Psychiatry
and Neurology Sample Questions
2000
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QUESTION
4.
A 27-year-old man in an agitated state is brought in to a
psychiatric emergency service by his family. Six weeks
ago, the family noted increasing irritability. His wife
had first noticed it, and soon his siblings became concerned
as well. One brother, who would visit the patient several
times per week, commented that the patient's home was usually
so calm and peaceful, thus, making his brother's irritability
quite striking. The patient had begun complaining of
inability to sleep during the night and instead, increasingly
wandered the house. He became argumentative, and then began
accusing his wife of poisoning his food and his brothers of
stealing his belongings. In the last week, his speech
became rambling and confused. He seemed to be listening
to voices.
Three
years prior to this episode, he had been hospitalized for
similar problems. Following discharge, he continued
treatment and taking medication for a 1½ years. He had
been working and the family felt he had been doing well until
the last 6 weeks.
Which
one of the following statements is MOST appropriate
concerning this patient?
A)
During the first day he received 35 mg of haloperidol to
start treatment
B) He should have received on-going neuroleptic treatment
for several years after his first episode
C) The lowest possible maintenance dose of haloperidol decanoate
will be 100 mg every 4 weeks
D) A five-year course of aftercare treatment will be recommended
E) After 18 months of effective treatment, the family will
be trained to monitor for prodromal symptoms, and active
treatment will be discontinued
ANSWER
4.
D A five-year course
of aftercare treatment will be recommended
After
an initial psychotic episode, a year of treatment is recommended.
After a second episode, five years of treatment is recommended.
The former practice of giving higher doses of neuroleptics
during the initial phase of treatment has been found not to
be more effective. The usual dose of haloperidol would
be 10 mg to 20 mg per day. For maintenance treatment, as with
any other use of medication, the dose should be individualized.
However,
a maintenance dose of 50 mg of haloperidol decanoate injected
every four weeks can be effective, as can 2.5 mg of oral haloperidol
on a daily basis.
[26:989-91]
QUESTION
5.
A 25-year-old woman comes to you for help at the insistence
of her family who has become increasingly concerned by her
behavior. During her husband's recent business trip,
she accused him of being unfaithful, alternately begging and
insisting that he return home, and finally threatened suicide.
She has been drinking too much, but attributes this to seeking
relief from her constant sadness and emptiness.
All
of the credit cards have been placed in her husband's name
because of her frequent overspending. She complains
of "mood swings." Sleep and appetite can both be excessive
or diminished for periods of time. Her mother was known
to have similar behavior at the same age, and she was helped
by an antidepressant.
While
further detailed information is being pursued concerning this
person's history, which one of the following statements is
accurate?
A)
Since the patient has borderline features, cyclical intensification
of symptoms is irrelevant
B) Since drinking is involved, no diagnosis concerning
a mood disorder can be made in the near future
C) Since she has recently developed panic attacks,
an anxiety disorder is likely
D) Her mother's response to medication may be helpful
in choosing a medication, but not in establishing the diagnosis
E) Since apparent personality disturbances can resolve
with treatment of the mood disorder, erring in the
direction of diagnosing the latter is wise
ANSWER
5.
E Since
apparent personality disturbances can resolve with treatment
of the mood disorder, erring in the direction of diagnosing
the latter is wise.
In
arriving at an accurate diagnosis, considering the cyclical
presence and absence of symptoms is relevant, as is a family
history of a mood disorder and a positive response to antidepressant
medication. If a period of sobriety lasting a number
of months has been accompanied by significant depression,
or depression predated the drinking, a mood disorder can be
diagnosed. Panic attacks can develop during depression: if
they predated the depression, along with tension, phobias,
perceptual distortions and hypochondriasis, an anxiety disorder
followed by a depression would be likely.
Since
state dependency of personality characteristics is well documented,
and since apparent personality traits have resolved with treatment
of the mood disorder, it is wise to carefully assess the patient
for the presence of a mood disorder and to treat it effectively.
[26:1147]
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