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214 Cards in this Set
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32 y/o w/ no psychiatric history brought to ER with 2 days of memory loss,
insomnia, poor appetite, and difficulty performing daily routines. Subjective sense of numbing, detachment, and anxiety. One week earlier pt witnessed her child being fatally injured in a motor vehicle accident. All labs and scans normal. Dx |
(4x) ACUTE STRESS DISORDER |
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What symptom is more likely to occur inacute stress d/o than in PTSD |
REDUCTION IN AWARENESS OF SURROUNDINGS |
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Important determinant factor to whether an individual who was exposed to trauma will develop PTSD |
SEVERITY AND PROXIMITY OF TRAUMA |
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Acute stress d/o differentiated from \PTSD by |
DURATION OF SYMPTOMS |
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29 y/o pt reports having been robbed at knifepoint almost a month ago. Pt escaped unharmed, but has been experiencing a sense of unreality, detachment, and dampened emotions that is interspersed with periods of intense physiological arousal. These symptoms are causing difficulties at work. The most likely Dx |
ACUTE STRESS DISORDER |
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7 y/o child BIB parents report he’s been hyperactive since age 4, talks constantly, interrupts, has trouble sitting still to do homework, will not play quietly outdoors. What else do you need to make the Dx of ADHD |
(4x)
TEACHER REPORT |
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Studies show effective intervention for children with ADHD is to involve their parents in what part of Tx |
(4x)
BEHAVIORAL MANAGEMENT |
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Child w ADHD ineffective Tx with methylphenidate. Next step in management |
(4x) DEXTROAMPHETAMINE
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Child w ADHD not respond to methylphenidate IR. What med to try next (3x) |
MIXED AMPHETAMINE SALTS |
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What aspect of ADHD is most likely to improve as children age |
(3x) HYPERACTIVITY
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Atomoxetine’s principal mechanism of action exerts a therapeutic action because it |
(2x)
IS A SELECTIVE NOREPINEPHRINE REUPTAKE INHIBITOR. |
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Atomoxetine is most likely to be considered as initial treatment in ADHD in adolescents with |
(2x)
SUBSTANCE USE D/O |
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Go to Table of Contents 155 The multimodal Tx study of children w/ ADHD examined the comparative responses over 14 months of children to medication and intense psychosocial interventions. What did the findings of the study reveal w/ respect to ADHD symptom changes |
(2x)
MEDICATION MANAGEMENT IS SUPERIOR TO COMMUNITY CARE TREATMENT |
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Which perinatal factor is specifically associated with development of ADHD |
MATERNAL TOBACCO USE PRENATALLY
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The component of ADHD that is most likely to remain in adulthood |
INATTENTION
Which DSM-V diagnosis requires symptoms to be present in 2 or more settings ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD) |
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Current thinking about relationship between ADHD in children and adults |
SIGNIFICANT NUMBER OF CHILDREN WILL GO ON TO BECOME ADULTS WITH ADHD |
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8 y/o boy w/ ADHD, oppositional defiant disorder, and chronic motor tic disorder has worsening of his tics on a good dose of a stimulant that seems to control his ADHD. How do you manage this further in trying to improve the tics |
MONITOR THE TICS ONLY |
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Which comorbid diagnosis of childhood ADHD worsens the prognosis into adolescence and adulthood to the greatest degree |
CONDUCT DISORDER |
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32 y/o w/ ADHD mixed type as child. As adult still has Sx. Tx |
\METHYLPHENIDATE
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Which med would you prescribe for 20 y/o college student being worried over his grades He complains that he has not been able to focus on studying and that his mind wanders frequently during classes. His energy level is low. He sleeps well and his appetite is good. History indicates he was treated with stimulants since second grade.\ |
METHYLPHENIDATE |
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10yo w ADHD and aggressive outburst is started on a moderate dose of a stimulant. ADHD symptoms have improved, but aggression has not. In addition to behavioral intervention, what is the next best step to manage both the ADHD and aggression |
MAXIMIZE DOSAGE OF LONG ACTING STIMULANT |
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Which psychiatric disorder is comorbid with ADHD Which of the following side effects can result from stimulant medication treatment and warrants immediate discontinuation of the medication and a reassessment of the treatment plan |
DISRUPTIVE BEHAVIOR DISORDERS HALLUCINATIONS |
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Abnormal LFTs would be most commonly associated w/ what medication used to treat ADHD in children/adol |
PEMOLINE |
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ADHD comorbid disorder |
DEPRESSION |
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These empirical non-stimulant meds have empirical support to treat ADHD |
CLONIDINE, BUPROPION, IMIPRAMINE, ATOMOXETINE
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What procedure is necessary to diagnose childhood ADHD |
CLINICAL INTERVIEW OF PARENTS AND CHILD
