Transcript Psychobehavioral

Thought, Mood and
Somatoform Disorders
When comparing the “newer” high
potency antipsychotic meds, such as
haloperidol & droperidol to the
“older” low potency antipsychotic
meds, such as chlorpromazine,
haloperidol drugs cause which of the
following side effects?
A. More extrapyramidal symptoms
B. More cardiovascular toxicity
C. More orthostatic hypotension
D. More sedation
E. All of the above
Compared to
droperidol,
haloperidol does
which of the
following?
A. Causes more sedation than droperidol
B. Has a faster onset of action than
droperidol
C. Has a shorter duration of action than
droperidol
D. Has more antipsychotic activity than
droperidol
E. Requires higher doses than droperidol
A 32yo F c/o 4 days of anxiety,
restlessness, and an inability to stop
moving. 2 days ago her doctor increased
her haloperidol from 2 mg PO bid to 4 mg
PO bid, with no change in her symptoms.
Appropriate management includes:
• A.  Haldol to 6mg PO bid, & f/u tomorrow w/ 1°MD
• B. Stop Haldol, start clozapine, and f/u in AM w/ her
primary physician.
• C.  Haldol to 1 mg PO bid, add benztropine 1 mg PO
tid, & f/u in AM w/ 1°MD
• D. Stop Haldol, give dantrolene 1mg/kg IV, & admit
to the hospital.
• E. Admit for management of her decompensating
psychosis.
Which of the following is
INCORRECT regarding
dystonic reactions from
neuroleptic medications:
• A. Torticollis
• B. Laryngospasm
• C. Motor restlessness
• D. Sustained upward deviation of the
eyes
• E. Symptoms decrease with voluntary
activities and increase with stress
Which is the correct diagnosis of a
28yo M on chronic neuroleptic drug
therapy presenting to the ED w/
complaints of involuntary wiggling
movements of his face and tongue?
A. Akinesia
B. Dystonia
C. Neuroleptic malignant
syndrome
D. Tardive dyskinesia
E. None of the answers
Psychotic symptoms can be clinically
sorted into four categories. Which of
the following is NOT one of these
categories?
A. Aggressive behavior disorders
B. malingering or factitious
C. brief reactive psychosis
D. functional psychosis
E. organic brain syndrome
What drug could potentiate
symptoms of a phenothiazine
overdose?
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•
•
•
A. Magnesium sulfate
B. Phenytoin
C. Lidocaine
D. Procainamide
E. Amiodarone
After a very traumatic or stressful
experience, a previously healthy
patient develops acute confusion,
hallucinations and bizarre behavior.
Choose the correct diagnosis assuming
symptoms last less than two weeks.
A.
B.
C.
D.
brief reactive psychosis
schizophreniform disorder
paranoid disorder
stress induced transient
psychosis
Depression during childhood and
adolescent years is seen in 10 to 20% of
the patients seen in child psychiatry
clinics. In samples of normal
schoolchildren and adolescents, what
percentage meet diagnostic criteria
for depression?
A.
B.
C.
D.
0.5-2%
2-5%
5-10%
10-15%
Which of the following
is a risk factor for child
suicide?
A. 2-parent family
B. family history of suicide
C. close peer relationships
D. presence of chronic disease
E. family history of epilepsy
Life-threatening sympathomimetic
rxns can occur when MAO inhibitors
are combined w/ the wrong meds.
Which of the following is NOT a MAO
inhibitor?
A.
B.
C.
D.
tranylcypromine (Parnate)
phenelzine (Nardil)
selegiline (Eldepryl)
pergolide (Permax)
Tricyclic antidepressants
increase the
concentration of this
neurotransmitter at the
synapse by blocking
presynaptic reuptake.
A.
B.
C.
D.
norepinephrine or serotonin
glutamate and epinephrine
dopamine and GABA
epinephrine and norepinephrine
Most of the serious toxic effects of lithium
occur at serum levels over 2 mEq/L, but
mild adverse effects may be seen at levels
of 1.5-2.0 mEq/L. Dehydration, salt
restriction, diuretic use, childbirth and
infection predispose patients to these side
effects. Which of the following is NOT one
of these side effects?
