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Question 1
Incorrect
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A 42-year-old man is brought to the GP by his wife. She reports that his behaviour has become increasingly erratic and that he often appears to be listening to something that she cannot hear.
During the consultation, the GP notices that he keeps standing up and sitting down again. When questioned on these movements, the patient says, 'I can't help it, my neighbour is controlling my legs.'
What symptom is the patient experiencing?Your Answer: Catatonia
Correct Answer: Passivity
Explanation:Passivity is the belief that one’s movements or sensations are controlled by an external force. Grandiose delusion is a false belief in one’s own superiority. Avolition is a decrease in motivation for purposeful activities. Catatonia is a state of unresponsiveness with repetitive movements or abnormal postures.
Schizophrenia: Symptoms and Features
Schizophrenia is a mental disorder that is characterized by a range of symptoms. One of the most prominent classifications of these symptoms is Schneider’s first rank symptoms. These symptoms can be divided into four categories: auditory hallucinations, thought disorders, passivity phenomena, and delusional perceptions. Auditory hallucinations can include hearing two or more voices discussing the patient in the third person, thought echo, or voices commenting on the patient’s behavior. Thought disorders can include thought insertion, thought withdrawal, and thought broadcasting. Passivity phenomena can include bodily sensations being controlled by external influence or experiences that are imposed on the individual or influenced by others. Delusional perceptions can involve a two-stage process where a normal object is perceived, and then there is a sudden intense delusional insight into the object’s meaning for the patient.
Other features of schizophrenia include impaired insight, incongruity/blunting of affect (inappropriate emotion for circumstances), decreased speech, neologisms (made-up words), catatonia, and negative symptoms such as anhedonia (inability to derive pleasure), alogia (poverty of speech), and avolition (poor motivation). It is important to note that not all individuals with schizophrenia will experience all of these symptoms, and the severity of symptoms can vary from person to person.
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This question is part of the following fields:
- Psychiatry
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Question 2
Incorrect
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Sophie is at a crowded concert. She is standing near a group of her favorite band's fans and she can hear part of their conversation. She thinks she hears the name of her favorite band member mentioned.
What kind of illusion is Sophie experiencing?Your Answer: Fantastic illusion
Correct Answer: Auditory illusion
Explanation:Types of Illusions and Examples
Illusions can occur in any sensory modality, but the most commonly reported are visual. However, there are three broad types of illusions: affect illusion, completion illusion, and pareidolia. Affect illusion is associated with specific mood states, such as someone who has recently been bereaved may ‘see’ their loved one. Completion illusion is due to inattention when reading, such as misreading words or completing faded letters. Pareidolia occurs when an individual perceives a vivid picture in an otherwise vague or obscure stimulus, such as seeing faces or animals in clouds.
Fantastic illusions were described by some of the classic psychiatrists. For example, Fish described a patient who, during an interview, stated that the psychiatrist’s head changed to a rabbit’s head. This patient was known to confabulate and exaggerate. Another example of an auditory illusion is when a partially overheard conversation is misrepresented or misinterpreted by the listener, leading them to believe that they are being discussed.
In conclusion, illusions can occur in various forms and can be caused by different factors. It is important to understand the different types of illusions to avoid misinterpretation and confusion.
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This question is part of the following fields:
- Psychiatry
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Question 3
Incorrect
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Tina, who is in her mid-30s, is currently facing a challenging situation at work that is causing her to feel increasingly frustrated and angry. To cope with these emotions, she has decided to take up kickboxing as a form of release. By channeling her energy into physical activity, Tinais able to manage her anger in a healthy way. This is an example of which defense mechanism?
Your Answer: Displacement
Correct Answer: Sublimation
Explanation:Defense Mechanisms: Coping Strategies for Unacceptable Emotions
Defense mechanisms are psychological strategies that individuals use to cope with unacceptable emotions and thoughts. These mechanisms are often unconscious and can be helpful in managing difficult situations. One such mechanism is sublimation, which involves channeling negative emotions into more acceptable outlets. For example, a person who is angry may choose to engage in physical exercise as a way to release their emotions.
