PA PSYCHIATRY EXAM 5 2026 COMPLETE
PRACTICE QUESTIONS WITH ANSWERS AND
MENTAL HEALTH REVIEW GUIDE
◉ Manic episode criteria.
Answer: A period of abnormally and persistently elevated,
expansive, or irritable mood, lasting at least 1 week (or any duration
if hospitalization is necessary) and including at least three of the
following (four if mood is irritable):
I. Distractibility
2. Inflated self-esteem or grandiosity
3. tin goal-directed activity (socially, at work, or sexually)
4. J, need for sleep
5. Flight of ideas or racing thoughts
6. More talkative or pressured speech (rapid and uninterruptible)
7. Excessive involvement in pleasurable activities that have a high
risk of negative consequences (eg, shopping sprees, sexual
indiscretions)
These symptoms cannot be due to substance use or medical
conditions, and they must cause social or occupational impairment.
Seventy-five percent of manic patients have psychotic symptoms.
◉ Mania vs hypomania.
,Answer: Mania: Lasts at least 7 days, Causes severe impairment in
social or occupational functioning, May necessitate hospitalization
to prevent harm to self or others, May have psychotic feature
Hypomania: Lasts at least 4 days, No marked impairment in social or
occupational functioning, Does not require hospitalization, No
psychotic features
◉ Bipolar 1 disorder criteria.
Answer: The only requirement for this diagnosis is the occurrence of
one manic or mixed episode - depression, dysthymia, and
hypomania can happen between episodes, but are not required for
diagnosis
◉ Bipolar 1 and 2 treatment.
Answer: Lithium
Anticonvulsants (carbamazepine or valproic acid) are also mood
stabilizers. They are especially useful for rapid cycling bipolar
disorder and mixed episodes, although associated with T risk of
suicide.
Atypical antipsychotics (olanzapine, quetiapine, ziprasidone) are
effective as both monotherapy and adjunct therapy
Psychotherapy: Supportive psychotherapy, family therapy, group
therapy (prolongs remission once the acute manic episode has been
controlled). • ECT: Works well in treatment of manic episodes
,◉ Lithium Side Effects.
Answer: Weight gain • Tremor • Gastrointestinal disturbances •
Fatigue • Cardiac arrhythmias • Seizures • Goiter/hypothyroidism •
Leukocytosis (benign) • Como • Polyuria (nephrogenic diabetes
insipidus) • Polydipsia • Alopecia • Metallic taste
◉ Bipolar 2 Criteria.
Answer: History of one or more major depressive episodes and at
least one hypomanic episode. Remember: If there has been a full
manic episode even in the past, then the diagnosis is not bipolar II
disorder, but bipolar I.
◉ Cyclothymic disorder.
Answer: Alternating periods of hypomania and periods with mild to
moderate depressive symptoms.
Chronic disorder - 1/3 of patients are eventually diagnosed with
bipolar disorder
◉ Cyclothymic disorder criteria.
Answer: • Numerous periods with hypomanic symptoms and
periods with depressive symptoms for at least 2 years.
• The person must never have been symptom free for > 2 months
during those 2 years.
• No history of major depressive episode or manic episode.
, ◉ Cyclothymic disorder treatment.
Answer: Same as bipolar disorder
◉ Persistent depressive disorder (dysthymia).
Answer: Chronic mild depression
Dysthymic disorder (DD) =
2 D's
2 years of depression
2 listed criteria
Never asymptomatic for > 2 months
◉ Dysthymia Criteria.
Answer: l. Depressed mood for the majority of time most days for at
least 2 years (in children or adolescents for at least I year)
2. At least two of the following: • Poor concentration or difficulty
making decisions • Feelings of hopelessness • Poor appetite or
overeating • Insomnia or hypersomnia • Low energy or fatigue •
Low self-esteem
3. During the 2-year period: • The person has not been without the
above symptoms for > 2 months at a time. • No major depressive
episode. • The patient must never have had a manic or hypomanic
episode (this would make the diagnosis bipolar disorder or
cyclothymic disorder, respectively)
PRACTICE QUESTIONS WITH ANSWERS AND
MENTAL HEALTH REVIEW GUIDE
◉ Manic episode criteria.