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Parents bring their 10 yo child for an eval due to concerns about child’s reported difficulty paying attention in a class and completing assignments in the expected time. Parents report that the child has trouble staying on task while doing homework and they are concerned that the child has an attention disorder. At the completion of the eval, the psychiatrist requests that both a parent and a teacher fill out a rating scale. The parent ratings fall into the clinical range but the teacher’s ratings do not meet criteria for a clinical problem. How should the psychiatrist account for the differences in observed ratings |
RATING DISCREPANCIES BY DIFFERENT OBSERVERS ARE COMMON IN CLINICAL PRACTICE. |
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Antidepressant for ADHD\ |
BUPROPION |
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With respect to ADHD symptoms, the 1999 multimodal treatment study of children with ADHD was most notable for demonstrating which of the following |
THE EQUIVALENCE OF COMBINED METHYLPHENIDATE AND PSYCHOSOCIAL TREATMENT COMPARED TO MEDICATION ALONE |
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Which of the following instruments is most helpful in the assessment of children suspected of having ADHD |
CONNERS TEACHER RATING SCALE |
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What med used for ADHD has been associated with liver damage |
ATOMOXETINE (STRATTERA)
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11 y/o with reading disability. Most likely comorbid dx |
ADHD
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Describes the relationship of stimulant treatment of children with ADHD and the emergence and/or presence of tic d/o |
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TREATMENT WITH STIMULANTS HAS BEEN SHOWN TO REDUCE TICS IN CHILDREN WITH COMORBID ADHD AND TIC D/O. |
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What DSM-IV-TR disorder requires symptoms to be present in two or more settings |
ADHD
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12 yo comes in for worsening attention, impulsive, and hyperactive. He is snoring and hard to wake in the AM. Central adiposity, broad based neck and enlarged tonsils. exam is unremarkable. In child with ADHD and sleep problems, what is the most accurate about ADHD and sleep in this patient |
CORRECTING THE UNDERLYING SLEEP DISORDER CAN IMPROVE ADHD SYMPTOMS |
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5 y/o is evaluated for ADHD. Parents complain that the child has multiple symptoms of hyperactivity, impulsivity, inattention, and distractibility. Parents also bring teacher feedback reports that confirm these symptoms and state child is failing academically and having social problems. In psych MD office child is quiet, calm and cooperative, and very engaging . The difference in clinical presentation from parent and school reports is most likely because |
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CHILDREN WITH ADHD CAN PRESENT WITH BRIEF PERIODS OF HEIGHTENED FOCUS AND CALM, ESPECIALLY IN A STRUCTURED SETTING. |
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Failing grades, poor organization, spending sprees, spontaneous trips ditching class, fidgety, euthymic. No change in sleep, appetite, no anhedonia. Dx |
ADHD |
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When compared to the other subtypes of ADHD, children with the inattentive subtype have higher rates of anxiety and somatic complaints and |
LEARNING DISORDERS |
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Evidence based therapy treatment for tic disorder in children HABIT REVERSAL THERAPY DSM 5 prior age of presentation ADHD symptoms 12yo Increased rate of comorbidity with ADHD |
Anxiety or Oppositional defiant
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Go to Table of Contents 157 30 10yr old child, 3 yr hx of involuntary movements and vocalizations, symptoms wax and wane but never disappeared, child is aware of symptoms and only mildly distressed, academic performance is below average, what is the co-occurring disorder most likely causing this functional impairment at school |
ADHD |
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What distinguishes ADHD in children vs adults |
Hyperactivity
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Which of the following strategies exemplifies use of reciprocal inhibition by a patient to attenuate anxiety |
Rehearsing mental images of pleasurable experiences while attending the party |
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A diagnostic feature of panic attack is |
(2x) DEREALIZATION
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Which of the following is the initial treatment of choice for mild anxiety disorders in children |
(2x)
PSYCHOTHERAPY ALONE |
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The key distinction in the differential diagnosis of social phobia versus agoraphobia is |
(2x)
NATURE OF THE FEARED OBJECT |
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Best therapy for patient with illness anxiety disorder CBT Differential Dx of anxiety in the ER typically includes |
PULMONARY EMBOLISM
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The parent of a 43 y/o pt died 5 years ago from pancreatic cancer. 4 years ago patient began feeling full after eating large fatty meals, fearing it was pancreatic cancer. Constantly weighs himself so that he is not losing weight. Now avoids going to doctor to avoid being diagnosed with cancer. No other psychiatric symptoms. What is diagnosis |
Illness anxiety disorder |
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Treatment for severe performance anxiety |
PROPRANOLOL |
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36 y/o with several episodes of palpitations, sweating, trembling, SOB. Work suffering due to anxiety. Initial Tx regimen |
PAROXETINE AND CBT |
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Which of the following agents has been shown to augment the effects of CBT on anxiety disorders |
D-CYCLOSERINE |
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A 28 yo pt presents with a 1 year history of agoraphobia. The pt is able to drive to the local drugstore, but only with considerable pre-travel apprehension. The pt will venture alone no further then within ~5 miles of home. Personal history of panic attacks or depression is denied, although family history is positive for depression and alcoholism. The pt has had no previous treatment. The best initial treatment, and one that offers the best long-term prognosis for this patient is |