Another defense mechanism is displacement, which involves transferring emotions from one person or situation to another. This can be seen when a person who is angry with their boss comes home and takes out their frustration on their family members. Intellectualization is another mechanism that allows individuals to focus on the facts of a situation rather than the emotions they are feeling. This can be helpful in situations where emotions may be overwhelming, such as when dealing with a serious illness.
Rationalization is a defense mechanism that allows individuals to justify their behavior in a logical manner when their ego is threatened. For example, a student who fails an exam may blame the teacher rather than accepting responsibility for their own actions. Finally, denial is a mechanism that involves consciously avoiding painful topics. This can be seen when a patient denies being told that they have a serious illness.
Overall, defense mechanisms can be helpful in managing difficult emotions and situations. However, it is important to recognize when these mechanisms are being used and to seek help if they are interfering with daily life.
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This question is part of the following fields:
- Psychiatry
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Question 4
Correct
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Oliver takes medication for a heart condition. He notices that everything he sees appears to be tinged with yellow.
What term could be used to describe this symptom?Your Answer: Xanthopsia
Explanation:Types of Visual Perceptions and Distortions
Xanthopsia, chloropsia, and erythropsia are all types of visual perceptions that involve a predominant color. Xanthopsia, in particular, is often caused by digitalis toxicity. Autoscopy, on the other hand, is a type of visual hallucination where an individual sees themselves and knows it is them. Dysmegalopsia, micropsia, and macropsia all describe changes in the perceived shape or size of an object. Hyperaesthesia, meanwhile, refers to an increased intensity of sensation, which can be uncomfortable for some individuals. Lastly, pareidolia is a visual illusion where an individual perceives an image in an otherwise vague or obscure stimulus.
It is important to note that sensory distortions can occur in any sense modality, not just in vision. These types of perceptions and distortions can be caused by various factors, such as medication side effects, neurological conditions, or even psychological states. these phenomena can help individuals recognize and seek appropriate treatment if necessary.
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This question is part of the following fields:
- Psychiatry
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Question 5
Incorrect
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What kind of hallucination is it when Lilly hears the phone ringing and John Lennon's voice at the same time?
Your Answer: Autoscopy
Correct Answer: Functional hallucination
Explanation:Types of Hallucinations and Illusions
Functional hallucinations are auditory hallucinations that occur in response to an external stimulus. The individual can distinguish between the stimulus and the hallucination, and the hallucination only occurs when the stimulus is present. Reflex hallucinations, on the other hand, occur when a sensory stimulus in one modality causes a hallucination in another modality.
Autoscopy, also known as phantom mirror-image, is the experience of seeing oneself and recognizing that it is oneself. This can be a disorienting experience, as the individual may feel as though they are outside of their own body. Extracampine hallucinations occur when an individual experiences a hallucination outside of their own sensory field, such as seeing something behind them when they are looking straight ahead.
Auditory illusions occur when an auditory stimulus is misinterpreted by the listener. This can happen when the listener is in a noisy environment or when the sound is distorted in some way. It is important to note that hallucinations and illusions can be symptoms of various mental health conditions and should be evaluated by a medical professional.
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This question is part of the following fields:
- Psychiatry
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Question 6
Correct
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A 27-year-old female presents to her GP after giving birth 8 months ago. She had planned for a normal vaginal delivery, but due to an umbilical cord prolapse, she had to undergo an emergency caesarean section. Since then, she has experienced several health changes, such as excessive sleep, joint pains, and weight loss. She also reports seeing animals around her that others cannot see and now takes a different route to work to avoid driving past the hospital where the events occurred. Based on her history, what is the most significant feature that supports a diagnosis of post-traumatic stress disorder (PTSD)?
Your Answer: Avoidance
Explanation:PTSD is characterized by a set of common features, including re-experiencing, avoidance, and hyperarousal. Patients may experience intrusive flashbacks or nightmares related to the traumatic event. PTSD can develop after exposure to a variety of traumatic events, such as accidents, natural disasters, military exposure, and traumatic births. Healthcare workers during the COVID-19 pandemic have also reported experiencing PTSD. Insomnia is a common symptom associated with PTSD, while excessive sleep is not. Although hallucinations have been reported in some patients with PTSD, they are not as common as flashbacks and should prompt doctors to consider other possible diagnoses. Joint pains may occur in patients with PTSD, but they are not a defining feature of the disease.
