Mental Health Final
Which of the following is NOT a side effect of benzodiazepines?
Ataxia
Nightmares
Drowsiness
Amnesia
Restlessness
Which is of the following is NOT a side effect of benzodiazepines?
Ataxia
Confusional state
Acute dystonia
Aggression
Drowsiness
Which of the following is a feature of the sleep pattern upon benzodiazepine withdrawal?
Decreased sleep latency
Increased stage 4 sleep
Decrease in REM sleep
Suppression of NREM sleep
REM sleep rebound
The presence of benzodiazepines withdrawal as opposed to anxiety is suggested by all of the following EXCEPT:
Dysphoria
Abnormal sense of body movement
Poor sleep with excess worry
Hyperawareness of senses
Metallic taste in mouth
Which of the following is NOT seen with benzodiazepines use?
Leucopenia
Change in plasma cortisol
Esinophilia
Induction of hepatic microsomal enzymes
Respiratory depression
The elimination of which of the following benzodiazepines is NOT influenced by liver disease?
Lorazepam
Alprazolam
Midazolam
Chlordiazepoxide
Diazepam
Which of the following has active metabolites?
Temazepam
Lorazepam
Chlordiazepoxide
Triazolam
Oxazepam
Which of the following is TRUE regarding benzodiazepines?
Lorazepam is more extensively distributed in the body than diazepam
Diazepam is more lipid-soluble than lorazepam
Temazepam produces active metabolites
Chlordiazepoxide has a longer half-life than diazepam
All of the following drugs can cause tremors EXCEPT:
Amitriptyline
Diazepam
Haloperidol
Phenelzine
Lithium
With which of the following is lithium administration during pregnancy associated?
Depression in the infant
Hyperglycemia in the newborn
Ebstein's anomaly
Neural tube defects
All of the following are side effects of tricylic antidepressants EXCEPT
Tachycardia
Diarrhea
Impotence
Blurred vision
Tremors
Which of the following is a side effect of tricyclic antidepressants?
Gastric ulcers
Cataract
Xerostomia
Hypothyroidism
Hypertension
Which of the following tricyclics is a secondary amine?
Amitriptyline
Doxepine
Imipramine
Desipramine
Clomipramine
The inability of the patient's body to deaminate which of the following causes the hypertensive crisis seen with MAOIs?
Tyrosine
Leucine
Tyramine
Tryptophan
Tranylcypromine
All of the following are side effects of MAOI's EXCEPT:
Alopecia
Peripheral neuropathy
Seizures
Mani
Blurred vision
Which of the following is a contraindication to the use of MAOI's?
Asthma
Concurrent use of calcium antagonists
Congestive cardiac failure
Concurrent use of tricyclic antidepressants
Pheochromocytoma
A 45 year old patient who has been receiving treatment with phenelzine for a long time presents with confusion, agitation, and elated mood. On examination, she is sweating and her body temperature is elevated. Her partner reports that she has recently started a new medication for migraines. What does this clinical picture resemble?
Serotonin syndrome
Cheese reaction
Respiratory infection
Neuroleptic malignant syndrome
Rhabdomyolysis
Which of the following should be used with caution in patients with acute angle glaucoma?
Tetrabenazine
Diazepam
Baclofen
Thioridazine
Pyrodostigmine
Which of the following is a feature of drug-induced tardive dyskinesia?
It is worse on stopping antipsychotics
It is more common in male patients
It is present during sleep
Movements are painful
Benztropine is an effective treatment
People with anxiety disorders have all of the following cardiac abnormalities EXCEPT:
High beat-to-beat fluctuation
Decreased deceleration after stress
Higher baseline heart rate
Increased deceleration after stress
Higher subjective awareness of heartbeats
Which of the following is true about specific phobias?
Phobic avoidance uncommon
More common in men
Onset in adult life
Treatment usually not effective
More common in women
A 24 year old woman is diagnosed with social phobia. All of the following are effective treatments EXCEPT:
Modeling
Flooding
ECT
Systematic desensitization
SSRIs
Of all the following factors, which is the most important risk factor for the development of post-traumatic stress disorder?
Sex of the victim
Age of the victim
Nature of the trauma
Individual vulnerability
All of the above are equally important
Regarding post-traumatic stress disorder (PTSD), all of the following are true EXCEPT:
Prevalence is about 8% in the general population.
Acute stress disorder is a different diagnosis
There are four subtypes: acute, subacute, chronic, and delayed onset.
Prevalence is up to 20% in people exposed to combat
Symptoms should last for more than 1 month.
