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1
Q

A 19yo female presents with cc of intermittent abd pain associated with recent, frequent episodes of regurgitation of food for the past several months and worsening over the past 12 hours. She maintains a normal weight for her height however she seems obsessed with losing weight. On exam, PA notes multiple dental caries, bilat parotid gland tenderness and mild epigastric tenderness.
What would you expect to find on lab testing to support your suspected diagnosis?

A

Hypokalemia

most likely dx is bulemia nervosa- purging type. supportive lab findings would be hypochloremia with subsequent hypokalemia d/t renal compensatory mechanisms, hypomag and metabolic alkalosis

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2
Q

Divorced female pt presents for employment physical. states she has not been able to hold any job for longer than 2-3 months. She has been arrested several times for fighting when out with girls. she reports she drinks and occasional beer but denies significant problems with alcohol.
what lab findings support suspected dx?

A

Increase MCV

pt likely abuses alcohol. lab tests reveal elevated MCV, triglycerides, serum uric acid and LFTs.

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3
Q

53 year old male with hx of HTN treated with Atenolol. Currently presenting with cc of chronic fatigue, insomnia, decreased appetite and difficulty concentrating for 3 weeks. wife notes he no longer goes out with friends and has lost interest in sexual intimacy. PE is unremarkable.
What is the most likely diagnosis

A

Major depression

dx criteria include loss of pleasure in activities, vegatative or physical changes and cognitive changes.

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4
Q

Pt presents within 1 hour of ingesting 30 tablets of Diazepam. What is the most appropriate intervention

A

Gastric lavage

along with admin on activated charcoal and monitoring of vitals and CNS status. Flumazenil might be used with caution in certain patients

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5
Q

Which of the following is effective in long-term management on panic attacks?
* Triazolam
* Propranolol
* Lorazepam
* Fluoxetine

A

Fluoxetine

SSRI are initial drug of choic for long term tx of panic d/o

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6
Q

Phenothiazines exert their antipsychotic effect by blocking…

A

dopamine receptors

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7
Q

17 yo presents to ED with agitation and hallucinations and has had one seizure. Pt admits to “some drugs” but doesn not know what they were. On PE temp is 103, BP 140/90, pulse 120, Resp 20. remainder of PE WNL.
What diagnostic study is most helpful in manageent of this patient?

A

Serum Creatinin Kinase

most sensitive test for rhabdomyolosis

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8
Q

What is first-line therapy for schizophrenia?

A

Olanzapine (Zyprexa)

initial rx treatment should be ‘atypical’ antipsychotics due to decreased SE profile

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9
Q

25 yo female presents to student health center for 8th time in 3 weeks. Pt is concered she has meningitis becuase she heard someone on campus had meningitis one month ago and now she has headaches. Pt is requesting to be tested to rule out meningitis. PE has been WNL every visit.
what is the most likely dx?

A

somatic symptom disorder

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9
Q

28yo male treated for depression with paroxetine for the past 2 1/2 months with improvement in symtpoms. Pt reports sexual dysfunction believed to be due to medication.
what is the immediate concern with abrupt discontinuation of paroxetine?

A

risk of drug withdrawal symtpoms

can see cholinergic rebound

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9
Q

What are early impending delirium tremens signs

A

agitation and decreased cognition

anxiety, decreased cognition, increasing irritability and hyperactivity are common early clues.

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10
Q

19yo female has been consuming 6 beers/day since she was 16. Pt is pregnant with her first child, little prenatal care, due to deliver in 4 weeks.
what neonatal problems should be anticipated?

A

Low birth weight

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10
Q

Pt with advanced AIDs complicated by Toxoplasmosis presents with AMS, recent seizure onset, and focal neurological deficits. what diagnostic study would be most helpful?

A

MRI of the brain.

assist in showing mass lesions

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11
Q

Pt presents with episode of expanisve, elevated mood during which she cleaned excessively without sleeping. What is the most likely dx?

A

Bipolar disorder

Bipolar disorder is characterized by episodic mood shifts form depression to manic type moods.

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12
Q

25 yo female presents to ED due to collapse at work. hx is significant for mood disorder that causes her to have “wild mood swings and reckless behavior” according to husband. dx a year ago and been treated with several medications. symptoms today are nausea, vomiting, fatigue, tremor and hyperreflexia. Labs show elevated BUN and Cr, low sodium and elevated drug levels.
What medication is most likely to cause her symptoms?

A

Lithium

Lithium toxic

any sodium loss results in increased lithium levels.

