Mental Health & Neurological Health Problems

A 17-year-old male is brought to the clinic by a parent who is concerned that the patient has become more isolated and withdrawn and expresses suspicions that his teachers hate him and want him to fail. What will the provider tell this parent? a. The adolescent should be evaluated by a psychiatrist. b. The adolescent should be given a trial of antipsychotic medications. c. These are common adolescent behaviors and will eventually go away. d. These signs are diagnostic for schizophrenia. - a. The adolescent should be evaluated by a psychiatrist. ANS: A These signs, along with a family history of psychosis can be predictive of schizophrenia, so referral for psychiatric evaluation should be made. Unless symptoms are present longer than a month and the patient is diagnosed, antipsychotic medications are not indicated. Without evaluation, these behaviors should not be dismissed as normal. While these signs may raise concerns for schizophrenia, they are not diagnostic. REF: Clinical Presentation A 35-year-old patient reports suddenly experiencing an asymmetric smile along with drooping and tearing in one eye. The patient has a history of a recent viral illness, but is otherwise healthy. During the exam, the provider notes that there is unilateral full face paralysis on the right side. What is the initial intervention for this patient? a. Perform confirmatory diagnostic tests b. Prescribe oral prednisolone c. Recommend wearing an eye patch d. Refer the patient to a neurologist - b. Prescribe oral prednisolone ANS: B Steroids are highly effective and increase the probability of complete nerve recovery and should be started within 72 hours of onset. There are no confirmatory diagnostic tests, but other tests may be performed to rule out certain causes. Patients may be instructed to tape the eye closed at night, but eye patches are not recommended. A neurology referral is needed only if patients have an atypical presentation or other comorbid conditions.REF: Management A college student is brought to clinic by a parent who is concerned about increasingly bizarre behavior and poor school performance. The provider notes difficulty engaging the patient in an organized conversation. The patient denies any concerns about behavior. What will the provider do initially to manage this patient's symptoms? a. Admit the patient for inpatient treatment b. Begin treatment with lithium or lamotrigine c. Counsel the parent to report any symptoms of depression d. Schedule an appointment with a psychiatrist - b. Begin treatment with lithium or lamotrigine ANS: B Patients with symptoms of mania should begin treatment with a mood stabilizer and the primary care provider should initiate treatment for an acute episode. It is not necessary to admit as an inpatient unless there is indication of harm to the self or others. The primary provider should refer for psychiatric evaluation, but should begin medications as soon as possible.REF: Bipolar Disorder/Management