Understanding Post-Traumatic Stress Disorder (PTSD)
Post-traumatic stress disorder (PTSD) is a mental health condition that can develop in individuals of any age following a traumatic event. This can include natural disasters, physical or sexual assault, or military combat. PTSD is characterized by a range of symptoms, including re-experiencing the traumatic event through flashbacks or nightmares, avoidance of triggers associated with the event, hyperarousal, emotional numbing, depression, and substance abuse.
Effective management of PTSD involves a range of interventions, including watchful waiting for mild symptoms, trauma-focused cognitive behavioral therapy (CBT), and eye movement desensitization and reprocessing (EMDR) therapy for more severe cases. While drug treatments are not recommended as a first-line treatment for adults, venlafaxine or a selective serotonin reuptake inhibitor (SSRI) such as sertraline may be used. In severe cases, risperidone may be recommended. It is important to note that single-session interventions, also known as debriefing, are not recommended following a traumatic event.
Understanding PTSD and its symptoms is crucial in providing effective support and treatment for those who have experienced trauma. With the right interventions, individuals with PTSD can learn to manage their symptoms and improve their quality of life.
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This question is part of the following fields:
- Psychiatry
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Question 7
Incorrect
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An older gentleman is brought to the acute psychiatric ward. He has ceased eating and drinking as he believes that his intestines are dead and decaying and that he cannot consume anything orally. He is experiencing severe depression. He denies auditory hallucinations.
What is the probable characterization of his delusions?Your Answer: Hypochondriacal delusions
Correct Answer: Nihilistic delusions
Explanation:Nihilistic Delusions and Cotard Syndrome
Nihilistic delusions are a severe form of negative thinking often experienced by depressed patients. These delusions are characterized by an exaggerated belief that all or part of the patient’s body, mind, or the world has ceased to exist. Patients may report that they do not have a brain or bowel, or that their body has died and they are awaiting a burial. This type of thinking is associated with a lack of insight and can be dangerous, particularly if the patient refuses to eat or drink. Urgent treatment, such as electroconvulsive therapy (ECT), may be necessary.
Nihilistic delusions are not limited to depression and can also occur in psychotic disorders like schizophrenia and organic disorders like delirium. Cotard syndrome is a specific type of nihilistic delusion where the patient believes that they are dead. This syndrome is often associated with depression and can be a sign of severe mental illness.
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This question is part of the following fields:
- Psychiatry
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Question 8
Correct
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A 32-year-old patient with schizophrenia visits the clinic. He has observed discharge on his shirt twice and upon inspection, he noticed a milky fluid coming from his nipples. He recalls his psychiatrist mentioning that this could happen with his medication. What is the most probable reason for his discharge?
Your Answer: Risperidone
Explanation:Hyperprolactinaemia, which is characterized by high levels of prolactin, is a common side effect of certain atypical antipsychotics like risperidone. This medication can cause galactorrhoea, which is the abnormal secretion of milk due to the development of breast tissue and mammary glands.
Different antipsychotics have their own unique side effect profiles, and the most likely culprits of hyperprolactinaemia are haloperidol (a conventional antipsychotic) and risperidone (an atypical antipsychotic). While it is uncommon for most atypical antipsychotics to cause galactorrhoea, risperidone is an exception.
Other antipsychotics like clozapine are associated with agranulocytosis and myocarditis, while olanzapine is linked to dyslipidaemia, diabetes mellitus, and weight gain.
Atypical antipsychotics are now recommended as the first-line treatment for patients with schizophrenia, as per the 2005 NICE guidelines. These agents have a significant advantage over traditional antipsychotics in that they cause fewer extrapyramidal side-effects. However, atypical antipsychotics can still cause adverse effects such as weight gain, hyperprolactinaemia, and clozapine-associated agranulocytosis. Elderly patients who take antipsychotics are at an increased risk of stroke and venous thromboembolism, according to the Medicines and Healthcare products Regulatory Agency.
