FRCPC Mental Health Review

Question 1

List 5 short term side effects of risperidone

Answer 1

• Acute dystonic reaction
• Tremor
• Sedation
• Akathisia
• Parkinsonian symptoms
• Weight gain
• Lethargy
• Hyperprolactinemia

Question 2

List 5 long term side effects of risperidone

Answer 2

• Hyperlipidemia
• Hyperglycemia
• Type 2 DM
• Significant weight gain
• HTN

Question 3

List a differential diagnosis for psychosis

Answer 3

• Mood disorder with psychotic features
• Substance use disorder
• Manic episode with psychosis
• Obsessive compulsive disorder
• Psychotic disorder due to a generalized medical condition: NMDA receptor encephalitis, seizure disorder, CNS lupus, post viral encephalitis, temporal lobe lesion

Question 4

List the diagnostic criteria for serotonin syndrome

Answer 4

• Spontaneous clonus
• Hypertonia PLUS temp > 38 PLUS inducible or ocular clonus
• Inducible clonus PLUS agitation/diaphoresis
• Tremor, hyperreflexia
• Ocular clonus PLUS agitation/diaphoresis

Question 5

Contrast three differences between SS and NMS

Answer 5

• SS: Rapid onset within 24 hours, neuromuscular hyperreactivity (tremors, clonus), resolution over 24 hours with discontinuation of SSRI and benzos
• NMS: Slow onset over days to weeks, bradyreflexia and lead pipe rigiditiy, treated with bromocriptine and resolves over days to weeks

Question 6

List 5 adverse effects seen with stimulant medications

Answer 6

• Appetite suppression
• Transient weight loss
• Irritability
• Emergence of tics
• Mild sleep disturbances

Question 7

List the DSM-5 Diagnostic criteria for depression

Answer 7

A. Presence of a major depressive episodes
B. MDE not better accounted for by schizoaffective disorder and is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder or psychotic disorder NOS
C. There has never been a history of mania or hypomania

Question 8

List the DSM-5 diagnostic criteria for manic episode

Answer 8

Need to have 3 of 7 (or 4 of 7 if the mood is only irritable) [GST PAID] for 1 week

• Grandiosity
• Sleep need decreased
• Talkative
• Pleasurable activities, painful consequences
• Activity increased
• Ideas: flight of ideas
• Distractibility

Question 9

List the DSM-5 diagnostic criteria for OCD

Answer 9

A. Presence of obsessions, compulsions or both
Obsessions defined as:
- Recurrent and persistent thoughts, urges, images experienced, are intrusive or unwanted and cause distress
- Individual attempts to ignore, suppress or neutralize these thoughts
Compulsions defined as:
- Repetitive behaviours, mental acts the individual feels driven to perform in response to an obsession or according to their rules
- Behaviours or mental acts aimed at preventing/reducing anxiety or distress or preventing some dreaded thing from happening
B. Obsessions/compulsions time consuming and take up > 1 hour of the day or cause clinically significant impairment in functioning

Question 10

List the DSM 5 diagnostic criteria for trichotillomania

Answer 10

• Recurrent pulling of ones hair resulting in hair loss
• Recurrent attempts to stop puling out hair
• Hair pulling causes significant distress and impairment in at least one important area of functioning
• Hair pulling is not attributable to another medical condition or disorder
• Hair pulling is not better explained by another mental disorder

Question 11

What is the natural history of trichotillomania?

Answer 11

Usually spontaneously resolves

Question 12

List the four categories of symptoms for Conduct disorder

Answer 12

1. Aggression to people and animals: bullies, picks fights, has used a weapon, physically cruel to both people and animals, stolen while confronting a victim, forced someone into sexual activity
2. Destruction of property: fire setting, deliberately destroying others property
3. Deceitfulness or theft: B and E, lies to get things, stealing items of non trivial value
4. Serious rule violations: stays out at night before age 13, run away from home, truant from school

Question 13

List 7 features of ODD

Answer 13

• Annoying
• Resentful
• Easily annoyed
• Blames others
• Rule breaking
• Argues with adults
• Temper
• Spiteful/vindictive

Question 14

List the three categories of behaviours for ODD

Answer 14

1. Angry and irritable mood
2. Argumentative and defiant behaviour
3. Vindictiveness

Question 15

List two non pharmacological management strategies for ODD

Answer 15

• Parent skills training

- Child directed social emotional skills training

Question 16

List 5 comorbidities associated with ODD

Answer 16

• ADHD
• Anxiety
• Depression
• Bipolar disorder
• PTSD
• Substance abuse
• Problems with impulse control
• Communication disorders

Question 17

List 5 clinical characteristics of PANDAS

Answer 17

• OCD and/or tic disorder
• Prepubertal age of onset
• Abrupt onset and relapsing-remitting course
• Associations with neurological abnormalities
• Temporal association between symptom exacerbation and GAS infection

Question 18

List five differential diagnoses for separation anxiety disorder and school refusal

Answer 18

• Selective mutism
• Specific phobia
• Social phobia
• Agoraphobia
• Panic disorder
• GAD
• OCD
• Acute stress disorder
• PTSD
• Substance induced anxiety disorder
• Adjustment disorder with anxiety
• ODD
• CD
• MDD
• Dysthymia

Question 19

List the diagnostic criteria for panic disorder

Answer 19

A. Recurrent panic attacks
B. 1 month or longer feeling anxious about panic attacks and maladaptive behavioural change
C. Disturbance not attributable to psychological effects of a substance or another medical condition
D. Disturbance not better explained by another mental disorder

Question 20

Describe features of a panic attack

Answer 20

Need to have > 4 of the following:

