psychiatry

Question 1

DSM V criteria for Tourettes

Answer 1

A. Both multiple motor and one or more vocal tics have been present at some time during illness - not necessarily at the same time
B. The tics may wax and wane in frequency but have persistent for more than a year since first tic onset
C. Onset before 18 years
D. Disturbance is not attributable to to an organic cause (medication or medical condition)

Question 2

what is echolalia

Answer 2

repeating phrases of others - a common symptom of tourettes

Question 3

what is coprolalia

Answer 3

shouting of obscenities - can occur in tourettes

Question 4

what is echopraxia

Answer 4

the repeating of gestures of others

Question 5

what is palilalia

Answer 5

repetition of one’s own stated phrases

Question 6

what is abulia

Answer 6

refers to an motivational state which can be seen in traumatic brain injury, post neurosurgery and in dementia

Question 7

Tourettes treatment options

Answer 7

dopamine blockers, dopamine depletors, clonidine, clonazepam, DBS

Question 8

post partum depression

Answer 8

10-15% general population

4 months to 1 year post partum

Question 9

elements in mental status exam

Answer 9

General appearance
Behaviour
Speech
Mood and affect 
Thought process/Form
Thought content
Perception
Cognition
Insight
Judgement

Question 10

what are clang associations

Answer 10

speech based on sound such as rhyming or punning

Question 11

neologism

Answer 11

use of novel words or of existing words in a novel fashion

Question 12

thought blocking

Answer 12

sudden cessation of flow of thought and speech

Question 13

ideas of reference

Answer 13

similar to delusion of reference, but less fixed (the reality of the belief is questioned)

Question 14

Persecutory delusion

Answer 14

belief that others are trying to

cause harm to you

Question 15

Reference delusion:

Answer 15

interpreting publicly known
events/celebrities as having direct
reference to you

Question 16

Erotomania delusion:

Answer 16

belief that another is in love

with you

Question 17

Grandiose delusion:

Answer 17

belief that he or she has special

powers, talents or abilities

Question 18

Religious delusion:

Answer 18

belief of receiving instructions/
powers from a higher being; of being a
higher being

Question 19

Somatic delusion:

Answer 19

belief that you have a physical

disorder/defect

Question 20

Nihilistic delusion:

Answer 20

belief that things do not exist; a

sense that everything is unreal

Question 21

epidemiological risk factors to suicide

Answer 21

male
15-24 highest attempts
over 65 more successful suicides
native canadian and White
widowed or divorced
Alone / no children
stressful life event
access to firearms

Question 22

psychological risk factors for suicide

Answer 22

■ mood disorders (15% lifetime risk in depression; higher in bipolar)
■ anxiety disorders (especially panic disorder)
■ schizophrenia (10-15% risk)
■ substance abuse (especially alcohol – 15% lifetime risk)
■ eating disorders (5% lifetime risk)
■ adjustment disorder
■ conduct disorder
■ personality disorders (borderline, antisocial)

Question 23

management of low risk of suicide

Answer 23

not actively suicidal, with no plan or access to lethal means
■ discuss protective factors and supports in their life, remind them of what they live for, promote
survival skills that helped them through previous suicide attempts
■ make a safety plan that could include an agreement that they will:
◆ not harm themselves
◆ avoid alcohol, drugs, and situations that may trigger suicidal thoughts
◆ follow-up with you at a designated time
◆ contact a health care worker, call a crisis line, or go to an emergency department if they feel
unsafe or if their suicidal feelings return or intensify

Question 24

management of high risk of suicide

Answer 24

(hospitalization needs to be strongly considered)
■ patients with a plan and intention to act on the plan, access to lethal means, recent social stressors,
and symptoms suggestive of a psychiatric disorder
■ do not leave patient alone; remove potentially dangerous objects from room
■ if patient refuses to be hospitalized, complete form for involuntary admission (Form 1)

Question 25

diagnostic criteria for schizophrenia

DSM 5

Answer 25

A. two (or more) of the following, each present for a significant portion of time during a 1 mo period (or
less if successfully treated). At least one of these must be (1), (2), or (3)
1. delusions
2. hallucinations
3. disorganized speech (e.g. frequent derailment or incoherence)
4. grossly disorganized or catatonic behaviour
5. negative symptoms (i.e. diminished emotional expression or avolition)