Clozapine is one of the first atypical antipsychotics to be developed, but it carries a significant risk of agranulocytosis. Therefore, full blood count monitoring is essential during treatment. Clozapine should only be used in patients who are resistant to other antipsychotic medication. The BNF recommends introducing clozapine if schizophrenia is not controlled despite the sequential use of two or more antipsychotic drugs, one of which should be a second-generation antipsychotic drug, each for at least 6-8 weeks. Clozapine can cause adverse effects such as reduced seizure threshold, constipation, myocarditis, and hypersalivation. Dose adjustment of clozapine may be necessary if smoking is started or stopped during treatment.
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This question is part of the following fields:
- Psychiatry
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Question 9
Incorrect
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What is the term used to describe the recurring thoughts of harming one's own family, even though the person does not want to act on them?
Your Answer: Compulsions
Correct Answer: Obsessional thoughts
Explanation:Possession of Thought
Possession of thought can be understood through the concepts of ego-syntonicity and ego-dystonicity. Ego-syntonic experiences are consistent with an individual’s self-image, while ego-dystonic experiences are not. Obsessional thoughts are unwanted and distressing thoughts, ideas, or images that are recognized as the individual’s own, making them ego-dystonic.
Thought broadcast is a passivity experience where the individual believes their thoughts are taken away from their head and widely broadcast. On the other hand, thought insertion is a phenomenon where the individual believes that their thoughts have been placed inside their head from outside. Both thought broadcasting and insertion are thought alienation experiences and are first rank symptoms of schizophrenia.
In the case of thought alienation experiences, the division between ego-syntonicity and ego-dystonicity is less clear. Although initially ego-syntonic, as the individual recovers from psychosis, they may recognize thought alienation experiences as more distressing and therefore more ego-dystonic in nature.
Compulsions are obsessional motor acts that the patient recognizes as unnecessary but cannot resist performing. possession of thought and its various experiences can aid in the diagnosis and treatment of mental health disorders.
Overall, possession of thought is a complex phenomenon that can have significant impacts on an individual’s mental health and well-being. By the different experiences and their relationship to ego-syntonicity and ego-dystonicity, mental health professionals can provide more effective treatment and support to those experiencing these symptoms.
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This question is part of the following fields:
- Psychiatry
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Question 10
Correct
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A middle-aged male patient with a history of schizophrenia and non-compliance with medication presents with delusions of alien possession. How would you characterize his delusions?
Your Answer: Delusions of control
Explanation:Schizophrenia Symptoms: Delusion of Control, Depersonalisation, and Delusions of Misidentification
Delusion of control, also known as passivity experience, is a primary symptom of schizophrenia identified by Schneider. This symptom is characterized by the belief that one’s body, mind, volition, or emotion is being controlled by another entity, being, or force. On the other hand, depersonalisation is the feeling of being disconnected from reality, often accompanied by derealisation.
Delusions of misidentification, another symptom of schizophrenia, can be divided into two types: Fregoli Syndrome and Capgras Syndrome. Fregoli Syndrome is the belief that someone whose appearance is unfamiliar is actually someone you know, while Capgras Syndrome is the belief that someone who looks familiar is an imposter.
Overall, these symptoms can significantly impact an individual’s perception of reality and their ability to function in daily life. It is important to seek professional help if experiencing any of these symptoms or suspecting someone else may be experiencing them.
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This question is part of the following fields:
- Psychiatry
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Question 11
Incorrect
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Sarah, a 25-year-old woman, arrives at the Emergency department after an impulsive overdose of 15 paracetamol tablets and a bottle of vodka. This is her sixth visit to the emergency department with a similar presentation in the past year.
Upon evaluation by the on-call psychiatry doctor, Sarah reveals that she took the pills after a fight with her boyfriend. Further questioning about her background reveals that she was a victim of childhood abuse. Sarah has had multiple intense relationships, but they never seem to last.
Sarah describes herself as feeling empty inside for several months. What is the most likely diagnosis?Your Answer: Emotionally unstable personality disorder - impulsive type
Correct Answer: Emotionally unstable personality disorder - borderline type
Explanation:Personality Disorders and their Characteristics
Janet’s behavior suggests that she may have emotionally unstable personality disorder – borderline type. This disorder is characterized by emotional instability, impulsivity, and deliberate attempts at self-harm. Individuals with this disorder often have intense but unstable relationships and feel a chronic sense of emptiness. Traumatic events in childhood may also be a factor.
