SMLE Psychiatry 6

Question 1

A 22-year-old university student presents with severe social anxiety, inability to attend classes or speak in groups, and avoidance of social situations for 2 years. CBT has been partially effective. What pharmacotherapy should be added?

Accepted Answer

SSRI (e.g., sertraline or paroxetine)

Answer

SSRIs (sertraline and paroxetine have FDA approval for social anxiety disorder) combined with CBT provide the best outcomes for social anxiety disorder. Paroxetine is specifically well-studied for this indication. Long-term benzodiazepine use is avoided due to dependence risk.

Question 2

A patient attempts suicide by hanging and is found unconscious. After medical stabilisation, what is the most important aspect of the initial psychiatric assessment?

Accepted Answer

Comprehensive suicide risk assessment including intent, plan, and protective factors

Answer

After medical stabilisation of a serious suicide attempt, a comprehensive suicide risk assessment is essential. This includes evaluating ongoing suicidal intent, presence of a plan, access to means, psychiatric diagnosis, substance use, social supports, and protective factors to guide the level of care.

Question 3

A patient with schizophrenia has been resistant to two adequate trials of different antipsychotics. What is the recommended next pharmacological step?

Accepted Answer

Start clozapine

Answer

Clozapine is the gold standard treatment for treatment-resistant schizophrenia, defined as failure of ≥2 adequate antipsychotic trials. Despite its superior efficacy, it requires regular blood monitoring due to the risk of agranulocytosis.

Question 4

A 30-year-old woman presents with episodes of depersonalisation, identity confusion, and amnesia for significant personal events. She has a history of severe childhood abuse. What is the most likely diagnosis?

Accepted Answer

Dissociative identity disorder

Answer

Dissociative identity disorder (formerly multiple personality disorder) is characterised by disruption of identity with ≥2 distinct personality states, recurrent gaps in recall, and significant distress. It is strongly associated with severe, repeated childhood trauma.

Question 5

A 65-year-old patient with Parkinson disease develops visual hallucinations. Which antipsychotic is safest to use?

Accepted Answer

Quetiapine or pimavanserin

Answer

Quetiapine (low dose) and pimavanserin (5-HT2A inverse agonist specifically approved for Parkinson disease psychosis) are the safest antipsychotic options as they have the least D2 blocking activity. Typical antipsychotics and most other atypicals can worsen parkinsonian symptoms.

SMLE Practice Test

SMLE Practice Test

SMLE Psychiatry 6