Psychiatry Module 1

Which of the following drug is least likely to be beneficial in the treatment of bulimia nervosa?

The use of this drug will most likely to lead to the onset of Type 2 diabetes:

Which of the following complication is likely to occur with long term use of lithium?

Which of the following antipsychotic medication is most likely to cause the greatest weight gain when prescribed to adolescents?

Which anti-psychotic medication should be avoided in patients with a history of ventricular arrhythmia or torsades de pointes?

Which of the following feature is most characteristic of anorexia nervosa in a female with weight loss?

The following are appropriate management of osteopenia in Anorexia nervosa except?

In anorexia nervosa, the plasma concentration of which hormone is less likely to be reduced?

A patient has the following abnormal findings:

• sodium 130 mmol/L [134-145]
• potassium 2.9 mmol/L [3.5-5.0]
• phosphate 0.22 mmol/L [0.6-1.3]
• magnesium 0.6 mmol/L [0.72-0.92]
• creatinine 120 μmol/L [70-110]
• ionised calcium 1.1 mmol/L [1.14 – 1.27]
• glucose 5.1 mmol/L [4.1- 6.1]

Which of the following condition is the most likely explanation for these abnormal lab results?

Which of the following feature is most helpful in diagnosing depression in medically ill patients?

A 59-year-old man presents to the emergency department complaining of increasing light-headness and feelings of anxiety and agitation over the previous two months. He also complains of vague muscle aches and fatigue.

He has been unable to work and has become less involved with any of his usual interests. He has been well until this time.

Organic investigations have failed to reveal any abnormality and he has been presenting to a number of different doctors with similar complaints.

At interview, he is anxious and preoccupied with a range of vague physical symptoms, for which he is seeking reassurance. He says he is worried about a range of financial and family problems.

What is the most likely diagnosis?

Tricyclic antidepressants would be contraindicated in the following situation:

When comparing between tricyclic antidepressants (TCA) to selective serotonin re-uptake inhibitors (SSRIs) for the treatment of major depression in the elderly group, which effect is most pronounced in TCA compared to SSRIs?

What could be the potential side effect in someone who have been recently commenced on oral Venlafaxine for depression?

An 80-year-old woman presents with major depression. After four months of interpersonal therapy and treatment with an antidepressant drug, her depression resolves.

Which one of the following maintenance regimens is most likely to prevent recurrence of her major depression?

The use of anti-epileptic agents in patients with depression increases the risk of:

A 24-year-old man with a previous diagnosis of schizophrenia has been receiving depot haloperidol monthly for four years.

He presents with the gradual onset of choreo-athetoid movements of his upper limbs.

The most likely explanation for this presentation is:

A 17-year-old boy, repeating the second last year of secondary schooling, has been previously diagnosed by a paediatrician and a psychologist, as suffering from Attention Deficit Hyperactivity Disorder (ADHD) and a specific learning disorder.

Central nervous system stimulants were helpful but discontinued because of poor sleep and volatile mood.

The paediatrician is overseas and the boy now comes to you for help because he cannot study, is failing at school and he wants to go back on dexamphetamine.

He comes from a well functioning family in which there is no history of psychiatric illness or developmental disorder. His parents report a progressive decline in his academic progress throughout secondary school and his network of friends has been steadily reducing. He complains that his parents and teachers are too critical of him but admits that he often cannot be bothered studying and uses alcohol and marijuana but denies other drug use. He says that he has not slept and has eaten little over the last few days.

He worries that people are talking about him. He looks unkempt, is agitated, restless and guarded. His affect is flat and you have trouble following his thought processes. He denies that he is hearing voices.

What is the most likely cause for his latest presentation?

A patient with schizophrenia on atypical anti-psychotics is at increased risk of which of the following event?

A 15-year-old girl presents with a three-year history of school avoidance, attending approximately one week per month. She held a scholarship in secondary school but this was withdrawn due to poor attendance.

At home, she spends her day watching television, drinking alcohol or smoking marijuana. She has a few friends but is reluctant to leave the house. She is preoccupied with her body and feels herself to be a freak because she perceives asymmetry in her facial appearance.

She panics in social situations, believing that other people see this appearance. She is volatile and flies into a rage if she is thwarted. She hates herself, has grazed her wrists and there are scars from cigarette burns on her arms.

She denies suicidal ideation. At night, she finds it difficult to fall asleep, worries about being attacked and often checks the door and window locks. She has frequent nightmares and on waking, she thinks she hears strangers in her room.

Her parents divorced eight years ago and do not get on well. She lives with her mother and brother, the latter having similar but less severe difficulties. He is now at university. Her mother is anxious and ineffectual and it is clear that the children control the family.

Which one of the following diagnoses best explains this picture?

Which one of the following psychiatric disorders has the highest heritability (rate of inheritance)?

A 16-year-old girl with schizophrenia has been commenced on risperidone.

The following are possible side effects of this medication, except?

Which aspect of the patient’s mental state is  not typically disturbed in a classical presentation of first episode schizophrenia?

You interview a 15-year-old girl with a history of child sexual abuse. She often fights with her mother and stepfather and they describe a worsening in her behavior over the past six months. She has outbursts of anger after slight provocation, is sensitive to loud noises and stays up after they have gone to bed. She is performing badly at school. At times she seems normal and can enjoy going out, but her irritability has left her with few friends.

When interviewed by herself, the girl is alert and shows no features of thought disorder. She startles at noises from outside the consulting room. She describes difficulties getting to sleep and concentrating at school but denies any drug use.

She then tells you that she frequently hears male voices at home and school making derogatory comments about her and telling her to cut herself. The voices, which she doesn’t recognise, have been occurring for months and often follow fights with her parents.

Her presentation is most consistent with a primary diagnosis of:

A 17 -year-old male presents with a slowly evolving history of frequent and excessive checking of locks around the house at night, lining up his books in his bedroom and hoarding paper and string. These new symptoms are distressing for him and may preoccupy him for one to two hours every day.

The most likely diagnosis is:

Which of the following anti-psychotics have the lowest potency?

Hoarding is considered to be a form of mental disorder.

Which one of the following intervention has the strongest evidence base for efficacy in treating a hoarding disorder?

A 30-year-old single woman reports that she has been experiencing surges of sadness and emptiness since her mother died 10 months ago. Lately, she has been having trouble getting to sleep, having low energy, poor appetite, and frequent headaches.

She said that when her mother was alive, she and her mother would talk on the phone every evening and now she sometimes finds herself crying on her way home from work. She experiences periodic intense longing for her mother but does not feel hopeless.

She denies having any suicidal ideations.

She continues to work as a teacher aid and considers it a welcome distraction. School is the place where she most often feels like her “normal self” again. She also enjoys socializing with friends and continues to perform regular exercises at the gym four times per week.

Based on the above description, what is the most likely diagnosis in this lady?

A 54-year-old man presents with a variety of physical symptoms that have been present for the past 9 years. Numerous investigations and review by a variety of specialties have indicated no organic basis for his symptoms. This is an example of:

Which one of the following is not a recognised feature of anorexia nervosa?