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269 Cards in this Set
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Patient with depression on admission. Which risk factor suggests need for
maintenance psychotherapy |
(2X)
3 OR MORE EPISODES OF DEPRESSION IN A LIFETIME |
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A/w improved outcome in late-life depression....Focused attention, altered consciousness usually seen in pts w dissociative D/O |
Family history of depression trance (2x) |
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This symptom is essential to support a diagnosis of dissociative identity disorder (2x) |
EXTENSIVE INABILITY TO RECALL PERSONAL INFORMATION |
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Pt brought to ed by family because of concern for pts ability to recognize them since TBI one month ago. Pt had LOC after trauma. Tenderness and swelling over L temporal area. Neuro exam normal. Pt knows own name, but unable to identify family members or events related to family. What is diagnosis |
DISSOCIATIVE AMNESIA |
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Go to Table of Contents 169 Whenever the culture of western med has been a focus of inquiry by anthropologists, what diagnosis has been seen as a culture bound syndrome in north America |
DISSOCIATIVE IDENTITY D/O |
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Pt w memory lapses, talks like adult at times & like a scared child at other times. Dx |
DISSOCIATIVE IDENTITY D/O
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Psychiatrist asks, “Do you find things in your possession that you cannot explainTrying to elicit |
” Dissociation |
DISSOCIATION |
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Detachment of emotional component from perception |
DEREALIZATION
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Pts with dissociative identity disorder are also most likely to meet the diagnostic criteria for which of the following disorders |
PTSD |
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20 y/o in MVA, no injuries – speaks softly, feels calm, dim vision, mechanical movements, feels detached |
DEPERSONALIZATION |
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Depersonalization is classified as disturbance of which of the following |
PERCEPTION
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44 y/o pt reports hx of repeated episodes of self-mutilation and sudden changes in relationships. After several months of psychotherapy, the pt speaks in unusual accent, is irritable, and has little awareness of in-session discussions. Psych MD has past records that state pt has been Dx with borderline personality disorder and has a sexual trauma history. Dx |
DISSOCIATIVE IDENTITY D/O |
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Pts that “cut” as a form of self-mutilation typically |
CLAIM TO FEEL NO PAIN
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Newly married 22-year-old pt is strongly encouraged by husband to seek eval due to abrupt changes in pt’s attitudes and behaviors. Pt denies awareness of this, but does acknowledge “missing time” that made her feel like her life is “scattered on the floor of a film editor’s studio after pieces were cut and the ends spliced back together.” Old gf of husband has threatened to file charges 2/2 hostile telephone messages that have been traced to pt’s phone. Pt denies memory of making calls. What is the d/o |
DISSOCIATIVE IDENTITY D/O |
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45 y/o pt w lung cancer and depression. Physical and emotional symptoms are stable, pt worries that "family always seems on edge w me." Family meeting shows children fear losing father, frustrated that lives seem "on hold". Daughter feels she can't invite friends over out of fear of "stressing her father." Father feels guilty about this but does prefer quiet environment. Best strategic systemic approach to problem |
Task family with coming up w practical schedule |
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Episodes of unrestrained eating w/o compensatory behaviors of bulimia. Dx |
(5x) BINGE-EATING DISORDER
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Metabolic abnormality commonly found w anorexia nervosa/purging subtype |
(4x) DECREASED SERUM POTASSIUM |
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Dehydrated bulimic w/ BP 100/60 and orthostasis HR 60. Stat lab test |
(3x) POTASSIUM
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Go to Table of Contents 170 Complication of anorexia nervosa LEAST likely to resolve after restoring weight is |
(2x) OSTEOPOROSIS |
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A diagnosis of anorexia nervosa requires that the patient has maintained a weight below what percentage of a minimally normal weight for age and height |
(2x)
85% |
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Pt with significant medical hx admitted to inpatient psych unit. Labs showlow K and Cl, elevated HCO3 and amylase, and normal lipase. Dx |
(2x) BULIMIA NERVOSA, PURGING TYPE |
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The proposed Dx of binge eating d/o differs from bulimia nervosa in that pts w/ binge eating d/o |
USUALLY DO NOT MAINTAIN A NORMAL WEIGHT |
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During the acute initial refeeding phase of tx for pt w/ severe anorexia nervosa, which is most helpful focus of psychotherapeutic interventions with the pt |
COACHING, SUPPORT, AND POSITIVE BEHAVIORAL REINFORCEMENT |
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Which of the following meds has been extensively studied and found to be effective, in combination with CBT, in tx of bulimia nervosa |
FLUOXETINE |
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23 y/o pt w/ excessive preoccupation with body shape. Pt is in no apparent distress, but admits to binge eating episodes followed by purging twice weekly for past 6 months, Body weight wnl dx |
normal. Dx |
(x2) BULIMIA NERVOSA |
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Abdominal pain, diarrhea, hypokalemia, weight loss, steatorrhea, skin pigmentation. Possible laxative abuse. Measure |
PHENOLPHTHALEIN |
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Patient with anorexia nervosa is admitted to inpatient unit and has begun treatment with high caloric oral feedings; 2 days after admission an EKG shows ventricular tachycardia. Which tests would best determines the likely cause of arrhythmia |
PHOSPHATE |
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The primary focus of behavior therapy in the treatment of anorexia nervosa is to |
RESTORE WEIGHT
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Bulimia is comorbid with...Frequentlyw a medical sx/sign in pts with anorexia |
MDD
REPRODUCTIVE HORMONE DYSFUNCTION |
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During the acute initial refeeding phase of treatment for a patient with severe anorexia nervosa, which of the following is the most helpful focus of psychotherapeutic interventions with the patient |
COACHING, SUPPORT, AND POSITIVE BEHAVIORAL REINFORCEMENT |
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What electrolyte abnormality is most seen in bulimics |
HYPOCHLOREMIC ALKALOSIS WITH HYPOKALEMIA
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32 y/o pt reveals a long-standing preoccupation with the shape of her moth and teeth, though she says that her friends and spouse have assured her that her feelings are inappropriate. Pt reports that she often spends an hour cleaning her teeth, so that the abnormality will be less noticeable. At times she avoids social contact, fearing that people will silently criticize the appearance of her mouth. She has no other obsessions on cleaning rituals. Best dx for pt’s long-standing preoccupation |
