medication in the same class (a different SSRI)

If there is no improvemnt and/or side effects after 2 trials, switching to a different class of antidepressants is indicated.

84
Q

The intentional production or feigning of physical or psychologic symptoms because the individual enjoys the “sick” role is characteristic of what>

A

Factitious disorder

85
Q

This personality disorder is characterized by social detachment and a restricted range of expressed emotion. These patients do not enjoy close relationships with others and prefer to be aloof and isolated. They rarely indulge in any pleasurable activities and appear indifferent to praise or criticism. They are able to recognize reality, however, and do not demonstrate the bizarre cognition or psychosis that would be consistent with schizophrenia.

A

Schizoid personality disorder

86
Q

Donepezil is used for the treatment of what?

A

Alzheimer’s disease

87
Q

Acute dystonia can develop at what point following typical antipsychotic therapy?

A

Between 4 hours and 4 days after beginning antipsychotic medication

It is characterized by muscle spasmps or stiffness, tongue protrusions or twisting, opisthotonus (severe extension of the head with arching of the back), and oculogyric crisis (a forced, sustained elevation of the eyes in an upward position)

88
Q

What is the 1st line agent for treating enuresis?

A

Desmopressin

The exact mechanism of action of desmopressin in nocturnal enuresis is unclear.

90
Q

Primary insomnia is characterized by the isolated symptom of difficulty in falling or staying asleep for at least how long?

A

1 month

91
Q

What immature defense mechanism is characterized by an individual expressing his aggression toward another person with repeated, passive failures to meet the other person’s needs?

A

Passive aggression

92
Q

What neurotic defense mechanism is characterized by completely blocking off disturbing thoughts or feelings from consciousness in an attempt to avoid emotional upset?

A

Dissociation

An example would be a patient who was rescued from a burning building and now denies any memory of the event.

92
Q

Pregnant women with a current or previous diagnosis of anorexia are at risk for numerous complications, including what?

A
  1. Miscarriage
  2. Intrauterine growth retardation
  3. Hyperemesis gravidarum
  4. Premature birth
  5. Cesarean delivery
  6. Postpartum depression
93
Q

Generalized anxiety disorder is characterized by excessive anxiety about multiple events, in conjunction with 3 or more symptoms (impaired sleep, poor concentration, easy fatigability, irritability, muscle tension, and restlessness) for at least how long?

A

6 months

93
Q

What are the first-line treatments for cognitive symptoms of Alzheimer’s dementia?

A

Cholinesterase inhibitors such as Donepezil, Galantamine, and Rivastigmine

94
Q

Amitriptyline is a tricyclic antidepressant that has been used for what conditions other than depression?

A
  1. Diabetic neuropathy
  2. Prevention of migraine headaches
95
Q

What diagnosis would be assigned to a patient exhibiting grossly exaggerated physical or psychological complaints, often accompanied by the conscious production of false physical symptoms with the intention of some form of secondary gain?

A

Malingering

Malingering is always associated with secondary gain, whereas factitious disorder is to assume the sick role

95
Q

Bereavement is a normal reaction to the loss of a loved one. Persistent complex bereavement disorder, however, can occur in patients experiencing significant and other symptoms for how long?

A

>12 months following the loss

96
Q

Does a pregnant woman who is competent have the right to refuse treatment even if it places her fetus at risk?

A

Yes

97
Q

Bupropion is an antidepressent that produces its effects primarily through what mechanism?

A

Inhibition of the re-uptake of norepinephrine, dopamine, and serotonin

98
Q

For an individual with a first-degree relative (eg parent, sibling, or dizygotic twin) who suffers from bipolar disorder, what is the lifetime risk of developing this condition?

A

5-10%

100
Q

What is the diagnosis for a child who has fear of situations that call for him/her to speak, and who demonstrates poor communication and reduced verbal expression in a specific social setting but behaves normally at home when he/she feels comfortable and relaxed there?

A

Selective mutism

DSM-V criteria:

  1. Consistent failure to speak in some specific situations but not others
  2. Duration of at least 1 month
  3. Interference with educational or other expected achievement or with social communication
  4. Not attributable to lack of knowledge or comfort with the spoken language
  5. Not accounted for by autism spectrum disorders or psychosis
101
Q

What immature defense mechanism is characterized by the altered perception of disturbing aspects of external reality in an effort to make it more acceptable?

A

Distortion

An example would be an intravenous drug abuser who contracts hepatitis C and blames his condition on inadequate control of hepatitis C within the community.

