ROSH Psych EOR

A patient under your care with a history of symptoms, including hypervigilance, insomnia, nightmares, flashbacks, and an exaggerated startle response, after being involved in a car collision 3 months ago presents requesting help managing their symptoms. Which of the following is the best initial treatment approach? Cognitive behavioral therapy Cognitive behavioral therapy with fluoxetine Dialectical behavior therapy Fluoxetine

Cognitive Behavioral therapy Fluoxetine use used in patients who are REFRACTORY to psychotherapy alone or who express desire to pharmacotherapeutic tx

A 23-year-old woman with no significant prior medical history presents to the clinic reporting a chronic history of sleep issues. She states that in the evenings and during attempted sleep, she often feels a persistent "crawling and tingling" feeling in the legs that is relieved by movement, making falling asleep difficult. Physical exam is benign. Which of the following is the most likely next step in diagnosis? Iron studies Magnetic resonance imaging of the brain Polysomnography Urine drug screen

Iron Studies Restless leg syndrome

A 39-year-old woman presents to the clinic with a persistent depressed mood. She reports anhedonia, increased sleep, and feelings of worthlessness for most days of the week, most weeks of the year, without a significant symptom-free period over the last 6 years. She reports no suicidal ideation, mania, hypomania, or psychotic features. She is otherwise healthy. Which of the following treatment options is the best choice for this patient? 6 months of pharmacotherapy followed by life-long psychotherapy 6 months of psychotherapy followed by life-long pharmacotherapy Combined pharmacotherapy and psychotherapy for an indefinite period Pharmacotherapy alone for an indefinite period

Combines pharmacotherapy and psychotherapy for an indefinite period

A 21-year-old man presents to the clinic with his father for a routine follow-up. His father notes he has improved significantly over the past few months. He states the patient is no longer worried that the FBI has hacked his computer and cell phone. The patient reports he is no longer hearing voices, and he has been making efforts to attend social gatherings on the weekend. The patient has been stable and treated with clozapine. Which of the following lab panels should be monitored for this patient? Arterial blood gas Basic metabolic panel Complete blood count Hepatic function panel

Complete Blood Count Clozapine = agranulocytosis

A 16-year-old boy presents to the clinic with his parents after being arrested for killing the neighbor's dog. The parents report that he has vandalized his school and other property and is consistently getting into fights with other children at school. Which of the following is the most likely diagnosis? Antisocial personality disorder Borderline personality disorder Conduct disorder Oppositional defiant disorder

Conduct Disorder if pt >18 yo: antisocial

A 10-year-old boy presents to the clinic with his mother, who is concerned about his poor school performance. She reports he makes careless mistakes, has difficulty maintaining attention, and is easily distracted during class. Which of the following medications for treating the suspected condition has a black box warning for misuse and dependence? Atomoxetine Clonidine Guanfacine Methylphenidate

Methylphenidate ADHD medication

A 35-year-old man presents to the emergency department after getting in a bar fight with another patron. He has been in the emergency department multiple times due to injuries relating to the destruction of private property. He reports alcohol use and occasional marijuana use and has a difficult time retaining employment. On multiple occasions on this visit, he has tried to hit the nursing staff as they attempted to place an IV. Which of the following diagnoses did this patient most likely have during childhood and adolescence? Attention-deficit/hyperactivity disorder Bipolar disorder Conduct disorder Oppositional defiant disorder

Conduct disorder Antisocial personality disorder

25-year-old man presents, stating his boss told him to be evaluated because he is obsessed with perfectionism. Which of the following historical elements would be present in a patient with obsessive-compulsive personality disorder versus obsessive-compulsive disorder? Avoiding situations because of a fear a dog is going to bite him Conflicts with family and friends about his excessive perfectionism Inability to drive across bridges because he is afraid the bridge will fail Symptoms get better or worse depending on the amount of anxiety a situation causes

Conflicts with family and friends about his excessive perfectionism OCPD = Syntonic (does not see problem in behavior)

A 24-year-old man presents to the emergency department with agitation after ingesting a substance in brownies. He reports he has inhaled this substance before and it usually gives him a relaxed and euphoric feeling. He also reports dry mouth, nausea, and vomiting. Vital signs include a heart rate of 108 bpm and blood pressure of 155/92 mm Hg. Which of the following additional findings supports the suspected diagnosis? Auditory hallucinations Conjunctival injection Diaphoresis Pinpoint pupils

Conjunctival Injection Marijuana intoxication

A 20-year-old man presents to the emergency department complaining of being given some "bad stuff" to smoke at a party. The patient exhibits paranoia, avoidance of eye contact, sedation, diaphoresis, vomiting, bradycardia, and hypotension. He complains of extreme muscle pain and states he knows people are thinking evil thoughts about him. A urine toxicology screen is negative. Which of the following substances is most likely causing his symptoms? Bath salts Cannabis Crack cocaine Spice

Spice smokable, does not show in urine tox screen

A 30-year-old woman who is obese and has chronic hepatitis C presents to the clinic with episodes of deep depression followed by weeks of expansive mood, flight of ideas, risk-seeking behavior, and insomnia. Which of the following would need to be monitored frequently if the patient is started on the most appropriate therapy? Fasting plasma glucose Liver enzymes Thyroid function Urine beta-human chorionic gonadotropin

Thyroid Function Bipolar disorder - tx: Lithium --> hypothyroidism

Which of the following is the most commonly abused substance by schizophrenic patients? Alcohol Cannabis Cocaine Tobacco

Tobacco

A 13-year-old girl presents to the emergency department after being found unconscious in her room. Her parents walked into her room and saw her with a cloth against her mouth and an empty can of paint thinner next to her bed. You detect a glue odor on exam. Which of the following substances is the most likely intoxicant? Cannabis Lysergic acid diethylamide Nitrous oxide Toluene

Toluene

xA 30-year-old woman presents to her primary care provider with complaints of widespread, achy musculoskeletal pain, fatigue, and chronic headache for the past 9 months that have severely interfered with her activities of daily living. She states her pain is worse in the morning and aggravated by minor activities. She reports no known sick contacts but states she feels like she has had the flu for 9 months. Her past medical history is significant for anxiety and depression. Physical examination is significant for muscle tenderness over the neck, shoulders, bilateral arms and legs, and upper and lower back. Which of the following is most likely to be found in the patient's history?