BODY DYSMORPHIC DISORDER |
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Go to Table of Contents 171 A plastic surgeon asks the psychiatrist to evaluate a 15 yo pt who is requesting rhinoplasty. The surgeon is willing to perform the operation but is concerned by the pt’s young age. The pt is with her parents. The pt explains “I broke my nose playing hockey 2 years ago and it has bothered me ever since” On exam, her nose is noticeable asymmetrical. Patient shows no obvious psychological distress other than concern for her appearance. Pt states “I just want to look normal again”. Parents report child has had poor self esteem since the injury and they are hoping the operation will help her self confidence. Which of the following is the most likely psychological outcome for this pt following cosmetic surgery |
AN IMPROVEMENT IN QUALITY OF LIFE |
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25-year-old pt with no previous psych history has a new preoccupation with imagined defects in appearance, which is a cause of excessive concern. The pt has a normal medical workup and, other than the distress over appearance, the pt does not have other psych sx. Which of the following meds is most appropriate |
FLUOXETINE |
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In overcoming the resistance to treatment often encountered with patients who have anorexia nervosa, what is it most useful for the psychiatrist to emphasize |
EMPHASIZE HOW TREATMENT WILL ALLOW THE PATIENT TO FOCUS ENERGY ON OTHER MATTERS. |
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Bulimia and depression. Contraindicated |
BUPROPION
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Enlarged parotid glands in a pt being treated for anorexia nervosa would suggest which of the following |
(2x)
SELF-INDUCED VOMITING |
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What test findings are associated with anorexia and bulimia |
BRADYCARDIA, AMENORRHEA, HYPOKALEMIA, AND ELEVATED SERUM AMYLASE |
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Bulimia nervosa presents in which personality d/o |
BORDERLINE
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Which enzymes can be increased in serum of pt’s with bulimia |
AMYLASE
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At 30 years after presentation for treatment, mortality rates for anorexia nervosa are |
0.20% |
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Ekg finding in pt with bingeing and purging bx |
QT AND T WAVE CHANGES |
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What is associated with flattening of T waves and development of U waves on EKG |
purging behavior
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Psychotherapy that has been shown to be effective in bulimia nervosa |
CBT
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What med has shown some efficacy in reducing binging+purging in bulimia nervosa |
(x2)
FLUOXETINE |
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Which SSRI used to treat discontinuation syndrome caused by SSRI termination |
FLUOXETINE
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What factor differentiates malingering from factitious disorder |
(2x) HAVING EXTERNAL INCENTIVE
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What condition shows motivation to assume the sick role |
(2x) FACTITIOUS DISORDER
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Go to Table of Contents 172 Central characteristic of factitious disorder |
THERE IS MOTIVATION TO ASSUME THE SICK ROLE |
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Psychiatrist is evaluating frequent liar. Pt’s lies are grandiose and extreme. Pt appears to believe the stories. This is called |
PSEUDOLOGIA FANTASTICA |
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25 y/o prisoner claiming to be depressed is hospitalized after he swallowed some razor blades. Razor blades were carefully wrapped with surgical tape before swallowing. Confesses he wanted some time out of prison. Dx |
FACTITIOUS DISORDER |
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In contrast to pts with factitious disorder, pts with malingering are characterized by having |
MOTIVATION FOR SECONDARY GAIN. |
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Pt complaining of an inability to move his arm. Pt is becoming enraged at his wife and, on several occasions, feared he might strike her. Shortly after one argument, his arm became limp. Dx |
PRIMARY GAIN |
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Psych MD is asked to recommend treatment interventions for a 16 y/o pt with a presumptive diagnosis of conversion disorder. Which of the ff is most likely to be both accepted by the pt and result in functional improvement |
REHABILITATIVE TREATMENT |
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24 y/o M seen in ED with chest pain claims to have a rare connective tissue d/o and said he required a recent heart transplant due to aorta dissection. He provides the MD with a list of immunosuppressive meds and requests that a transesophageal echo be done. He has no sternotomy scar and outside records indicate his story is false. Is this likely factitious d/o or malingering |
FACTITIOUS D/O (MALINGERERS USUALLY AVOID INVASIVE TESTS) |
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Hallucinations in patients with conversion disorder are characterized by |
HAVING A CHILDISH, FANTASTIC QUALITY
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What key factor distinguishes factious disorder from malingering |
MOTIVATION TO BE IDENTIFIED AS ILL
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According to DSM-IV-TR, compulsive skin picking would be |
IMPULSE CONTROL D/O NOS
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Comorbid condition w/ pathological gambling |
MAJOR DEPRESSION
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What is a very common impulse control d/o NOS |
PATHOLOGIC GAMBLING
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Pathological gambling is included in what grouping |
IMPULSE CONTROL D/O
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Pt is hoarding, home filled with filth, acknowledges is she is keep a lot of things (hoarding) |
Hoarding DO |
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A genetic susceptibility for OCD is suggested by evidence that there is a familial link with (4x) |
TIC DISORDERS |
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Principal behavioral technique for OCD (2x) |
EXPOSURE & RESPONSE PREVENTION
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Go to Table of Contents 173 25 y/o with OCD diagnosed 2 years ago is likely to benefit from what medicine (in addition to psychotherapy) |
(2x)
CLOMIPRAMINE |
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Hx of OCD, Zoloft only partially effective. Next |
TRY ANOTHER SSRI
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What is an effective treatment for obsessive compulsive disorder |
ESCITALOPRAM
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Anterior capsulotomy and/or cingulotomy are indicated and demonstrated effective for pts with what severe incapacitating disorder |
OCD |
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Which condition is least likely to respond to hypnosis |
OCD
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Persistently intrusive inappropriate idea, thought, impulse, or image that causes marked distress is |
OBSESSION |
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Obsessive-compulsive symptoms are characterized by which defense mechanism |