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13
Q

What are formications

A

sensation of insects crawling on skin and commonly associated with delirium tremens

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14
Q

Formications are most commonly associated with what?

A

Alcohol withdrawal

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15
Q

What class of antidepressants are associated with anticholinergic side effects, including cardiac dysrhythmias, sedation, orthostatic hypotension and dry mouth?

A

TCAs

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16
Q

24 yo female presents to the office for PE. Dressed in low cut shirt and short skirt. Dramatic, emotional and sexually provocative. She complains of difficulty being intimate with men. she seems to over emphasize the severity of current cold. what personality disorder is suspected?

A

Histrionic

attention seekers and exaggerate their thoughts and feelings and are often sexually provocative.

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17
Q

25 yo male given Haloperidol IM for violent psychotic outburst. Initially he quiets down, but an hour later develops confusion, inability to open his mouth and temp of 40 degrees C. What is the initial tx of choice for this patient

A

Dantrolene

pt likely has neuroleptic malignant syndrome and tx is dantrolene and bromocriptine.

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18
Q

What is neuroleptic malignant syndrome

A

life-threatening neurologic emergency associated with the use of antipsychotic (neuroleptic) agents and characterized by a distinctive clinical syndrome of mental status change, rigidity, fever, and dysautonomia.

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19
Q

what is the difference between schizophrenia and schizophreniform disorder?

A

same features as schizophrenia except duration of illness is at least one month and less than six months

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20
Q

What lab test should be taken every 6-12 months for a pt on Lithium

A

TSH

lithium induces hypothyroidism because of the decrease in concentration of circulating thryoid hormones

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21
Q

38yo female brought to ED with complaint of paralysis of bilateral arms. hx significant for sexual assalut 2 days ago. PE is unremarkable with normal reflexes.
What is the most likely diagnosis?

A

conversion disorder

pt have abrupt loss of motor or sensory function caused by psychological factors that often precede physical symptoms