Insomnia

A 24-year-old woman presents to the emergency department with right upper extremity weakness for the past 2 weeks. Physical examination reveals 2/5 strength in the right upper extremity and 5/5 strength in all other extremities. You review the patient's medical records and see that she has been to the emergency department four times in the past with similar symptoms, and diagnostic tests, including neuroimaging, have always been unremarkable. She has also been seen in a neurology outpatient clinic and had a normal nerve conduction study and a normal electromyography. You suspect a psychiatric condition marked by unintentional production of symptoms without clear secondary gain. Which of the following is the suspected diagnosis? Conversion disorder Factitious disorder Illness anxiety disorder Malingering

Conversion Disorder significant distress caused by neurologic symptoms that are not consistent with known general or neurologic medical conditions Factitious disorder vs conversion: symptoms. are intentionally produced and not always neurologic

A 20-year-old woman is seeing a therapist for a condition marked by repetitive excessive food intake followed by self-induced vomiting. These behaviors have been happening several times per week for 6 months, and the patient reports an intense fear of gaining weight. Her body mass index is 29.2 kg/m2. Which of the following is the most likely diagnosis? Anorexia nervosa Binge eating disorder Borderline personality disorder Bulimia nervosa

Bulimia nervosa

A 24-year-old woman presents to the clinic complaining of palpitations and depressed mood. On physical exam, she is visibly cachectic with a body mass index of 13 kg/m2. A systolic murmur and systolic click are appreciated at the cardiac apex, and her skin is cool and dry with an abundance of fine, dark hair over her entire body. The patient reports eating only one small salad per day because she has an intense fear of becoming fat. The patient is admitted for evaluation and treatment. Which of the following medications should be avoided? Bupropion Buspirone Olanzapine Sertraline

Bupropion increased incidence of seizure activity in eating disorders

A 45-year-old man presents due to feeling depressed for the last several weeks. He reports he feels very depressed and fatigued, has lost interest in his hobbies, never feels like he gets enough sleep, and has not been able to concentrate at work over the last 3 weeks. You note in the patient's history that he has a history of erectile dysfunction and takes sildenafil as needed. Which of the following medications is the most appropriate treatment for this patient? Bupropion Sertraline Trazodone Venlafaxine

Bupropion used to avoid sexual dysfunction

During a sleep study, electroencephalography indicates low voltage, sawtooth waves while electromyography indicates atonia. Electro-oculography indicates conjugate, irregular, sharply peaked eye movements. Which of the following is most accurate of this stage of sleep? Associated with vivid dreaming Comprises the largest percentage of total sleep time Frequently referred to as deep sleep Time in this stage is increased with benzodiazepine use

Associated with vivid dreaming REM sleep (NREM = deep sleep)

A 23-year-old woman presents to the clinic to discuss an episode of intense fear following a stressful life event. She reports that the episode was not incited by a trigger reminding her of a previous life event. Which of the following additional findings supports the suspected cause of her symptoms? Absence of somatic symptoms Duration of 4 hours Gradual onset Peak intensity within minutes

Peak Intensity within minutes Panic Attacks

A 43-year-old man presents with anhedonia, insomnia, weight loss, intense fatigue, and feelings of worthlessness for the past 3 weeks. In addition to psychotherapy, you decide to prescribe the most suitable atypical antidepressant based on his symptoms. Which of the following side effects for this medication should you educate the patient about? Diarrhea Drowsiness Orthostatic hypotension Psychomotor agitation

Drowsiness Atypical Antidepressants - mirtazapine, bupropion, agomelatine

A 16-year-old boy presents with his mother due to behavioral concerns. She is concerned he has antisocial personality disorder. What is the minimum age requirement for diagnosis of antisocial personality disorder? 15 16 18 21

18 Patient presents with *conduct disorder* before age of 15

A 22-year-old man presents to the emergency department in a catatonic state. He was found at home with a few white tablets in his hand. Vital signs show tachypnea, tachycardia, hyperpyrexia, and hypertension. Physical exam shows nystagmus and hyperreflexia. Urine toxicology screening is negative, and laboratory results show lactic acidosis. Which of the following substances did this patient most likely ingest? 3-Methoxyphencyclidine Heroin Lysergic acid diethylamide Tetrahydrocannabinol

3-methoxyphencyclidine PCP

A 24-year-old man presents to the emergency department with intractable vomiting. He reports he has had similar episodes previously, and his symptoms seem to be relieved by hot showers. What is the maximum time the substance suspected to be causing this patient's symptoms can be detected in the urine? 14 days 2 days 30 days 60 days

30 days Cannabis (cannabis hyperemesis syndrome - vomiting typically relieved by hot showers)

A 38-year-old man presents to the emergency department with his wife. The patient is in an altered mental state and continues to report there are spiders crawling on him. His vitals are heart rate of 138 bpm, blood pressure of 158/96 mm Hg, and respiratory rate of 20 breaths per minute. He appears angry and diaphoretic on exam. The patient's wife reports heavy alcohol use at home. Which of the following timeframes is consistent with this patient's presenting symptoms? 12-48 hours after the last drink 48-96 hours after the last drink 6-24 hours after the last drink 6-48 hours after the last drink

