NR 547 DIFFERENTIAL DX MIDTERM
EXAM
What is Silexan? - ANSWERS-Is a branded extract of lavender. OTC in the US. Similar to CAM
therapies
Harold is a 32-year-old who presents to the clinic with complaints of fatigue, difficulty
concentrating, and difficulty falling asleep at night. He states he worries about finances, his
performance at work, and his relationship, and his worries have been "almost constant" for
8 months. He denies substance use and recently had a normal physical exam. He feels that
his relationship is suffering due to his constant worry.
Based on the DSM-5-TR, does Harold meet diagnostic criteria for generalized anxiety
disorder?
A) Yes
B) No - ANSWERS-A) Yes
Rationale: Harold meets the following diagnostic criteria for generalized anxiety disorder: He
has three symptoms associated with worry, including fatigue, difficulty concentrating, and
sleep difficulties. He has experienced anxiety more days than not for over 6 months, and his
worries are impacting his relationship.
SAD treatment plan? - ANSWERS-Not all clients with social anxiety disorder (SAD) require
treatment. Young adults may experience benefits from learning about their disorder and
reflecting on how the disorder impacts their personal life to make an educated decision
about treatment options. Many clients diagnosed with SAD have experienced symptoms for
years and have learned to navigate the symptoms at a functional level. Treatment for SAD is
rarely an emergent situation. Treatment includes cognitive behavioral therapy, medications,
or a combination of both.
SAD medication treatment options? - ANSWERS-Selective serotonin reuptake inhibitors
(SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs)
SAD is usually treated using anti-depressants.
,Benzodiazepines
These psychoactive drugs are known for inducing calm.
Monoamine oxidase inhibitors (MAOIs)
This class of drugs are for clients who are able to undergo dietary and medication
restrictions. SSRIs or SNRIs must be completely flushed from the system first.
Performance- only SAD Tx for one or rarely recurring performance? - ANSWERS-Beta blocker
or Benzodiazepine 30-60 min before performance
Performance-only SAD Tx for Recurring performances - ANSWERS-1) CBT
2) Beta blocker or Benzodiazepine 30-60 min before performance
Panic disorder Tx plan - ANSWERS-Exposure therapy
Cognitive behavioral therapy
Medications
Combination of modalities
Treatment may include exposure therapy, cognitive behavioral therapy, medications, or a
combination of modalities. SSRIs are a safe, economical pharmacologic treatment for panic
disorder. Benzodiazepines may be used in emergencies
Obsessions vs compulsions - ANSWERS-Obsessions: (intrusive or unwanted thoughts)
"Did I forget to turn the stove off?"
Fear of germs
Continued thoughts of harming another person
Compulsions: (repetitive behaviors in response of intrusive thoughts)
,Checking the lock on the door multiple times
Taking several hours to eat a meal
Counting
Repetitive prayers
OCD Tx options? - ANSWERS-Pharmacotherapy, psychotherapy or combo
Typical night dose of SSRI - common dosage fluoxetine 80mg
What is Exposure and response prevention (ERP) - ANSWERS-Is a specific CBT for clients with
OCD. Provides exposure to obsessive thoughts and learned behaviors to choose not to
complete a compulsive behavior
Y-BOCS - ANSWERS-Yale-brown Obsessive Compulsive Scale
Chuck has checking compulsions that he performs occasionally. The compulsions slightly
interfere with other activities, and he feels very anxious if he is interrupted in his compulsive
activities. He does not feel that he has control over the compulsive actions.
Based on his score, Chuck is likely to have a moderate case of OCD. Which initial medication
would you select for Chuck?
A) fluoxetine 80 mg
B) fluoxetine 20 mg
C)venlafaxine 75 mg
D) venlafaxine 150 mg - ANSWERS-B) fluoxetine 20mg, always start at the lowest dose and
titrate as needed
What should you monitor with clients who have OCD and anxiety disorders? - ANSWERS-
There is a higher incidence of SI and completion. Therefore monitor clients carefully during
therapy and psychopharmacologic Tx
, The United States Food and Drug Administration (FDA) issued a black box warning for nine
antidepressants related to an increased risk of suicide in children and adolescents. The
medications include - ANSWERS-citalopram, fluvoxamine, paroxetine, fluoxetine, sertraline,
venlafaxine, mirtazapine, nefazodone, and bupropion.
What is the most psychiatric disorder in people 60 and over - ANSWERS-Anxiety
Match the brain area with malfunctioning circuitry with the symptoms produced:
Mesocortical and ventromedial prefrontal cortex - ANSWERS-negative and affective
symptoms
Match the brain area with malfunctioning circuitry with the symptoms produced:
Dorsolateral - ANSWERS-cognitive symptoms
Match the brain area with malfunctioning circuitry with the symptoms produced:
Orbitofrontal and connections to the amygdala: - ANSWERS-aggressive, impulsive symptoms
Traditionally, schizophrenia and psychosis symptoms have been associated with a surplus of
____________, since medications that block dopamine, specifically D2, have been found to
reduce the positive symptoms of schizophrenia - ANSWERS-Dopamine
positive symptoms - ANSWERS-Hallucinations
Delusions
Thought disorder
Hostility
Excitability
negative symptoms - ANSWERS-Affective flattening
EXAM
What is Silexan? - ANSWERS-Is a branded extract of lavender. OTC in the US. Similar to CAM
therapies
Harold is a 32-year-old who presents to the clinic with complaints of fatigue, difficulty
concentrating, and difficulty falling asleep at night. He states he worries about finances, his
performance at work, and his relationship, and his worries have been "almost constant" for
8 months. He denies substance use and recently had a normal physical exam. He feels that
his relationship is suffering due to his constant worry.
