PSYCH EOR questions and answers 100% correct

PSYCH EOR questions and answers 100% correct What is the treatment of choice for refractory schizophrenia? A: Haloperidol B: Clozapine C: Risperidone D: Fluphenazine E: Lithium B: Clozapine has come to be the accepted as the treatment of choice in patients with schizophrenia that is refractory to other treatment methods A 52 year old Caucasian female is brought to the emergency room by her brother who found her unconscious in her living room this afternoon. He reports that this is not the first time that this has happened, and he is fairly certain that it is another suicide attempt following an argument that she had with her husband over the huge shopping spree she went on the day before. Which of the following psychiatric conditions is most likely in this patient? A: Bipolar Disorder B: Dysthymic Disorder C: Brief Psychotic Disorder D: Delusional Disorder E: Schizophrenia Answer A: Bipolar disorder is characterized by impulsivity, and repeated self-destructive behavior, including suicide attempts. 00:54 02:01 How long must a patient have an abnormally and persistently elevated, expansive, or irritable mood to be classified as a Hypomanic Episode? A: 1 day B: 2 days C: 3 days D: 4 days E: Greater than 5 days Answer D: Patients must exhibit these symptoms for at least four days to be classified as having a Hypomanic Episode according to the DSM Criteria. A very depressed patient presents to your office for treatment. The patient has great difficulty "getting going" early in the day, but is sleeping fine. Which of the following would be the most appropriate pharmacological intervention for this patient? A: Trazodone B: Mirtazapine C: Paroxetine D: Sertraline E: Duloxetine Answer D: Sertraline is an antidepressant which is activating, and may be used to help relieve this patient's symptoms. This is an antidepressant medication that is sometimes used at lower doses to produce a sedating effect, to help patients get to sleep Trazodone This medication is generally used for depression with insomnia and decreased appetite Mirtazapine This medication is used for depression with anxiety Paroxetine This medication is most used in combination with other medications, and is not particularly activating Duloxetine A 14 year old boy is brought to the emergency room by his mother. Two days earlier his older brother had died in a serious car accident. The boy had become hysterical at the funeral, yelling and having to be restrained. He has been agitated at home, and his mother and father have not been able to get him to calm down. Since yesterday he has been sitting on his bed, rocking back and forth, and mumbling to himself about bees coming to get him. His mother states that he was completely normal before the car accident. Urine drug screen is negative. Which of the following is this patient's most likely diagnosis? A: Grief B: Post-traumatic stress disorder C: Brief psychotic disorder D: Drug induced psychosis E: Schizophrenia Answer C: This is the most likely diagnosis in this patient. The symptoms that he is experiencing are much more severe than that of a normal grief pattern, and he was reportedly normal prior to the death of his brother. Which of the following drugs would be most appropriate for a 28 year old female with Major Depressive disorder, single episode, moderate who has QT prolongation syndrome. The patient is not exhibiting any symptoms of psychosis or mania. A: fluoxetine B: paroxetine C: lamotrigine D: olanzapine E: phenelzine Answer B: This is the best choice as current research shows that paroxetine carries the least potential for QT prolongation of the SSRIs. Which of the following is not common in patients with alcoholism? A: Legal problems B: Elevated MCV C: Hypocalcemia D: Elevated serum uric acid E: Elevated triglycerides Answer C: Hypocalcemia is not a common finding in the alcoholic patient. A 44 year old male with history of alcohol dependence presents to your clinic complaining of feeling on edge all of the time. He is worried about things from different aspects of his life. Which of the following medications would be the most appropriate for use in this patient? A: Trazodone B: Buspirone C: Risperidone D: Lorazepam E: Gabapentin Answer B is correct. Buspirone is an anxiolytic medication that would be the most appropriate choice for this patient due to its non-habit forming properties. Answer D: Though an effective anxiolytic medication, this would not be recommended for this patient, due to his previous history of alcohol dependence. 00:02 02:01 Which of the following is not a characteristic of Binge-Eating Disorder? A: Eating more rapidly than normal B: Eating large amounts of food throughout the day C: Eating large amounts of food when physically hungry D: Feeling disgusted or guilty after eating E: Eating alone due to embarrassment of quantity consumed Answer C: DSM Criteria include recurrent episodes of binge eating, and lack of control over food intake. It may also include any of the other listed options and these symptoms must be presents at least twice a week for six months to make the diagnosis. Which of the following is true regarding Paranoid personality disorder? A: The first signs show up during midlife B: The treatment of choice is cognitive behavioral therapy C: Childhood shyness is a predisposing factor D: The patient shows little interest in sexual activities E: The patient negatively misinterprets actions, words, or intentions Answer E: Patients with Paranoid personality disorder exhibit pervasive distrust and suspiciousness, and may also show some of the following: suspect others are plotting against them, doubt loyalty of others (especially those closest to them), fear that others may exploit information shared, bear grudges, feel socially isolated. During what time in life does paranoid personality