A
d) Recurring episodes of hypomania and depression
Which one of the following is a required DSM criterion for schizoaffective disorder?
a) Catatonic features
b) a mood episode in the absence of psychotic symptoms
c) delusions or hallucinations for one month in the absence of a major mood episode
d) Mood episodes that have been present for the majority of the psychotic illness
e) Mixed mood and psychotic symptoms present only during states of intoxication and withdrawal.
d) Mood episodes that have been present for the majority of the psychotic illness
Out of the following diagnoses, which one is least likely to present with all of the following symptoms: sleep disturbances, concentration impairment, suicidal ideation, and irritability:
a) bipolar disorder
b) major depressive disorder
c) generalized anxiety disorder
d) borderline personality disorder
e) post traumatic stress disorder
c) generalized anxiety disorder
b) borderline personality disorder
Which of the following statements is false with regard to schizophreniform disorder and brief psychotic disorder?
a) Brief psychotic disorders can occur in the absence of a clear stressor
b) Patients with brief psychotic disorder are expected to return to baseline functioning after the episode resolves
c) both conditions can present with delusional beliefs
d) brief psychotic disorder is ruled out when a medical condition can adequately explain the onset of psychotic symptoms.
e) The duration of brief psychotic disorder is at least one month but less than six months
e) The duration of brief psychotic disorder is at least one month but less than six months
4. A patient comes into the clinic carrying a diagnosis of schizoid personality disorder. To better confirm this diagnosis, you would be looking for which of the following?
a) disdain towards others due to perceived criticism
b) grandiosity
c) paranoia and suspiciousness
d) lack of close relationships and restricted affect
e) magical thinking
d) lack of close relationships and restricted affect
Which of the following would be inconsistent with a diagnosis of a child with attention deficit hyperactivity disorder (ADHD)?
a) the patient fails to follow through on instructions or complete school work
b) the patient is prone to fidgeting and squirming in their seat
c) the patient has difficulty awaiting his or her turn, often interrupting others during talks
d) the patient appears aloof and not to be listening when spoken to directly
e) the patient shows impairments from symptoms at school but not at home
e) the patient shows impairments from symptoms at school but not at home
b) illness anxiety disorder
3. A 26 year old male presents himself to the emergency room with a chief complaint of homicidal ideation towards his girlfriend of 4 years. The patient reports that he has been experiencing increasing emotional distress related to the unwanted thoughts and images of stabbing his girlfriend with a knife, though he tearfully pleads to you that he would never intentionally act on this monstrous thought. He is disturbed by the potential that he could do this to a person he has come to love so dearly and is requesting inpatient psychiatric hospitalization because he feels he is a danger to her, and likely the community at large. Over the past 9 months the patient has had more difficulty managing the distress when alone together, so he has been using strategies such as inviting friends to join activities they do so that they could unknowingly chaperone and intervene if he became violent, avoiding meals together to distance himself from knives in her presence, and taking increased work travel to reduce the amount of time they have together. The patient denies any past psychiatric history, denies any history of depression but has become increasingly saddened to see his relationship suffer from these thoughts. He denies other violent ideation towards others or himself, he has no history of past violence or legal problems, no history of traumatic experience, no history of substance use disorder. What is the patient’s most likely diagnosis?
A patient with borderline personality disorder and past suicide attempts calls you after an argument with her boyfriend. She has been cutting herself since the fight, and is beginning to hear atypical derogatory voices. She has a history of past inpatient psychiatric hospitalizations (the last of which was several years ago for lethal suicidal behavior.) She has been struggling with mood symptoms in recent history and was increased on her antidepressant treatment at last weeks appointment. What is the best level of care for this patient at this time?
a) direct her to the emergency department for evaluation of inpatient psychiatric hospitalization
b) earlier outpatient follow up with you in 3 days
c) augment outpatient treatment with group therapy (DBT)
d) Intensive outpatient program (IOP)
e) apply for assertive community treatment (ACT)
a) direct her to the emergency department for evaluation of inpatient psychiatric hospitalization
c) countertransference
6. By working in the emergency room you evaluate a patient with confusion, myoclonus, diarrhea, hypotension, tachycardia, and the normal creatinine phosphokinase (CPK) level. The patient is not speaking. His family tells you that he was recently started on a new medication by a psychiatrist for the treatment of bipolar disorder. They don't know what the name or class of medication. Which diagnosis and justification is most accurate.
