Psychiatry and Behavioral Medicine Flashcards

A 35-year-old woman presents with persistent sadness, anhedonia, insomnia, fatigue, difficulty concentrating, and feelings of worthlessness for 3 weeks. What is the minimum number of symptoms required to diagnose Major Depressive Disorder per DSM-5?

Answer: 5 symptoms for at least 2 weeks

DSM-5 requires at least 5 of 9 specified symptoms present for at least 2 weeks, with depressed mood or anhedonia being mandatory.

A 22-year-old man with schizophrenia has persistent auditory hallucinations and delusions despite adequate trials of two second-generation antipsychotics. Which medication is most appropriate for treatment-resistant schizophrenia?

Answer: Clozapine

Clozapine is the only FDA-approved medication for treatment-resistant schizophrenia, defined as failure of at least two adequate antipsychotic trials.

Which feature best distinguishes Bipolar I disorder from Bipolar II disorder?

Answer: At least one full manic episode lasting 7 or more days

Bipolar I requires at least one full manic episode lasting ≥7 days (or any duration requiring hospitalization), while Bipolar II involves hypomania but never full mania.

A 28-year-old woman reports recurrent, unexpected episodes of intense fear with palpitations, dyspnea, chest pain, and fear of dying peaking within 10 minutes. She now avoids crowded places. What is the most likely diagnosis?

Answer: Panic Disorder with Agoraphobia

Panic Disorder with Agoraphobia presents with recurrent unexpected panic attacks plus avoidance of situations where escape might be difficult if an attack occurs.

A 32-year-old veteran presents with intrusive flashbacks, nightmares, hypervigilance, emotional numbing, and avoidance of combat-related stimuli persisting for 6 months post-deployment. What is the first-line pharmacological treatment?

Answer: Sertraline or paroxetine

SSRIs (sertraline and paroxetine) are the only FDA-approved medications for PTSD, and are recommended as first-line pharmacotherapy.

A 68-year-old man continues to experience intense longing, difficulty accepting his wife's death, and significant functional impairment 14 months after her passing. He does not meet criteria for Major Depressive Disorder. What is the most likely diagnosis?

Answer: Prolonged Grief Disorder

Prolonged Grief Disorder (DSM-5-TR) is diagnosed when intense grief with functional impairment persists beyond 12 months in adults following bereavement.

A physician is assessing suicide risk in a 45-year-old man with depression. Which factor is the single strongest predictor of completed suicide?

Answer: Prior suicide attempt

A prior suicide attempt is the single strongest predictor of future completed suicide, increasing risk approximately 30-40 times compared to the general population.

A 40-year-old woman with depression is started on fluoxetine. What is the primary mechanism of action of SSRIs?

Answer: Inhibition of serotonin reuptake at the presynaptic terminal

SSRIs block the serotonin transporter (SERT), preventing reuptake of serotonin into the presynaptic neuron and increasing serotonin availability in the synaptic cleft.

A patient on lithium for bipolar disorder presents with coarse tremor, confusion, ataxia, and nausea. His serum lithium level is 2.1 mEq/L. What is the most appropriate immediate management?

Answer: Discontinue lithium and provide supportive care with hydration

Lithium toxicity (levels >1.5 mEq/L with symptoms) requires immediate discontinuation and supportive care; the therapeutic range is 0.6–1.2 mEq/L.

A 25-year-old woman presents with intense fear of abandonment, markedly unstable relationships alternating between idealization and devaluation, identity disturbance, recurrent self-harm, and severe emotional lability. What is the most likely diagnosis?

Answer: Borderline Personality Disorder

Borderline Personality Disorder is characterized by fear of abandonment, unstable relationships, identity disturbance, impulsivity, and recurrent self-harm or suicidal behavior.

A patient with alcohol use disorder is admitted for detoxification. During which timeframe after the last drink is the risk for alcohol withdrawal seizures highest?