ISOLATION AND UNDOING
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40 y/o pt complains of repetitive, continuous hand-washing throughout day to the point of chaffing skin. Pt denies fear of germs or any obsessive thoughts, cannot explain continuous washing. Dx |
OCD |
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A 20 year old male pt presents to his physician for a physical examination because he is worried that he may have contracted an infectious disease. He states that his worry is interfering with his ability to complete work assignments. He states that he counts to 100 repetitively in order to distract himself from this worry. He has no prior medical or psychiatric history. He does not abuse substances and is not involved in any relationships. Which of the following regions of the pt’s brain is most likely to show increased activity on PET scan |
CAUDATE |
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Child OCD. Which comorbid diagnosis is associated with poor response to SSRI |
TIC DISORDER
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Psych MD asks a patient, “are there things you must do in a particular way or order” which this question, psych MD is trying to elicit |
COMPULSIONS |
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Which of the following is the initial treatment of choice for children with OCD....What infectious agent can exacerbate or cause initial manifestation of OCD in children
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CBT ALONE
GROUP A BETA-HEMOLYTIC STREPTOCOCCUS |
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Man obsesses about killing his g/f. Instead of killing, picks his face w/ a pin. Medication |
FLUVOXAMINE |
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Pt with contamination fears and hand washing rituals is treated with response prevention combined with |
EXPOSURE THERAPY |
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What is the most common pattern of obsessions in pts with OCD |
CONTAMINATION
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Repetitive behaviors that the pt feels compelled to perform ritualistically, while recognizing the irrationality and absurdity of the behaviors, describes |
COMPULSIONS |
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Go to Table of Contents 174 35 M w/ severe OCD, failed multiple meds, CBT and ECT, what next.....What condition is frequently associated with OCD |
CINGULOTOMY
TOURETTE SYNDROME |
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What principal behavior technique is used in the treatment of pts w/ OCD |
EXPOSURE AND RESPONSE PREVENTION
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What statement reflects current thinking about neurological procedures for intractable OCD |
AT PRESENT, THERE IS LITTLE EVIDENCE TO SUGGEST THAT ANY ONE PROCEDURE IS SUPERIOR TO ANOTHER. |
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Pediatric Autoimmune Disorder Associated with Streptococcus (PANDAS) is associated with what disorder |
OCD |
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Children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) often manifest |
CHOREIFORM MOVEMENTS and OCD SYMPTOMS |
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Respiratory illness is most clearly a risk factor for developing which anxiety disorder |
(2x)
PANIC DISORDER |
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What is the principle goal of the cognitive-behavioral therapy of panic d/o |
USING RESTRUCTURED INTERPRETATION OF DISTURBING SENSATIONS |
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Diff diagnosis of pt presents at ED with panic d/o |
PULMONARY EMBOLISM
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Hyperthyroidism should be ruled out as part of the DDx of what psychiatric d/o |
PANIC D/O
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Which clinical feature distinguishes panic disorder from pheochromocytoma |
ANTICIPATORY ANXIETY (in panic d/o)
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Panic attack reaches peak in |
A FEW MINUTES
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Presence of what disorder puts a child at greatest risk for developing panic disorder as an adult |
SEPARATION ANXIETY DISORDER |
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Childhood physical and sexual abuse increases the risk for which anxiety do |
PANIC DISORDER
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Though many symptoms can be associated with a panic attack, the cardinal symptom that appears to be central to the pathophysiology of the syndrome is |
HYPERVENTILATION |
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Psych MD in the ED evaluates a 67 y/o pt w/ h/o depression who c/o panic attacks since the death of her spouse 1 month ago. Pt has frequent episodes of acute-onset palpitations, chest tightness, nausea, shortness of breath, and intense anxiety lasting several minutes, with no specific triggers. This morning it woke her up from her sleep. Examoverweight, pale, anxious appearing, and mildly diaphoretic. Tachycardic |
EKG |
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Go to Table of Contents 175 pt w panic disorder failed 2 SSRI trials. Which med should be used next |
IMIPRAMINE
32yo h/o panic disorder, phobias, numerous failed trials of andtidepressants. On clonazepam 0.5mg bid with good response. 1mo later response still good but not as good. Dose incr to 1mg bid, on 3rd visit pt reports some loss of benefit again. What is the appropriate course of action |
INCREASE TO 1.5MG PER DAY |
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Compared to pharmacotherapy, advantage of CBT in tx of panic disorder is |
LOWER RATE OF RELAPSE FOLLOWING D/C OFTREATMENT
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Once it becomes effective, pharmacological tx of pts with panic d/o should generally continue for what length of time |
8-12 MONTHS |
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This statement best characterizes current information on the recommended initial treatment of psychotherapy or pharmacotherapy for a pt with panic disorder |
THERE ARE INSUFFICIENT DATA TO CHOOSE ONE TREATMENT OVER ANOTHER, OR COMBINATION OVER MONOTHERAPY |
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42 y/o surgeon experienced intense stomach cramps and palpitations when unable to immediately find the right instrument when performing an appendectomy. The surgeon was extremely alarmed by this and began to worry about the symptoms recurring. The surgeon then traded all ED calls so as to avoid these situations, began to avoid other crowded and noisy environments, and avoided a variety of social and professional settings. Likely diagnosis |
AGORAPHOBIA WITHOUT PANIC |
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A diagnosis of panic d/o requires which of the following |
AT LEAST SOME ANXIETY ATTACKS THAT ARE UNPROVOKED |
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10 month old child distressed when parents leave him with the babysitter. The parents say good bye and leave quickly without display of affection. What is most likely to observed later in life |
INCREASED CLINGING AND AVOIDANT BEHAVIOR TOWARDS BEHAVIOR |
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First-line treatment of panic disorder |
FLUOXETINE
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Pt reports having a fear of driving and experiences feeling of panic, SOB, heart racing, sweating, and clamminess when anticipating a drive down street roads. Pt acknowledges going out of the way to avoid this situation. Pt denied similar Sx in other settings. Dx |