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22
What is the pharmacologic treatment of narcissistic personality disorder
Lithium
23
What are the most affective agents in the treatment of somatoform spectrum pain disorders?
Antidepressants ## Footnote help with both pain and worry surrounding the pain
24
What is the treatment of choice for benzodiazapine intoxication?
Flumazenil ## Footnote The benzodiazepine receptor antagonist flumazenil can reverse severe sedation and respiratory depression secondary to benzodiazepine overdose. However, its clinical usefulness is not well-defined because most people who overdose on benzodiazepines recover with only supportive care, and occasionally flumazenil precipitates seizures.
25
What is the difference between Bipolar 1 and Bipolar 2
Bipolar I has a hx of more mania than depression Bipolar 2 has hx of more depression than mania
26
What is Cyclothymic Disorder?
Alternating hypomanic episodes with long history of low mood state for at least 2 years
27
What is the common medical treatment for Bipolar 1?
Lithium
28
What class of medications should never be given to a patient with Bipolar 1?
Antidepressants
29
What condition manifests as chronically depressed mood for more than 2 years?
Persistent depressive disorder
30
What is the medical treatment for Bipolar 2?
Antipsychotics (i.e. Olanzapine, Risperidone, Quetiapine)
31
What is the treatment that causes brief seizures with the use of electric currents through the brain?
ECT (Electroconvulsive therapy)
32
a 27-year-old man accompanied by his girlfriend. In the office, he seems to be running from topic to topic without a clear message. His speech is pressured. The patient’s girlfriend reports that he took steroids recently for a bad sinus infection and since he started them, his behavior has been abnormal. After discontinuing the medication, he has still been having symptoms. He has not had a normal night of sleep for the past ten days, and he just bought a new sports car though he has no need for one or the money to afford it. She also reports that she has caught him with multiple other women in the past few days, though they were in a committed relationship. The physical exam is benign and the patient’s vital signs are within normal limits. **What is the most likely diagnosis?**
Bipolar 1 Disorder ## Footnote this is a manic episode without major depressive episodes
33
What medications can be used to treat Acute Mania?
Lithium Valproate SGAs (olanzapine, aripiprazole) Carbamazepine
34
a 19-year-old male who has had bouts of sadness for a course of 1 year in which he says that often he cannot even get out of bed so he tells his parents he is ill. Jim states that he recently felt so energized that he could not keep his thoughts straight and jumped from one idea to another. During this energized state, he did become irritable and others stated that he was louder than usual and wondered if he took something that increased his energy. During the week of high energy, he maxed out two of his credit cards and is not sure how he will pay them off before he goes to school in the fall. It was only a week later that he became so depressed that he did not find any pleasure in anything he did, was so tired he did not want to get out of bed which has continued to be a struggle today. **What is this patients most likely diagnosis?**
Bipolar 2 Disorder ## Footnote a pt with bouts of sadness and distractibility and an episode of mania.
34
What medications are used for maintenance of mania
SGAs (olanzapine, aripiprazole) Gabapentin Lamotrigine
35
a 33-year-old woman complaining of fatigue and decreased interest in “the things that used to make me happy.” She is sleeping less and eating less, and she says that she is forcing herself to eat “because I know I have to eat something.” She finds herself spending less time with her kids and husband as she retreats to her room. She feels guilty that she lacks the energy and enthusiasm she used to have. **What is this patients most likely diagnosis?**
Major Depressive Disorder ## Footnote SIGECAPS for 2 or more weeks.
36
What is SIGECAPS
Sadness Interest/Anhedonia Guilt Energy Concentration Appetite Psychomotor Activity Suicidal
37
What is the first line treatment of Major Depressive Disorder (MDD)?
SSRIs although TCA and MAOI are often helpful but not first line
38
What are the treatment options for Persistent depressive disorder?
SSRI or other antidepressants Psychotherapy Physical exercise
39
a 35-year-old female with a complaint of worry which she cannot control for the last year. She tells you that her symptoms daily consisting of sleep disturbances, difficulty concentrating, and irritability. She reports her symptoms started around age 17 but have worsened. **What is the most likely diagnosis?**
Generalized Anxiety Disorder ## Footnote excessive anxiety/worry occurring more days than not for atleast 6 months.
40
What are the medication treatment options for GAD?
SSRI (paroxetine and escitalopram) SNRI (venlafaxine) Buspirone(onset of 2 weeks) Benzos (short term use) Beta Blockers Psychotherapy
41
What are the Treatment options for Panic Disorder?
SSRI (paroxetine, sertraline, fluoxetine) Benzos (for acute attacks) CBT
42
What is the first line treatment of a specific phobia disorder
exposure therapy ## Footnote to teach to relax and try to understand/overcome the fear
43
What are the medication options for the treatment of specific phobia disorders?
SSRI + CBT Benzos (i.e. prior to flying)
44
What is the treatment of Agoraphobia
SSRI and CBT
45
What is the first line treatment of PTSD?
SSRI ## Footnote Can also use CBT, Prazosin (nightmares), Benzos (acute)
46
What is Adjustment disorder?
