review Flashcards
Pt is 26yo w/ persistent depression and mood swings, but no periods of decreased sleep, pressured speech, or disinhibition that lasted for several days. They cut themselves with a razor blade when anxious or upset but say this is not meant to kill themselves. They have been hospitalized several times for suicidal ideation and OD. They have a deep fear of their loved ones leaving them and chronic feelings of emptiness. After the interview, they say you are the best doctor ever and speak poorly of their previous doctor. What is the most likely dx?
a. bipolar II
b. histrionic personality disorder
c. borderline personality disorder
d. dependent personality disorder
e. schizotypal personality disorder
c. borderline personality disorder: mood and interpersonal instability + fears of abandonment
bipolar II = discrete episodes of mania and depression
histrionic = attention seeking behavior and shallow affect
dependent = overly reliant on others
schizotypal = odd speech/thinking but no mood instability
Pt is 27yo w/ anxiety who lives alone and has no social contacts besides mother. He spends most time playing video games and expresses little interest in relationships. He does not have symptoms of major depression or psychosis. He is very stiff and formal in interview and displays little emotion. What is the most likely dx?
a. avoidant personality disorder
b. schizotypal personality disorder
c. schizoid personality disorder
d. antisocial personality disorder
c. schizoid personality disorder: profound defect in ability to form personal relationships and respond to others in meaningful way
avoidant = desire social contact but anxiety interferes
schizotypal = odd/eccentric/unusual thinking and speech, tend to have a few relationships
antisocial = lack of respect for others
Pt is 33yo w/ “anxiety.” They say they are uncomfortable in social situations because they fear others will not understand them. They are not married, have trouble maintaining employment due to anxiety, and sometimes think magazine articles have special messages for them. They sometimes see shadows that look like people or animals and have been trying to learn to communicate telepathically by studying a “new age” book they bought online. They deny history of auditory hallucinations and do not appear to have delusions. What is the best dx?
a. schizophrenia
b. schizotypal personality disorder
c. avoidant personality disorder
d. schizoid personality disorder
e. schizoaffective disorder
b. schizotypal personality disorder: odd/eccentric with unusual thinking/speech
schizoid personality disorder = profound defect in ability to form personal relationships and respond to others in meaningful ways, but tend not to be eccentric
schizophrenia and schizoaffective disorder have frank delusions and hallucinations
complex motor tic disorder vs provisional tic disorder vs persistent vocal tic disorder vs Tourette’s syndrome
complex motor tic disorder - does not include vocal tics
provisional tic disorder - occurring for less than a year
persistent vocal tic disorder - does not include motor tics
Tourette’s syndrome - multiple motor tics and at least 1 vocal tic present for a long period of time
the Vanderbilt assessment is used in the diagnosis of…
ADHD
what drug class is used to prevent symptoms of alcohol withdrawal?
benzodiazepines
what is the time course difference between brief psychotic disorder, schizophreniform disorder, and schizophrenia?
brief psychotic disorder = 1 day - 1 month
schizophreniform disorder = 1 month - 6 months
schizophrenia = 6+ months
how long after last alcoholic drink does delirium tremens occur?
48-96 hours later
what drug is used to reverse the effects of CNS depression caused by benzodiazepine overdose?
flumazenil: competitive antagonist at the benzo binding site on GABA(A) receptor
An 18-year-old man is diagnosed with major depression. He also has idiopathic epilepsy. Which of the following agents is contraindicated in this patient?
Fluoxetine
Venlafaxine
Bupropion
Mirtazapine
Bupropion
At what age does a typically developing child usually first speak in complete sentences?
Children at age 3 are able to speak in complete sentences and can carry conversations using 2-3 sentences.
At age 2, children are able to form 2-3 word sentences but they tend to be incomplete, often missing the verb required for the sentence.
A new patient comes to your office for a psychiatric evaluation. His history suggests a pattern of subclinical depressions along with episodes of hypomania. He denies any drug or alcohol use, and he has no significant medical problems. Which of the following diagnoses is most likely?
Bipolar I disorder
Bipolar II disorder
Dysthymic disorder
Cyclothymic disorder
Double depression
Cyclothymia is characterized by episodic mood disturbances of hypomania and subclinical depression
[Dysthymic disorder is a chronic depression that does not meet severity for a major depressive episode; in dysthymia, symptoms persist for 2 years with no more than 2 months of symptom-free periods. “Double depression” occurs when a major depressive episode is superimposed on dysthymic disorder]
A 21-year-old patient is brought to the psychiatrist by family due to his poor academic performance. When asked about sleep, the patient responds, “sleep deep in the bed fed red, can’t sleep well bell.” Which of the following best describes the patient’s thought process?
Word salad
Circumstantial
Tangential
Clanging
Neologism
Clanging refers to a mode of speech characterized by association of words based upon sound rather than concepts. For example, this may include compulsive rhyming or alliteration without apparent logical connection between words. Such presentation can been seen in schizophrenia spectrum disorders.
Which of the following findings on the mental status exam of a psychiatric patient is the strongest predictor of incapacity to make medical decisions?
Suicidal ideation
Abnormal thought content
Perceptual disturbances
Lack of insight
Poor judgement
lack of insight is the strongest predictor of incapacity to make medical decisions. Lack of insight, or anosognosia, is a symptom of severe mental illness experienced by some that impairs a person’s ability to understand and perceive his or her illness.
