SPEX Psychiatry 5 — Questions and Answers
Question 1: A 40-year-old man with alcohol use disorder presents with confusion, ophthalmoplegia, and ataxia after 5 days of poor oral intake. What is the immediate treatment?
- Oral thiamine 100 mg daily
- IV dextrose followed by thiamine
- IV thiamine 500 mg followed by dextrose (Correct answer)
- High-dose IV multivitamins without thiamine
Correct answer: IV thiamine 500 mg followed by dextrose
Wernicke encephalopathy requires immediate high-dose IV thiamine before glucose to prevent precipitating or worsening the encephalopathy.
Question 2: A patient with schizophrenia is non-adherent to oral antipsychotics. She has had three hospitalizations in the past year. What pharmacological strategy best addresses adherence?
- Add a second oral antipsychotic
- Switch to a long-acting injectable antipsychotic (Correct answer)
- Add a mood stabilizer
- Increase oral dose and add medication reminders
Correct answer: Switch to a long-acting injectable antipsychotic
Long-acting injectable antipsychotics (LAIs) eliminate the need for daily oral adherence and are the preferred strategy for patients with repeated non-adherence-related relapses.
Question 3: Which of the following is the primary mechanism by which benzodiazepines exert anxiolytic and sedative effects?
- Direct opening of chloride channels at GABA-A receptors
- Positive allosteric modulation of GABA-A receptors, increasing chloride conductance frequency (Correct answer)
- Blockade of NMDA glutamate receptors
- Inhibition of serotonin reuptake
Correct answer: Positive allosteric modulation of GABA-A receptors, increasing chloride conductance frequency
Benzodiazepines are positive allosteric modulators at GABA-A receptors; they increase the frequency of chloride channel opening in the presence of GABA but do not activate the receptor directly.
Question 4: A psychiatrist is treating a patient who discloses intent to kill a specific identifiable third party. The psychiatrist is located in a state that has a Tarasoff-based duty-to-protect statute. What is the MINIMUM required action?
- Document the threat and increase session frequency
- Notify the patient's next of kin
- Warn the potential victim and/or notify law enforcement (Correct answer)
- Consult a peer and maintain strict confidentiality
Correct answer: Warn the potential victim and/or notify law enforcement
Most state duty-to-protect laws require clinicians to take reasonable steps to protect an identifiable third party, which typically includes warning the victim and/or notifying law enforcement.
Question 5: A 68-year-old man with major depressive disorder fails to respond to two adequate SSRI trials. Which of the following is a reasonable augmentation strategy with strong evidence?
- Adding haloperidol 5 mg/day
- Adding lithium to the existing antidepressant (Correct answer)
- Switching to a tricyclic antidepressant monotherapy
- Adding benzodiazepine monotherapy
Correct answer: Adding lithium to the existing antidepressant
Lithium augmentation of antidepressants has strong evidence for treatment-resistant depression, converting partial responders or non-responders to full response.
Question 6: A 25-year-old woman with borderline personality disorder presents after self-cutting during a conflict with her partner. She says she either 'loves or hates' people with nothing in between. This defense mechanism is called:
- Projection
- Reaction formation
- Splitting (Correct answer)
- Rationalization
Correct answer: Splitting
Splitting is the primitive defense mechanism central to BPD, characterized by viewing people or situations as all-good or all-bad without integration of ambivalent feelings.
Question 7: Which of the following is TRUE regarding informed consent for psychiatric treatment?
- Patients must consent in writing for all psychiatric medications
- Informed consent requires disclosure of risks, benefits, and alternatives (Correct answer)
- A patient's agreement to any treatment implies informed consent
- Informed consent is waived in all emergency situations indefinitely
Correct answer: Informed consent requires disclosure of risks, benefits, and alternatives
Informed consent requires that clinicians disclose material information including risks, benefits, and alternatives so the patient can make a voluntary, competent decision.
SPEX Psychiatry 5
A 40-year-old man with alcohol use disorder presents with confusion, ophthalmoplegia, and ataxia after 5 days of poor oral intake.
What is the immediate treatment?