disorder show up? Early Adulthood Shyness as a child may predispose a patient to developing? Avoidant personality disorder In which personality disorder does the patient show little interest in sexual activities Schizoid personality disorder Which of the following is a positive symptoms associated with schizophrenia? A: Hallucinations B: Anhedonia C: Disorganized thought processes D: Avolition E: Flat affect Answer A: Schizophrenia is often described as having positive and negative symptoms. Positive symptoms are those that were not present before the condition manifested itself. Negative symptoms are those that negatively affect the patients functioning, such as those listed. Hallucinations is the only listed symptom here that would be considered a positive symptom. Which of the following medical conditions cannot mimic depressive symptoms? A: Hyperthyroidism B: Stroke C: Parkinson's disease D: Vitamin B12 deficiency E: Pancreatic carcinoma Answer A: Medical Conditions that can mimic depressive symptoms include: 1. Stroke 2. Parkinson's disease 3. Multiple Sclerosis 4. Huntington's Disease 5. Vitamin B 12 deficiency 6. Hypothyroidism 7. Cushing's disease 8. Pancreatic carcinoma 9. HIV Treatment with which of the following agents can lead to decreased serum lithium levels? A: Valproic acid B: ACE Inhibitors C: Potassium sparing diuretics D: Theophylline E: Indomethacin Answer A: VPA when administered concurrently with lithium may lead to a decrease in lithium levels. These levels should be monitored closely to ensure efficacy when starting VPA, and to prevent lithium toxicity when stopping VPA. Which of the following characteristics is most consistent when describing a patient with Antisocial personality disorder? A: Impulsivity in self-damaging areas B: Self-destructive behavior C: Lying to promote personal gain D: Inappropriate sexually seductive behaviors E: Exaggerated sense of self importance Answer C: Patients with antisocial personality disorder generally have exhibited the characteristics since the age of 15 years old, and have a history of violating the rights of others. They may break the law, "con" others for personal gain, be aggressive, disregard the safety of themselves or others, while feeling no remorse for any of these activities. Exaggerated sense of self importance Narcissistic personality disorder Inappropriate sexually seductive behaviors Histrionic personality Impulsivity in self-damaging areas and Self-destructive behavior borderline personality disorder Which of the following is the initial drug of choice for mood stabilization? A: Tricyclic antidepressants B: Quetiapine C: Lithium D: Benzodiazepines E: Valproic acid Answer C: Lithium, although the mechanism of action is not well understood, is considered the initial drug of choice for mood stabilization. When visiting with one of your patients, a 34 year old male, he states that he is just now "getting back on his feet". He tells you that five months ago he became very ill. In addition to his medical illness, he felt "down" and increasingly irritable. He struggled to maintain his job, and his girlfriend broke up with him. Now he has things more under control, is doing well at work, and is dating again. Which of the following is the most likely diagnosis? A: Adjustment disorder B: Post-traumatic stress disorder C: Bereavement D: Personality disorder E: Schizotypal personality disorder Answer A: Anxiety, depression, or a combination of the two is also associated with this disorder. Adjustment disorder is defined as development of anxiety, depression, or both within three months of an identified stressor such as finances, divorce, or illness in an individual's life. Impairment in their job and relationships occur, but the condition usually resolves within six months. Signs of tobacco withdrawal include all of the following except? A: Increased heart rate B: Irritability C: Dysphoria D: Poor concentration E: Restlessness Answer A: Heart rate actually decreases in withdrawal from tobacco. Which of the following is true of a patient who is suspected of malingering? A: They have perfectionist attitude B: Their history agrees With their physical symptoms C: They demonstrate function only when observed D: Have Hardworking values E: They use illness to achieve a goal Answer E: A malingerer is a patient that is using their illness (or supposed illness) to attain a certain goal, and will not improve until that goal is met. They may act differently when they think they are being observed. A 32 year old African American male presents to your office for evaluation. For the last eight months he describes being depressed on most days, and feeling especially irritable. On further examination you find the patient is unable to focus the conversation, and sometimes uses disorganized speech patterns, including echolalia. He admits that at times he hears voices, but cannot make out what they are saying. The patient is unkempt, and you cannot ascertain exactly where he sleeps at night. No evidence of a medical condition or substance abuse can be found upon laboratory testing. What is the next best step in the management of this patient? A: Discharge home and initiate antidepressant therapy B: Discharge home with follow-up for individual psychotherapy C: Discharge home on a course of antipsychotic medications D: Admit for observation and start antipsychotic therapy E: Admit to hospital and order restraints Answer D: This patient must be admitted to the hospital and antipsychotic therapy initiated for Schizophrenia. He is clearly psychotic, and not caring for his own needs. Which of the following characteristics distinguishes Obsessive Compulsive personality disorder from Obsessive Compulsive disorder? A: Patients do not exhibit obsessions or compulsions, and believe they are behaving normally B: Symptoms may cause marked distress and