48-96 hours after the last drink late alcohol withdrawal symptoms

A 32-year-old woman presents to the clinic complaining of irritability, difficulty concentrating, and fatigue for the past 8 months. She reports that she feels stressed at home and work and easily becomes anxious in response to trivial stressors. She reports no anhedonia or a depressed mood. You decide to start her on venlafaxine to treat the suspected diagnosis. How long should treatment be continued before increasing the dose or switching to another medication if she is not experiencing improvement on a therapeutic dose? 12 weeks 3 weeks 6 weeks 9 weeks

6 Weeks

A 24-year-old woman presents to her therapist to discuss her dietary habits. She reports that she intermittently consumes large amounts of food, such as two large pizzas or two dozen cookies, and subsequently feels guilty. Which of the following additional features is most suggestive of binge eating disorder? Abnormally low body weight Absence of compensatory behaviors Distortion of body weight Excessive exercise

Absence of compensatory behaviors binge-eating disorder

A 4-year-old boy presents to the clinic for his annual physical. His vital signs are within normal limits, and the physical exam is normal. He avoids eye contact with the clinician and with his mother, speaks only in one- or two-word sentences, and is preoccupied with a toy car he has brought to the office. His mother states he has never liked to be hugged or touched, and he prefers to play by himself. Which of the following is a risk factor for the most likely diagnosis? Advanced paternal age Infants born after 42 weeks gestation Measles, mumps, and rubella vaccination Slow rate of head growth during infancy

Advanced Paternal Age autism spectrum disorder

A 36-year-old woman presents to the clinic for an annual physical and reports new-onset intermittent headaches that have been ongoing for the past month. Despite normal laboratory studies, CT, MRI, and EEG, the patient is insistent that part of her brain is rotting and frustrated that no one believes her. She reports no constitutional symptoms, hallucinations, or changes in cognition or memory. Her physical exam results are unremarkable compared to her previous visits. Which of the following medications would be most beneficial for this patient? Aripiprazole Diazepam Duloxetine Fluoxetine

Aripiprazole Delusional disorder - 1 month or longer, functioning not markedly impaired apart from delusions and their behavior ramifications 1st line: antipsychotics (aripiprazole, ziprasidone > fewer side effects)

A 3-year old boy presents to the pediatrician with his mother. She reports the preschool he goes to is concerned about his behavior. She notes the patient has difficulty remaining seated during lessons, is always "on the go," blurts out the answers to questions without raising his hand, talks to his classmates during lesson times even after correction, and cannot wait his turn when required. Which of the following is the recommended first-line treatment for this patient's suspected diagnosis? Behavioral interventions Elimination diet Pharmacotherapy Psychotherapy

Behavioral Interventions

A woman presents to the emergency department via ambulance after her husband witnessed a brief episode of seizure-like activity. The patient has a medical history including insomnia, major depressive disorder, and schizophrenia. Under observation, the patient reports hyperacusis, photosensitivity, anxiety, and dizziness. Vital signs include HR 132 bpm, RR 18 breaths per minute, BP 148/92 mm Hg, T 98.9°F, and SpO2 99% on room air. Which of the following is the most likely diagnosis? Benzodiazepine withdrawal Cerebrovascular accident Neuroleptic malignant syndrome Serotonin syndrome

Benzodiazepine Withdrawal tremor, anxiety, perceptual disturbances, dysphoria, psychosis, seizure, death

A 19-year-old man presents to the office accompanied by his brother for a 7-month history of changes in his behavior. The brother reports the patient's college roommate notified the family that the patient has been acting strangely. The brother reports the patient has an infatuation with a local news reporter, who the patient believed was talking directly to him during her newscast. The patient started writing letters to her and calling the station frequently to talk to his "girlfriend." He has missed several lectures for one of his courses so he would not miss the newscast. At one point, he went to the station on Valentine's Day with flowers and was turned away by security. His grades have dropped. In speaking with the patient, his speech is often off topic, and he exhibits neologisms and poor insight. He has a flat affect. Based on his presentation and suspected diagnosis, you decide to start him on treatment. What is the mechanism of action for the recommended treatment for this patient's condition? Blocks dopamine D2 receptors at the postsynaptic membrane Blocks voltage-gated sodium channels Enhances the inhibitory effect of gamma-aminobutyric acid Inhibits acetylcholinesterase to increase the concentration of available acetylcholine at the synaptic cleft

Blocks dopamine D2 receptors at the postsynaptic membrane MOA of FIRST generation antipsychotic - schizophrenia

A 22-year-old man presents to the emergency department with acute confusion and paranoia. Vital signs are notable for a temperature of 99.5°F, HR of 132 bpm, and blood pressure of 198/110 mm Hg. You notice that the patient is diaphoretic with dilated pupils on exam. Urine drug screen detects the metabolite benzoylecgonine. Which of the following describes the mechanism of action of the most likely intoxicant? Blocks the reuptake of biogenic amines Decreases glutamate activity in the brain Increases gamma-aminobutyric acid activity in the brain N-methyl-D-aspartate receptor complex antagonism

Blocks the reuptake of biogenic amines cocaine intoxication

A 35-year-old woman presents to the clinic with suicidal thoughts. She states she has been an impulsive person throughout her entire life and has always had difficulties with interpersonal relationships. Which of the following personality disorders carries an increased risk of suicide? Avoidant personality disorder Borderline personality disorder Obsessive-compulsive personality disorder Schizoid personality disorder

Borderline Personality Disorder

A 20-year-old woman presents to the clinic due to feeling cold and having irregular menses, stating that her last menstrual cycle was over 6 months ago. Her body mass index is 17 kg/m2, and her urine pregnancy test is negative. She states she exercises every day for at least 2 hours because she is overweight and is terrified of gaining weight. Which of the following physical exam findings is most consistent with the diagnosis? Bradycardia Eroded teeth enamel Hypertension Oily skin

Bradycardia

A 22-year-old man presents to the emergency department due to headache, myalgia, and chest pain. He is agitated, appears angry, and is difficult to restrain. Vital signs indicate blood pressure 180/100 mm Hg, pulse 130 beats per minute, and temperature 100.1°F. Physical exam reveals mydriasis, diaphoresis, and diffuse muscular tenderness to palpation. Which of the following is most likely found on this patient's urine toxicology screening? Cocaine Lysergic acid diethylamide Marijuana Opiates