SSRI and BZD |
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Weight loss, 3-month hx of anxiety, mild depression, & insomnia, thin, elevated HR, low BP, mild tremor |
HYPERTHYROIDISM |
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Prevalence of separation anxiety d/o and GAD in children follows what pattern with regard to age |
GAD INCREASES WITH AGE WHILE SEPARATION ANXIETY DECREASES WITH AGE |
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Go to Table of Contents 158 28 y/o pt presents w/ 1 yr hx of agoraphobia. Pt is able to drive to the local drug store, but only with considerable pre-travel apprehension. Pt will venture alone no further than within approximately 5 miles of home. Personal history of panic attacks or depression is denied, although family history is positive for depression and alcoholism. Pt has had no previous treatment. The best initial treatment, and one that offers the best long-term prognosis for this pt is |
CBT, INCLUDING EXPOSURE |
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14 y/o pt with a long-standing h/o of perfectionism has recently developed a fear of talking in class after forgetting her lines in a school play. Pt says, “I don’t like talking to other kids” and practices reading aloud over and over so “I remember what I am saying.” Dx |
SOCIAL PHOBIA |
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Pt presents with chapped and reddened hands. Upon questioning, pt admits to washing the hands many times a day because “I work in a hospital cafeteria and am intensely afraid of contracting a flesh-eating bacterial infection.” The most likely Dx |
SPECIFIC PHOBIA |
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In some Japanese and Korean cultures, rather than an intense fear of embarrassing oneself socially, social phobia symptoms may instead manifest with intense fear of what |
OFFENDING OTHERS |
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Which of the following is a common medical cause of anxiety in a pt dying of cancer |
POORLY CONTROLLED PAIN
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Pts with blood phobia have 2 stage response when exposed to stimulus. First is increased anxiety and elevated BP. 2nd response |
HYPOTENSION |
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6 y/o child generally healthy throws a fit every time family goes hiking. Exposure to snake on one hike led child to become loud, agitated. Now child has intense distress when hiking, pleads to stay with parents at all times. Dx |
SPECIFIC PHOBIA |
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18 y/o restless, feels mind going blank, poor concentration, irritability, insomnia, fatigue > 1 yr, used to be good student up until 2-3 yrs ago, no substance use |
GAD |
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Core feature of GAD |
EXCESSIVE WORRYING |
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Pt with OCD resistant to entering treatment is a candidate for |
MOTIVATIONAL INTERVIEWING
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35 y/o truck driver diagnosed w/ GAD. Does not want med that causes sleepiness |
BUSPAR Episodic OCD with variable severity of Sxs, independent of Tx, is more common in BIPOLAR MOOD DISORDER |
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Which TCA has consistently been found to be useful in long term treatment and relapse prevention of OCD |
CLOMIPRAMINE |
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The Child-Adolescent Anxiety Multimodal Study (CAMS) compared sertraline, CBT, and combination therapy in children/adolescents with moderate/severe GAD, SAD, and Social Phobia. Primary findings |
COMBINATION TREATMENT SUPERIOR TO MONOTHERAPY |
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Psych MD was consulted for anxiety and depression. Pt reports severe pain and indicates that doctors refuse to prescribe enough medication to control pain. A factor important for psychiatrist to consider |
ACUTE PAIN IS OFTEN UNDERTREATED, AND POOR PAIN MANAGEMENT CAN CONTRIBUTE TO ANXIETY AND DEPRESSION. |
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Pt with leukemia underwent marrow transplant. Psych consulted. Pt more anxiousand fearful about leaving hospital. Having trouble sleeping. MSE unremarkable. Dx
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ADJUSTMENT DISORDER WITH ANXIETY |
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Other insists she attends. Teachers reports after her mom leave she usually settles down and does academically well. |
DxSEPARATION ANXIETY DISORDER |
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Diagnose a child who persistently refuses to attend school or sleep in bed alone, complaining of somatic symptoms with no physiological origin |
SEPARATION ANXIETY |
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Which of the following is a manifestation of unresolved grief in a school-age child who has experience the loss of a sibling |
SEPARATION ANXIETY FROM PARENTS |
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A 45yr old pt, terminated treatment with previous PCP "because he didn’t take my concerns seriously." Pt believes he has dreaded illness and stomach cancer, denies all symptoms and labs are normal, diagnosis |
ILLNESS ANXIETY DISORDER |
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Generalized anxiety disorder is characterized by excessive worrying along with what combination of symptoms |
BEING EASILY FATIGUED AND FEELING KEYED UP |
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Childhood disorder with greatest genetic association for adult onset panic attacks.. EEG-biofeedback training is efficacious for what d/o |
separation anxiety disorder GAD |
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8yo p/w “always worried” and fearing getting lost or being kidnapped, frequently insisting on sleeping in parent’s room (does well academically & interacts with circle of friends, but frequently c/o HA and visiting school nurse office to call parent)\ |
Separation anxiety disorder |
