DHA DHA Mental Health & Psychiatry 5 — Questions and Answers
Question 1: A 45-year-old male with no psychiatric history develops sudden-onset confusion, agitation, and visual hallucinations 48 hours after his last drink following a 10-year history of heavy alcohol use. What is the most likely diagnosis?
- Wernicke encephalopathy
- Korsakoff syndrome
- Alcohol withdrawal delirium (delirium tremens) (Correct answer)
- Alcoholic hallucinosis
Correct answer: Alcohol withdrawal delirium (delirium tremens)
Delirium tremens typically presents 48–72 hours after cessation with autonomic instability, confusion, and hallucinations, and carries significant mortality.
Question 2: Which of the following is the primary neurotransmitter implicated in the reward pathway dysregulation seen in substance use disorders?
- Serotonin
- Dopamine (Correct answer)
- Norepinephrine
- GABA
Correct answer: Dopamine
Dopamine in the mesolimbic pathway (nucleus accumbens) is central to the reinforcement and craving mechanisms in substance use disorders.
Question 3: A patient undergoing clozapine therapy develops a fever, sore throat, and absolute neutrophil count of 400 cells/mm³. What is the immediate action?
- Reduce clozapine dose by 50%
- Discontinue clozapine immediately and initiate G-CSF (Correct answer)
- Add prophylactic antibiotics and continue clozapine
- Switch to olanzapine at equivalent dose
Correct answer: Discontinue clozapine immediately and initiate G-CSF
An ANC below 500 cells/mm³ indicates severe neutropenia (agranulocytosis), requiring immediate clozapine discontinuation; G-CSF may be used to accelerate neutrophil recovery.
Question 4: According to DSM-5, persistent depressive disorder (dysthymia) requires a depressed mood lasting at least:
- 2 weeks
- 1 month
- 6 months
- 2 years (Correct answer)
Correct answer: 2 years
DSM-5 requires at least 2 years of persistent depressed mood (1 year in children/adolescents) for a diagnosis of persistent depressive disorder.
Question 5: A psychiatrist learns that a patient with paranoid schizophrenia has made specific threats to kill a named coworker. According to the Tarasoff principle, the psychiatrist's duty includes:
- Maintaining confidentiality as the threat may not be acted upon
- Warning the identified potential victim and notifying authorities (Correct answer)
- Increasing the patient's antipsychotic dose without disclosure
- Documenting the threat but taking no external action
Correct answer: Warning the identified potential victim and notifying authorities
The Tarasoff duty-to-protect doctrine obligates clinicians to warn identifiable potential victims and take reasonable protective steps when a credible, specific threat exists.
Question 6: Which cognitive distortion is exhibited when a patient concludes they are 'a complete failure' after making one mistake at work?
- Selective abstraction
- Magnification
- Overgeneralization (Correct answer)
- Personalization
Correct answer: Overgeneralization
Overgeneralization involves drawing a sweeping negative conclusion from a single event, such as labeling oneself a total failure after one error.
Question 7: A 30-year-old presents with episodes of intense fear, palpitations, shortness of breath, and fear of dying, peaking within 10 minutes and resolving spontaneously. Medical workup is negative. What is the most likely diagnosis?
- Generalized anxiety disorder
- Acute stress disorder
- Panic disorder (Correct answer)
- Somatic symptom disorder
Correct answer: Panic disorder
Recurrent unexpected panic attacks peaking within minutes, with physical symptoms and fear of dying, are the hallmark of panic disorder after medical causes are excluded.
DHA DHA Mental Health & Psychiatry 5
A 45-year-old male with no psychiatric history develops sudden-onset confusion, agitation, and visual hallucinations 48 hours after his last drink following a 10-year history of heavy alcohol use.
What is the most likely diagnosis?