Cocaine

A 28-year-old man presents to the emergency department with fatigue and chest pain. Electrocardiogram reveals nonspecific ST changes. Serum erythrocyte sedimentation rate and cardiac troponin are elevated. Physical exam reveals pitting lower extremity edema. The patient states he was recently started on a medication to control hallucinations, self-injurious behavior, and delusions of persecution. Which of the following medications is most likely causing his current symptoms? Amitriptyline Clozapine Olanzapine Risperidone

Clozapine

A 27-year-old man is brought to the psychiatric emergency department by police. The police were called because he was screaming and punching the air on the side of a street. The man reports he was defending his castle from aliens. During your assessment, he has blunted facial expressions and answers your questions in a roundabout way. You review his electronic medical records and see he has been brought in six times over the past 7 months with similar presentations. He has not been able to keep a job during this time, and his urine drug screens have been negative each time. Which of the following is considered a negative symptom of the suspected diagnosis? Decreased goal-directed behavior Nonbizarre delusions Tangentiality Visual hallucinations

Decreased goal-directed behavior Other options are POSITIVE symptoms

An 18-month-old girl presents to the clinic with parental concerns for odd motor behaviors. They have noticed the patient flapping her hands frequently. They report she has frequent tantrums as well. Which of the following is an early sign of the most likely diagnosis? Delay in spoken language Frequent gesturing to indicate wants Interested in new sounds and sensations Wanting to be with others all the time

Delay in spoken language Autism Spectrum Disorder

19-year-old man presents to the office with concerns and wants to be evaluated. He reports his friend gave him a brownie approximately 1 hour ago that contained an unknown substance. You note slurred speech. He appears mildly paranoid. His vital signs indicate tachycardia and a slightly elevated blood pressure. Eye examination reveals conjunctival injection with normal pupils and horizontal gaze nystagmus. What component of this unknown substance is primarily responsible for its psychoactive response, given the most likely cause for his presentation? 3,4-methylenedioxymethamphetamine 3-methylfentanyl Delta-9-tetrahydrocannabinol Lysergic acid diethylamide

Delta-9-tetrahydrocannabinol Cannabis intoxication

26-year-old woman presents to the clinic for group therapy. She reports that she is prone to interpersonal submissiveness, has a fear of abandonment, and relies heavily on others in making everyday decisions. Which of the following is the most likely personality disorder? Avoidant Borderline Dependent Schizoid

Dependent

A 25-year-old woman presents to a therapist due to persistent conflict in close relationships. She reports that one day it feels like her boyfriend is the love of her life, and the next day she wants to end their relationship. She also reports that she has had trouble maintaining a job because she will abruptly become upset with her boss and leave. She has attempted suicide twice in the past 6 months. Which of the following is the first-line treatment for the suspected personality disorder? Dialectical behavioral therapy Exposure and response prevention therapy Fluoxetine Lorazepam

Dialectical behavioral therapy Borderline personality disorder

A 35-year-old patient reports an alcohol intake of two cases of beer per week. This alcohol consumption causes him to miss work frequently, and he reports risky sexual encounters while acutely intoxicated. He would like to discuss options to help him reduce his reliance on alcohol. In addition to behavioral and social interventions, which of the following medications is appropriate? Acarbose Chlordiazepoxide Disulfiram Naloxone

Disulfiram discourage alcohol use: causes unpleasant side effects such as flushing and palpitations if used concomitantly with alcohol

A 19-year-old woman presents to the primary care clinic with decreased pleasure in usually pleasurable activities for the past 3 months. She also reports hypersomnia, decreased appetite, difficulty concentrating, and fatigue. Which of the following is a risk factor for the suspected diagnosis? Asian ancestry Cigarette smoking Divorced marital status High socioeconomic status

Divorced Marital status

A 45-year-old woman presents to the clinic due to insomnia. She has no trouble falling asleep but awakens in the middle of the night and cannot stay asleep. She has been practicing good sleep hygiene according to a prescribed cognitive behavioral approach for the past 6 months but continues to struggle maintaining sleep. Which of the following medications is most appropriate for this patient? Doxepin Ramelteon Triazolam Zaleplon

Doxepin histamine receptor antagonist

A 66-year-old man with a history of hyperlipidemia, type 2 diabetes, and diabetic neuropathy presents for mood disturbance for the last 3 weeks. He reports feeling his life is worthless and has lost interest in activities that used to bring him joy. He has no interest in seeing friends or family and has recurrent thoughts of death, although he has no specific suicidal plan. He reports a 5 lb unintentional weight loss but states he has lost his appetite. He mentions he has not been controlling his glucose over the last 6 months and thinks his neuropathy has worsened. Which of the following medications would be best for this patient? Duloxetine Gabapentin Pregabalin Sertraline

Duloxetine Major Depressive Disorder + neuropathic pain = duloxetine

A 27-year-old woman is arrested after running onto a concert stage and hugging the main performer. She tells the police that she is the performer's special fan and that they will get married one day. The performer states he does not know the woman. Which of the following types of delusions is this? Erotomanic Ideas of reference Nihilistic Paranoid

Erotomanic person erroneously believes they have a special relationship with someone

A 20-year-old man with a prior history of recurrent episodes of major depression presents to the emergency department with his family, who has noticed a change in his mood in the past 4 days. They report he has been euphoric, overly confident, and engaging in reckless and uncharacteristic spending. He reports that he has slept 10 hours total the past 5 nights and does not feel tired. On exam, you notice he talks rapidly and bounces from one idea to another. Urine drug screen is unremarkable. Which of the following is the strongest risk factor for the suspected diagnosis? Family history of the suspected condition Lower socioeconomic status Male sex Stressful life events

Family history of the suspected condition Bipolar I disorder- manic episode

A 26-year-old woman presents to the clinic with poor sleep. She states she has nightmares that cause her to scream and sweat several times per night. She also complains of daytime episodes of extreme anxiety, palpitations, sweating, and panic that occur after replaying mental images of a physical assault that happened to her last year. Which of the following is a common predisposing factor in the development of this patient's clinical disorder? Being married Female sex Higher socioeconomic status Older age at time of trauma

Female Sex PTSD factors: young age at time of trauma; adverse childhood events; female sex; being widowed, separated, or divorced; lower socioeconomic status; lower education level; personal or family history of psychiatric disease; poor social support; and a severe stress reaction at the time of the inciting event.