a) NMS because the patient is confused
b) NMS because rigidity is more commonly a part of serotonin syndrome
c) serotonin syndrome because it commonly presents with hypotension
d) NMS because it usually presents with normal CPK
e) serotonin syndrome because it more commonly presents with myoclonus end gastrointestinal symptoms
e) serotonin syndrome because it more commonly presents with myoclonus end gastrointestinal symptoms
a) Social phobia and avoidant personality disorder share a fear of embarrassment in the presence of others
7. A 34 year old woman presents to the doctor with depressed mood for the last 6 months, with associated weight gain over this time. Associated triggers include moving to New York City 2 years ago, as she feels cold all the time, feeling “older” now that she is in her thirties and observing her more brittle hair, dry skin, constipation, and muscle weakness. She denies any acute psychiatric concerns, without suicidal ideation, and no psychotic or manic symptoms. Which is the most appropriate next step in her care?
a) Start sertraline for antidepressant effects
b) start bupropion for antidepressant effects whilst minimizing weight gain
c) check thyroid stimulating hormone (TSH) level and T4 (thyroxine)
d) prescribe an exercise routine to build strength and increase self-esteem
e) order a urine toxicology to rule out cocaine withdrawal
c) check thyroid stimulating hormone (TSH) level and T4 (thyroxine)
a) Avoidant restrictive food intake disorder (ARFID)
Heroin withdrawal does not include which of the following symptoms?
a) yawning
b) abdominal pain
c) piloerection
d) miosis
e) muscle twitching
d) miosis
Which of the following is true regarding suicide?
a) Deaths by suicide per year in the United States is roughly half the amount of death by homicide
b) The majority of people who experience suicidal ideation will eventually complete suicide
c) Past suicide attempts is the biggest risk factor for future death by suicide
d) suicidal ideation, if retrieved on interview, should always result in psychiatric admission
e) men have a higher rate of suicide attempts but women have higher rates of death by suicide
c) Past suicide attempts is the biggest risk factor for future death by suicide
6. You are the longtime psychiatrist for a 65 year old patient with schizophrenia. He was first diagnosed with the condition at 20 years old when he began to experience disorganized thoughts, auditory hallucinations, and social withdrawal with flattened affect. Thought disorganization and perceptual disturbances have been in remission throughout the duration of your care on risperidone. Over the last month, after changing residences, he has been reporting depressed mood, low energy, sleep disturbances, poor concentration, and anhedonia. After a thorough conversation about your concerns for his new onset symptoms, you both decide to start a trial of antidepressant therapy. What is his most likely diagnosis?
a) Schizoaffective disorder, depressive type
b) Schizoaffective disorder, bipolar type
c) schizophrenia AND major depressive disorder, single episode
d) schizophrenia AND an adjustment disorder
e) exacerbated negative symptoms of schizophrenia
c) schizophrenia AND major depressive disorder, single episode
6. In the mental status exam for a patient with bipolar disorder, manic episode; which of the following is commonly observed in thought process?
a) pressured speech
b) flight of ideas
c) euphoria
d) thought blocking
e) perseveration
b) flight of ideas
Which of the following is an important technique in cognitive behavioral therapy?
a) Maintenance of therapeutic neutrality
b) offering interpretations of patients unconscious wishes
c) abreaction
d) working through unresolved internal conflict
e) identifying and testing automatic thoughts
e) identifying and testing automatic thoughts
A patient with major depressive disorder with psychotic features is admitted to the inpatient psychiatric unit for safety and to stabilize new onset psychotic symptoms. He was started on fluoxetine and risperidone and titrated to moderate dosage without any adverse effect, but after 2 weeks of treatment the conviction of his psychotic beliefs and severity of his guilt and depression have persisted. Risperidone was converted to an alternative antipsychotic (olanzapine) to better target his sleep and achieve greater efficacy but his symptoms have been unchanged for several days. What would be the most beneficial next step in his care?