SPECIFIC PHOBIA |
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The case of “Little Hans” led Freud to develop a psychological theory of the formation of which of the following symptoms |
PHOBIA |
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Diagnosis for child w/ behavioral inhibition |
SOCIAL PHOBIA
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First-line treatment in panic attacks |
FLUOXETINE
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10 y/o is seen in outpt clinic w/ hx of extreme fear of using the bathroom at school. He states to be afraid that other children will laugh if they hear or smell him in the bathroom. Dx |
SOCIAL PHOBIA |
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Go to Table of Contents 176 Avoids interpersonal situations due to anxiety and panic attacks |
SOCIAL PHOBIA
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28 y/o M episodic anxiety, palpitations, flushing, shaking, chest tightness. Mostly at work or w/ group of friends. Embarrassed, afraid to go to work, avoiding people |
SOCIAL PHOBIA |
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Principal aim of treatment of child with school phobia is |
RETURN CHILD TO SCHOOL
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42 y/o pt has had chronic abdominal pain, constipation and nausea for the past 14months. Extensive medical work-up has revealed no organic cause, but the pt insists that these are symptoms of a serious disease. Most likely diagnosis |
HYPOCHONDRIASIS WITH POOR INSIGHT |
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Most effective approach in behavioral treatment of phobias |
IN-VIVO EXPOSURE
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This medication is commonly used in social phobia associated with performance situations, shortly before exposure to a phobic stimulus |
ATENOLOL |
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The parents of an 18 y/o adol who is overweight notice that their child is avoiding high caloric foods, such as meat and pasta. When the parents inquire about this, the teen says, “I am afraid of eating.” teen reports having had an episode of panic which occurred while eating and was accompanied by choking feelings. A fear of choking while eating and a wish to avoid foods that might cause choking developed. Dx |
SPECIFIC PHOBIA |
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Parents of 18yr old find child avoiding high calorie foods due to fear of eating, and pt links the fear to and episode of panic that occurred while eating accompanied by choking, denies other episodes of panic, diagnosis |
SPECIFIC PHOBIA |
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12 y/o disclosed to counselor hx of sexual abuse by relative. Report made to authorities. During eval, pt reports anxiety/inability to concentrate due to thinking about event/irritability/sleep problems/crying frequently. Grades fell significantly after abuse began & relationships suffered. Dx |
(5x)
PTSD |
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40 y/o has hyperarousal after seeing bad MVA. Has nightmares, avoids freeways, isolating at home. Therapy only moderately helpful. Which medication |
(3x)
SERTRALINE |
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Which of the following is the best use of hypnosis in a patient with chronic PTSD with severe dissociative symptoms due to childhood abuse |
Learning to gain volitional control over dissociation |
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28 y/o graduate student BIB wife and reports a change in his behavior since he witnessed a fatal motor vehicle collision 3 wks ago. Pt felt feeling of helpless, horrified at time of accident. Now pt feels like “his spirit leaves his body.” And feels numb and detached, and dreams about events. Dx |
ACUTE STRESS |
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Go to Table of Contents 177 A 28 yo patient presents to the ED after experiencing a sexual assault 1 week earlier. Although the patient cannot recall all aspects of the event, she remembers feeling helpless, detached, and as if her surroundings were not real during the assault. For the past week the pt has has difficulty sleeping due to nightmares about the assault and has not been able to talk about the event with any of her friends. She is also experiencing intermittent episodes of palpitations, SOB, dizziness, and nausea throughout the day. Dx |
ACUTE STRESS DISORDER |
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How would a social biologist describe adaptive benefit of PTSD |
HYPERVIGILANCE ALLOWS FOR QUICK SENSING OF REAL THREATS |
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A patient presents to the ED after witnessing a tragic MVA in which they witnessed a death. What symptom present immediately following the event increases the individual’s risk of developing PTSD |
DISSOCIATION |
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What symptom commonly develops relatively late in children with PTSD |
SENSE OF FORESHORTENED FUTURE
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Which of the following is the best predictor of whether or not a patient who sustained a significant trauma will develop early PTSD morbidity |
THE NATURE AND SEVERITY OF THE TRAUMA |
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Sx for a pt 2 months after traumatic experience |
INCREASED AROUSAL AND INTRUSIVE THOUGHTS
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Adding which class of medication to an SSRI is an effective augmentation for treatment of PTSD |
ATYPICAL ANTIPSYCHOTICS |
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Student presents for psych eval with continued anxiety, hyperalertness, flashbacks, and social avoidance after barely escaping an attacker 1 month ago. These symptoms are expected to last no longer than ___ |
4 WEEKS |
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How to prove patient not criminally responsible for attacking neighbor’s house in middle of night with shotgun after hearing imaginary gunfire. |
Flashback prevented patient from understandingwrongfulness of his act. |
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Schneiderian first-rank symptom of schizophrenia
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(3x) HEARING VOICES AND ARGUING ABOUT ONESELF |
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What factor is a good prognostic indicator in schizophrenia |
(2x) FEMALE GENDER
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Successful psychosocial interventions in schizophrenics |
(2x) ASSERTIVE COMMUNITY TREATMENT
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16 y/o boy treated as outpatient for Schizophrenia after recent inpatient first break. Parents concerned reanhedonia, withdrawn. No psychosis. Goal ofoutpatient eval |
(2x)ADDRESS PT’S FEELINGS OF DEPRESSION AND SCREENFOR SI |
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19 y/o pt reported hearing a voice that talked about what pt was thinking. The pt’s speech has a normal rate and rhythm, but says things such as, “It is white, very white. I know. Things are that way. They are. I am.” (Poverty of speech and content) This speech is an example of |
(2x)
ALOGIA |
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Subtype of schizophrenia less severe and starts older |
(2x) PARANOID
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Go to Table of Contents 178 Late-onset schizophrenia is more common in men or women |
(2x) WOMEN
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Schizophrenic with poor response to 3 trials of antipsychotic meds, next step |
(2x) CROSSOVER TO CLOZAPINE