A 26-year-old woman presents to a plastic surgery clinic concerned about the appearance of her nose. She reports that her nose is long and causes her to have an ugly face. She frequently asks her close friends if her nose looks too long and spends several hours each day looking at her nose in the mirror, which temporarily makes her feel better. Physical exam reveals a relatively normal-appearing nose. You review her chart and notice she has previously had two plastic surgeries on her nose. Which of the following is an acceptable first-line treatment for the suspected diagnosis? Aripiprazole Buspirone Fluoxetine Venlafaxine

Fluoxetine Body dysmorphic disorder -- SSRIs (1st line) (2nd line: Clomipramine)

A patient with major depressive disorder is refractory to both first- and second-line therapies. You decide to prescribe selegiline. Which of the following is appropriate patient education regarding this agent? Foods that contain tyramine should be strictly eliminated while taking this agent Leafy green vegetable intake should be regulated to maintain level serum concentration levels Sexual dysfunction is a common side effect This agent should be taken concurrently while decreasing the most recent antidepressant dosage

Foods that contain tyramine should be strictly eliminated while taking this agent Monoamine Oxidase Inhibitor (MAOI) agents MAOI + Tyramine = hypertensive crisis/seretonin syndrome

A 62-year-old man presents with concerns over having "too much stress." He describes feeling worried most days about family, friends, finances, and health concerns. He notes feeling restless and unable to relax. He also reports he is having difficulty sleeping and thinks that is leading to difficulty concentrating at work. These symptoms have been present for the last 8 months. What is the most likely diagnosis? Adjustment disorder Generalized anxiety disorder Panic disorder Separation anxiety disorder

Generalized Anxiety Disorder

An 8-year-old boy presents to the clinic with his parents, who have behavioral concerns. At a recent parent-teacher conference, the teacher brought up concerns of inattention, emotional outbursts, and general restlessness in class. The parents confirm these behaviors have been disruptive at home as well. They report the patient gets frustrated easily and has difficulty handling his emotions. Which of the following predisposes the patient to the most likely diagnosis? Excessive dietary iron and zinc Genetic factors Higher birth weight Prenatal exposure to salicylates

Genetic Factors ADHD risks: genetic predisposition (polymorphisms in dopamine transporter gene and dopamine receptor gene

A 48-year-old man presents to the clinic for a rash. He states he has had poor personal hygiene for as long as he can remember. He likes to wear his shirts until they fall apart then keep a piece of them in his pocket when he picks out a new shirt. He believes his Magic 8-ball gives him good advice every morning. He has been a factory worker for the past 10 years and is often faulted for his disorganization and lack of attention to detail. He reports no auditory or visual hallucinations. He states he has always been too nervous, distrustful, and shy to get married. Which of the following pharmacologic interventions may be beneficial for this patient's personality disorder? Fluoxetine Guanfacine Haloperidol Mirtazapine

Guanfacine to gain cognitive organization while also decreasing anxiety -- Schizotypal personality disorder

A 26-year-old woman presents for therapy after being arrested for public nudity. Her family reports she has a persistent pattern of attention-seeking behavior and excessive emotionality. Which of the following personality disorders does this patient most likely have? Borderline Histrionic Narcissistic Schizotypal

Histrionic excessive emotionality and attention-seeking behaviors

A 28-year-old man presents to the psychiatrist for treatment of his anxiety. He reports that he is suspicious his wife is having an affair because she goes to the gym three times per week. He states that he has had trouble developing friendships because he cannot trust people due to suspicion that they are trying to exploit him. Which of the following features is consistent with the suspected diagnosis? Cognitive-perceptual disturbances Holding grudges Hypersensitivity to negative evaluation by others Lack of desire for interpersonal relationships

Holding Grudges Paranoid personality disorder

A 21-year-old woman with anorexia nervosa is admitted to an inpatient treatment facility for nutritional rehabilitation. She develops lower extremity edema and orthopnea after a week of treatment. Her creatine kinase is 5,000 U/L. Which of the following electrolyte abnormalities is the primary cause of tissue hypoxia? Hyperkalemia Hyperphosphatemia Hypokalemia Hypophosphatemia

Hypophosphatemia refeeding syndrome

A 24-year-old man presents to the clinic with depressed mood, feelings of worthlessness, extreme guilt, difficulty concentrating, decreased sleep, decreased appetite, and lack of interest in any activity. These symptoms have been present for more than 1 month and are worsening in severity. The patient states that recently he has felt that life is not worth living. Which of the following is an indication for hospitalization? Allergy to selective serotonin reuptake inhibitors Firearm in the home Inability to discuss safety planning Multiple concerned family members in the home

Inability to discuss safety planning

A 32-year-old woman presents with depressed mood, loss of interest in daily activities, and weight gain. She reports difficulty sleeping and concentrating and feels she would be "better off dead," although she reports no specific suicidal ideation or plan. She has been feeling this way for the past month since her divorce was finalized. She is given a prescription for amitriptyline. What is the mechanism of action of the class of this medication? Antagonism of presynaptic alpha-2 adrenoreceptors Antagonism of the 5-HT2A receptor Increase of vesicular stores of norepinephrine and serotonin Inhibition of reuptake of norepinephrine and serotonin