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A 19-yo college student complains of “difficulty concentrating and my mind going blank when I try to study.” She feels restless, keyed up and worries excessively. Does not use substances.\ |
Generalized anxiety disorder |
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55yr old Hispanic American brought to psychiatrist by family, spells of uncontrollable shouting, crying, trembling, insomnia, pt feels chest heat going up to head, pt and family believe pt is suffering ataque de nervios, pt meets criteria for |
ANXIETY DISORDER |
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9yr with behavioral problems for 4 yrs, at home and school, irritability, anger, verbal outbursts, was previously social, asked to leave teams, uncooperative with parents, which disorder will he have by the time he reached young adulthood |
Anxiety |
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hat predicts bipolarity in adolescent with depression |
(2x) PSYCHOTIC SYMPTOMS
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40 y/o w/ 6 kids insomnia, poor appetite, dizziness/nausea, thinks husband is poisoning her. Despite all classes of meds marked fluctuations from sadness to euphoria 5x during the year. |
Dx(2x)BIPOLAR W/ RAPID CYCLING |
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Go to Table of Contents 160 24-year-old w/ 1 month increasing fatigue, difficulty falling asleep, poor motivation, and trouble paying attention in night school. No personal or family hx of depression. Rx Mirtazapine 15mg qhs. After two doses, pt becomes euphoric, hyperactive, talkative, and full of creative ideas. Pt stood on a chair at night school and offered hearty congratulations to teacher for contributing to pt’s certain future success. Most likely dx |
SUBSTANCE-INDUCED BIPOLAR DISORDER |
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Lamotrigine is effective treatment for what mood disorder |
BIPOLAR DEPRESSION
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Which med is treatment of choice for bipolar with rapid cycling |
VALPROATE tegretol ??? |
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Psychiatrist is treating pt with bipolar disorder whose condition is relatively stable, recently reports feeling depressed. The psychiatrist is considering adding lamotrigine, however is concerned it may interact with pts current meds. Which medication interaction is psychiatrist concerned about |
VALPROATE |
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Manic episode while on carbamazepine. Good response in 2 wks. 4 wks recurrence. |
AUTOINDUCTION OF EPOXIDE PATHWAY |
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What is most effective and rapid in treatment of mania |
COMBINED ANTIPSYCHOTIC MEDICATION WITH LITHIUM OR VALPROATE |
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Bipolar pt w/ 2 hospitalizations for mania taking lithium |
vNEEDS LIFETIME LITHIUM TREATMENT |
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First-degree relatives of patient with BMD II have a higher incidence of what disorder |
MDD |
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What drug is good for acute mania |
LITHIUM
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The natural course of an untreated manic episode lasts approximately what length of time |
3 MONTHS |
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Which of the following baseline levels should be assessed prior to starting lithium treatment |
TSH |
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The presence of adverse life events has been associated with precipitation of which of the following aspects of bipolar disorder |
DEPRESSIVE EPISODE |
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According to the AACAP Practice Parameters, diagnosis of bipolar disorder, type I in children requires which of the following |
A DISTINCT PERIOD OF ABNORMAL MOOD AND EPISODIC SYMPTOMS |
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One controversy about pediatric bipolar disorder is whether severe irritability and emotional dysregulation are |
PREDICTIVE OF CLASSIC BIPOLAR DISORDER IN ADULTHOOD |
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32 y/o w/ diarrhea x 2 wks, is anxious, and not oriented to date/time of day. Taking “some drug” for BMD and patient doubled her dose a month ago when she felt she wasn’t getting better fast enough. What med caused these Sx |
LITHIUM |
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Go to Table of Contents 161 42 y/o pt with episodes of feeling “sad and down” accompanied by decreased energy/interest in activities. Pt estimates these episodes occurred at least four timesin his life, lasting 2-3 weeks at a time. During episodes, spends most of the time in bed. Most recent episode of sx ended 1 week ago. Since then, pt reports feeling energetic and “on top of the world.” He now sleeps only 1-2 hours a night, wakes feeling refreshed. Friends remark pt seems flighty, but pt notes no deleterious effect of the mood change and finds that his productivity at work is the best it has ever been. Most likely Dx |
BIPOLAR II DISORDER |
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29 y/o pt is admitted to the hospital with a 1 week history of euphoria, insomnia, pressured speech, and grandiosity. Pt has delusions of being monitored by the FBI, and the staff observes pt responding to unseen others. In addition to these symptoms, what is required for diagnosis of SCHIZOAFFECTIVE disorder |
Presence of PSYCHOTIC SYMPTOMS for at least 2 WEEKS in the ABSENCE of MOOD SYMPTOMS |
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Which med has FDA approval for tx of mania in children 12 years of age or older |
LITHIUM
27 y/o pt w/ BMD I, has been stabilized as an outpt one month following a hospitalization, and is now receiving weekly med management and supportive psychotherapy. Pt has been euthymic for the past 2 wks, but today does not show up for a scheduled appointment. The most appropriate response by the psychiatrist is |
CALL THE PT TO EXPRESS CONCERN AND FIND OUT WHY THE PT DID NOT MAKE THE APPOINTMENT |
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BMD II with rapid cycling have higher prevalence of what endocrinologic dysfunction |