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Dysprosody is an abnormality of (2x) |
SPEECH
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Pt with CPS hospitalized 6x in the past year, hx of nonadherece to treatment, difficulty maintaining housing, and mult med probs – which treatment most appropriate for this patient |
(3x)
ASSERTIVE COMMUNITY TREATMENT |
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75 y/o male brought in by family for psych eval, family reports no past psych history, has gotten suspicious, withdrawn, hostile. Talks to self, talks about being controlled by aliens, believes aliens are putting thoughts in his head. 28/30 on MOCA, MRI shows age-related changes. Diagnosis |
SCHIZOPHRENIA |
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Only one criterion is necessary for Dx of schizophrenia if the reported delusion is |
BIZARRE
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23 y/o pt w/ no previous psych hx BIB family. Parents reports that pt has stopped seeing friends for the last 6 months, is afraid when cars pass by on the street, seems to be talking to self and television. Pt also has unusual movements of arms at times, flap and wave on their own accord. What is the diagnosis |
SCHIZOPHRENIA |
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Which of the following is a non-DSM term for the category of schizophrenia when the dx is based solely on deficit or negative symptoms |
SIMPLE SCHIZOPHRENIA |
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Which of the following statements characterizes late-onset schizophrenia |
OCCURS MORE FREQUENTLY IN WOMEN THAN MEN
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Assessing whether a schizophrenic criminal defendant may meet standard for insanity defense, what do you ask |
“WHAT WERE THE VOICES SAYING TO YOU AT THE TIME OF THE CRIME |
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Which differentiates deteriorative d/o from schizophrenia |
ABSENCE OF PROMINENT POSITIVE SYMPTOMS
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Schizophrenia with onset in childhood is different from adult-onset because… |
IT IS MORE LIKELY TO HAVE A GRADUAL ONSET
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Though recent research has demonstrated that the blunted emotional expression in schizophrenia does not imply that a patient is anhedonic, individuals with schizophrenia do experience loss of interest or pleasure associated with |
SOCIAL INTERACTIONS |
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Focus for outpatient psychotherapeutic groups for schizophrenia |
SOCIAL SKILLS DEVELOPMENT
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Which Tx modalities provides care for seriously mental ill pts in community via a multidisciplinary Tx team |
ASSERTIVE COMMUNITY TREATMENT |
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24 y/o pt w/ hx of epilepsy since childhood has several seizures in rapid succession. Following Szs, pt developed paranoia and hallucination, but resolved over a matter of days. Dx |
INTERICTAL PSYCHOSIS |
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When compared with adult-onset schizophrenia, children with schizophrenia have |
(x2) SIMILAR DEFICITS IN ATTENTION, LEARNING AND ABSTRACTION |
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No additional criterion A symptoms are required for the dx of schizophrenia if the pt has which of the following symptoms |
HALLUCINATIONS OF 2 OR MORE PEOPLE CONVERSING |
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Go to Table of Contents 179 44 y/o pt with schizophrenia is admitted to an inpatient psychiatric unit. After several days pt has muscle tremor, ataxia, twitching, diarrhea, restlessness, vomiting, polyuria, and stupor. Dx |
WATER INTOXICATION |
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What is a negative sx of schizophrenia |
SOCIAL INATTENTIVENESS
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20 y/o avoids everyone but parents. Stopped going to school. Feels everyone watching him. Always quiet, sits at home doing nothing, mumbles to self, some bizarre movements, flat affect. Denies depression or substance use. |
SCHIZOPHRENIFORM |
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Characterizes schizophrenics that smoke REQUIRE MORE NEUROLEPTIC MEDS 29 y/o 1wk euphoria, insomnia, pressured speech, grandiose. Delusions, AH. Need what else for Dx schizoaffective d/o |
PSYCHOTIC SX’S X 2WKS IN ABSENSE OF MOOD SYMPTOMS |
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Most closely correlates w/ social fx in schizophrenics |
NEGATIVE SYMPTOMS
55 y/o pt w/ hx of ETOH dependence reports hearing voices for the past 6 weeks. Pt reports that the last episode of ETOH intoxication was 1 month prior, with moderate drinking since that time. There is no prior hx of psychosis. On exam, pt is alert and oriented. On laboratory evaluation, pt has a GGT of 54, an MCV of 110, and an AST/ALT ratio of 2.1. the most likely cause of this pt’s hallucinations is |
ALCOHOL INDUCED PSYCHOTIC DISORDER |
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Healthy 37 y/o F business exec learns that her brother is killed in a MVA and is decapitated. Three days after the funeral, she spots a man driving a car just like her brothers and is now convinced he is not dead. She believes she is the victim of a conspiracy in which others are manipulating her into losing her mind on order to take over her business. She hears a buzzing noise on her phone at work and believes her line is tapped. At home, she thinks the light in her neighbor’s window is a sign that she is under surveillance. She calls the police and begs that action be taken. A month after treatment, her symptoms are gone and within 3 months she has returned to normal function. The diagnosis is |
BRIEF PSYCHOTIC DISORDER |
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45 y/o F pt with vague complaints of “not feeling good,” not sleeping well X 1 month. Pt discloses fear/anxiety over “weird things happening to me,” including believing that some personal possessions are mysteriously missing or altered. Pt aware “this all sounds crazy,” but cannot help feeling frightened that “someone is messing with my mind, maybe my ex-husband.” |
Pt called police several times, butthey never found anything suspicious. Pt had been a successful insurance agent, andexpresses worry that his distress is distracting and may negatively affect workperformance, which could result in job loss. Denies past psychiatric hx, except forfeeling depressed for several months after the divorce a few years ago
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resolved
without treatment. Which course of action would best clarify the diagnosis |
OBTAIN A GENERAL MEDICAL/ NEUROLOGICAL WORKUP |
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Which medical condition is likely to include psychosis in the symptom complex |
SYSTEMIC LUPUS ERYTHEMATOSUS
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A 35 yo F patient has discoid lupus which has long been controlled with a stable dose of oral prednisone. She abruptly develops increased fatigue, inflamed joints, and diffuse myalgias. Pt also exhibits depressed mood and cognitive impairment. She has no prior psychiatric history and no focal neurological signs. Which of the following is the most likely etiology |
DISEASE INDUCED CEREBRITIS |
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MC complication of corticosteroid therapy |
Mood disorder
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Schneiderian first-rank symptom of schizophrenia |
(3x) HEARING VOICES AND ARGUING ABOUT ONESELF