Inhibition of reuptake of Norepinephrine and serotonin Amitriptyline = TCA

A 37-year-old man presents to the office with concerns of increasing stress and "difficulty controlling urges." He notes for the past few years he has found himself sexually aroused by young children. This has manifested through sexual fantasies. He reports he has not acted on these fantasies (he has not watched child pornography or sexually abused a prepubescent child), but he is finding his fantasies are becoming more intense and more difficult to control, and they are causing him significant distress. He recently contacted a young boy over the internet. The patient requests pharmacologic therapy that can reduce the frequency of his fantasies and his sex drive. What should be recommended at this time? Flibanserin Fluoxetine Leuprolide acetate Surgical castration

Leuprolide Acetate Hormonal therapy - reduce sex drive, sexual fantasies, sexual arousal or activity

A 28-year-old man presents to the clinic reporting episodes of both elevated and depressed moods over the past few years. He reports that some days he goes without sleeping and continues to have excessive thoughts and ideas that race in his mind, while other days, he is stuck in bed with little to no desire to do anything. Which of the following is the most appropriate treatment for this patient? Fluoxetine Lithium Sertraline Venlafaxine

Lithium The patient has cyclothymic disorder. -Dx: multiple hypomanic and depressive-like symptoms that cause significant distress in day-to-day life (course over 2 years & symptomatic for at least half the time & not symptom free for period over 2 months) for which they do not meet the criteria for having a major depressive episode or bipolar disorder or attributed to substance use. - Tx for cyclothymic disorder is similar to that of bipolar I. (mood stabilizer (lithium)/antipsychotic (haloperidol) A,C,&D: antidepressants that are commonly used to treat patients with major depressive disorder (anhedonia in addition to five or more other associated depressive symptoms) (CIGCAPS)

A 41-year-old man presents to the office with a 1-month history of trouble sleeping, loss of appetite, decreased energy, and difficulty concentrating at work. He states that he used to go for daily walks with his neighbor which helped to clear his mind, but he no longer has an interest in doing this anymore. Which of the following tools has the highest specificity and sensitivity for screening for the suspected diagnosis? 5-item Geriatric Depression Scale Patient Health Questionnaire-2 Patient Health Questionnaire-9 World Health Organization Well-Being Index

Patient Health Questionnaire-9 (PHQ9)

A 21-year-old woman presents to the emergency department saying she feels as if she will die soon. She is sweating profusely, is tachypneic, and has tachycardia. All other vital signs are within normal limits. Radiologic and laboratory studies reveal no cardiopulmonary disease. The patient states that she tends to have feelings of impending doom when she is in crowded areas like she was earlier today. Which of the following clinical interventions would be most appropriate treatment of this patient's acute symptoms? Buspirone 15 mg Lorazepam 1 mg Mirtazapine 15 mg Sertraline 20 mg

Lorazepam 1mg Acute panic attack tx: benzodiazepines for SHORT TERM, immediate relief of panic symptoms **should not be given long-term daily basis > abusive potential and CNS depression

A 31-year-old woman presents to the emergency department after ingesting a full bottle of sertraline 100 mg tablets. Her pulse is 120 beats per minute, blood pressure is 160/100 mm Hg, and temperature is 104.1°F. On exam, she has ocular clonus, hyperreflexia, agitation, dilated pupils, and diaphoresis. Which of the following represents the best first-line therapy for this patient? Acetaminophen 1,000 mg PO every 8 hours Benztropine 2 mg IV once every 24 hours Cyproheptadine 12 mg PO once, then 6 mg PO every 6 hours Lorazepam 2 mg IV every 4 hours

Lorazepam 2 mg IV every 4 hours Serotonin Syndrome tx FIRST LINE- Benzodiazepines SECOND LINE (if not responding to first) - Cyproheptadine

A 20-year-old gymnast presents with amenorrhea. Her body mass index is 16 kg/m2. She says she feels fat and exercises for hours every day in addition to practicing gymnastics. She reports she eats one small meal per day and limits the calories she eats because she is afraid of gaining weight. Which of the following is included in the female athlete triad? Eating food more rapidly than normal Eating nonfood substances Loss of bone mineral density Tooth enamel loss

Loss of bone mineral density Triad: low bone mineral density, low energy availability, menstrual dysfunction

A 32-year-old man presents to the clinic with recurrent, episodic intense fear with symptoms of choking and dyspnea. He cannot identify a trigger to these episodes but states they resolve spontaneously after 10 to 15 minutes. Which of the following comorbidities is the most likely to be found in this patient? Major depressive disorder Obsessive-compulsive disorder Social anxiety disorder Specific phobia

Major Depressive Disorder

A 23-year-old woman presents to the clinic with decreased pleasure in usually enjoyable activities for the past month. She also reports hypersomnia, weight gain, decreased concentration, and excessive guilt. Which of the following is the most likely diagnosis? Bipolar disorder type 2 Cyclothymic disorder Major depressive disorder Persistent depressive disorder

Major Depressive disorder Bipolar disorder type 2 (A)-- criteria for a major depressive episode and a hypomanic episode. Cyclothymic disorder (B) -- recurrent episodes of hypomanic or depressive symptoms that do not meet the criteria for bipolar disorder type 2 or major depressive disorder, respectively. Persistent depressive disorder (D)-- depressed mood for at least 2 consecutive years with at least two of the following symptoms: decreased or increased appetite, insomnia or hypersomnia, low energy or fatigue, low self-esteem, impaired concentration or decision making, and hopelessness.