For a diagnosis of chronic PTSD according to DSM-IV, for at least how long must the patient have symptoms of PTSD?
3 months
1 month
1 year
6 months
2 years
A 36 year old woman is diagnosed with post-traumatic stress disorder following a violent assault and rape. Over the next 2 years, although the posttraumatic stress disorder abates, she feels anxious and depressed and starts using alcohol and other illicit drugs. Which of the following is the most common comorbid condition in women with PTSD?
Psychotic disorders
Depression
Anxiety disorder
Eating disorder
Substance abuse (alcohol or drugs
Apart from SSRIs, which have proven efficacy in PTSD, all of the following medications are considered to be useful in the treatment of PTSD EXCEPT:
Anticonvulsants
MAOIs
Trazodone
Propranolol
Antipsychotics
Which of the following is the most common somatoform disorder?
Somatization disorder
Conversion disorder
Pain disorder
Hypochondriasis
Body dysmorphic disorder
According to DSM-IV, all of the following are the criteria for somatization disorder EXCEPT:
One sexual symptom
Four or more pain symptoms
Two gastrointestinal symptoms that are not pain related
One pseudoneurologic symptom
Age of onset after 30 years
Which of the following does NOT suggest a somatization disorder?
Family history of bipolar disorder and histrionic personality
Early onset of symptoms
Chronic course
Involvement of multiple organs
Absence of laboratory, radiologic, and physical abnormalities
All of the following are characteristic features of conversion disorder EXCEPT:
Patients are usually suggestible
Symptoms are initiated or exacerbated following severe stress
Patients believe that they are severely ill
Symptoms are not feigned
Usually occurs between the ages of 10 to 35 years
All of the following are true about conversion disorders except:
About one-third of patients with conversion disorder have concurrent neurological illness
The symptoms tend to conform to the patient's own idea of illness.
Thirty percent of patients' pseudoseizures are due to a neurological illness.
Remission is usually observed within 2 weeks of hospitalization.
Recurrence rate is as high as 20-25% within the first year.
A 24 year old woman is referred for a psychiatric consultation by a plastic surgeon. She is very angry that the surgeon thinks "It's in my brain" and refused to acknowledge that she has a "crooked nose". The psychiatrist thinks that there is no obvious defect with the patient's nose but reassures her and tries to calm her. After obtaining all the collateral information and extensively interviewing the patient, he diagnoses her with body dysmorphic disorder. All of the following about this disorder are true, EXCEPT:
Suicide is rare.
Preoccupation with imagined or slight physical anomaly us markedly excessive
Up to one-third of patients with this disorder may be housebound.
Hair, nose, and skin complaints are most common.
Comorbid depression and anxiety are common
All of the following are true about factitious disorder EXCEPT:
A desire to assume the role of sick patient
No secondary gain
Good prognosis once the condition is diagnosed
Intentional production of signs and symptoms
Exact prevalence is unknown
A 28 year old woman is admitted to a general medical unit for hypoglycemia. A psychiatry consultation is requested because the patient's story "doesn't fit". The patient tells the psychiatrist how bad the problem is and uses medical jargon. She appears to be an intelligent person with strong dependency needs. The nurse interrupts the psychiatrist and tells him that she found insulin-filled syringes beneath the patient's pillow. This upsets the patient and before anything can be done about it, she elopes from the hospital. The most likely diagnosis in this patient is:
Somatization disorder
Hypochondriasis
Factitious disorder
Malingering
Munchausen syndrome by proxy
All of the following are true about the psychological profile of patients with factitious disorder EXCEPT:
Poor sense of identity
Strong dependence needs
Narcissism
High frustration tolerance
Absence of formal thought disorder
All of the following are features of Ganser syndrome EXCEPT:
Most commonly seen in mentally retarded people
Approximate answers
Considered by some to be a variant of malingering
Classified as a dissociative disorder NOS in DSM-IV
Existence of this disorder is controversial
Severe debilitating OCD in a 42-year-old patient is found to be resistant to pharmacotherapy, psychotherapy, and ECT. The option of psychosurgery is discussed with the patient. The most common psychosurgical procedure for OCD is:
Cingulotomy
Subacute tractotomy
Caudate nucleus ablation
Internal capsule stimulation
Frontal tractotomy
Which of the following is TRUE regarding bulimia nervosa?
Individuals with bulimia have enlargement of the parotid gland.
There is an increased frequency of depression in people with bulimia nervosa
Persons with bulimia nervosa have a 30% prevalence of substance abuse or dependence
Persons with bulimia nervosa exhibit mildly elevated levels of serum amylase.