a) Recommend a trial of clozapine given two failed antipsychotic trials
b) Recommend augmenting with lithium for empiric treatment of bipolar disorder
c) recommend the patient undergo electroconvulsive therapy
d) convert fluoxetine (SSRI) to venlafaxine (SNRI)
e) Convert fluoxetine (SSRI) to Clomipramine (TCA)
c) recommend the patient undergo electroconvulsive therapy
A 26 year old female with no past psychiatric history is 5 weeks post-partum from the birth of her first child. The patient’s partner arranges a psychiatric intake for assessment and treatment considerations. The patient reports that since the birth of her daughter, her sleep has been poor due to breastfeeding her child every 2 hours. Her energy has been subsequently impaired, and when she has the opportunity to sleep between feeds she struggles to rest due to fears that her daughter will need something and she won’t be able to wake up to help. She is ashamed to say that she is feeling depressed during a time where she expected herself to be so happy, and has been feeling guilty that she is failing her child due to her inexperience as a mother. She has been dismissive of encouragement from family that she is a fantastic mother, and shares doubts about her ability to develop a maternal instinct. She adamantly denies suicidal ideation or thoughts of harming her child. She denies any perceptual disturbances. What is her most likely diagnosis?
a) Normal response to post-partum period
b) Post Partum blues
c) Adjustment disorder with mixed anxiety and depressed mood
d) Major Depressive Disorder, with peripartum onset
e) Bipolar I Disorder, with peripartum onset
d) Major Depressive Disorder, with peripartum onset
6. A 55 year old man is admitted to the hospital for back surgery. On day two post-operatively, the patient begins to show signs of alcohol withdrawal evidenced by elevated anxiety, tremor, nausea, and headache (Clinical institute withdrawal assessment for alcohol - CIWA: 10) with BP: 145/99 HR: 104. The hospital has introduced an algorithm for benzodiazepine treatment based on CIWA severity. As per hospital protocol, the patient is given lorazepam 4mg IV Once and reassessed in 2 hours. At that time, the patient’s symptoms are pertinent for milder tremor and anxiety, with new onset agitation and disorientation (CIWA: 16) with BP: 125/90, HR: 92. Given the worsening CIWA score the patient is placed on one-to-one observation and the benzodiazepine dosage is doubled to lorazepam 8mg IV Once. At the next 2 hour assessment, concern for the patient’s alcohol withdrawal is rising as the patient’s CIWA escalates with severe agitation, confusion, and expressed anxiety (CIWA: 22) BP: 114/78, HR: 74). What would be the next best step?
a) Stop benzodiazepines and reassess CIWA in 1 hour
b) Continue with lorazepam 8mg IV and reassess CIWA in 1 hour
c) Continue with lorazepam 8mg IV and add haloperidol 5mg for agitation, reassess CIWA in 1 hour
d) Administer lorazepam 16mg IV and reassess CIWA in 1 hour
e) Treat empirically for opioid withdrawal with methadone 30mg orally once
a) Stop benzodiazepines and reassess CIWA in 1 hour
4. A 30 year old man presents to the emergency room with a complaint that there is a parasite living in the tissue of his face. He is observed to have a large wound on his right cheek notable for swelling and purulent discharge. He denies any prior psychiatric history, and reports no medical history aside from parasitosis starting 8 months ago, initially with an infection in his leg. After meeting with several physicians (internist, infectious disease specialist, and a surgeon) who told him that workup and physical exam were not conclusive for parasitosis, he self administered bleach which killed the parasite in his leg, but it has now recurred on his face. He is worried that applying bleach to his face would be more harmful to his health so he is seeking a compassionate medical provider for treatment despite the recent negative experiences and now limited trust in the medical community. He works as a lawyer in a successful firm, reports social supports in the community, denies any history of substance use disorder, and no history of traumatic experience. His presentation is most suggestive of what condition:
a) paranoid personality disorder
b) schizophrenia
c) depression with psychotic features
d) delusional disorder
e) illness anxiety disorder
d) delusional disorder
. A 26 year old man is brought to the CPEP by ambulance for agitated behavior in the community. He is pacing the CPEP with psychomotor agitation, rapidly shouting his discontent for being brought to the hospital inappropriately. On mental status examination, the patient is profoundly irritable, reporting his intention to sue the hospital and EMS providers into bankruptcy because he is intricately knowledgeable about the legal system and esteemed member of the local community. Collateral from the patient’s father indicates that the patient is a very gentle person at baseline, without any history of legal problems or agitated behavior. He notes that he was uncharacteristically depressed in recent months, but seemed to be turning a corner with much improved energy and goal directed activity since connecting to treatment and initiating a trial with sertraline 2 weeks ago. CBC, BMP, TSH, and urine toxicology is negative. What is the patient’s most likely diagnosis?
a) Narcissistic personality disorder
b) Major depressive Disorder
c) Oppositional Defiant Disorder
d) Bipolar I Disorder
e) Cocaine Withdrawal
d) Bipolar I Disorder