Psychiatry and Neurology Sample Questions
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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.

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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.

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