102
Q

What thought process is characterized by the lack of a ligical connection between the thoughts or ideas of an individual?

A

Loose associations

It tends to be a more severe form of tangentiality in which one statement follows another but there is no clear association between the sentences.

103
Q

Following acute stabilization, patients with severe bipolar disorder should receive what maintenance therapy?

A

Combination therapy with lithium or valproate + an atypical antipsychotic

105
Q

Atypical antipsychotics are less likely to cause extrapyramidal side effects but are more likely to cause what?

A
  1. Weight gain
  2. Hyperglycemia
  3. Dyslipidemia
  4. Hypertension
106
Q

When treating a single episode of major depression, the antidepressant should be continued for how long following the patient’s response?

A

6 months

If multiple episodes of depression have occured, maintenance therapy will likely need to be continued for a longer period.

106
Q

Increased anxiety, depression, or disturbed behavior within three months of an identifiable stressor, and lasting no longer than six months after the stressor ends is characteristic of what disorder/condition?

A

Adjustment disorder

107
Q

The intentional production of false or grossly exaggerated physical or psychologic symptoms with the motivation of secondary gain is characteristic of what?

A

Malingering

109
Q

Neuroleptic malignant syndrome is an unusual but potentially lethal side effect from the use of antipsychotics. It is primarily treated with what?

A

Dantrolene sodium and supportive care

Amantadine or a dopamine agonist like bromocriptine can also be used.

110
Q

Patients suffering from panic disorder have an increased incidence of physical and mental health problems, especially what?

A

Depression

Both fibromyalgia and irritable bowel syndrome are occasionally associated with panic disorder but this association is not as common as that between depression and panic disorder..

111
Q

What is the long-term treatment for panic attacks?

A

Selective serotonin reuptake inhibitors (SSRIs)

114
Q

Abrupt cessation of alprazolam (Xanax), a short-acting benzodiazepine, is associated with what significant withdrawal symptoms?

A

Generalized seizures and confusion

115
Q

What disorder is distinguished from bipolar I disorder by the longitudinal course of the core symptoms? Both conditions may have irritability as a central feature. The irritability and other symptoms comprising bipolar I disorder are episodic and distinctly different. In this disorder, irritability is persistent and the disorder is not considered to be an episodic condition.

A

Disruptive mood dysregulation disorder

116
Q

What thought process is characterized by unnecessarily detailed answers that deviate from the topic of conversation but remain vaguely related?

A

Circumstantiality

Disorganized speech is common in schizophrenics

118
Q

Which personality disorder is characterized by splitting, unstable relationships, impulsivity, angry outbursts, and suicidal gestures?

A

Borderline personality disorder

Cluster B (dramatic, emotional)

120
Q

What is the main difference between anorexia nervosa and bulimia nervosa is what?

A

Patients with anorexia nervosa are severely underweight and often have secondary amenorrhea

121
Q

Altered levels of which neurotransmitter plays an important role in the development of obsessive-compulsive disorder?

A

Serotonin

This disorder results from altered levels of serotonin, a neurotransmitter that regulates mood, aggression, and impulsivity.

122
Q

Some of the more serious adverse effects associated with lithium include what?

A
  1. Nephrogenic diabetes insipidus
  2. Hypothyroidism
  3. Ebstein’s anomaly
123
Q

Patients have the right to refuse treatment except when?

A

When doing so would pose a threat to the health and welfare of others.

124
Q

This personality disorder is characterized by hypersensitivity to criticism, social inhibition, and feelings of inadequacy. Although these individuals very much want friendships, they avoid intimate relationships because they fear ridicule. They also perceive themselves as inferior and are reluctant to engage in new activities or to take risks for fear of being embarrassed.

A

Avoidant personality disorder

126
Q

How long must a patient have symptoms of schizophrenia before it can be diagnosed as schizophrenia?

A

6 months

128
Q

This is the misinterpretation of an external stimulus.

A

Illusion

An example would be the perception that a tree in a dark forest is a menacing creature.

129
Q

What mature defense mechanism is characterized by diverting consciously unacceptable instinctual drives into more socially or personally acceptable activities?

A

Sublimation

For example, a man with an explosive temper could channel his anger into athletic pursuits. In sublimation, a consensus of society would view the instinctual drive as unacceptable or causing detriment to the person or others if not addressed.

130
Q

In a shared psychotic disorder, or folie a deux, one person’s delusion is transferred to another person. It is important for a physician to do what?