A 26-year-old woman with no significant medical history presents to the clinic for irregular menstrual cycles. She reports her menstrual cycles have been absent for the past 5 months, during which time she reports no new medications or supplements but reports increased exercise daily. Vital signs indicate HR of 57 bpm, RR of 18 breaths per minute, BP of 99/56 mm Hg, T of 97.7°F, SpO2 of 99% on room air, and a body mass index of 17.1 kg/m2. A urine human chorionic gonadotropin test is negative. Which of the following is the best initial treatment for this patient? Cognitive behavioral therapy Hospital admission for advanced therapy Nutritional counseling and rehabilitation Olanzapine

Nutritional counseling and Rehabilitation

A 6-year-old boy presents to the clinic for evaluation of a conduct disorder. His mother states he has been irritable and angry several days a week for the past year. When he is irritable, he defies her and his teachers, argues with everyone, and deliberately annoys his siblings. His grades are poor, and his friendships are few due to his anger and defiance. At least once per month, he acts vindictively toward his mother but has never harmed a person or animal. Which of the following environmental elements is more common in patients with this boy's most likely disorder? Maternal aggression Overprotective parenting Paternal absence Rigid structure in the home

Maternal aggression

A 7-year-old girl presents to the pediatrician multiple times for hematuria until it is discovered that her mother is contaminating the urine samples with her own blood. Which of the following is the suspected diagnosis? Conversion disorder Factitious disorder Medical child abuse Somatic symptom disorder

Medical Child Abuse

A 5-year-old boy presents to the emergency department with his mother for evaluation of abdominal pain. A chart review reveals this patient has been to the emergency department several times for a variety of symptoms with no specific diagnoses given. Abdominal exam is unremarkable, and while the mother is out of the room, the patient seems much improved, though when the mother returns, she insists something is wrong with her child. Which of the following is the most likely diagnosis? Child neglect Conversion disorder Malingering Medical child abuse

Medical Child abuse Munchausen Syndrome by proxy

A 34-year-old woman presents to the clinic for a mammogram. She reports that she is worried she will develop breast cancer because one of her friends developed breast cancer at a young age. She does not report any breast pain or lumps but does report that she had a transient tingling sensation on her left breast that occurred once and lasted 5 seconds. She has had eight mammograms in the past year and does self-breast examinations twice daily. She reports that her concern about having breast cancer has led to her spending excessive money on health care usage and hours each day reading about preventing breast cancer on the internet. Which of the following is a core feature of the suspected diagnosis? Desire for an external reward Fabrication of symptoms Minimal somatic symptoms Neurologic symptoms without a known medical explanation

Minimal Somatic Symptoms Illness anxiety disorder

A 19-year-old girl presents to the clinic for an annual physical. She states she runs at least 45 miles per week to maintain her figure. The patient has no significant medical history and has been amenorrheic for 6 months. Physical examination reveals a thin patient with peripheral edema and fine, downy hair on her face and arms. Vital signs include body mass index of 16.52 kg/m2, HR of 52 bpm, RR of 17 breaths per minute, BP of 98/52 mm Hg, T of 97.2°F, and SpO2 of 97% on room air. Which of the following is the best diagnosis? Extreme anorexia nervosa Mild anorexia nervosa Moderate anorexia nervosa Severe anorexia nervosa

Moderate Anorexia Nervosa Mild: BMI 17-17.99 Moderate: BMI 16-16.99 Severe: BMI 15-15.99 Extreme: BMI <15

A 25-year-old man presents to marital counseling with his wife, who reports that he emotionally abuses her. His wife also reports that he is unable to keep a job and has been fired three times in the past year. The man reports that, as an adolescent, he was sent to juvenile detention once for setting the school on fire and dropped out of high school in ninth grade. Which of the following additional findings would most support the suspected diagnosis? Excessive need for admiration Pathological lying Relationships beginning with intense attachment and ending with slight conflict Use of physical appearance to draw attention

Pathological lying Antisocial personality disorder

10-year-old boy presents to the clinic for evaluation after his teacher voiced concerns about his behavior in school. She reports the patient has difficulty remaining seated during class, talks excessively, interrupts others, and blurts out answers too quickly. His parents state that, since he was 4 years old, the patient gets angry when waiting for his turn and enjoys boisterous play. His family voices concerns about the first-line medication and would like to try an alternative agent. Which of the following side effects is most likely with this alternative medication? Growth suppression Insomnia Motor tic development Nausea

Nausea Primary alternative non stimulant: Atomoxetine

A 53-year-old man with a history of schizophrenia was recently transitioned to a new antipsychotic drug after becoming refractory to several other antipsychotics. At his follow-up visit, he has gained 10 pounds. Which antipsychotic most commonly causes weight gain? Haloperidol Olanzapine Prochlorperazine Ziprasidone

Olanzapine O = Obese

A 23-year-old woman reports to the clinic with pain, swelling, and instability in her right knee. She states her symptoms arose while playing soccer 2 days ago when she felt a "pop" while cutting and had subsequent swelling. She reports severe anxiety when discussing first-line diagnostic testing. Which of the following is most appropriate? Applied tension technique Diagnosis without imaging Oral diazepam Referral for cognitive behavioral therapy

Oral diazepam acute phobia

A 24-year-old woman presents to the emergency department with generalized weakness. Her partner who is with her notes that she purges to avoid weight gain and has an intense fear of gaining weight. On exam, you note that she is emaciated and calculate her body mass index to be 15.1 kg/m2. Which of the following is an indication for admission in women with the suspected eating disorder? Blood pressure of 95/65 mm Hg Body mass index of 15.9 kg/m2 Heart rate of 48 bpm Orthostatic increase in pulse of 28 bpm

Orthostatic increase in pulse of 28 bpm (considered unstable--> inc in pulse of at least 20 bpm or dec in sys bp of at least 20 mm Hg) Unstable: BP: <80/60 BMI: <15 HR: <40

An 18-year-old woman with no prior psychiatric history presents to the emergency department by ambulance after having a witnessed seizure at home. The patient's height is 5 foot 8 inches and weight is 105 pounds (BMI 16 kg/m2). Physical exam reveals lanugo on bilateral upper extremities, brittle nails, and cyanosis of the hands and feet. Laboratory workup reveals hyponatremia with hypokalemic alkalosis. In addition to seizures, which of the following complications is consistent with the suspected diagnosis? Hypertension Osteoporosis Polymenorrhea Tachycardia