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What factor is a good prognostic indicator in schizophrenia |
(2x) FEMALE GENDER
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Successful psychosocial interventions in schizophrenics |
(2x) ASSERTIVE COMMUNITY TREATMENT
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19 y/o pt reported hearing a voice that talked about what pt was thinking. The pt’s speech has a normal rate and rhythm, but says things such as, “It is white, very white. I know. Things are that way. They are. I am.” (Poverty of speech and content) This speech is an example of |
(2x)
ALOGIA |
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Subtype of schizophrenia less severe and starts older |
(2x) PARANOID
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Late-onset schizophrenia is more common in men or women Schizophrenic with poor response to 3 trials of antipsychotic meds, next step |
(2x) WOMEN
(2x) CROSSOVER TO CLOZAPINE |
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Dysprosody is an abnormality of (2x) |
SPEECH
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Pt with CPS hospitalized 6x in the past year, hx of nonadherece to treatment, difficulty maintaining housing, and mult med probs – which treatment most appropriate for this patient |
(3x)
ASSERTIVE COMMUNITY TREATMENT |
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75 y/o male brought in by family for psych eval, family reports no past psych history, has gotten suspicious, withdrawn, hostile. Talks to self, talks about being controlled by aliens, believes aliens are putting thoughts in his head. 28/30 on MOCA, MRI shows age-related changes. Diagnosis |
SCHIZOPHRENIA |
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Only one criterion is necessary for Dx of schizophrenia if the reported delusion is |
BIZARRE
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23 y/o pt w/ no previous psych hx BIB family. Parents reports that pt has stopped seeing friends for the last 6 months, is afraid when cars pass by on the street, seems to be talking to self and television. Pt also has unusual movements of arms at times, flap and wave on their own accord. What is the diagnosis |
SCHIZOPHRENIA |
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Which of the following is a non-DSM term for the category of schizophrenia when the dx is based solely on deficit or negative symptoms |
SIMPLE SCHIZOPHRENIA |
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Which of the following statements characterizes late-onset schizophrenia |
OCCURS MORE FREQUENTLY IN WOMEN THAN MEN
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Assessing whether a schizophrenic criminal defendant may meet standard for insanity defense, what do you ask |
“WHAT WERE THE VOICES SAYING TO YOU AT THE TIME OF THE CRIME |
”
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Which differentiates deteriorative d/o from schizophrenia |
ABSENCE OF PROMINENT POSITIVE SYMPTOMS
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Schizophrenia with onset in childhood is different from adult-onset because… |
IT IS MORE LIKELY TO HAVE A GRADUAL ONSET |
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Though recent research has demonstrated that the blunted emotional expression in schizophrenia does not imply that a patient is anhedonic, individuals with schizophrenia do experience loss of interest or pleasure associated with |
SOCIAL INTERACTIONS |
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Focus for outpatient psychotherapeutic groups for schizophrenia |
SOCIAL SKILLS DEVELOPMENT
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Which Tx modalities provides care for seriously mental ill pts in community via a multidisciplinary Tx team |
ASSERTIVE COMMUNITY TREATMENT |
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24 y/o pt w/ hx of epilepsy since childhood has several seizures in rapid succession. Following Szs, pt developed paranoia and hallucination, but resolved over a matter of days. Dx |
INTERICTAL PSYCHOSIS |
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When compared with adult-onset schizophrenia, children with schizophrenia have |
(x2) SIMILAR DEFICITS IN ATTENTION, LEARNING AND ABSTRACTION |
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No additional criterion A symptoms are required for the dx of schizophrenia if the pt has which of the following symptoms |
HALLUCINATIONS OF 2 OR MORE PEOPLE CONVERSING |
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Go to Table of Contents 179 44 y/o pt with schizophrenia is admitted to an inpatient psychiatric unit. After several days pt has muscle tremor, ataxia, twitching, diarrhea, restlessness, vomiting, polyuria, and stupor. Dx |
WATER INTOXICATION |
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What is a negative sx of schizophrenia |
SOCIAL INATTENTIVENESS
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20 y/o avoids everyone but parents. Stopped going to school. Feels everyone watching him. Always quiet, sits at home doing nothing, mumbles to self, some bizarre movements, flat affect. Denies depression or substance use. |
SCHIZOPHRENIFORM
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Characterizes schizophrenics that smoke REQUIRE MORE NEUROLEPTIC MEDS 29 y/o 1wk euphoria, insomnia, pressured speech, grandiose. Delusions, AH. Need what else for Dx schizoaffective d/o |
PSYCHOTIC SX’S X 2WKS IN ABSENSE OF MOOD SYMPTOMS |
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Most closely correlates w/ social fx in schizophrenics |
NEGATIVE SYMPTOMS
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55 y/o pt w/ hx of ETOH dependence reports hearing voices for the past 6 weeks. Pt reports that the last episode of ETOH intoxication was 1 month prior, with moderate drinking since that time. There is no prior hx of psychosis. On exam, pt is alert and oriented. On laboratory evaluation, pt has a GGT of 54, an MCV of 110, and an AST/ALT ratio of 2.1. the most likely cause of this pt’s hallucinations is |
ALCOHOL INDUCED PSYCHOTIC DISORDER |
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Healthy 37 y/o F business exec learns that her brother is killed in a MVA and is decapitated. Three days after the funeral, she spots a man driving a car just like her brothers and is now convinced he is not dead. She believes she is the victim of a conspiracy in which others are manipulating her into losing her mind on order to take over her business. She hears a buzzing noise on her phone at work and believes her line is tapped. At home, she thinks the light in her neighbor’s window is a sign that she is under surveillance. She calls the police and begs that action be taken. A month after treatment, her symptoms are gone and within 3 months she has returned to normal function. The diagnosis is |
BRIEF PSYCHOTIC DISORDER |
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Which medical condition is likely to include psychosis in the symptom complex |
SYSTEMIC LUPUS ERYTHEMATOSUS
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|
A 35 yo F patient has discoid lupus which has long been controlled with a stable dose of oral prednisone. She abruptly develops increased fatigue, inflamed joints, and diffuse myalgias. Pt also exhibits depressed mood and cognitive impairment. She has no prior psychiatric history and no focal neurological signs. Which of the following is the most likely etiology |
DISEASE INDUCED CEREBRITIS |
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MC complication of corticosteroid therapy... 32y/o cannot move the right leg. Exam does not find a cause. Dx is likely to beconversion d/o if which of the following is found |
Mood disorder