In contrast, emotionally unstable personality disorder – impulsive type is characterized by explosive outbursts due to poor impulse control. These individuals may be quarrelsome and easily enter into conflict, particularly when their impulsive or explosive acts are interrupted.
Depressive episodes are characterized by low mood and other symptoms such as anhedonia, emotional blunting, changes in appetite and sleep patterns, feelings of guilt, and thoughts of suicide or death. Although Janet has taken an overdose, there are no other indications of a depressive episode in her history. However, a more detailed history may be necessary to determine if she is experiencing these symptoms or any other psychiatric illnesses.
It is important to note that individuals with personality disorders may also suffer from other psychiatric illnesses, known as co-morbidity. Histrionic personality disorder is characterized by shallow and labile affectivity, self-dramatization, theatricality, egocentricity, and a continual need for appreciation, excitement, and attention. Anakastic personality disorder is similar to obsessive-compulsive personality disorder and is characterized by preoccupation with detail, rules, organization, and schedules, which can hinder completion of tasks and relationships.
Overall, the characteristics of different personality disorders can help in identifying and treating individuals who may be struggling with these conditions.
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This question is part of the following fields:
- Psychiatry
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Question 12
Correct
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A teenager has presented to the school nurse and says that she is feeling fantastic. She is talking a lot, but also getting easily sidetracked and using exaggerated hand movements. This behavior is unusual for her, and the nurse decides to look into it further.
What symptom/sign is most commonly linked to this diagnosis?Your Answer: Decreased fatigability
Explanation:Hypomania is associated with a reduced need for sleep and lack of fatigue, which is a symptom commonly seen in type II bipolar disorder. It is less severe than mania but can still cause changes in mood and behavior. Schizophrenia is typically associated with third person auditory hallucinations, while second person auditory hallucinations are more commonly seen in mood disorders such as mania and depression. Decreased fatigability is a symptom of mania/hypomania, and patients with hypomania may sleep less without experiencing negative consequences. Nihilistic delusions are more commonly seen in severe depression, while impaired social functioning is more typical of mania than hypomania. Patients with hypomania tend to be more confident and sociable.
Understanding Bipolar Disorder
Bipolar disorder is a mental health condition that is characterized by alternating periods of mania/hypomania and depression. It typically develops in the late teen years and has a lifetime prevalence of 2%. There are two types of bipolar disorder: type I, which involves mania and depression, and type II, which involves hypomania and depression.
Mania and hypomania both refer to abnormally elevated mood or irritability. Mania is more severe and involves functional impairment or psychotic symptoms for 7 days or more, while hypomania involves decreased or increased function for 4 days or more. Psychotic symptoms, such as delusions of grandeur or auditory hallucinations, suggest mania.
Management of bipolar disorder involves psychological interventions specifically designed for the condition, as well as medication. Lithium is the mood stabilizer of choice, with valproate as an alternative. Antipsychotic therapy may be used for mania/hypomania, while fluoxetine is the antidepressant of choice for depression. comorbidities, such as diabetes, cardiovascular disease, and COPD, should also be addressed.
If symptoms suggest hypomania, routine referral to the community mental health team (CMHT) is recommended. If there are features of mania or severe depression, an urgent referral to the CMHT should be made. Understanding bipolar disorder and its management is crucial for healthcare professionals to provide appropriate care and support for individuals with this condition.
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This question is part of the following fields:
- Psychiatry
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Question 13
Correct
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Samantha is a 60-year-old female who is well known to the emergency department due to regular admissions of intoxication and related incidents. The last time she was admitted was because of a fall after a drinking binge, it was later discovered that this was caused by visual impairment and balance issues. Before treatment could be initiated, she self-discharged.
This admission she was found roaming the streets with no clothes on, no idea of how she got there or who she was. Whilst in the department she would constantly ask where she was and when she could home, despite being told numerous times.
Which of the following would you expect to see in this patient?Your Answer: Confabulation
Explanation:Withdrawal from alcohol can lead to hallucinations, often in the form of visual images such as rats or bugs crawling on or around the patient.
Understanding Korsakoff’s Syndrome
Korsakoff’s syndrome is a memory disorder that is commonly observed in individuals who have a history of alcoholism. This condition is caused by a deficiency in thiamine, which leads to damage and haemorrhage in the mammillary bodies of the hypothalamus and the medial thalamus. Korsakoff’s syndrome often follows untreated Wernicke’s encephalopathy, which is another condition caused by thiamine deficiency.