Based on the DSM-5-TR, does Harold meet diagnostic criteria for generalized anxiety
disorder?
A) Yes
B) No - ANSWERS-A) Yes
Rationale: Harold meets the following diagnostic criteria for generalized anxiety disorder: He
has three symptoms associated with worry, including fatigue, difficulty concentrating, and
sleep difficulties. He has experienced anxiety more days than not for over 6 months, and his
worries are impacting his relationship.
SAD treatment plan? - ANSWERS-Not all clients with social anxiety disorder (SAD) require
treatment. Young adults may experience benefits from learning about their disorder and
reflecting on how the disorder impacts their personal life to make an educated decision
about treatment options. Many clients diagnosed with SAD have experienced symptoms for
years and have learned to navigate the symptoms at a functional level. Treatment for SAD is
rarely an emergent situation. Treatment includes cognitive behavioral therapy, medications,
or a combination of both.
SAD medication treatment options? - ANSWERS-Selective serotonin reuptake inhibitors
(SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs)
SAD is usually treated using anti-depressants.
,Benzodiazepines
These psychoactive drugs are known for inducing calm.
Monoamine oxidase inhibitors (MAOIs)
This class of drugs are for clients who are able to undergo dietary and medication
restrictions. SSRIs or SNRIs must be completely flushed from the system first.
Performance- only SAD Tx for one or rarely recurring performance? - ANSWERS-Beta blocker
or Benzodiazepine 30-60 min before performance
Performance-only SAD Tx for Recurring performances - ANSWERS-1) CBT
2) Beta blocker or Benzodiazepine 30-60 min before performance
Panic disorder Tx plan - ANSWERS-Exposure therapy
Cognitive behavioral therapy
Medications
Combination of modalities
Treatment may include exposure therapy, cognitive behavioral therapy, medications, or a
combination of modalities. SSRIs are a safe, economical pharmacologic treatment for panic
disorder. Benzodiazepines may be used in emergencies
Obsessions vs compulsions - ANSWERS-Obsessions: (intrusive or unwanted thoughts)
"Did I forget to turn the stove off?"
Fear of germs
Continued thoughts of harming another person
Compulsions: (repetitive behaviors in response of intrusive thoughts)
,Checking the lock on the door multiple times
Taking several hours to eat a meal
Counting
Repetitive prayers
OCD Tx options? - ANSWERS-Pharmacotherapy, psychotherapy or combo
Typical night dose of SSRI - common dosage fluoxetine 80mg
What is Exposure and response prevention (ERP) - ANSWERS-Is a specific CBT for clients with
OCD. Provides exposure to obsessive thoughts and learned behaviors to choose not to
complete a compulsive behavior
Y-BOCS - ANSWERS-Yale-brown Obsessive Compulsive Scale
Chuck has checking compulsions that he performs occasionally. The compulsions slightly
interfere with other activities, and he feels very anxious if he is interrupted in his compulsive
activities. He does not feel that he has control over the compulsive actions.
Based on his score, Chuck is likely to have a moderate case of OCD. Which initial medication
would you select for Chuck?
A) fluoxetine 80 mg
B) fluoxetine 20 mg
C)venlafaxine 75 mg
D) venlafaxine 150 mg - ANSWERS-B) fluoxetine 20mg, always start at the lowest dose and
titrate as needed
What should you monitor with clients who have OCD and anxiety disorders? - ANSWERS-
There is a higher incidence of SI and completion. Therefore monitor clients carefully during
therapy and psychopharmacologic Tx
, The United States Food and Drug Administration (FDA) issued a black box warning for nine
antidepressants related to an increased risk of suicide in children and adolescents. The
medications include - ANSWERS-citalopram, fluvoxamine, paroxetine, fluoxetine, sertraline,
venlafaxine, mirtazapine, nefazodone, and bupropion.
What is the most psychiatric disorder in people 60 and over - ANSWERS-Anxiety
Match the brain area with malfunctioning circuitry with the symptoms produced:
Mesocortical and ventromedial prefrontal cortex - ANSWERS-negative and affective
symptoms
Match the brain area with malfunctioning circuitry with the symptoms produced:
Dorsolateral - ANSWERS-cognitive symptoms
Match the brain area with malfunctioning circuitry with the symptoms produced:
Orbitofrontal and connections to the amygdala: - ANSWERS-aggressive, impulsive symptoms
Traditionally, schizophrenia and psychosis symptoms have been associated with a surplus of
____________, since medications that block dopamine, specifically D2, have been found to
reduce the positive symptoms of schizophrenia - ANSWERS-Dopamine
positive symptoms - ANSWERS-Hallucinations
Delusions
Thought disorder
Hostility
Excitability
negative symptoms - ANSWERS-Affective flattening