The disproportionate response to a stressor that would normally be expected (ex. job loss, physical illness) which begin within 3 months of the stressor and end within 6 months after stressor resolved
47
What is the treatment of adjustment disorder?
Psychotherapy
48
What is the treatment for a Lithium overdose?
Dialysis
49
What is Pyrexia
elevation of an individuals core body temp above normal
50
What is the benzo antidote?
Flumazenil
51
What is the antidote for TCAs?
Sodium Bicarbonate
52
What is the antidote for Calcium Channel blockers?
Calcium Chloride
53
What is the antidote for amphetamine?
Benzos
54
What is the antidote for Warfain
Vitamin K - FFP
55
What is the antidote for Heparin
Protamine Sulfate
56
What is the antidote for Tylenol?
N-acetylcysteine
57
What is the antidote for Opiates
Naloxone
58
What is the antidote for Beta Blockers?
Glucagon
59
What is the antidote for cocaine?
Benzos
60
What is the treatment for psychosis due to drug overdose?
Haloperidol
61
a 69-year-old female who presents to the emergency department with sudden, severe onset epigastric pain that began while she was watching television. On physical exam is an unkempt female with pain upon palpation of the epigastric region. Labs are drawn and the patient has an elevated amylase and lipase. The patient is made NPO, an NG tube is placed, and the patient is given IV fluids. The patient is noted to be experiencing hallucinations. On her second hospital day, the patient has a seizure. **What is the most likely diagnosis**
Alcohol Use Disorder ## Footnote patient is likely suffering from alcohol withdrawal which symptoms may develop within several hours to a few days after the cessation or decrease of alcohol intake
62
What is the treatment for Alcohol withdrawal
Thiamine, magnesium, multivitamin, Dextros Benzos if in acute withdrawal
63
What is the treatment of Delirium Tremens?
High dose IV benzos - preferably in ICU May be fatal
64
What is the treatment for opioid intoxication?
Nalozone/Naltrexone symptomatic treatment
65
What are treatment options for opioid withdrawal
clonidine methadone (long acting) Buprenorphine + naloxone (suboxone) zofran (for nausea and vomiting)
66
What is the treatment of stimulant intoxication
Antipsychotics - benzos do not restrain the pt - may result in rhabdo
67
What is the treatment of stimulant withdrawal
bupropion bromocriptine SSRI for depression
68
What is Delusional Disorder?
otherwise normal functioning person with a belief in something that does not exist - but no other symtpoms of schizophrenia
69
What is Schizoaffective disorder
psychotic d/o that features symptoms of both schizophrenia and MDD. symptoms may occur at the same time or different times
70
What is schizophrenia
characterized by delusions, hallucinations, disorganized speech, and/or diminished inappropriate emotional expression for greater than 6 months causes difficulty in regular functioning
71
What is schizophreniform disorder?
Major psychosis for > 1 week but < 6 months no social or occupational impairement
72
a 75 year old pt began thinking that her daughter was telling her caretakers to steal her money, although both her daughter and caretakers deny this. **What is the most likely diagnosis?**
Delusional Disorder
73
A 45-year-old truck driver who c/o "hearing things that are not there" for two weeks. He reports that he was severely depressed five months ago and was placed on Prozac by his PCP. He recently started hearing voices. **What is the most likely diagnosis?**
Schizoaffective disorder
74
A 23-year-old male with c/o visual & auditory hallucinations that have been ongoing for two months. He is a graduate student at a local university, and he states that his hallucinations have been getting worse. He is still able to attend classes, but it is becoming more difficult to focus in class. **What is the most likely diagnosis?**
Schizophreniform disorder
75
What are the treatment options for delusional disorder?
psychotherapy atypical antipsychotics
76
What are the treatment options for schizoaffective disorder?
psychotherapy atypical antipsychotic agents anticonvulsants SSRI
77
What are the treatment options for schizophrenia
atypicals (risperidone, olanzapine, aripiprazole, quietiapine) for negative symtpoms clozapine - not first line due to agranulocytosis Dopamine antagonists - haloperidol, chlorpromazine, fluphenazine) - best for positive symptoms
78
A child is referred to your office for unusual animal cruelty and bullying at school. **What is their likely diagnosis?**
Conduct disorder
79
A child is found to back talk and resist following instructions from parents or authorities. **what is their likely diagnosis?**
Oppositional defiant disorder
80
What is the Treatment for ADD/ADHD?
Stimulant (methyphenidate (adderal), ritalin)
81
What is the typical presentation of factitious disorder?
pt consciously reports false symtpoms or induces symtpoms with the goal of playing the "sick" role.
82
What is somatic symptom disorder?
Preoccupation with having a serious illness
83
What are the personality disorders in cluster A?
Cluster A: characterized by appearing odd or eccentric. Includes, paranoid, schizoid, schizotypial.
84
What are the personality disorders in cluster B?
Cluster B: characterized by appearing dramatic, emotional, or erratic. includes: antisocial, borderline, histrionic, narcissistic
85
What is histrionic personality disorder?
Attention seeking and excessive emotionality
86
What are the personality disorders in Cluster C?
Cluster C: characterized by appearing anxious or fearful. Includes: avoidant, dependent, OCD.
87
What is Schizoid personality Disorder
disinterest in others. tend to have emotional aloofness, indifferent to praise or criticism, without bizarre or idiosyncratic thinking.
88
what is schizotypal personality disorder?
pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capactiy for close relationships. pt presents with eccentric behavior, magical thoughts, odd beliefs, and perceptual distortion.
89
What is antisocial personality disorder?
Sociopath - lack remorse and concern for others. diregard for and violation of rights of others.
90
What is BPD?
(borderline personality disorder) presents with emotional instability, unstable relationships, poor self-image, and self-harming behavior.
91
What is narcissistic personality?
need for admiration, grandiose thoughts, concerned about what other think, yet lack empathy.
92
What is avoidant personalty disorder?
avoid interpersonal contact due to fear of rejection. feel inadequate, hypersensitive to negative evaluation.
93
What is the different from Obsessive-compulsive disorder and obsessive compulsive personality disorder?
obsessive-compulsive personality disorder is ego-syntonic - pt isnt aware of their behavior causing issues. OCD is ego-dystonic - behavior is inconsistent with ones own beliefs and attitudes
94
Of the eating disorders, which one is commonly treated with SSRIs?
Bulimia nervosa.
95
which eating disorder is commonly associated with mitral valve prolapse, pericardial effusion, and myocardial atrophy?
anorexia nervosa
96
Mr. Addley is a 69yo recently retired accountant who comes to your family practice with his wife for a routine f/u for his BP. during the visit he comments that he is concerned about his memory. He notes that he has difficulty remembering where he left his car keys, the day of the week and names of people immediately after being introduced to them. when his wife is asked, she has noticed nothing regarding his mental status or ability to perform ADLs. you perform a MMSE and he scores a 25 out of 30. **what is the most appropriate working diagnosis for Mr. Addley?**
Mild Neurocognitive disorder
97
What is sublimation?
a defense process by which an unacceptable feeling is unconsciously replaced with a course of action that is constructive and personally and socially acceptable. i.e. the concious use of work, sports, art or hobbies to divert one's thoughts from a problem or from a rejected wish
98
What is Reaction formation?
A defense mechanism where those with an insecurity will express the opposite of how they are feeling. ex: a man who feels insecure about his masculinity might act overly aggressive
99
What is the MADRAs score and what is it used for?
Montgomery Asberg Depression Rating Scale designed to be used in pts with major depressive disorder to measure the change in symptom severity during the treatment of depression.
100
What is the AIMS scale and what is it used for?
Abnormal Involuntary Movement Scale used to assess the occurrence of dyskinesia in pts recieving neuroleptic treatment
101
what is the WSAS scale and what is it used for?
Weinberg Screening Affective Scale self-reported questionnaire used to evaulate the presence of depressive symptoms in children and adolescents
102
What is the DBDRS Scale and what is it used for
Disruptive Behavior Disorders Rating Scalre used to screen to ADHD and conduct disorders
103
what is the BPRS scale and what is it used for
Brief Psychiatric Rating Scale designed to assess psychopathology, which includes positive, negative and affective symptoms in a pt with diagnosed or suspected schizophrenia or other psychotic illnesses.
104
87 yo male residing in an assisted living facility has been treated with Sertraline 50mg daily for tx of depression. Staff has noticed a change in his behavior including agitation, irritability and friends have noted him to be withdrawn. Pt refuses to participate in recreational activities and rarely appears for meals. **What test would you most likely want to use in the evaluation of this patient?** 2. WSAS 3. DBDRS 4. MADRS 5. BSRS | 1. AIMS
MADRS
105
16yo slightly overweight female presents becuase she wants to lose weight. she heard that drugs for ADD can help you lose weight. she is unsure the name of the drug but wonders if she can use it as a diet pill instead. since she was told drugs like meth have similar properties, she also wants to know if these are safe. she is told to avoid them because they can become habit forming and their effectiveness is short lived. **What is the MOA of the drug she is referring to?**
Releases dopamine and NE stores ## Footnote pt is referring to methylphenidate (ritalin)
106
38yo female present to family practice for f/u of anxiety. she experiences symtpoms of worry, irritability, and difficulty concentrating nearly every day. She has tried multiple medications including Paroxetine, citalopram, and venlafaxine. she is currently taking escitalopram 20mg QD with improveemnt in symtpoms. pt stated this med helps more than anything else she has tried. her symtpoms persist but she prefers to continue if possible. **which medication would be the best choice as an adjunctive daily treatment? | alprazolam buproprion flumazenil Buspirone sertraline
Buspirone ## Footnote the pt has GAD. the best adjunctive treatment to an SSRI for GAD is Buspirone. there is a 2-4 week delay before antidepressants and buspirone take effect.
107
30yo female presents to ED with extreme fatigue, body aches and tremor that started several days ago. No illness or stressors recently. reports feeling "warm". PMH includes cigarette smoking and depression. denies GI, GU, or UR symptoms. recently increased her amitriptyline. PE reveals BP 135/8-, pulse 103 bpm, temp 101.5, RR 18bpm, pulse ox at 98%. on PE she is noted to have ocular clonus, a fine tremor and hyperreflexia as well as hypertonia. she is agitated but oriented. CBC, TSH, LP, and CXR all WNL. **which of the following answer choices best describes the pathophysiology of the pts most likely diagnosis?** ## Footnote - competetive antagonism of acetylcholine at central and peripheral muscarinic receptors - excessive release of thyroid hormone causing adrenergic hyperactivity - insufficient levels of cortisol - inflammation of the brain cased by either infection or virus - increased serotonergic activity in the CNS