(6x)SYMPTOMS NOT INTENTIONALLY PRODUCED |
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Preoccupation and fear of having contracted serious disease based on misinterpretation of bodily sxs despite medical eval and reassurance. (3x) |
HYPOCHONDRIASIS |
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25 y/o referred by plastic surgeon, claims that part of her face is swollen. |
(2x) BODY DYSMORPHIC DISORDER
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Evoked potential testing may be useful in the eval of which condition |
PSYCHOGENIC BLINDNESS
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In the US, pts meeting the diagnostic criteria for neurasthenic often meet criteria for somatoform disorder depression e disorder and which of he following categories of disorders |
ANXIETY |
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43 y/o who c/o “lump in throat,” headaches, bloating, back pain,diarrhea, chest pain, painful urination, sexual indifference; complaints do NOTmatch objective findings from dx workup. What should be recommended to pt’sPCP |
SCHEDULE REGULAR VISITS WITH A PHYSICAL EXAM |
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Multiplicity of complaints, multiple organ systems |
SOMATIZATION D/O
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What is commonly associated with conversion d/o |
LOW INTELLIGENCE
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40-year-old cannot speak after a screaming argument with spouse. Patient writes, “I have been trying to speak, but cannot make a single sound.” Throat exam is normal. There is an occasional loud cough. Diagnosis |
CONVERSION DISORDER |
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Somatic sx/complaint, negative medical workup, negative psych eval |
LOOK AGAIN FOR ORGANIC ETIOLOGY
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Main clinical factor of hypochondriasis vs. somatization d/o |
FEAR OF HAVING A DISEASE
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Go to Table of Contents 182 Hallucinations in pt with conversion d/o are characterized as |
HAVING CHILDISH, FANTASTIC QUALITY
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Primary focus of pt with hypochondriasis |
DISEASE
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The presence of which of the following would suggest that a patient has somatization disorder rather than a general medical condition |
COMPLAINTS INVOLVING MULTIPLE ORGAN SYSTEMS |
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Characterized mainly by cognitive rather than perceptual preoccupation |
HYPOCHONDRIASIS |
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Psychiatrist is asked to see a general medical inpatient for reported hypochondriasis. Which of the following is the most important differential diagnostic consideration |
MEDICAL CONDITION |
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Pt is evaluated for unilateral lower extremity weakness with no apparent physiologic explanation. |
THERE IS A RISK THAT RELEVANT NEUROLOGIC ILLNESSWILL BE IDENTIFIED IN THE FUTURE. |
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A patient has periodic pelvic pain for past two years. Had laparoscopy, diagnosed with endometriosis, started oral contraceptives and analgesics with some relief, still has symptoms. The patient reports worry that she will quit job due to pain. Calls doctor every few days to ask whether new tx should be considered or she may have cancer. What is diagnosis |
Somatic symptoms disorder |
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18 y/o pt presents with an acute onset of blindness after witnessing the murder of a close friend. Neurological examination is inconsistent with loss of vision but otherwise unremarkable. What is most probable outcome for this pt |
SYMPTOMS WILL FULLY RESOLVE IN A MATTER OF DAYS OR WEEKS. |
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24 y/o pt w/ sudden onset stumbling and pain in legs, negative neuro workup – saw a counselor previously for protracted grief after father’s death – increased conflict with husband. Dx |
CONVERSION D/O |
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Neurasthenia, an accepted condition in Europe and Asia, corresponds to which of the following in DSM-IV-TR |
UNDIFFERENTIATED SOMATOFORM DISORDER |
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What is the key element for successful management of somatoform disorders |
ENSURING REGULAR FOLLOW UP FROM PCP
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What symptoms are most commonly associated with Tourette’s syndrome |
OBSESSIONS AND COMPULSIONS
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Pathologic findings in brain of Tourette’s |
NO ABNORMALITY
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What antipsychotic medication is helpful in treating Tourette’s |
HALOPERIDOL
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Which med is helpful in Tourette Syndrome who can’t tolerate clonidine |
GUANFACINE
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Guanfacine’s primary effect is through what mechanism of action |
Presynaptic alpha2 adrenergic receptor activation
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Name for tics comprised of obscene gestures |
COPROPRAXIA |
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One of the earliest sx of Tourette’s |
EYE-BLINKING AND HEAD JERKING
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Initial approach for child with new-onset tic disorder |
CLINICAL MONITORINGGo to Table of Contents 183 |
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What med is effective in tx of motor/vocal tics associated w |
Tourette syndrome |
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refractory to tx with antipsychotics and alpha adrenergic agonists |
(x2)
TETRABENAZINE |
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Comorbid condition w/ Tourette’s in kids |
ADHD
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Tic severity begins to decrease during which age period |
ADOLESCENCE
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Psychotherapy technique for children with Tourette’s syndrome. Habit reversal Which test to confirm personality disorder |
Millon Clinical Multiaxial Inventory (MCMI-III)
Personality d/o w chronic feelings of emptiness, transient psychotic sx, mood swings, tumultuous relationships, self-mutilation, poor self-image, impulsivity |
(5x) BORDERLINE |
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Which is a target of DBT in older adults that is not otherwise included in the standard DBT protocol |
(3x)
EMOTIONAL CONSTRICTION |
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What personality d/o is associated with transient psychotic symptoms (2x) |
BORDERLINE |
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Which disorder has greatest co-incidence of alcohol abuse and dependence |
(2x) ANTISOCIAL PERSONALITY DISORDER
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Personality d/o should be considered in ddx of cyclothymic d/o |
(2x) HISTRIONIC
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What personality disorder results in displays of rapidly shifting and shallow expression of emotions in patients |
(3x)
HISTRIONIC |
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Pts with which personality d/o sees themselves socially inept, personally unappealing, or inferior to others |
(2x)
AVOIDANT |
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Pt prominently uses the defenses of isolation of affect & intellectualization. Description of life events appears to involve reaction formation. What personality trait is most likely to characterize this pt |