A. Diarrhea
B. Vomiting
C. Drowsiness
D. muscular weakness
E. lack of coordination
F. hypoglycemia
What is the usual amount of time
between manic and depressive
episodes in bipolar patients?
A. 1-4 years
B. 1-2 months
C. 2-3 weeks
D. 6-12 months
Which of the following is
paired Incorrectly?
A. Bupropion : potent anticholinergic/ antihistaminic
effects & has cardiac/ neurotoxicity with
overdose.
B. Heterocyclic antidepressants: less side effects &
toxicity relative to the tricyclics.
C. Serotonin reuptake inhibitors: may cause anxiety,
nausea, drowsiness; highly protein bound & may
displace Coumadin and digoxin, increasing
toxicity. Relatively nontoxic with overdose.
D. Tricyclic antidepressants: highly anticholinergic
and antihistaminic; cardiac and neurotoxicity
with overdose (OD).
____ percent of patients
with major depressive
disorder die by suicide
A. 1 %
B. 4 %
C. 15 %
D. 30 %
E. 35%
Which of the following statements is
INCORRECT?
A. The sole presentation of porphyria may be psychiatric
symptoms including anxiety, apathy, depression, or
psychosis
B. 10% of patients with Wilson's disease present with
psychiatric problems including personality change,
paranoia, depression, and catatonia.
C. 20-40% of patients with severe adrenal insufficiency
have depression and/or psychosis.
D. Pancreatic cancer patients frequently suffer from
anxiety prior to their diagnosis.
E. There is a higher incidence of psychiatric disease in
patients with thyroid disease
Which of the following
is characteristic of
somatoform disorders?
A. Giving drugs or substances to another person
to produce symptoms
B. Desire for painful tests or surgery in order to
continue hospitalization
C. Ingestion of substances to produce symptoms
D. Intentional fabrication of symptoms for
secondary gain
E. Involuntary control of symptoms with the
unconscious goal to be "sick"
A 38year-old woman presents with a
chronic history of headache, dizziness,
nausea, fatigue, and dysmenorrhea.
Her exam is normal. Which of the
following is a likely diagnosis?
A. Conversion disorder
B. Factitious disorder
C. Malingering
D. Pain disorder
E. Somatization disorder
Which of the following is INCORRECT
regarding characteristics of
conversion disorder?
A. Motivated by external
incentive to feign illness
(voluntary)
B. Nonpainful, usually
neurologic complaint
C. Rapid onset
D. Single organ system
E. Without anatomic or
physiologic explanation
A 42yo woman has neck pain and
headaches from a MVC 3 years ago.
She presents to your ED with
disabling neck pain. Her past work-up
for neck pathology is negative and she
is now on disability. What is the most
likely diagnosis?
A. Hypochondriasis
B. Somatization disorder
C. Somatoform pain disorder
D. Factitious disorder
E. Malingering
Which of the following is
NOT an example of a
dissociative disorder?
A. localized or selective
dissociative amnesia
B. dissociative fugue
C. paranoid personality
disorder
D. dissociative identity
disorder
E. depersonalization disorder
A 8 year old child presents with a cough
that resolves with distraction & during
sleep. After a neg exam, the child's chest is
wrapped w/ a sheet & the child is told that
the chest muscles are tired & that the sheet
will cure the cough w/in 15 min. 15 min later
the cough is gone.
A.Conversion Disorder
B. Panic Disorder
C. Brief Reactive Psychosis
D.Hypokalemia
Some symptoms of schizophrenia are
not as responsive to phenothiazine
therapy as hallucinations & delusions.
Which of the following is NOT one of
these so-called "negative" symptoms?
A. neologism and "word
salad" (abnormal).
B. blunted affect (lack of
emotion).
C. abulia (lack of volition).
D. alogia (poverty of speech)
Some brief psychotic syndromes are
characterized by good premorbid
functioning & a good prognosis
compared to a formal chronic diagnosis
of schizophrenia. Which of the following
is NOT one of these ‘good prognosis’
syndromes?
A. brief psychotic disorder or brief reactive
psychosis
B. transient paranoid disorder
C. schizophreniform disorder
D. substance induced psychotic disorder