Answer: A period of abnormally and persistently elevated,
expansive, or irritable mood, lasting at least 1 week (or any duration
if hospitalization is necessary) and including at least three of the
following (four if mood is irritable):
I. Distractibility
2. Inflated self-esteem or grandiosity
3. tin goal-directed activity (socially, at work, or sexually)
4. J, need for sleep
5. Flight of ideas or racing thoughts
6. More talkative or pressured speech (rapid and uninterruptible)
7. Excessive involvement in pleasurable activities that have a high
risk of negative consequences (eg, shopping sprees, sexual
indiscretions)
These symptoms cannot be due to substance use or medical
conditions, and they must cause social or occupational impairment.
Seventy-five percent of manic patients have psychotic symptoms.
◉ Mania vs hypomania.
,Answer: Mania: Lasts at least 7 days, Causes severe impairment in
social or occupational functioning, May necessitate hospitalization
to prevent harm to self or others, May have psychotic feature
Hypomania: Lasts at least 4 days, No marked impairment in social or
occupational functioning, Does not require hospitalization, No
psychotic features
◉ Bipolar 1 disorder criteria.
Answer: The only requirement for this diagnosis is the occurrence of
one manic or mixed episode - depression, dysthymia, and
hypomania can happen between episodes, but are not required for
diagnosis
◉ Bipolar 1 and 2 treatment.
Answer: Lithium
Anticonvulsants (carbamazepine or valproic acid) are also mood
stabilizers. They are especially useful for rapid cycling bipolar
disorder and mixed episodes, although associated with T risk of
suicide.
Atypical antipsychotics (olanzapine, quetiapine, ziprasidone) are
effective as both monotherapy and adjunct therapy
Psychotherapy: Supportive psychotherapy, family therapy, group
therapy (prolongs remission once the acute manic episode has been
controlled). • ECT: Works well in treatment of manic episodes
,◉ Lithium Side Effects.
Answer: Weight gain • Tremor • Gastrointestinal disturbances •
Fatigue • Cardiac arrhythmias • Seizures • Goiter/hypothyroidism •
Leukocytosis (benign) • Como • Polyuria (nephrogenic diabetes
insipidus) • Polydipsia • Alopecia • Metallic taste
◉ Bipolar 2 Criteria.
Answer: History of one or more major depressive episodes and at
least one hypomanic episode. Remember: If there has been a full
manic episode even in the past, then the diagnosis is not bipolar II
disorder, but bipolar I.
◉ Cyclothymic disorder.
Answer: Alternating periods of hypomania and periods with mild to
moderate depressive symptoms.
Chronic disorder - 1/3 of patients are eventually diagnosed with
bipolar disorder
◉ Cyclothymic disorder criteria.
Answer: • Numerous periods with hypomanic symptoms and
periods with depressive symptoms for at least 2 years.
• The person must never have been symptom free for > 2 months
during those 2 years.
• No history of major depressive episode or manic episode.
, ◉ Cyclothymic disorder treatment.
Answer: Same as bipolar disorder
◉ Persistent depressive disorder (dysthymia).
Answer: Chronic mild depression
Dysthymic disorder (DD) =
2 D's
2 years of depression
2 listed criteria
Never asymptomatic for > 2 months
◉ Dysthymia Criteria.
Answer: l. Depressed mood for the majority of time most days for at
least 2 years (in children or adolescents for at least I year)
2. At least two of the following: • Poor concentration or difficulty
making decisions • Feelings of hopelessness • Poor appetite or
overeating • Insomnia or hypersomnia • Low energy or fatigue •
Low self-esteem
3. During the 2-year period: • The person has not been without the
above symptoms for > 2 months at a time. • No major depressive
episode. • The patient must never have had a manic or hypomanic
episode (this would make the diagnosis bipolar disorder or
cyclothymic disorder, respectively)