All of the above.
Patients with bulimia nervosa are characterized by scars on the knuckles of their hands from constantly putting the knuckles of their hands from constantly putting their hands into their mouths to induce vomiting. What is this sign called?
Russell's sign
Feingold's sign
McCain's sign
None of the above
Patients with bulimia nervosa sometimes develop cardiac myopathy. What is the most common cause?
Electrolyte disturbance
Starvation
Loss of cardiac muscle
Toxicity from ipecac
All of the above
What is considered the first line of treatment for bulimia nervosa?
Family therapy
Interpersonal therapy
Pharmacotherapy
Cognitive-behavioral therapy
Brief psychoanalytic therapy
Which of the following is NOT true for anorexia nervosa?
It is more common in females
It is more prevalent in developing countries
Patients have a body weight less than 85% of that expected
Patients have an intense fear of gaining weight
In postmenarchal women, there is an absence of at least three consecutive menstrual cycles.
Which is the most common age of onset of anorexia nervosa?
Between 14 and 15
18
Both between 14 and 15 and at age 18 (a bimodal peak
12-13
None of the above
For which of the following are hormone levels decreased in patients with anorexia nervosa?
GnRH
FSH
LH
Estrogen
All of the above
Which of the following medical complications is seen with anorexia nervosa?
Leucopenia
Hypokalemic alkalosis
Lanugo
Fatty degeneration of the liver
All of the above
Patients suffering from anorexia nervosa have a high incidence of which of the following psychiatric conditions?
Obsessive compulsive disorder
Major depression
Social Phobia
Decreased sexual interest
All of the above
Which of the following is NOT a good prognostic indicator for anorexia nervosa?
Early age of onset
Late age of onset
No purging behavior
No previous hospitalization for the illness
Parents who are cooperative and willing to come for family therapy
Which of the following medications has been found useful in the treatment of anorexia nervosa?
Fluoxetine
Sertraline
Chlorpromazine
Cyprohepatidine
All of the above
Melancholia is also known as
Reactive depression
Exogeneous depression
Endogeneous depression
Psychotic depression
Masked depression
Which of the following is NOT a symptom of benzodiazepine withdrawal?
Hallucinations
Tremor
Depression
Tinnitus
Depersonalization
All of the following are features of endogeneous depression EXCEPT:
Lack of appetite
Irritability
Wight loss
Psychomotor retardation
Anhedonia
A 68 year old man is admitted to an acute psychiatric unit for severe suicidal ideation. He is very much preoccupied with death and refuses to agree to a contract for safety. The diagnostician determines the patient to be severely depressed because of noncompliance with medication and severe social stressors. The patient refuses to take any medication because, he says, "Nothing will change, anyway". He also stops eating and drinking and becomes increasingly dehydrated. A reasonable choice of treatment in this patient would be to:
Persuade the patient to take antidepressants
Wait and watch for the patient to change his mind
Restrain the patient and administer intravenous fluids
Prescribe electroconvulsive therapy
Prescribe intensive psychotherapy
A 28 year old woman is being assessed for bipolar disorder. She complains of mood swings from time to time ranging from "tearfulness to feeling really good" On further questioning, she reveals that she has not been able to maintain any relationship because of her mood swings and feels empty. She fears abandonment by her friends because of her mood swings but also blames everyone for her "current state". The most important differential diagnosis in this patient is:
Major depressive disorder
Borderline personality disorder
Histrionic personality
Depressive personality
Generalized anxiety disorder
A 32 year old woman is admitted to an acute psychiatric impatient unit for severe depression. The patient has been ruminating about suicide and guilt feelings. She believes that she has committed a sin and deserves to be punished. The resident physician thinks that the patient is obsessed with thoughts of guilt and suspects that patient has a primary obsessional disorder. The attending psychiatrist explains that patient is not obsessional but severely depressed because:
The patient has suicidal ideation
The patient has indeed committed a sin
The patient is not distressed by the guilt feelings and is mood congruent
The psychiatrist thinks so
Antidepressants alone were not effective
All of the following are features of "atypical depression" EXCEPT:
Intense, unstable emotions
Increased appetite
Increased sleep
Mood reactivity
Rejection sensitivity
How many categories of unipolar depressive disorder are listed by DSM-IV?