The primary features of Korsakoff’s syndrome include anterograde amnesia, which is the inability to acquire new memories, and retrograde amnesia. Individuals with this condition may also experience confabulation, which is the production of fabricated or distorted memories to fill gaps in their recollection.
Understanding Korsakoff’s syndrome is crucial for individuals who have a history of alcoholism or thiamine deficiency. Early diagnosis and treatment can help prevent further damage and improve the individual’s quality of life. Proper nutrition and abstinence from alcohol are essential for managing this condition.
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This question is part of the following fields:
- Psychiatry
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Question 14
Incorrect
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A 26-year-old woman confides in you that she cannot leave her house without first performing a specific ritual of sanitizing her door handle and washing her hands before and after leaving. She admits that if she deviates from this routine, she becomes extremely anxious and tense. This behavior has been ongoing for two years and is causing her significant distress.
What is the recommended course of treatment for this probable diagnosis?Your Answer: Olanzapine
Correct Answer: Exposure-response prevention (ERP) therapy
Explanation:Understanding Obsessive-Compulsive Disorder
Obsessive-compulsive disorder (OCD) is a mental health condition that affects 1 to 2% of the population. It is characterized by the presence of obsessions, which are unwanted intrusive thoughts, images, or urges, and compulsions, which are repetitive behaviors or mental acts that a person feels driven to perform. OCD can cause significant functional impairment and distress.
The causes of OCD are multifactorial, with possible factors including genetics, psychological trauma, and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS). OCD is also associated with other mental health conditions such as depression, schizophrenia, Sydenham’s chorea, Tourette’s syndrome, and anorexia nervosa.
Treatment for OCD depends on the level of functional impairment. For mild impairment, low-intensity psychological treatments such as cognitive behavioral therapy (CBT) including exposure and response prevention (ERP) may be sufficient. If this is not effective or the patient cannot engage in psychological therapy, a course of an SSRI or more intensive CBT (including ERP) may be offered. For moderate impairment, a choice of either an SSRI or more intensive CBT (including ERP) may be offered. For severe impairment, combined treatment with an SSRI and CBT (including ERP) may be necessary.
ERP is a psychological method that involves exposing a patient to an anxiety-provoking situation and then stopping them from engaging in their usual safety behavior. This helps them confront their anxiety, and the habituation leads to the eventual extinction of the response. If treatment with an SSRI is effective, it should be continued for at least 12 months to prevent relapse and allow time for improvement. If an SSRI is ineffective or not tolerated, another SSRI may be tried.
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This question is part of the following fields:
- Psychiatry
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Question 15
Incorrect
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A 30-year-old male presents to a mental health specialist with a belief that the government has taken over his body. He is prescribed an antipsychotic medication. What are the potential side effects of this type of medication?
Your Answer: Hypothyroidism
Correct Answer: Metabolic syndrome
Explanation:Antipsychotics block dopamine receptors, resulting in a broad range of side effects. These may include dystonia, dyskinesia, antiemetic effects, and hyperprolactinemia. Additionally, antipsychotics can cause metabolic syndrome and a prolonged QT interval, so caution is necessary. The other choices do not pertain to the side effects of antipsychotics.
Antipsychotics are a type of medication used to treat schizophrenia, psychosis, mania, and agitation. They are divided into two categories: typical and atypical antipsychotics. The latter were developed to address the extrapyramidal side-effects associated with the first generation of typical antipsychotics. Typical antipsychotics work by blocking dopaminergic transmission in the mesolimbic pathways through dopamine D2 receptor antagonism. However, they are known to cause extrapyramidal side-effects such as Parkinsonism, acute dystonia, akathisia, and tardive dyskinesia. These side-effects can be managed with procyclidine. Other side-effects of typical antipsychotics include antimuscarinic effects, sedation, weight gain, raised prolactin, impaired glucose tolerance, neuroleptic malignant syndrome, reduced seizure threshold, and prolonged QT interval. The Medicines and Healthcare products Regulatory Agency has issued specific warnings when antipsychotics are used in elderly patients due to an increased risk of stroke and venous thromboembolism.