HYPOTHYROIDISM |
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This is a risk factor for the rapid cycling form of bipolar disorder |
FEMALE SEX |
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What symptoms are seen in a manic episode but not in MDE |
FLIGHT OF IDEAS
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Suggest underlying bipolar in 27 y/o F who presents w/ first major depressive episode |
FAMILY HX OF BIPOLAR |
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Tx of acute mania w/ lithium. What is the best adjunctive agent |
ECT
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Bipolar w/ 4+ manic episodes / yr for 3 yrs. Treatment of choice |
CARBAMAZEPINE, 1200 mg DAILY
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DSM-IV defines h/o major depression plus hx of mixed manic and depressive episode as |
BIPOALR DISORDER, TYPE I |
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Unlike adults with bipolar disorder, prepubertal children with bipolar disorder are believed to have |
PREDOMINANTLY CHRONIC MIXED MANIC STATES |
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Hx of MDD, irritable, restless, distractible, insomnia, poor appetite, guilt, impulsive spending |
BIPOLAR D/O, MIXED |
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Postpartum psychosis is often associated with which of the following disorders |
(x2) BIPOLAR |
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Male and female prevalence rates are comparable for which of the following disorders |
BIPOLAR DISORDER |
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Medication that increases serum level of lamictal |
VALPROATE
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80 yo male tells PCP he thinks his wife of 55 years is having an affair, wife and two middle aged children disagree. Pt acknowledges no clear evidence of his belief. Pt is healthy, no psych history, no hallucinations, cognitive testing is normal for age. What is his most likely diagnosis |
DELUSIONAL DISORDER |
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Term for unreasonable and sustained belief that patient acknowledges may not be true when challenged |
OVERVALUED IDEA |
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Length of time criteria for delusional d/o ONE MONTH Body dysmorphic d/o vs. Delusional d/o somatic type |
INTENSITY W WHICH PT INSISTS ON PERCEIVED BODY DEFICITS |
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Complaints of skin infection with insects, negative medical w/u |
DELUSIONAL D/O, SOMATIC TYPE
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Normal male, except that he is paranoid about wife cheating on him |
DELUSIONAL D/O
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26yo pt thinks his brow bridge is too prominent and looks like a neanderthal. Physician finds brow bridge prominent but WNL. Pt wants plastic surgery consult. What best describes the pt’s belief |
OVERVALUED IDEA |
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Erotomania refers to which of the following conditions |
DELUSIONS OF A SECRET LOVER
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Isolated erotomania is a form of what |
DELUSIONAL D/O
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Pts complain of having lost not only possessions, status, and strength, but also heart, blood, and intestine suffer from which of the following syndromes |
COTARD |
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Pt believes he is the Son of God. This Sx is called |
DELUSION
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Immediate intervention in case of a pt with paranoid delusion and idea of reference |
ASKING FOR DETAILS OF PERCEPTION THAT LED TO THIS DISTRESSING DISCOVERY. |
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The most important risk factor for developing postpartum psychosis |
PREVIOUS POSTPARTUM PSYCHOSIS
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Pt reports the continuing suspicion that the spouse is committing adultery, but acknowledges the possibility of being wrong since there is no evidence to support the pt’s belief |
(x2)
OVERVALUED IDEA |
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20 yo Japanese American patient present of complaining of personal body odor that is offensive to other people. This is most often compared to this DSM diagnosis |
SOCIAL PHOBIA, BODY DYSMORPHIC DISORDER, DELUSIONAL DISORDER (SOMATIC TYPE) |
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A patient with somatic delusional disorder refusing to see a psychiatrist but sees a dermatologist regularly. What should the psychiatrist recommend the dermatologist do |
SUGGEST THAT THE DERMATOLOGIST ASK ABOUT DRUG USE |
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Belief that television is sending you special messages Delusion of reference Go to Table of Contents 163 A 20 y/o female patient reports menses stopped 4 months ago and she’s pregnant. Reports morning sickness and vomiting, bigger breasts. Pregnancy test negative, ultrasound negative, still thinks she’s pregnant. What’s the diagnosis |
PSEUDOCYESIS |
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Which is associated w/ worsened retrograde amnesia during ECT |
(5x) BILATERAL ELECTRODE PLACEMENT
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In learned helplessness model, the behavioral deficits in animals exposed to uncontrollable stress is reversed by |
(4x)
ANTIDEPRESSANTS |
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65y/o had MDD but was treated w/ CBT to remission. Usually has 1 glass of wine w/ dinner. Same level of drinking for many years. Family h/o dementia in both parents. Advice |
(3x)
CONTINUE THE ALCOHOL AS LONG AS THE PATTERN OF USE DOES NOT CHANGE |
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Which d/o is treated w/ light therapy |
(3x) SEASONAL AFFECTIVE DISORDER
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79y/o asks for eval for STD. Upset and guilty about an affair. Spouse says affair happened many years ago. Pt is sad but not confused. Dx |
(2x)
MAJOR DEPRESSION WITH PSYCHOSIS |
