Behavioral/Ethics

Question 1

patients with schizophrenia have what NT change?

Answer 1

Increased dopamine
Dopamine hypothesis: hyperactive dopaminergic activity in the mesolimbic system leads to psychosis, and dec in mesocortical dopamine causes negative and cognitive sx.

Question 2

patient with dilated pupils, tremors, inc HR and RR, lack coordination, hallucinations, and ideas of reference from TV are consistent with intoxication with what?

Answer 2

LSD (hallucinogen)

Question 3

dry mouth, slowed reactions, inc appetite are common symptoms of ____ intoxication?

Answer 3

cannabis.

Question 4

Nightmares are a common symptom accompanying withdrawal from what?

Answer 4

Amphetamines or alcohol

Question 5

Hallucinations while falling asleep is a common symptom of what condition?

Answer 5

Narcolepsy

Question 6

What is it called when we respond to people or situations in the present as if they were people or situations from our past experience?

Answer 6

Transference

Question 7

Dilated pupils, yawning, piloerection, lacrimation, hyperactive bowel sounds are common signs of _____ withdrawal

Answer 7

heroin

Question 8

Delusions, hallucinations, disorganized speech for at least 1 mo. Negative sx (flat affect, asociality, anhedonia). Continuous signs for >6mo

Answer 8

Schizophrenia

Question 9

In what disorders do psychotic symptoms occur EXCLUSIVELY during major depressive or manic episode?

Answer 9

Major depressive disorder with psychotic features

Bipolar disorder

Question 10

Acute onset of psychotic symptoms >=1 day but <1 mo with full return to premorbid level of functioning

Answer 10

Brief psychotic disorder

Question 11

How is schizophreniform disorder different from schizophrenia?

Answer 11

> 1 mo and <6mo

Question 12

Delusions or hallucinations can occur in the ABSENCE of mood symptoms for >=2 wk at some point

Answer 12

SchizoAFFECTIVE

Question 13

Violent behavor, hallucinations, nystagmus, amnesia, and ataxia are signs of ____ intoxication

Answer 13

PCP - phencyclidine

Question 14

Chest pain, agitation, euphoria, seizures, tachycardia, HTN are signs of ____ intoxication

Answer 14

Cocaine

Question 15

Violent behavior, choreiform movements, tooth decay are signs of _____ intoxication

Answer 15

Methamphetamine

Question 16

Differentiate chronic tic disorder from Tourretes

Answer 16

Chronic tic disorder: 1+ motor or verbal tics (but not both) for >= 1 year
Tourretes: BOTH vocal and motor tics

Question 17

How does opioid intoxication present?

Answer 17

Miosis, depressed mental status, dec resp rate, dec bowel sounds
HYPOtension, BRADYcardia

Question 18

Differentiate delusional disorder from paranoid personality disorder

Answer 18

Delusional: >=1 delusions in absence of other psych sx
Paranoid personality: persistent patterns of behavior pervasive across broad range of situations. Suspiciousness or distrust of many people.

Question 19

Selection bias created by choosing hospitalized patients as the control group

Answer 19

Berkson’s bias

Question 20

Tendency of study subjects to change behavior as a result of awareness they are being studied

Answer 20

Hawthorne effect

Question 21

Researcher’s belief in the efficacy of treatment can potentially affect outcome

Answer 21

Pygmalion effect (eg case with “low IQ and high IQ students”)

Question 22

Differentiate acute stress disorder from PTSD

Answer 22

Can present similarly - duration makes the difference
Acute stress = 3 days to 1mo after trauma
PTSD = >=1 mo

Question 23

Inc appetite, hypersomnia, intense PSYCHOMOTOR RETARDATION, severe depression is a sign of ____ withdrawal

Answer 23

Cocaine/stimulants

Question 24

Inc appetite, dysphoria, irritability, and anxiety is a sign of ___ withdrawal

Answer 24

nicotine

Question 25

Differentiate bipolar I vs bipolar II

Answer 25

Bipolar I - manic episodes +/- depressive episodes
Bipolar II - hypomanic + >=1 depressive episode
Note: hypomanic - no psychosis and able to work without hosp.