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This question is part of the following fields:
- Psychiatry
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Question 16
Correct
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What is one of Schneider's primary symptoms of schizophrenia?
Your Answer: Delusional perception
Explanation:First and Second-Rank Symptoms of Schizophrenia
Schizophrenia is a mental illness that is characterized by a range of symptoms. Kurt Schneider, a German psychiatrist, identified certain symptoms as strongly suggestive of schizophrenia and called them first-rank symptoms. These symptoms include delusions, auditory hallucinations, thought disorder, and passivity experiences. Delusions can be described as false beliefs that are not based on reality. Auditory hallucinations involve hearing voices that are not there, and thought disorder refers to a disruption in the normal thought process. Passivity experiences include feelings of being controlled by an external force.
Schneider also identified second-rank symptoms, which are common in schizophrenia but can also occur in other mental illnesses. These symptoms include mood changes, emotional blunting, perplexity, and sudden delusional ideas. It is important to note that while these symptoms are suggestive of schizophrenia, they are not diagnostic.
Other experiences that can occur in schizophrenia include reflex hallucinations, thought blocking, flight of ideas, and hypnopompic hallucinations. Reflex hallucinations occur when a true sensory stimulus causes an hallucination in another sensory modality. Thought blocking is a sudden interruption of the train of thought, often experienced as a snapping off. Flight of ideas is a rapid stream of thought that may lack direction or purpose. Hypnopompic hallucinations occur as a person awakes and can continue once the individual’s eyes open from sleep.
In summary, schizophrenia is a complex mental illness that can present with a range of symptoms. While certain symptoms are strongly suggestive of schizophrenia, a diagnosis should be made by a qualified mental health professional based on a comprehensive evaluation.
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This question is part of the following fields:
- Psychiatry
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Question 17
Correct
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A 25-year-old patient with paranoid schizophrenia has discontinued their medication and is experiencing distress. As they walk home, they observe a traffic light turn red and immediately interpret it as a sign of the impending apocalypse. How would you classify this delusion?
Your Answer: Delusional perception
Explanation:Types of Delusional Symptoms in Psychotic Disorders
Delusional perception is a symptom commonly seen in schizophrenia and other psychotic disorders. It occurs when a normal perception takes on a unique and delusional significance for the patient. For example, a red traffic light may be perceived as a sign of the end of the world. This symptom is considered a first rank symptom by psychiatrist Kurt Schneider.
Autochthonous delusions, also known as delusional intuitions, are sudden and unexplained delusions that arise in the patient’s mind. These delusions are not based on any external stimuli or perceptions, but rather grow from within the patient’s mind.
Delusional memories are memories that are partially based on true events from the past, but with delusional beliefs attached to them. For example, a patient may believe that a chip has been inserted in their head following a surgery to remove a cyst, even though this is not true.
Delusional atmosphere is a poorly understood phenomenon where the patient experiences an overwhelming feeling that something important is happening or that the world has changed, but they are unable to understand what or how. This feeling may be associated with anxiety, depression, or excitement, and can lead to the development of delusions.
In summary, delusional symptoms can take on various forms in psychotic disorders, including delusional perception, autochthonous delusions, delusional memories, and delusional atmosphere. These symptoms can greatly impact the patient’s perception of reality and require careful management and treatment.
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This question is part of the following fields:
- Psychiatry
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Question 18
Incorrect
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A middle-aged woman presents with complaints of profound sadness, marked difficulty concentrating, and an inability to make decisions. During the evaluation, she speaks slowly and struggles to articulate her emotions. How would you characterize the alterations in her cognitive functioning and thought processes?
Your Answer: Thought block
Correct Answer: Psychomotor retardation
Explanation:Psychomotor Retardation in Severe Depression
Psychomotor retardation is a cognitive symptom commonly observed in individuals with severe depression. It is characterized by a significant slowing down of both thinking and behavior. This symptom can manifest in various ways, such as slowed speech, reduced movement, and delayed responses. Psychomotor retardation can significantly impact an individual’s ability to carry out daily activities and can lead to social withdrawal and isolation.