(2x)
OBSESSIVE-COMPULSIVE |
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Another psychiatrist refers to a pt by saying this pt is “special” and need really good treatment. You need to be careful with the pt to |
(2x)
ANTICIPATE THE POTENTIAL FOR SPLITTING BETWEEN THE REFERRING MD AND YOURSELF. |
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Avoidant PD differs from Schizoid PD by |
(2x) DESIRE FOR SOCIAL RELATIONS
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Which are the dimensions of the Five Factor Model of Personality |
NEUROTICISM, EXTRAVERSION, OPENNESS, AGREEABLENESS, CONSCIENTIOUSNESS |
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Which symptom is associated with schizophrenia spectrum disorders (cluster A personality disorders) |
SOCIAL WITHDRAWAL |
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Which personality disorder is most associated with alcoholism |
ANTISOCIAL
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Go to Table of Contents 184 Which intervention is helpful in dealing with a borderline pt on a medical ward |
SETTING LIMITS WITH THE PT ON THE STRUCTURE OF THE MEDICAL CARE |
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Extremely demanding patient repeatedly calls psychiatrist’s office and berates staff in offensive terms. Which step should the psychiatrist take first |
SET LIMITS WITH THE PATIENT |
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Useful info to confirm diagnosis of antisocial personality d/o (APD) in 20 y/o patient |
SCHOOL COUNSELING RECORDS
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Interpersonal exploitativeness is a diagnostic feature of (2x) |
NARCISSISTIC PERSONALITY DISORDER
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29 y/o F w/ mood swings- mood changes very rapidly, sometimes without prompting, from elation to depression or intense anger. These moods last minutes to hours. Her history is significant for promiscuity, spending sprees, tumultuous relationships, unstable self-image, and occasional use of cocaine. Hx of a brief period of paranoia and AH |
During and emotional break-up with her last boyfriend,
which remitted after a 2-day admission to the psych unit. When asked about SI, she reports that it is always in her mind and that, whenever she is under stress, she cuts her arms with a sharp blade to relieve a strong feeling of emptiness. Most likely Dx |
BORDERLINE PERSONALITY D/O |
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Person with covert obstructionism, procrastination, stubbornness, and inefficiency may be classified as suffering from which personality d/o outside of current DSM classification |
PASSIVE-AGGRESSIVE |
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40 y/o M emotional detachment, little interest in sex, no close friends. Axis II Dx |
SCHIZOID PD
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Common symptoms of paranoid personality disorder |
PREOCCUPATION W/ UNJUSTIFIED DOUBTS OF LOYALTY/TRUSTWORTHINESS OF FRIENDS/ASSOCIATES |
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Underlying dynamic of much of the behavior of pts with paranoid personality d/o |
A DEVELOPMENTAL FAILURE TO ACHIEVE OBJECT CONSTANCY |
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20 y/o M with poor performance in college, before was very good student except for not being able to finish assigned projects at college. Classmates have described bizarre behavior, such as counting loudly or repeating words silently. He does not want to follow others rules but his owns, he believes nobody understands him and are against him. |
OBSESSIVE COMPULSIVE PERSONALITY DISORDER |
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Pt with body dysmorphic d/o may have what personality d/o |
NARCISSISTIC
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Which personality disorder is characterized by a style of speech that is excessively impressionistic and lacking in detail |
HISTRIONIC |
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40 y/o hand surgeon has come into conflict with the hospital admin. Though the hospital went out of its way to recruit this surgeon, he has felt consistently betrayed and has accused the administration of trying to exploit him by expecting that he should take more calls, though this has never been stated. The doctorhospital relationship deteriorated further when peer review raised a question about one of the surgeon’s cases. The surgeon believes that none of his complaints have been satisfactorily resolved. He has become more unforgiving and isolated |
(2x) PARANOID PERSONALITY DISORDER |
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Go to Table of Contents 185 Pt becomes panicky and distressed every time psychiatrist goes on vacation, this pattern is most likely a characteristic of |
DEPENDENT PERSONALITY |
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Pt with histrionic personality d/o storms in his psychodynamic session and a few minutes late, clearly in rage. He expresses hopelessness and declares vehemently that he must divorce his wife. Next best intervention |
ENCOURAGE THE PT TO REFLECT MORE ON WHAT HAS HAPPENED TO TRIGGER SUCH PAINFUL FEELINGS. |
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22 y/o borderline splitting inpatient staff. You should |
EDUCATE STAFF ABOUT SPLITTING
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DDx of histrionic personality disorder includes what other personality d/o |
DEPENDENT PERSONALITY DISORDER
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Which personality d/o should be in the dif dx of agoraphobia |
DEPENDENT PERSONALITY DISORDER
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23 y/o M w/ Borderline. Had fight w/ g/f now psychotic, cutting, AH w/ command to harm self. What level of care |
BRIEF INPATIENT HOSPITALIZATION |
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Pts w/ this personality d/o most likely to have 1st degree relatives with depression |
BORDERLINE
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According to DSM-IV-TR, what personality disorder in adults requires evidence of another specific psychiatric diagnosis prior to age 15 |
ANTISOCIAL |
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Pt repeatedly becomes distressed after what seems, even to the pt, to be minor disappointments. Pt also seems to suffer from extreme narcissistic vulnerability. A therapist utilizing self-psychology would be most likely to interpret this as due to |
A LACK OF DEVELOPMENTALLY APPROPRIATE EMPATHIC CAREGIVERS. |
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DBT has been shown to be effective in the treatment of what personality disorder |
BORDERLINE
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What personality disorders should be the main consideration in differential dx of schizotypal personality disorder |
AVOIDANT |
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16-year-old adolescent is being evaluated for possible schizophrenia. A family history of which of the following personality d/o is most strongly associated with this dx |
SCHIZOTYPAL |
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25 y/o hospitalized for appy. Pt reports being "bothered by surgeon's aura". Lives alone, no close friends, gets on websites about auras and crystal work. Pt's mother affirms he's "always been this way." Which personality disorder |
SCHIZOTYPAL |
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DBT patient arrives late with recent relapse on drugs and cutting after marital fight. Highest priority of session should focus on what |
Self Injurious Behavior |
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