A

Assess both individuals separately to determine the degree of impairment of each individual

131
Q

What personality disorder is characterized by a pattern of odd and eccentric behavior, a reduced capacity for close relationships, magical thinking (telepathy, clairvoyance, or a sixth sense), often paranoid ideation, and unusual perceptual experiences?

A

Schizotypal personality disorder

132
Q

Which personality disorder is characterized by clingy and submissive behavior?

  1. Fear of separation
  2. Inability to take initiative
  3. Desire for others to assume responsibility for all major decision making
A

Dependent personality disorder

Cluster C (anxious, fearful)

133
Q

Symptoms of pupillary dilatation, rhinorrhea, muscle/joint aches, abdominal cramping, nausea, and diarrhea are indicative of what?

A

Heroin withdrawal

The symptoms are severe and out of proportion to the physical findings.

134
Q

What medication can be given to treat parkinsonism caused by antipsychotic medication?

A

Anticholinergics

135
Q

Lithium therapy for three or more relapses of manic episodes in a patient with bipolar should be continued for how long?

A

Lifelong maintenance therapy

136
Q

The mechanism of action of antipsychotic medications primarily consists of what?

A

Dopamine-D2 blockade

The added serotonin receptor binding of atypical antipsychotics reduces the likelihood of extrapyramidal side effects.

137
Q

What disorder is characterized by the development of unexplained serious neurological symptoms preceded by an obvious emotional trigger?

A

Conversion disorder

138
Q

Alcohol withdrawal seizures are best treated with what?

A

Long-acting benzodiazepines such as Diazepam, Lorazepam, or Chlordiazepoxide

139
Q

What is diagnosed in patients aged 18 years or older who engage in illegal activities (e.g. theft or assault), disregard the rights of others, and often display evidence of conduct disorder as minors?

A

Antisocial personality disorder

141
Q

Patients taking monoamine oxidase inhibitors like phenelzine should avoid foods high in tyramine, as the combination can result what?

A

Hypertensive crisis

142
Q

What are the first-line medications for treating generalized anxiety disorder?

A
  1. Selective-serotonin reuptake inhibitors (SSRI)

and

  1. Serotonin-norepinephrine reuptake inhibitors (SNRI)
    * These medications are highly effective in combination with cognitive-behavioral psychotherapy.*
143
Q

What drug is helpful for patients with a combination of depression and insomnia or a combination of depression and a decreased appetite?

A

Mirtazapine

This is a tetracyclic antidepressant that also has anxiolytic and appetite stimulating properties.

144
Q

This personality disorder is characterized by eccentric behavior and a reduced capacity for close relationships. These patients usually exhibit “magical thinking” that is inconsistent with cultural norms. They may have bizarre fantasies or believe in telepathy, clairvoyance, or the concept of a sixth sense.

A

Schizotypal personality disorder

145
Q

What mature defense mechanism is characterized by the separating of a thought from its emotional components, thereby making it tolerable?

A

Isolation

An example would be a bank teller who is calm and collected while foiling a robbery attempt.

146
Q

What neurotic defense mechanism is characterized by substituting behavior or feelings that are the exact opposite of their own unacceptable feelings to address their anxiety?

A

Reaction formation

For example, a woman is angry with immigrants who compete with her for employement so she substitutes her anger into the opposite action of offering job search advice to the same group of people.

147
Q

What is/are the 2nd line agent(s) in treating enuresis?

A

Tricyclic antidepressants such as imipramine

148
Q

What is the first step in the care of patients with acute suicidality?

A

Admit them to psychiatric unit

To ensure their safety and against their will if necessary.

149
Q

What neurotic defense mechanism is characterized by the shifting of emotions associated with an upsetting object or person to a safer alternate object or person that represents the original in some regard?

A

Displacement

An example would be a woman who is angry with her husband and throws away his baseball card collection as retaliation.

150
Q

What is used to treat schizophrenia in patients who fail to respond to or cannot tolerate alternate antipsychotic medications?

A

Clozapine

This is the atypical antipsychotic with the greatest efficacy; however, it can cause agranulocytosis, seizures, and myocarditis.

151
Q

Following acute stabilization, patients with mild or moderate bipolar disorder should receive what maintenance therapy?

A

Monotherapy with atypical antipsychotics are preferred for mild to moderately ill patients

Monotherapy with lithium or valproic acid can be used as alternative therapy.

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