increased serotongergic activity in the CNS ## Footnote serotonin syndrome presents as autonomic instability, mental status changes and neuromuscular abnormalities.
108
What is the primary mechanism by which benzodiazepines exert their sedative and anxioultyic effects?
increasing GABAa receptor mediated cloride conductance. ## Footnote GABA is one of the major inhibitory neurotransmitters in the brain; hence, benzos enhance this inhibitory influence to produce sedation and calm.
109
Which of the following indicates a poor prognosis for someone diagnosed with schizophrenia? a. acute onset b. co-morbid mood disorder c. obvious precipitating event d. younger age at diagnosis
d. younger age at diagnosis ## Footnote younger age of onset/diagnosis along with insidious onset, social isolation and fhx of schizophrenia and negative symptoms all portend a poor prognosis.
110
17yo male pt is brought into psychiatry by his uncle. uncle reports that since he moved in with him 5 years ago they have had "issues". He is always skipping school, getting into trouble for lying and most recently was caught hurting the neighbors dog. he also has several issues with the police. the pt was diagnosed with conduct disorder a month ago by a school therapist. the uncle wants to discuss possible treatment options. **What is the first line treatment for this patient?**
Multisystemic therapy ## Footnote an intensive home-based model of care that works to strengthen and support coping skills of the individual and family.
111
What is 'clanging'?
a disturbance in thought in which the person selects words that are similar by sounds, but do not mean the same. somteimes the person will rhyme the words.
112
36yo male brought to ED in handcuffs after he sustained a laceration to his left leg while trying to outrun the police. apparently he was driving a stolen car when he was pulled over for speeding. Upon talking with him, you learn that he has been in jail twice before for robbery. During the hx and PE he appears callous and impulsive. **What is the most appropriate classifications for this personality disorder?**
Antisocial ## Footnote antisocial personality disorder consists of clincial findings that include selfishness, callousness, promiscuousness, impulsive behavior, and an inability to learn from exerpience and legal problems.
113
27yo male presents to ED for stomach pain. at check-in, he is demanding to get seen immediately at curses at the registering nurse when she notifies him of the expected wait time. he is a regular at the ED and is known for his aggressive manner with the nurses. several visits have been due to fractures because of fights with others. at todays visit his vitals were unremarkable as well as PE. A CMP, CBC, and abdominal radiographs are all negative. His gf who is with him tells the nurse he has "always been like this". They have been together since they were 15yo and she reports she is often afraid of him. **What is the most likely psychiatric diagnosis for this patient?**
antisocial personality disorder ## Footnote can only be dx in pts over 18 yo and require a hx of conduct disorder previously. pts with APD have no regard for others rights, lack conformity to social norms and lase. they often use lies for personal gain and are impulsive and irresponsible in a variety of settings.
114
38yo male presents to clinician for tx of persistent rash. He is disheveled and has difficulty making eye contact throughout the exam. his answers to questions are abbreviated. when asked bout work he says he is a research engineer and works mostly on his own. in his free time he enjoys working on various machines he has collected fromt he trash and very occasionally visits his older brother. Other than his brother, he reports spending most of his time alone. He denies ever hearing voices or seeing things others dont. He is very concerned about his rash, although when prescribed an ointment he is suspicious as to whether it will be helpful. **What is the most likely personality disorder?**
Schizoid personality disorder ## Footnote lack prolonged psychosis and hallucinations associated with schizophrenia, however they may present during periods of brief stress. these pts have difficulty navigating intense emotions and interpersonal conflicts so tend to isolate themselves and prefer dealing with technical or abstract constructs rather than people.
115
What is Circumstantial thoughts
someone whose thoughts are connected but goes off-topic before returning to the original subject
116
What is tangential thought
a series of connected thoughts that go off-topic but do not return to the original topic.
117
22yo female presents describing intermittent paralysis of the right arm. symtpoms began about 6 months ago. episodes occur 3-5 times per week, lasting 1-2 hours, then resolve. she denies injury. she states she has seen at least 6 different providers and no one takes her seriously. she states one provider told her that her bloodwork and imaging were noraml but she does n ot believe that to be true as she knows something is very wrong with her and believes they could not be normal. PE and imaging reveal no medical exam for her symtpoms. **What would be likely to improve her symptoms?** ## Footnote a. reassurance b. CBT c. MRI repeat every 3 month if no improvement d. SSRI e. shoulder immobilization
CBT ## Footnote clinical picture of somatic symptom disorder. CBT can help reduce the symptoms.

Psych Clinical (5 decks)

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