4
3
6
10
5
All of the following statements are true of the epidemiology of depression EXCEPT:
The rates are equal in men and women after the age of 50 years
Women are twice as affected as men between puberty and 50 years
Girls are four times more affected than boys before puberty
Point prevalence of depression have been observed over the past 4 to 5 decades
According to DSM-IV, one of the criteria for dysthymic disorder is that the patient should not be symptom free for more than a certain number of months in a 2-year period (or 1 year period in children or adolescents). How many months must the patient be symptom free?
3 months
2 months
1 month
6 months
8 months
A 29-year-old man comes along with his wife of 4 years to the psychiatric clinic. The patient's wife reports that he has had repeated episodes of "highs and downs" for the last 3 years. The episodes are short, lasting only a few days. These episodes disrupt the patient's work schedule and sometimes the young couple's social life. What is the most appropriate diagnosis?
Bipolar I disorder
Bipolar II disorder
Cyclothymia
Dysthymia
When compared to patients with unipolar disorder, patients with bipolar disorder have:
Less genetic loading
Greater genetic loading
The same genetic loading
No genetic loading
According to DSM-IV, rapid-cycling bipolar disorder is characterized by:
Four or more mood episodes per year
Four or more mood episodes per month
Four or more episodes of mania or hypomania in a year
Four or more episodes of depression per year
According to DSM-IV, for a mixed manic episode. Criteria for both major depressive disorder and mania should be present every day for:
1 day
1 week
1 month
3 days
2 months
All of the following are features of rapid-cycling bipolar disorder EXCEPT:
Four or more mood episodes per year
More common in women
Occurs early in the course of illness
Usually resistant to treatment with lithium
Antidepressant-induced hypomania
Which of the following neurotransmitters has been implicated in the pathophysiology of schizophrenia?
Glutamate
Serotonin
Dopamine
All of the above
Which of the following substances demonstrates effects that support the dopamine hypothesis of schizophrenia?
Cocaine
D-amphetamine
Levodopa
Methylphenidate
All of the above
Clonidine has been found by some studies to reduce psychotic symptoms in schizophrenic patients. Which of the neurotransmitters do these studies implicate as playing a role in the development of schizophrenia?
Serotonin
Aspartate
Norepinephrine
Dopamine
Which of the following is the most common symptom of acute schizophrenia?
Auditory hallucinations
Delusions of reference
Suspiciousness
Lack of insight
A 35 year old woman is referred to a psychiatric outpatient clinic by a plastic surgeon. According to the referral letter, this person has consulted three cosmetic surgeons in the last 6 months about what she perceives to be a deformity in her upper lip. All the physicians have told her that there is no deformity, and this belief has hampered her socially and occupationally. What is the diagnosis?
Hypochondriasis
Somatization
Body dysmorphic disorder
Delusional disorder, somatic type
Which of the following is not a good prognostic factor for delusional disorder?
Acute onset
Early age of onset
Absence of precipitating factors
Female sex
Being married
Which of the following types of delusions has the best prognosis?
Persecutory
Erotomanic
Jealous
Somatic
Grandiose
Which of the following is a positive symptom of schizophrenia?
Avolition
Alogia
Auditory hallucinations
Affective flattening
Which of the following suggests schizophrenia?
Perseveration
Autoscopy
Olfactory hallucinations
Asyndetic thinking
Visual hallucinations
Which of the following abnormalities, if present alone without any other symptoms, is sufficient for a diagnosis of schizophrenia according to DSM-IV?
Bizarre delusions
Hallucination giving a running commentary about the person's thoughts and actions
Auditory hallucination of two or more voices conversing with each other
All of the above
Which of the following is the most common symptom in persons with delusional disorder?
Delusions of reference
Delusions of persecution
Somatic delusions
Jealous delusions
Delusions of grandeur
For a diagnosis of delusional disorder according to DSM-IV, how long must the delusions be present?
2 weeks
1 week
3 months
1 month
6 months
Which subtype of delusional disorder is also known as de Clerambault syndrome?
Persecutory
Erotomanic
Somatic
Grandiose
Jealous
Which of the following delusional disorders responds specifically to primozide?
Persecutory
Erotomanic
Somatic
Grandiose
Jealous
Which of the following is one the four as identified by Eugene Bleuler as the primary symptoms of schizophrenia?
Abnormal association
Autistic behavior
Ambivalence
All of the above
Which of the following cognitive impairments is found in persons with schizophrenia?
Deficits in information processing
Deficits in executive function
Deficits in language ability
None of the above
All of the above
Which of the following did Bleuler consider a primary symptom of schizophrenia?
Abnormal associations
Autistic behavior
Abnormal affect
Ambivalance
All of the above
Which of the following forms of schizophrenia has the best prognosis?