Question 26

Learning disorder vs ADHD?

Answer 26

Learning d/o difficulty with key academic skills (eg reading, writing, math) –> low performance.
ADHD - inattentive/hyperactive across at least 2 settings

Question 27

College student with paranoid ideation tachy, HTN, hyperthermia, diaphoresis, mydriasis indicates what?

Answer 27

Substance-induced psychotic disorder

Note: brief psychotic disorder is similar, but less likely in college students. Substance abuse more likely

Question 28

Deficits of voluntary motor and/or sensory function that are incompatible with any recognized neurological condition

Answer 28

Conversion disorder
Note: somatic symptom d/o is characterized by excessive and persistent health anxiety and preoccupation with multiple somatic symptoms.

Question 29

Increased appetite and sleep, leaden paralysis, rejection sensitivity, and mood reactivity are hallmarks of what?

Answer 29

Atypical depression

Tx with MAOI - eg phenelzine

Question 30

Differentiate repression from suppression from rationalization

Answer 30

Repression - unacceptable thoughts or feelings are blocked from entering conscious awareness
Suppression - mature defense mech involving conscious choice not to dwell on a particular thought or feeling.
Rationalization - making excuses for unacceptable feelings or situations.

Question 31

In the US, the majority of overdose deaths are caused by what?

Answer 31

opioids - prescription analgesics and heroin

Question 32

Individuals with this personality disorder appear to comply or act appropriately, but actually behave negatively and passively resist. This personality disorder is a chronic condition, meaning that it lasts throughout life.

Answer 32

passive-aggressive personality disorder

Question 33

Boy with daily headaches, confused, forgetful, clumsy, broad-based, ataxic gait is suspicious of what substance abuse?

Answer 33

inhaled glue - intentional inhalation of volatile
hydrocarbons, such as model glue, correction fluid, spray paint, and gasoline, to achieve
an altered mental state.
It is a common health problem in adolescence. “quick drunk” because it resembles alcoholic intoxication. Initially, euphoria develops; then, lightheadedness and
agitation. Disorientation, ataxia, and dizziness might develop with increasing intoxication. In extreme cases, generalized weakness, hallucinations, and nystagmus can occur. Abusers often show deterioration in school performance, disturbance of family relationships, and increased risk-taking behaviors. Encephalopathy is the major chronic morbidity following chronic inhalant abuse. Hydrocarbons are highly lipophilic and can
easily distribute to the brain.

Question 34

If you are giving a patient bad news and before you can tell them they say “it’s bad news, isn’t it?”, what do you say?

Answer 34

Yes it is.

Question 35

Patient with close friend who wants to stay after visiting hours when the unit policy is only family members are permitted to stay. What do you say?

Answer 35

“the two of you seem to have a very important relationship. Of course you may stay together”

Question 36

What do you do if a patient’s family member wants to give a benign folk medicine instead of the treatment you are giving?

Answer 36

Negotiate rather than order
Treatment choices are the result of agreement, not commands by the physician.
Relationship and agreement support adherence.
Accept the health beliefs of the patients
Be accepting of benign folk medicine practice. Expect them. Dx need to be explained in the way patients can understand, even if not technically precise.
Offer to explain things to family members for the patients

Question 37

What symptoms would be more likely to improve in a patient treated with clozapine rather than haloperidol?

Answer 37

Atypical antipsychotics (e.g. clozapine, quetiapine, etc) are more likely to improve NEGATIVE symptoms (affective flattening, anhedonia, avolition, aphasia) when compared to typical antipsychotics (e.g. haloperidol). They are no more effective at treating positive symptoms (hallucinations, delusions). Highly testable fact.*