Question 26

Good Prognostic Factors for schizophrenia

Answer 26

• Acute onset
• Shorter duration of prodrome
• Female gender
• Good cognitive functioning
• Good premorbid functioning
• No family history
• Presence of affective symptoms
• Absence of structural brain abnormalities
• Good response to drugs
• Good support system

Question 27

Management of Schizophrenia

Answer 27

• biological / somatic
antipsychotics (haloperidol, risperidone, olanzipine,
paliperidone; clozapine if refractory); often regiments of IM q2-4 wk used in severe cases to ensure
compliance
■ adjunctive: ± mood stabilizers (for aggression/impulsiveness - lithium, valproate, carbamazepine) ±
anxiolytics ± ECT
■ treat for at least 1-2 years after the first episode, at least 5 years after multiple episodes (relapse
causes severe deterioration)
• psychosocial
■ psychotherapy (individual, family, group), supportive, CBT (see Table 14, PS41)
■ ACT (Assertive Community Treatment): mobile mental health teams that provide individualized
treatment in the community and help patients with medication adherence, basic living skills, social
support, job placements, resources
■ social skills training, employment programs, disability benefits
■ housing (group home, boarding home, transitional home)

Question 28

Schizophreniform Disorder

Answer 28

acute onset of A,D,E criteria lasting 1 month but less than 6.
A. two (or more) of the following, each present for a significant portion of time during a 1 mo period (or
less if successfully treated). At least one of these must be (1), (2), or (3)
1. delusions
2. hallucinations
3. disorganized speech (e.g. frequent derailment or incoherence)
4. grossly disorganized or catatonic behaviour
5. negative symptoms (i.e. diminished emotional expression or avolition)
D. rule out schizoaffective disorder and depressive or bipolar disorder with psychotic features because
either 1) no major depressive or manic episodes have occurred concurrently with the active-phase
symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been
present for a minority of the total duration of the active and residual periods of the illness
E. rule out other causes: GMC, substances (e.g. drug of abuse, medication)

Question 29

Brief psychotic disorder

Answer 29

meets criteria A,D,E for schizophrenia but symptoms last longer than a day but less than a month

Question 30

Schizoaffective Disorder criteria DSM 5

Answer 30

A. concurrent psychosis (criterion A of schizophrenia) and major mood episode - uninterrupted period of
illness
B. delusions or hallucinations for 2 or more wk in the absence of a major mood episode during the
lifetime duration of the illness
C. major mood episode symptoms are present for the majority of the total duration of the active and
residual periods of the illness
D. the disturbance is not attributable to the effects of a substance or another medical condition
• specifiers: bipolar type, depressive type, with catatonia, type of episode, severity

Question 31

Delusional disorder

DSM 5

Answer 31

A. the presence of one (or more) delusions with a duration of 1 mo or longer
B. criterion A for schizophrenia has never been met
Note: hallucinations, if present, are not prominent and are related to the delusional theme
C. apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and
behaviour is not obviously bizarre or odd
D. if manic or major depressive episodes have occurred, these have been brief relative to the duration of
the delusional periods
E. the disturbance is not attributable to the physiological effects of a substance or another medical
condition and is not better explained by another mental disorder
• subtypes: erotomanic, grandiose, jealous, persecutory, somatic, mixed, unspecified
• further specify: bizarre content, type of episode (e.g. first episode, multiple episode), severity

Question 32

criteria for depression

Answer 32

MSIGECAPS
at least 5:
Mood: depressed
Sleep: increased/decreased
Interest: decreased
Guilt
Energy: decreased
Concentration: decreased
Appetite: increased/decreased
Psychomotor: agitation/retardation
Suicidal ideation

Question 33

criteria for mania

Answer 33

GST PAID
at least 3?
Grandiosity
Sleep (decreased need)
Talkative
Pleasurable activities, Painful consequences
Activity
Ideas (flight of)
Distractible

Question 34

hypomania

Answer 34

• criterion of a manic episode is met, but duration is ≥4 d
• episode associated with an uncharacteristic change in functioning that is observable by others but not severe
enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization
• absence of psychotic features (if these are present the episode is, by definition, manic)

Question 35

treatment of depression

Answer 35

lifestyle: increased aerobic exercise, mindfulness based stress reduction, zinc supplementation,
medications: SSRI’s SNRI’s

Question 36

postpartum blues

Answer 36

• transient period of mild depression, mood instability, anxiety, decreased concentration; considered to
be normal changes in response to fluctuating hormonal levels, the stress of childbirth, and the increased
responsibilities of motherhood
• occurs in 50-80% of mothers; begins 2-4 d postpartum, usually lasts 48 h, can last up to 10 d
• does not require psychotropic medication
• usually mild or absent: feelings of inadequacy, anhedonia, thoughts of harming baby, suicidal thoughts