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Which depressive symptom is a melancholic feature specifier in DSM-IV |
(2x) LACK OF PLEASURE
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60 y/o w/ depressive syndrome has memory problems. Incorrect on date, messes up serial sevens, spells backwards, but slowly. After 4 wks of trazodone, both mood and cognition are improved. Dx |
(2x)
PSEUDODEMENTIA |
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Depression increases risk of mortality from what disease Hepatitis C treatment with interferon can cause what psychiatric symptom |
(2x) ISCHEMIC HEART DISEASE (3x) DEPRESSION |
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Instead of depressed mood, children w MDD may primarily show |
(2x) IRRITABILITY
What medication may cause mood d/o in pts being treated for melanoma |
Also
worsens fatigue and cognitive inefficiency |
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The treatment for adolescents with depression study recommended which of the following treatments for patients with moderate to severe depression |
(2x)
FLUOXETINE AND CBT |
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Depression, according to Beck’s model is a manifestation of |
(2x)
DISTORTED NEGATIVE THOUGHTS (COGNITIVE DISTORTIONS) |
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Which of the following characteristics is considered particularly likely to be found in patients with MDD with atypical features |
(2x)
INTERPERSONAL REJECTION SENSITIVITY |
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34 y/o F presents “unable to reach her potential” w mood switches frequently (day to day, sometimes within one day) from mildly to moderately. Depressed to happy in the morning. No episodes meeting criteria for mania. Hx suggests most likely Dx |
(2x)
CYCLOTHYMIC DISORDER |
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Go to Table of Contents 164 Melancholia is characterized as (2x) |
ANHEDONIA
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The most common reason that people discontinue the use of SSRI |
(2x) GI SIDE EFFECTS
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According to Joint Commission, what is primary risk factor for completed suicides in medically hospitalized pts |
Increase the dose |
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First line rx for pt with dilated cardiomyopathy who is depressed and has no relief with fluoxetine. Pt does not want side effects |
BUPROPION |
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Theory of kindling of depressive episodes is supported by what phenomena in some |
RECURRENT WITHOUT A STRESSOR |
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47 yo overweight female on celexa w sexual side effects. What med to switch to? Pt with low mood, middle insomnia, impaired concentration and memory x 3 mons,onset shortly after adult child was convicted with felony and imprisoned x 10 years. Most likely Dx |
BUPROPION xADJUSTMENT D/O WITH DEPRESSED MOOD |
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Bone marrow transplant for leukemia. More anxious, fearful than he was before transplant. Trouble sleeping, fearful about leaving hospital. What is dx |
ADJUSTMENT D/O WITH ANXIETY |
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Blunted response to TRH stimulation test correlates with … |
DEPRESSION |
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Most common psych d/o that occurs in pts s/p organ transplant |
MAJOR DEPRESSION |
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The mood disturbance of PMDD is characterized by …v |
IT CAN BE AS SEVERE AS IN MDD |
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Defining feature of mood in atypical depression \ |
REACTIVE |
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27 y/o F, 1 week postpartum, has sudden emotional outbursts; not sad, wants the baby. What’s going on |
MATERNITY BLUES |
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Which dietary supplement has demonstrated some efficacy in Tx of depression |
S-ADENOSYL-L-METHIONINE (SAME)
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The best describes data on suicide risk from meta-analysis of clinical studies of depressed children and adol treated w. SSRI |
MORE YOUTH APPEAR TO FAVORABLY RESPOND TO MEDS THAN SPONTANEOUSLY REPORT SUCIDALITY |
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Learned helplessness is a model for |
DEPRESSION
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Learned helplessness is based on principles of |
CLASSICAL CONDITIONING
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Implantation of DBS electrodes has been shown to lead to remission in about half of patients with treatment-refractory depression. To obtain this effect, the electrode is placed in the |
SUBGENUAL CINGULATE CORTEX |
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What disorder is most likely to be comorbid in pts w trichotillomania |
MOOD DISORDER
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Important distinction between depressive symptoms in pts with cancer as compared to those patients with depression but no cancer is that the patients w cancer |
USUALLY MAINTAIN INTACT SELF-ESTEEM |
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Go to Table of Contents 165 WHO study in 1990, what is the 2nd worldwide leading source of years of healthy life lost to premature death/disability (#1 is ischemic heart disease) |
UNIPOLAR MAJOR DEPRESSION |
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17 y/o with depressed mood, low self esteem and poor concentration possibly has dysthymia. Which feature would support the Dx |
SYMPTOMS >1 YEAR |
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10 y/o child with 2-month h/o irritability, inattention, sleep disturbance, and withdrawal. Child attempted to run in front of a car. No family h/o psychiatric d/o. On examination, no eye contact and has psychomotor agitation. What med |
SSRI |
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Compared to older adolescents with depression, 8-12 year-olds w/ depression most often show what |
SOMATIC COMPLAINTS |
