Psychiatry Module 2

Which one of the following symptoms may indicate mania rather than hypomania?

A 45-year-old man who takes chlorpromazine for schizophrenia presents with severe restlessness, associated with a particular movement disorder known as?

A 25-year-old man demands a CT scan of his abdomen in clinic. He states it is ‘obvious’ he has cancer despite previous negative investigations.

This is a classic example of:

A 34-year-old man confides in you that he experienced childhood sexual abuse.

Which one of the following features is not a characteristic feature of post-traumatic stress disorder?

A 25-year-old man with a history of schizophrenia is prescribed olanzapine.

Which one of the following adverse effects is he most likely to experience?

A 39-year-old man comes for review. Six months ago he was started on paroxetine for depression. Around five days ago he stopped taking the medication as he felt that it was having no benefit.

His only past medical history of note is asthma. For the past two days he has experienced increased anxiety, sweating, headache and the feeling ofa needle like sensation in his head. During the consultation he is pacing around the room.

What is the most likely explanation for his symptoms?

You are considering prescribing a tricyclic antidepressant for a patient who has not responded to two different types of selective serotonin reuptake inhibitors.

Which one of the following tricyclic antidepressants is most dangerous in overdose?

A 23-year-old male presents to his GP two weeks after a road traffic accident concerned about increased anxiety levels, lethargy and headache.

At the time, he had a CT brain after banging his head on the steering wheel, which revealed no abnormality. Six months following this episode his symptoms have resolved.

What did his original symptom likely represent?

An elderly patient in a nursing home, who exhibits persistent aggressive behavior unresponsive to non-pharmacological interventions, has been prescribed quetiapine.

Which of the following adverse effects is associated with an increased risk in elderly patients due to antipsychotic use

A 30-year-old man presents to his doctor as he has been feeling generally ‘out of sorts’ for the past few weeks. He is accompanied by his girlfriend who says he has ‘not been himself’. She is worried and feels he may need to see a psychiatrist. There is no history of past mental health problems.

Which one of the following symptoms would be most suggestive of depression?

A 23-year-old man asks to be referred to a plastic surgeon. From his records you can see he has been treated for anxiety and depression with fluoxetine previously and has been off work with back pain for the past three months. He is concerned that his ears are too big in proportion to his face.

He reports that he now seldom leaves the house because of this. On examination his ears appear to be within normal limits.

What is the most appropriate description of this behaviour?

A 68-year-old female is noted to be depressed following a recent admission for an exacerbation of chronic obstructive pulmonary disease.

What would be the most appropriate antidepressant to start?

A woman who gave birth 5 days ago presents for review as she is concerned about her mood. She is having difficulty sleeping and feels generally anxious and tearful. Since giving birth she has also found herself snapping at her husband. This is her first pregnancy, she is not breast feeding and there is no history of mental health disorders in the past.

What is the most appropriate management?

A 18-year-old sprinter who is currently preparing for a national athletics meeting asks to see the team doctor due to an unusual sensation in his legs. He describes a numb sensation below his knee.

On examination, the patient there is apparent sensory loss below the right knee in a non-dermatomal distribution.

The team doctor suspects a non-organic cause of his symptoms.

This case is an example of:

A 23-year-old man presents as he is concerned about a number of recent episodes related to sleep. He finds that when he wakes up and less often when he is falling asleep, he is ‘paralysed’ and unable to move.

This is sometimes associated with what the patient describes as hallucinations such as seeing another person in the room. He is becoming increasingly anxious about these recent episodes.

What is the most likely diagnosis?

A 34-year-old man originally from West Africa is seen in January with depression. There is no past medical history of note but he is known to smoke cannabis. He has had similar episodes for the past two winters.

What is the most likely diagnosis?

You review a patient who has been taking citalopram for the past two years to treat depression. He has felt well now for the past year and you agree a plan to stop the antidepressant.

How should citalopram be stopped?

Which one of the following side-effect is more common with atypical than conventional anti-psychotics?

A 45-year-old man is admitted due to haematemesis. He drinks 120 units of alcohol a week.
When is the peak incidence of seizures following alcohol withdrawal?

Which of the following conditions is least associated with obsessive compulsive disorder?

A 54-year-old man with a history of depression presents for review. Hewas started on fluoxetine eight weeks ago and is now requesting to stop his medication as he feels so well.

What should be recommended regarding his treatment?

Which one of the following feature is not associated with a poor prognosis in schizophrenia?

A 24-year-old female is reviewed following a course of cognitive behaviour therapy for bulimia. She feels there has been no improvement in her condition and is interested in trying pharmacological treatments.

Which one of the following is most suitable?

A 24-year-old male is admitted to the Emergency Department complaining of severe abdominal pain.

On examination he is shivering and rolling around the trolley. He has previously been investigated for abdominal pain and no cause has been found.

He states that unless he is given morphine for the pain he will kill himself.

This is an example of:

A 14-year-old boy is brought for review. He is normally fit and well and hasn’t seen a doctor for over five years. His mother has been increasingly concerned about his behavior in the past few weeks. She describes him staying up late at night, talking quickly and being very irritable.

Yesterday he told his mother he was planning to ‘take-over’ the school assembly and give ‘constructive criticism’ to his teachers in front of the other pupils. He feels many of his teachers are ‘underperforming’ and need to be ‘retaught’ their subjects by him.

He admits to trying cannabis once around six months ago and has drank alcohol ‘a few times’ in the past year, the last time being two weeks ago. Prior to his deterioration a few weeks ago his mother describes him as a happy, well adjusted, sociable
young man.

Which one of the following is the most likely diagnosis?

A 27-year-old woman is brought in by her husband. She has been refusing to go outside for the past 3 months, telling her husband she is afraid of catching avian flu.

On exploring this further she is concerned due to the high number of migrating birds she can see in her garden.

She reports that the presence of her husbands socks on the washing line in the garden alerted her to this.

What is the most likely diagnosis?

A 29-year-old fireman presents following a recent traumatic incident where a child died in a house fire. He describes recurrent nightmares and flashbacks which have been present for the past 3 months.

A diagnosis of post-traumatic stress disorder is suspected.

What is the most appropriate first-line treatment?

A patient you are looking after is started on imipramine for depression.

Which combination of side-effects is most likely to be seen in a patient taking this class of antidepressants?

Which one of the following statements regarding post-partum mental health problems is NOT true?