Answer: 24–48 hours after last drink

Alcohol withdrawal seizures most commonly occur 24–48 hours after the last drink; delirium tremens typically peaks at 48–72 hours.

A patient taking haloperidol develops hyperthermia (40.5°C), severe lead-pipe muscle rigidity, altered consciousness, and autonomic instability. CPK is markedly elevated. What is this condition?

Answer: Neuroleptic Malignant Syndrome

Neuroleptic Malignant Syndrome is a life-threatening antipsychotic reaction presenting with hyperthermia, lead-pipe rigidity, altered consciousness, and autonomic instability with elevated CPK.

An adult patient reports longstanding difficulty sustaining attention, frequent task-switching, forgetfulness, and disorganization present since childhood that impairs occupational functioning. What is the first-line pharmacological treatment for adult ADHD?

Answer: Amphetamine salts or methylphenidate

Stimulants (amphetamine salts or methylphenidate) are first-line pharmacological treatments for ADHD in both adults and children due to their superior efficacy.

A 55-year-old woman presents with excessive worry about multiple life domains occurring more days than not for 8 months, with associated muscle tension, fatigue, and irritability. What is the minimum duration of symptoms required to diagnose Generalized Anxiety Disorder?

Answer: 6 months

DSM-5 requires excessive anxiety and worry occurring more days than not for at least 6 months for a diagnosis of Generalized Anxiety Disorder.

A patient on an SSRI develops agitation, tremor, diaphoresis, hyperreflexia, and clonus within hours of adding tramadol. How does serotonin syndrome differ from Neuroleptic Malignant Syndrome?

Answer: Serotonin syndrome has rapid onset with clonus; NMS has slower onset with lead-pipe rigidity

Serotonin syndrome has rapid onset (within hours), features clonus and hyperreflexia, and is caused by serotonergic drugs; NMS has slower onset over days, lead-pipe rigidity, and is caused by antipsychotics.

Electroconvulsive therapy (ECT) is most appropriately indicated in which clinical scenario?

Answer: Severe treatment-resistant depression with acute suicidality or when medications are contraindicated

ECT is indicated for severe treatment-resistant depression, acute suicidality, catatonia, psychotic depression, or when rapid response is essential and medications are refused or contraindicated.

A physician uses motivational interviewing to help a patient with alcohol use disorder consider behavior change. Which principle best describes this therapeutic approach?

Answer: Eliciting and strengthening the patient's intrinsic motivation through a collaborative, patient-centered approach

Motivational interviewing uses a collaborative, empathetic approach to elicit intrinsic motivation for change by exploring ambivalence, working with the patient's own values rather than imposing external pressure.

A 30-year-old woman develops sudden paralysis of her left arm following a traumatic car accident. Neurological examination and brain MRI are normal. She appears surprisingly unconcerned about the deficit. What is the most likely diagnosis?

Answer: Conversion Disorder (Functional Neurological Symptom Disorder)

Conversion Disorder presents with neurological symptoms incompatible with known neurological disease, often following psychological stress, and may include la belle indifférence (apparent unconcern).

A 17-year-old girl with anorexia nervosa (BMI 14) is hospitalized for nutritional rehabilitation. Which electrolyte abnormality is the most dangerous complication of refeeding and must be closely monitored?

Answer: Hypophosphatemia

Refeeding syndrome causes rapid intracellular shift of phosphate with hypophosphatemia, which is the most dangerous complication and can lead to cardiac arrhythmias and respiratory failure.

A 28-year-old man with no psychiatric history experiences sudden onset psychosis with delusions and hallucinations following an acute stressor. Symptoms fully resolve after 3 weeks with complete return to baseline. What is the most likely diagnosis?

Answer: Brief Psychotic Disorder

Brief Psychotic Disorder involves sudden onset psychotic symptoms lasting 1 day to 1 month with full return to premorbid function; Schizophreniform requires 1–6 months and Schizophrenia requires ≥6 months.