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27 y/o M seen in ED c/o insomnia, hopelessness, anorexia, decreased concentration for 2 weeks and is now acutely suicidal. Pt has hx of ETOH use daily for the past 3 months. The most likely Dx |
SIMD |
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First-line Tx for 9 y/o w/ depression |
SERTARALINE |
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65 y/o morbidly obese pt with new onset of depression endorses fatigue and hypersomnia. He is not on meds and has no PMH. What test |
POLYSOMNOGRAPHY |
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First-line Tx for adolescents w/ major depression |
FLUOXETINE |
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40 y/o M reports long hx of continuous dysphoria and insomnia (dysthymia). Recently he feels worse and reports poor energy, hopelessness and SI. Dx |
DOUBLE DEPRESSION |
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Dx for 40yo male w/ mild chronic dysphoria, insomnia, fatigue, and lessened job performance, now with despondency, tearfulness, lack of energy, skipping work, hopelessness, psychomotor agitation, and SI |
DOUBLE DEPRESSION |
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Strongest predictor in pt following MI (ever stronger than EF) |
DEPRESSION
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Pt w OCD started on 100mg sertraline, at 4 week f/u increased to 150mg b/o no response. Week 10, pt reported no improvement. Next step |
INCREASE SERTRALINE TO 200MG |
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59 y/o ER physician with alcohol problem and depressed mood, less tolerant to day and night shift. In addition to abstinence from ETOH, what is next step |
RECOMMEND RELIEF FROM THE NIGHT SHIFT |
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Women at highest risk of MDD during |
REPRODUCTIVE YEARS
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M w/ HTN and MI, has stressors and depression, Tx |
RELAXATION TRAINING
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Pancreatic cancer patient just diagnosed, tells nurses he wishes he was dead. Distant with psychiatrist. Several month hx of depressive Sx’s, no support system. “The only family at home is my gun” PLACE ON SUICIDE PRECAUTIONS |
PLACE ON SUICIDE PRECAUTIONS |
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An effective antidepressant for depression w/ atypical features is |
PHENELZINE
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Child must have depressed or irritable mood for what length of time in order to meet criteria for dysthymic do |
ONE YEAR |
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Dexamethasone suppression test for diagnosing mood disorders |
NOT USEFUL IN ROUTINE CLINICAL PRACTICE
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61 y/o with left frontal lobe damage secondary to cerebrovascular accident may be predisposed to which psychiatric syndrome |
MDD |
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9 y/o w/ increased irritability and aggression for 3 mons. Used to be easygoing. Grades dropping. No insomnia or poor appetite. AH of voice telling him he is bad. Most likely Dx |
MDD |
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60 y/o w/ depression & paranoia treated with 50mg Zoloft and 6mg risperidone. On follow up pt c/o slow thinking & excessive salvation. On PE masked faces and cogwheel rigidity present. Mood and paranoia have greatly improved. What is the next step |
LOWER DOSE OF ANTIPSYCHOTIC MEDS |
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What is a characteristic of atypical depression |
LEADEN PARALYSIS
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77 y/o F whose husband died 6 wks ago, complains about the length of time it took for her to dress. She sounds irritable, looks fatigued. “I can’t accept he is gone…. I should have been able to save him”. She says “When the real darkness descends on me specially in the middle of the night I don’t want to call anyone.” What is more indicative of MDD rather than uncomplicated bereavement |
HAVING THOUGHTS OF SUICIDE. |
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Cognitive triad of depression |
negative self-perception, experience the world as selfdefeating, AND EXPECTATION OF CONTINUED FAILURE |
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Why is l-methylfolate preferable to folate in adjunctive tx of depression |
Increase transfer across BBB
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What augmentation strategies for treatment-refractory depression has shown the highest efficacy and replicability |
ELECTROCONVULSIVE THERAPY (ECT) |
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Tx for worsening depression, severe weight loss, dehydration, catatonia. |
ELECTROCONVULSIVE THERAPY (ECT) |
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Most commonly limits the use of ECT |
COGNITIVE IMPAIRMENT
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Which of the following medications should be stopped or reduced before starting a patient on ECT |
LITHIUM |
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Which disease is most likely to present as pain disorder |
DEPRESSION |
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Pt w/ unipolar depression has had 3 recurrence of depression each separated by 1 yr, after successful treatment w/ imipramine 200 mg qd. Which prophylactic treatment should be recommended |
CONTINUE IMIPRAMINE 200MG X 5YRS |
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Suicidal thoughts, constant worrying, feels depressed, guilt, lacks energy, hypersomnia, feels ineffective at work. Tx |
CONSIDER TX W/ ANTIDEPRESSANT |
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Prophylactic Treatment for a pt with severe delusional depression following a course of ECT includes what |
COMBINATION OF ANTIPSYCHOTICS AND ANTIDEPRESSANTS |
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Presence/severity of depressive Tx in MS is correlated with |
CEREBRAL INVOLVEMENT
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Go to Table of Contents 167 29 y/o M h/o recurrent depression & 1.5 PPD smoking. Medication |
BUPROPION
