Bipolar Disorders
Eating disorders
Somatic Disorders
Substance use
Mood Stabilizers
100
What is the mnemonic for mania/hypomania, and what does each stand for.
D - Distractibility
I - Indiscretion
G - Grandiosity
F - Flight of ideas
A - Activity increased
S - Sleep decreased
T - Talkativeness
100
Describe. What are the two eating disorders this is associated with:
Bulimia and binge-purge subtype of anorexia nervosa
100
A 35-year-old woman has experienced chronic abdominal pain and fatigue for 8 months. She spends several hours daily researching her symptoms, repeatedly visits physicians, and has significant difficulty functioning. Medical evaluation reveals irritable bowel syndrome, but her health-related anxiety and behaviors are disproportionate to her symptoms.
What is the most likely psychiatric diagnosis?
Somatic Symptom Disorder (SSD)
SSD involves one or more distressing physical symptoms, excessive thoughts, feelings, or behaviors related to those symptoms, and a persistent symptomatic state (typically more than 6 months). Symptoms do NOT have to be medically unexplained.
100
A 28-year-old man is found unresponsive with pinpoint pupils, a respiratory rate of 5 breaths/minute, and oxygen saturation of 79%.
What medication should be administered immediately to reverse the suspected intoxication?
Answer: Naloxone.
Shelf pearl: Opioid overdose classically causes CNS depression, respiratory depression, and miosis. Naloxone reverses opioid effects, but airway and ventilatory support remain essential.
100
A 30-year-old patient with Bipolar I disorder is started on a medication that requires routine monitoring of renal function, thyroid function, and serum drug levels.
Lithium.
200
What are 3 key differences between hypomania and mania: (Based on criterion E for BPII)
No marked social or occupational impairment.
There is never hospitalization.
No psychotic features (if there are psychotic features, the episode is, by definition, manic).
200
Three major criteria for Anorexia Nervosa
Restriction of energy intake leading to significantly low body weight.
Intense fear of weight gain.
Disturbance in perception of one's weight/body image
200
A 29-year-old man is convinced he has pancreatic cancer despite having no significant physical symptoms. For 9 months, he has repeatedly checked his body for abnormalities and sought medical reassurance. Appropriate medical evaluations have been reassuring.
Illness Anxiety Disorder, care-seeking type
The central feature is preoccupation with serious illness despite absent or mild somatic symptoms. Illness preoccupation persists at least 6 months, with excessive checking or avoidance. The care-seeking subtype involves frequent medical visits or testing.
200
A 23-year-old college student presents to the ED after a party with severe agitation, chest pain, diaphoresis, dilated pupils, tachycardia, and hypertension.
What class of substance most likely caused this presentation, and what medication class is typically used first-line for agitation?
Answer: Stimulant intoxication (e.g., cocaine or amphetamines); benzodiazepines.
200
A 27-year-old woman with Bipolar I disorder is taking valproic acid and tells her psychiatrist that she is planning to become pregnant.
What major fetal abnormalities are associated with this mood stabilizer, making it generally inappropriate during pregnancy?
Neural tube defects, particularly spina bifida, as well as other congenital malformations and adverse neurodevelopmental outcomes.
300
A 26-year-old man is brought to the emergency department by his family after exhibiting unusual behavior for the past 8 days.
He has been sleeping only 2–3 hours per night but reports feeling completely rested. He recently spent $15,000 on a new business venture despite having no prior business experience. His family reports that he has been working on multiple projects simultaneously, claiming he will become the next billionaire.
During the interview, he speaks so rapidly that the physician struggles to interrupt him. He frequently changes topics, jumping from discussing his business plans to politics to his childhood. He repeatedly stops talking whenever he hears conversations in the hallway.
His family reports that these behaviors are entirely different from his baseline and have significantly disrupted his ability to work.
D
Distractibility
Easily distracted by hallway conversations.
I
Indiscretion
Spending $15,000 on a risky business venture.
G
Grandiosity
Believing he will become the next billionaire.
F
Flight of ideas
Rapidly shifting between different topics.
A
Increased goal-directed activity
Working on multiple projects simultaneously.
S
Decreased need for sleep
Sleeping 2–3 hours and feeling rested.
T
Talkativeness
Rapid, difficult-to-interrupt speech.
300
A 19-year-old woman with a BMI of 16.2 reports recurrent episodes of eating large quantities of food, followed by self-induced vomiting. She has an intense fear of gaining weight and persistently restricts her food intake.
Anorexia nervosa, binge-eating/purging type.
300
A 26-year-old woman develops sudden weakness of her right leg. MRI and neurologic evaluation reveal no structural explanation. During examination, her weak hip extension improves when she is asked to flex her opposite hip against resistance (positive Hoover sign).
What is the most likely diagnosis, and which examination finding supports it?
A 26-year-old woman develops sudden weakness of her right leg. MRI and neurologic evaluation reveal no structural explanation. During examination, her weak hip extension improves when she is asked to flex her opposite hip against resistance (positive Hoover sign).
What is the most likely diagnosis, and which examination finding supports it?
300
A 35-year-old man presents with severe abdominal cramping, diarrhea, yawning, excessive tearing, dilated pupils, and goosebumps. He reports stopping heroin 36 hours ago.
What withdrawal syndrome is occurring, and name one medication used to treat the underlying substance use disorder?
Opioid withdrawal; buprenorphine or methadone.
300
A 45-year-old woman with Bipolar I disorder has been stable on lithium for several years. She recently started taking ibuprofen daily for back pain and developed vomiting, coarse tremors, confusion, and an unsteady gait.