Paranoid schizophrenia
Catatonic schizophrenia
Disorganized schizophrenia
Schizophrenia, undifferentiated type
In persons with schizophrenia, paranoid symptoms are more common in:
Children
Young adults
The middle aged
The eldery
Women
A 42 year old with schizophrenia keeps repeating certain words in the same fashion. What is this phenomenon called?
Echolalia
Perseveration
Echopraxia
Verbigeration
A 72 year old patient with over 50 years of being diagnosed with schizophrenia is observed to repeat the same words and phrases over and over again for days. What is this phenomenom called?
Echolalia
Echopraxia
Stilted language
Verbigaration
None of the above
The most common feature of chronic schizophrenia is
Social withdrawal
Underactivity
Lack of conversation
Few leisure interests
Slowness
Fertility rates among schizophrenic patients are:
Increased
Decreased
The same as for the general population
Subject to improvement with treatment
A 19year old man was recently discharged from the hospital after treatment for acute schizophrenia. On his follow up visit 2 weeks later, he reports having stopped taking the prescribed medication. What should be the next step in his treatment?
Start the patient on risperidal consta
Hospitalize the patient
Report him to the department of health services
Inquire about side effects from neuroleptics
None of the above
Which of the following should raise suspicions of child abuse?
Bucket-handle fractures
Inflammatory hair loss
Bilateral black eyes
Retinal hemorrhages
All of the above
Which of the following features should raise the suspicion of sexual abuse in children?
Anal dilatation with loss of rectal tone
Incidence of sexually transmitted diseases
Flattened rectal rugae
Inappropriate sexual behavior by children
All of the above
Which of the following is true about persons with oppositional defiant disorder?
They often lose their tempers
They deliberately annoy others
They blame others for their mistakes
Their symptoms last more than 6 months
All of the above
Which of the following is true regarding ADHD in children?
ADHD is more prevalent in girls
The symptoms should persist for at least 3 months for a diagnosis of ADHD
Depression is the most common comorbid condition associated with ADHD
Oppositional defiant disorder and conduct disorder are the most common comorbid conditions associate with ADHD
Low dose atypical antipsychotic medications are the treatment of choice for ADHD.
An 18 month old girl is separated from her parents for about 1 month following a natural calamity. The child develops severe depression following this episode. What is the name of this phenomenon?
Vulnerable child syndrome
Anaclitic depression
Separation anxiety disorder
None of the above
Which of the following tricyclic antidepressants used in treatment of ADHD has led to four reported deaths in children?
Imipramine
Nortiptyline
Desipramine
Maprotiline
Which of the following is not true for tourette syndrome?
Has an onset before age 18
Is more prevalent in boys
Has obsessive compulsive features in 40% of cases
Can be caused by postviral encephalitis
Which of the following is not true regarding gender identity?
Gender identity is the child's perception of self as male or female
In the majority of children, formation of gender identity starts at age 3-4 years and it complete by age 5-7 years.
Gender identity forms earlier in girls
Homosexual play in early childhood is indicative of adult sexual orientation
None of the above
Which is the only SSRI authorized by the FDA for treatment of depression in children?
Fluvoxamine
Fluoxetine
Paroxetine
Sertraline
Escitalopram
Which of the following is associated with use of illicit drugs?
High socioeconomic status
Low availability of drugs
High crime rate
Low unemployment
Good schools
Which of the following is a risk factor for alcoholism?
Female sex
Identical twin with alcoholism
Adoptive father with alcoholism
Family history of schizophrenia
Family history of ADHD
What is the most common comorbid psychiatric disorder in prisoners with addictive disorders?
Antisocial personality disorder
Schizophrenia
Depression
Bipolar disorder
Phobic disorder
Severe alcohol withdrawal is associated with all of the following medical complications except:
Magnesium deficiency
Wernicke's encephalophaty
Hypertension
Hyperglycemia
Seizures
Which of the following is not a complication of alcohol abuse?
Decreased serum testosterone
Carcinoma esophagus
Hypertension
Cardiomyopathy
Parkinson's disease
Which of the following is a good first-line drug for alcohol detoxification?
Chlorpromazine
Chlordiazepoxide
Carbamazepine
Clonidine
Barbituarates
Which of the following is caused by cocaine toxicity?
Bradycardia
Hypothermia
Hypersomnia
Hypotension
Intracranial hemorrhage
Which of the following is not useful in the assessment of a patient with alcoholism?
CAGE
AUDIT
CAMCOG
MCV
CDT
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