Question 37

Post partum depression

Answer 37

• MDD with onset during pregnancy or within 4 wk following delivery
• typically lasts 2-6 mo; residual symptoms can last up to 1 yr
• may present with psychosis (rare, 0.2%), usually associated with mania, but also with MDE
• severe symptoms include extreme disinterest in baby, suicidal and infanticidal ideation

Question 38

Risk factors for post partum depression

Answer 38

Risk Factors
• previous history of a mood disorder (postpartum or otherwise), family history of mood disorder
• psychosocial factors: stressful life events, unemployment, marital conflict, lack of social support,
unwanted pregnancy, colicky or sick infant

Question 39

treatment of post partum depression

Answer 39

• psychotherapy (CBT or IPT)
• short-term safety of maternal SSRIs for breastfeeding infants established; long-term effects unknown
• if depression severe or psychotic symptoms present, consider ECT

Question 40

prognosis postpartum depression

Answer 40

Prognosis
• impact on child development: increased risk of cognitive delay, insecure attachment, behavioural disorders
• treatment of mother improves outcome for child at 8 mo through increased mother-child interaction

Question 41

Indicators of sexual abuse

Answer 41

allegations by the child
allegations by an adult
injuries to genitalia or anus
genital infection
recurrent urinary tract infections
unexplained behavioural changes
psychological disorders

Question 42

indications for long term treatment of depression

Answer 42

2 depressive episodes within 5 years
three prior episodes

long term treatment should be continued for at least 3-5 years

Question 43

subsyndromal depressions

Answer 43

doesn’t quite meet the DSM V criteria but has higher associations with major depression, physical disability, medical illness and high use of medical services

Question 44

treating depression in patients who have had MI

Answer 44

Depression increases risk of IHD in Men but not women
Sertraline improves mood with lowest amount of cardiovascular side effects
if no effect 50% will respond to a change in SSRI

Question 45

ADHD

Answer 45

Attention deficit hyperactivity disorder
A syndrome of inattention, hyperactivity, and impulsivity.
classified as a developmental disorder

Question 46

DSM 5 criteria ADHD

Answer 46

9 signs and symptoms of inattention
6 of hyperactivity
3 of impulsivity
must occur in at least 2 situations and manifest before the age of 12

Question 47

DSM 5 inattention symptoms of ADHD

Answer 47

does not pay attention to details
has difficulty sustaining attention at school
does not seem to listen when spoken to
does not follow through on instructions or finish tasks
has difficulty organising tasks and activities
avoids, dislikes or is reluctant to engage in tasks that require mental effort
often lose things
easily distracted
easily forgetful

Question 48

DSM 5 hyperactivity criteria for ADHD

Answer 48

often fidgets with hands or feet or squirms
often leaves seat in class or elsewhere
often runs about or climbs excessively
has difficulty playing quietly
often on the go as if driven by a motor
often talk excessively

Question 49

DSM 5 criteria for impulsivity of ADHD

Answer 49

often blurts out answers before questions are finished
has difficulty awaiting their turn
interrupts or intrudes on others

Question 50

negative symptoms of schizophrenia

Answer 50

blunting of affect
poverty of speech
anhedonia - diminished capacity to experience pleasure
Asociality - lack of interest in relationships with others

Question 51

DSM V criteria for panic attack

Answer 51

chest pain or discomfort
chills or heat sensation
derealisation or depersonalization
fear of dying
fear of losing control or going crazy
feeling dizzy, light headed, unsteady or faint
feelings of choking
nausea or abdominal distress
palpitation or pounding heart or accelerated heart rate
paresthesias 
sensations of Shortness of breath or smothering
sweating
trembling or shaking

Question 52

treatments for panic attacks

Answer 52

MEDICAL:
antidepressants
Benzodiazepines work faster but high risk of dependance
PSYCHOTHERAPY:
cognitive behaviour therapy
exposure therapy
supportive psychotherapy

Question 53

major depressive disorder

Answer 53

characterised by 1 or more episodes of depression lasting for at least 2 weeks without a past history of manic or hypomanic episodes

Question 54

selective mutism

Answer 54

affects children entering school age and characterised by the persistent inability to speak in certain situations such as at school. But will happily talk at home.