What complication is occurring, and how did the new medication contribute?
Lithium toxicity.
NSAIDs such as ibuprofen can reduce renal lithium clearance, increasing serum lithium concentrations.
Shelf pearl: NSAIDs, ACE inhibitors/ARBs, and certain diuretics can increase lithium levels. Dehydration also raises toxicity risk. Symptoms warrant urgent evaluation and serum lithium/renal testing.
400
A patient has experienced several depressive episodes but also had one episode of mania. What is the diagnosis?
Bipolar I disorder.
400
A 22-year-old woman presents to the emergency department with fatigue, dizziness, palpitations, and muscle weakness.
She has a BMI of 22.4 kg/m² and reports episodes of consuming unusually large amounts of food while feeling unable to stop. These episodes occur approximately 4 times weekly and are followed by feelings of guilt and shame. She admits to occasionally making herself vomit afterward, and further questioning reveals that she has been doing so after most binge episodes for the past 6 months.
Physical examination reveals bilateral parotid gland enlargement and dental enamel erosion.
Sodium 137 mEq/L
Potassium 2.7mEq/L
Chloride: 89 mEq/L
Bicarbonate: 35mEq/L
pH 7.5
What is the most likely eating disorder diagnosis, and what acid-base disturbance explains these laboratory findings?
Bulimia Nervosa
Acid-base disturbance: Hypokalemic, hypochloremic metabolic alkalosis.
400
Two hospitalized patients deliberately falsify symptoms.
Patient A secretly manipulates laboratory specimens to produce abnormal results and undergoes repeated investigations, with no identifiable external reward.
Patient B exaggerates severe back pain specifically to obtain prescription opioids.
What is the most likely diagnosis or classification for each?
Patient A: Factitious Disorder Imposed on Self. Patient B: Malingering.
Both involve intentional deception. Factitious disorder involves presenting oneself as ill without obvious external incentives. Malingering involves external incentives, such as medications, money, shelter, or avoidance of responsibilities. Malingering is not classified as a mental disorder.
400
This medication treats opioid use disorder through high-affinity partial agonism at μ-opioid receptors and can precipitate withdrawal when initiated too soon after full opioid agonist use.
Answer: What is buprenorphine?
400
A 25-year-old woman with Bipolar II disorder is prescribed a medication for maintenance treatment, particularly to prevent depressive recurrences. Her psychiatrist emphasizes that the dose must be increased slowly because rapid titration increases the risk of a potentially life-threatening skin reaction.
What medication is she taking, and what is the feared adverse reaction?
Lamotrigine — Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN).
Shelf pearl: Lamotrigine is useful for maintenance, especially prevention of depressive episodes, but is not an effective treatment for acute mania.
500
What two types of mood episodes are required to diagnose Bipolar II Disorder, and what is the minimum duration of each?
Answer:
Major depressive episode: ≥2 weeks
Hypomanic episode: ≥4 consecutive days
No history of a manic episode
500
A 25-year-old woman with bulimia nervosa and major depressive disorder presents for treatment. She reports recurrent binge eating followed by self-induced vomiting three times weekly.
Her physician considers prescribing bupropion to treat her depression.
Question: Why should this medication be avoided?
Answer: Bupropion is contraindicated in patients with a current or prior diagnosis of anorexia nervosa or bulimia nervosa because of increased seizure risk.
Shelf pearl: Fluoxetine is the FDA-approved medication for bulimia nervosa.
500
A 38-year-old woman with well-controlled multiple sclerosis reports persistent leg pain and fatigue for 10 months. She fears every symptom represents irreversible neurologic deterioration, spends hours researching complications, and frequently misses work to obtain repeated evaluations.
Her physician states that because she has a confirmed neurologic disease, she cannot have a somatic symptom disorder.
Is the physician correct? Identify the most likely additional diagnosis and explain why.
No. Somatic Symptom Disorder can coexist with multiple sclerosis.
SSD is diagnosed based on distressing symptoms and disproportionate symptom-related thoughts, anxiety, or behaviors—not whether the symptoms have a medical explanation. The confirmed medical condition does not exclude SSD. The excessive response must be assessed in clinical context.
500
A 54-year-old man with severe alcohol use disorder is hospitalized. Three days after his last drink, he develops confusion, agitation, visual hallucinations, fever, tachycardia, and profound diaphoresis.
What is the most likely diagnosis, and what medication class is first-line for treatment?
Answer: Alcohol withdrawal delirium (delirium tremens); benzodiazepines.
Shelf pearl: Delirium and autonomic instability help distinguish alcohol withdrawal delirium from alcohol-induced hallucinosis with preserved awareness. It is a medical emergency requiring close monitoring.
500
A 45-year-old woman with Bipolar I disorder has been taking lithium for 10 years. She presents with fatigue, constipation, increased thirst, and recurrent kidney stones.
Laboratory Findings:
Test
Result
Normal range
Calcium
11.8 mg/dL ↑
8.5–10.5
PTH
105 pg/mL ↑
10–65
Creatinine
0.9 mg/dL
0.6–1.2
Lithium level
0.8 mEq/L
Therapeutic
Jeopardy Question
What endocrine complication of lithium therapy best explains these findings?
nswer: Lithium-induced hyperparathyroidism.
Shelf Teaching Pearl:
Lithium can alter calcium-sensing receptor function in the parathyroid glands, increasing the calcium level required to suppress PTH secretion.
This can result in:
Hypercalcemia
Elevated or inappropriately normal PTH
Kidney stones
Constipation, fatigue, and neuropsychiatric symptoms