It is essential to differentiate psychomotor retardation from other forms of thought disorders seen in other psychiatric conditions such as mania and schizophrenia. In mania, individuals may experience racing thoughts and increased energy levels, while in schizophrenia, disorganized thinking and speech patterns are common. Therefore, a thorough evaluation by a mental health professional is necessary to accurately diagnose and treat psychomotor retardation in severe depression.
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This question is part of the following fields:
- Psychiatry
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Question 19
Correct
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A nursing student is concerned after hearing a voice calling her name while drifting off to sleep. She has no history of hearing voices and denies any symptoms of psychosis. There is no evidence of substance abuse or alcohol misuse.
What is the probable diagnosis for her encounter?Your Answer: Hypnagogic hallucination
Explanation:Hypnagogic and Hypnopompic Hallucinations
Hypnagogic and hypnopompic hallucinations are common experiences that have been known since ancient times. Hypnagogic hallucinations occur when falling asleep, while hypnopompic hallucinations occur when waking up in the morning and falling asleep again. These hallucinations are mostly auditory in nature, with individuals typically hearing their name being called. However, they can also occur in other modalities such as vision, smell, and touch.
It is important to note that hypnagogic and hypnopompic hallucinations differ from illusions and elementary hallucinations. An illusion is the misperception of an actual stimulus, while an elementary hallucination is a simple noise such as knocking or tapping. On the other hand, a functional hallucination is triggered by a stimulus in the same modality. For example, hearing a doorbell may cause the individual to hear a voice.
the different types of hallucinations can help individuals recognize and cope with their experiences. It is also important to seek medical attention if these hallucinations become frequent or interfere with daily life. By these phenomena, individuals can better navigate their experiences and seek appropriate treatment if necessary.
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This question is part of the following fields:
- Psychiatry
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Question 20
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A 68-year-old man is brought to the Emergency Department on Thursday evening after falling and hitting his head on the pavement. He was found to be heavily intoxicated and unable to stand. A CT scan of his head reveals a crescent-shaped hematoma on the right side. The patient undergoes a burr-hole craniostomy with irrigation, which goes smoothly. However, two days later, the nursing staff notices that he is restless and agitated. He is speaking to his deceased wife, who passed away 15 years ago, and does not recognize any of the nurses. Additionally, he has developed hand tremors.
What medication has been overlooked by the medical team caring for this patient?Your Answer: Morphine
Correct Answer: Chlordiazepoxide
Explanation:Long-acting benzodiazepines are administered in decreasing doses to manage alcohol withdrawal symptoms in patients with a history of alcohol abuse. A man with such a history presents with anxiety, restlessness, visual and auditory hallucinations, and tremors 48 hours after his last alcohol intake. Chlordiazepoxide, a benzodiazepine, is prescribed to alleviate acute alcohol withdrawal and anxiety. Mannitol is indicated for cerebral edema, furosemide is a diuretic, and escitalopram is commonly used to treat anxiety and depression.
Alcohol withdrawal occurs when an individual who has been consuming alcohol chronically suddenly stops or reduces their intake. This is due to the fact that chronic alcohol consumption enhances GABA-mediated inhibition in the central nervous system (CNS), similar to benzodiazepines, and inhibits NMDA-type glutamate receptors. When alcohol consumption is stopped, the opposite occurs, resulting in decreased inhibitory GABA and increased NMDA glutamate transmission.
Symptoms of alcohol withdrawal typically start within 6-12 hours and include tremors, sweating, tachycardia, and anxiety. Seizures are most likely to occur at around 36 hours, while delirium tremens, which is characterized by coarse tremors, confusion, delusions, auditory and visual hallucinations, fever, and tachycardia, is most likely to occur at around 48-72 hours.
Patients with a history of complex withdrawals from alcohol, such as delirium tremens, seizures, or blackouts, should be admitted to the hospital for monitoring until their withdrawals stabilize. The first-line treatment for alcohol withdrawal is long-acting benzodiazepines, such as chlordiazepoxide or diazepam, which are typically given as part of a reducing dose protocol. Lorazepam may be preferable in patients with hepatic failure. Carbamazepine is also effective in treating alcohol withdrawal, while phenytoin is said not to be as effective in the treatment of alcohol withdrawal seizures.
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This question is part of the following fields:
- Psychiatry
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