alter daily functioning C: Patients exhibit scrutinous attention to details D: Patients may exhibit poor insight as to the severity of their illness E: Washing and checking rituals may be common in children Answer A: This is unique to OCPD and distinguishes it from OCD. A 24 year old male presents to your emergency department exhibiting the following symptoms for the last two months: he thinks he is the devil, he seeing flames on surfaces, has racing thoughts, pressured speech, psychomotor agitation, disorganized speech and he has been awake for at least the 7 days continuously without even 5 minutes of sleep. What is the most likely diagnosis based upon the above listed symptoms? A: Schizophreniform disorder B: Bipolar I disorder C: Bipolar II disorder D: Schizoaffective disorder E: Major Depressive disorder Answer D: This patient most likely will be given a diagnosis of Schizoaffective disorder because he meets the DSM criteria for schizophrenia along with a mood disorder (here mania). La belle indifference is a symptom commonly associated with which of the following conditions? A: Gasner's syndrome B: Factitious disorder C: Conversion disorder D: Malingering E: Fibromyalgia Answer C: Patient with conversion disorder may display "La belle indifference", a serious physical ailment (i.e. paralysis of the lower extremities) to which the patient shows little emotional reaction or distress. A 32 year old female presents to your clinic, dressed lavishly and being very outspoken and forward in her comments. Which of the following is the treatment of choice for this patient's personality disorder? A: Lithium B: Avoidance of triggering stimuli C: Haloperidol D: Insight-oriented psychotherapy E: Electroconvulsive therapy Answer D: Drug therapies are less effective when used in the treatment of personality disorders. This type of psychotherapy, along with a relationship of trust between the clinician and patient, can most effectively help those patients with Histrionic personality disorder. A 42 year old male presents to the emergency department with the following symptoms: increased heart rate with palpitations, sweating, shortness of breath, chest pain, nausea, and dizziness. Which of the following additional pieces of information is the most consistent with the Diagnostic and Statistical Manual's criteria for the establishment of a diagnosis of panic disorder? A: The patient had at least one prior attack with similar symptoms and a heart attack was ruled out at that time B: Six months ago the patient had a negative cardiac stress test C: Marked or persistent fear of social or performance situations D: The patient has experienced at least one attack followed by one month of persistent concern about repeat attacks E: Patient has anxiety that is difficult to control & causes marked functional impairment Answer D: DSM criteria for panic disorder includes recurrent and unexpected panic attacks with symptoms as described in the clinical scenario, with at least one followed by one month of persistent concern about repeat attacks, worry about the implications associated with the attacks, or significant change in behavior. A 52 year old female presents to your office complaining of decreased appetite, trouble sleeping at night, feeling sad more days than not, and trouble concentrating at work and at home. The patient reports that her divorce became final one month earlier. Which of the following is the most likely diagnosis? A: Post-traumatic stress disorder B: Normal grief reaction C: Adjustment disorder D: Major depressive disorder E: Brief psychotic episode Answer C: Adjustment disorder involves many of the same characteristics as a depressive disorder, but occurs within three months of a specific distressing event, and usually resolves by six months. Which of the following is not considered one of the four "A's" used to describe symptoms associated with dementia? A: Amnesia B: Aphasia C: Anhedonia D: Apraxia E: Agnosia Answer C: This is not one of the four "A's" of dementia. Treatment for a paranoid personality disorder should include which of the following? A: Challenging the paranoid ideas B: Outlining a treatment plan in detail C: Confirming the paranoid beliefs D: Empathizing with the patient E: Challenging the delusions Answer B: Patients lack of trust is a characteristic of their disorder. Thus, treating a patient with this condition can be very complicated and usually involves a lengthy and complex legal course. The clinician should avoid challenging the ideas of the paranoia, be supportive, avoid confronting delusions, let the patient have as much control over treatment as possible. The patients are sometimes treated with low-dose neuroleptics as well. A patient with Narcissistic personality disorder would most likely exhibit which of the following characteristics? A: Handle criticism poorly B: May see relationships as more intimate than they are C: Excessive irritability or aggressiveness D: Restrained in intimate relationships E: Fears being left to take care of self Answer A: The patient with Narcissistic personality disorder tends to exhibit a pattern of grandiosity, the need for admiration of others, lacks of empathy for others and may show some of the following: an exaggerated sense of self importance, preoccupation with fantasies of success or power, thinking that others are inferior to themselves, feel a sense of entitlement, handle criticism poorly, and may be envious of those with success or knowledge (such as the clinician attempting to help them). May see relationships as more intimate than they are Histrionic personality disorder Excessive irritability or aggressiveness Antisocial personality disorder-more likely to have this characteristic Restrained in intimate relationships Avoidant personality patient Fears being left to take care of self Dependent personality disorder