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8 days after hip surgery a 75 y/o pt has episodes of disorientation, sleeplessness, and crying especially at night. Also little frogs in her room. In mid morning she is ok. Was Dx w/ MDD several months ago and taking doxepin 25 mg tid and diazepam 5 mg tid were d/c before surgery. Currently on meperidine, diphenhydramine. The recent confusion is NOT caused by |
ATYPICAL DEPRESSIVE DISORDER |
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Research on the use of psychostimulants to treat pts w/ secondary depressive symptoms in medical setting suggest |
WHEN TREATED WITH THESE AGENTS, PT MAY ENGAGE IN REHABILITATION SOONER. |
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Psych MD. Consulted for depression after an abortion. Pt reports she is relieved about the abortion b/c she was in abusive relationship, not emotionally/financially prepared to have child. Psych must be aware that |
STRONGEST PREDICTOR OF DEPRESSION AFTER ELECTIVE ABORTION IS HISTORY OF PRE-PREGNANCY DEPRESSION |
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21 y/o F hospitalized for excessive bleeding following elective first trimester abortion. Pt reports having anxiety about bleeding, but is relieved about abortion. Pt reports that baby’s father is abusive but does not want to leave him. What is the strongest predictor of depression |
HX OF PRE-PREGNANCY DEPRESSION |
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Pt has partial resection of bowel. Has not resumed ambulation despite encouragement. Pt has low mood, poor sleep, and anhedonia. Dx |
PSYCHOLOGICAL FACTORS AFFECTING GENERAL MEDICAL CONDITION |
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6 y/o presents with a 3 yrs hx of disruptive behaviors at home and school. Parents report he has difficulty paying attention and completing tasks. Recently pt has b/c more oppositional and angry with adults and peers. He often states, “I am no good.” What comorbid condition is most likely explanation for the child recent behaviors |
DEPRESSION |
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50 y/o pt is being treated for sadness, anorexia, poor energy, and difficulty concentrating. Fluoxetine 20mg is prescribed and the pt achieves full remission. Later pt admits that she had visual and auditory hallucinations. This improved with treatment and pt currently denies any hallucinations. Dx |
MDD WITH PSYCHOTIC FEATURES |
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25 y/o pt reports experiencing intense periods of profound tiredness over the past 2- 3 weeks. During these periods she has increased need for sleep and spend much of day in bed. Pt also reports increased appetite. These episodes often occur in setting of interpersonal discord. Dx |
MDD WITH ATYPICAL FEATURES |
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According to the World Health Organization, what is the number one psychiatric cause of loss of years of healthy life as measured by disability-adjusted life years for individuals between ages of 15 and 40 years |
UNIPOLAR MAJOR DEPRESSION |
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Pt is initiating light therapy for seasonal depression. What statement accurately represents what is known about the type, dose, and timing of effective treatment |
MORNING LIGHT TREATMENT APPEARS TO BE MORE EFFECTIVE THAN MID-AFTERNOON EXPOSURE. |
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Which antidepressant is LEAST LIKELY to produce sexual dysfunction |
BUPROPION
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Characterizes depression in pt with MS |
RESPONDS TO ANTIDEPRESSANTS
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Go to Table of Contents 168 Pt presents to ED with 5-day hx of N/V, diarrhea, HR of 90, BP 150/92, and temp 100, sweating, tremor, hyperreflexia and distractibility, normal labs an and CT head, and years of Fluoxetine use. One week ago a new med is started |
TRAMADOL |
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35 y/o pt presents with severe depression with episodes of anxiety for 9 months that have become so bad he can no longer leave the house, has severe weight loss, hyperpigmentation of exposed skin, and cold tolerance. Dx |
ADDISON’S DISEASE |
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How many symptom-free weeks must be between two episodes of depression for them to be considered separate and therefore recurrent according to DSM-IV |
8 SYMPTOM-FREE WEEKS |
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Which of the following functions is most likely to normalize in an 80 y/o pt successfully treated for depression |
IIFORMATION PROCESSING SPEED |
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19 y/o pt presents for evaluation of depression. Pt reports a generally very low mood, although it brightens up briefly when something good happens. Pt reports feeling best in the morning. Pt has been sleeping and eating more than usual, and complains of feelings of heaviness in the extremities. Pt reports always being very sensitive to perceived rejection by others. Trials with two selective serotonin reuptake inhibitors (SSRIs) have failed. Which of the following treatments may be particularly effective for this pt |
TRANYLCYPROMINE |
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In pts with recurrent depression, successful treatment with antidepressants should be followed by which treatment strategy |
CONTINUING ANTIDEPRESSANTS AT THE SAME DOSAGE |
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35 y/o F pt presents to the physician complaining of decreased interest in sexual activity and difficulty becoming aroused by her spouse over the last 3 months. Upon further questioning, the patient also reports anhedonia, difficulty sleeping, fatigue, and decreased appetite over the same time period. Medical history and workup are otherwise unremarkable, and pt is not currently taking any medications. According to the DSM-IV-TR, pt’s decreased interest in sex is most likely assoc w which |
SYMPTOM OF A MAJOR DEPRESSIVE EPISODE |
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Patient with depression on admission. Which risk factor suggests need for maintenance psychotherapy |
(2X)
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