• Sweating
• Tremors
• Unsteadiness, dizziness
• Depersonalization, derealization
• Excessive HR, palpitations
• Nausea
• Tingling
• Fear of dying, losing control, going crazy
• Chills, Choking, Chest pain

Question 21

List three management strategies for panic disorder

Answer 21

• CBT
• Relaxation techniques
• SSRIs

Question 22

Name 5 social/emotional/psychological conditions homosexual youth are at risk for

Answer 22

• Depression
• Anxiety
• Suicide
• Bullying: verbal and physical assaults at school
• Higher risk of dropping out of school
• Higher risk of being kicked out of their home
• More likely to start using tobacco, alcohol and drugs
• Poor self esteem, difficulties with identity formation

Question 23

List the DSM 5 diagnostic criteria for schizophrenia

Answer 23

A. Need to have 2 or more of the following each present for a significant period of time during a one month period. At least one of these must be 1, 2 or 3.
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behaviour
5. Negative symptoms
B. Level of functioning must be significantly below that previously attained prior to the onset
C. Continuous signs of disturbance persist for at least 6 months

Question 24

List 5 RFs for suicide

Answer 24

• Academic or social problems
• Bullying
• Trouble with the law
• Family instability
• Questioning one’s sexual orientation
• Newly diagnosed medical condition
• Recent or anticipated loss
• Mental illness
• Prior deliberate self harm or suicide attempt
• Impulsivity
• Family factors: family history of suicide
• Lack of connection to psychosocial support

Question 25

List 5 things that would make you suspect a diagnosis of Munchausen by proxy

Answer 25

- Reported history varies significantly from what is seen on direct observation of the child - Histories may vary significantly between different observers - Illness often recurrent, unexplained, unusual, prolonged and does not respond to treatment as expected - Family history may indicate siblings who have died or had similar illnesses - Patient is subject to a large amount of health care without improvement in their symptoms - Signs or symptoms only begin in the presence of the caregiver - Clinical improvement may occur when the child is separated from the caregiver

Question 26

Define Munchausen by proxy

Answer 26

- Child receiving unnecessary and harmful or potentially harmful medical care due to a caregiver's overt actions including exaggeration of symptoms, lying about the history, simulating physical findings or inducing illness in their child

Question 27

List a differential diagnosis for a teenager with recent behavioural change

Answer 27

- Substance abuse - Brief psychotic disorder - Schizophrenia - Psychotic disorder NOS - Schizoaffective disorder - MDD with psychotic features - Bipolar disorder with psychotic features - Tumor - Vasculitis - Infection/meningitis/cerebritis/encephalitis - Head trauma - NMDA receptor encephalitis

Question 28

List the diagnostic criteria for Tourette syndrome

Answer 28

- Multiple motor and verbal tics for > 1 year - No tic free interval lasting > 3 months - Onset before the age of 18 years - No medical causes

Question 29

List 5 comorbidities commonly seen with Tourette syndrome

Answer 29

- OCD - ADHD - Learning disorders - Conduct disorder - Oppositional defiant disorder

Question 30

List 5 differential diagnosis for a child who presents with inattentive and impulsive behaviour

Answer 30

- ADHD - Learning disability - Hearing impairment - Vision impairment - Autism spectrum disorder - Neurodevelopmental syndrome - Seizure disorder - Sequelae of CNS infection or trauma - Metabolic disorder: ALD, MPS - Motor coordination disorder - Anxiety disorder - Mood disorder - ODD - Conduct disorder - OCD - PTSD - Adjustment disorder - Parental mental health concerns - Lead poisoning - Thyroid problems - Sleep disorders - Substance use disorders

Question 31

List the diagnostic criteria for ADHD

Answer 31

``` Onset under 12 years of age Need 6/9 inattentive symptoms: 1. Avoids tasks requiring sustained mental effort 2. Bad at organizing tasks 3. Careless mistakes 4. Difficulty sustaining attention 5. Easily distracted 6. Forgetful 7. Going to lose their things 8. Fails to listen when spoken to directly 9. Fails to complete tasks Need 6/ hyperactivity/impulsivity symptoms 1. Fidgets 2. Leaves their seat inappropriately 3. Inappropriate running/climbing 4. Goes as if 'driven by a motor' 5. Hates engaging in quiet activities 6. Talkative 7. Blurts out the answer before the question is complete 8. Interrupts others 9. Difficulty waiting for their turn ```

Question 32

List the DSM-5 diagnostic criteria for Autism Spectrum Disorder

Answer 32

A. Persistent deficits in social communication and social interaction across multiple contexts: 1. Deficits in social emotional reciprocity 2. Deficits in non verbal communication behaviours 3. Deficits in developing, maintaining and understanding relationships B. Restricted, repetitive patterns of behaviour, interests or activities as manifested by 2 of the following: 1. Stereotyped or repetitive motor movements 2. Insistence on sameness, inflexible adherence to routines, ritualized patterns of verbal or non verbal behaviour 3. Highly restricted, fixated interests abnormal in intensity or focus 5. Hyper or hyporeactive to sensory inputs or unusual interests in sensory aspects of enviroment THINK SHELDON!

Question 33

List 5 disorders associated with autism

Answer 33

- Fragile X syndrome - Rett syndrome - Angelman syndrome - Tuberous sclerosis - Smith-Lemli-Opitz syndrome

Question 34

List the DSM-5 diagnostic criteria for specific learning disorder

Answer 34

A. Difficulties learning and using academic skills as indicated by the presence of the following symptoms that have persisted for at least 6 months despite provision of interventions that target those difficulties: 1. Inaccurate or slow and effortful word reading 2. Difficulty understanding the meaning of what is read 3. Difficulties with spelling 4. Difficulties with written expression 5. Difficulties mastering number sense, number facts of calculation 6. Difficulties with mathematical reasoning