Osteoporosis

A 26-year-old man with a benign medical history presents with multiple concerns for the past 3 months. He has recurrent attacks that consist of sweating, shaking, chest pressure, and dizziness that last for a few minutes at a time. Since these attacks began, he has worried that they will be triggered by certain events or situations and has avoided things that he thinks may trigger an episode. He reports no alcohol or illicit drug use, and he does not use any medications. Which of the following is the most likely diagnosis? Major depressive disorder Panic disorder Social anxiety disorder Somatic symptom disorder

Panic Disorder

A 23-year-old woman presents to the clinic reporting sudden-onset sharp chest pain, dyspnea, racing heartbeat, and a choking sensation. The symptoms lasted about 10 minutes. She has a past medical history including major depressive disorder and states she has never experienced these symptoms before. Current medications include bupropion and oral contraceptives. She does not report illicit drug use, alcohol use, or tobacco use. Vital signs include HR 113 bpm, RR 19 breaths per minute, BP 123/91 mm Hg, T 98.8°F, and SpO2 99% on room air. Preliminary ECG readings are shown above, and cardiac enzymes and d-dimer are within normal limits. Which of the following is the most likely diagnosis? Factitious disorder Illness anxiety disorder Myocardial infarction Panic attack

Panic attack

A 55-year-old man who takes medications for hypertension, hyperlipidemia, and major depressive disorder presents to the clinic to discuss sexual dysfunction. He also mentions he has been experiencing nausea recently as well as sedation. Which of the following medications is likely responsible for his symptoms? Bupropion Mirtazapine Paroxetine Venlafaxine

Paroxetine (SSRIs): MC used to treat major depressive disorder. Gastrointestinal upset and sleep disturbances are common side effects Paroxetine is known to cause sexual dysfunction, nausea, sedation, and sometimes weight gain. Bupropion (A) is a norepinephrine and dopamine reuptake inhibitor used to treat major depressive disorder - known to cause gastrointestinal side effects such as nausea, but it is not known to cause sexual side effects. Mirtazapine (B) is a tetracyclic antidepressant medication that can cause sedation but does not cause sexual side effects. Mirtazapine also causes weight gain, hypercholesterolemia, and constipation. Venlafaxine (D) is a serotonin and norepinephrine reuptake inhibitor, and common side effects include gastrointestinal upset, weight loss, and sleep disturbance. Sexual dysfunction is not a common side effect of venlafaxine.

A 35-year-old woman presents to a primary care clinic with chronic fatigue. She has been to several primary care providers and specialists and had numerous diagnostic tests performed, which have not revealed any clear etiology. She reports that she spends hours each day researching the cause of her fatigue. Which of the following additional findings would support the diagnosis of the condition that replaced hypochondriasis in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders? Enjoyment of playing the role of the patient External reward motivating symptoms Fear of a serious underlying illness Presence of multiple vague symptoms

Presence of multiple vague symptoms Somatic symptom disorder

A 30-year-old man with no comorbidities and who takes no medications presents to the clinic with tachycardia that occurs while speaking to large crowds. This has not been a problem in the past, but he has recently been promoted and must address many coworkers on a weekly basis. When he gives his presentations, he sweats profusely, trembles, and feels as if his heart is beating out of his chest. Which of the following is the most appropriate therapy for this man's clinical disorder? Amitriptyline Clonidine Mirtazapine Propranolol

Propanolol performance-only subset of social anxiety can also

A 28-year-old man with a history of substance use presents to the emergency department due to headache, nausea, vomiting, and restlessness. He is agitated upon arrival, making it difficult to obtain the history. Physical exam findings include mydriasis, pallor, tremors, and diaphoresis. Vital signs reveal blood pressure of 175/98 mm Hg and pulse of 110 bpm. Urine drug screen is positive for cocaine. Which of the following medications should be avoided in the acute phase of treatment? Aspirin Bromocriptine Nitroglycerin Propranolol

Propranolol due to concern for hypertension and coronary artery vasoconstriction due to unopposed alpha-adrenergic stimulation. beta-blockers worsen coronary artery vasoconstriction

A 28-year-old woman presents to the clinic reporting ongoing intermittent abdominal pain, fatigue, and back pain for the past 7 months. The patient notes she has been evaluated in the emergency department multiple times and has seen other health care clinicians, none of whom have found a cause of her pain. She is constantly worried about her symptoms. On physical exam, the patient appears anxious. Otherwise, there are no significant findings. Labs and imaging results that she had completed recently are all within normal range. Which of the following is the most appropriate initial treatment for this patient? Antidepressant therapy Cognitive behavior therapy Dialectical behavior therapy Regularly scheduled visits in the office

Regular scheduled visits in the office Somatic Symptom disorder

A 32-year-old woman presents to the emergency department with mental status changes, including agitation and confusion. Her vital signs reveal tachycardia and hyperthermia. On a physical exam, the patient is flushed and dilated pupils are noted. She has hyperreflexia and an inducible clonus. Her medical history includes gastroparesis and generalized anxiety disorder for which she takes metoclopramide and sertraline. Which of the following is the most likely diagnosis? Anticholinergic toxicity Malignant hyperthermia Neuroleptic malignant syndrome Serotonin syndrome

Seretonin Syndrome Rapid onset, combination of 2+ serotonin agonists AMS, Autonomic instability, neuromuscular hyperactivity

A 25-year-old man presents to the clinic due to breast tenderness and milk discharge from bilateral nipples for the past 3 weeks. Two months ago he presented to the clinic with auditory and visual hallucinations, persecutory thoughts, and paranoia and was prescribed a medication that he believes is causing his current symptoms. Which of the following medications is the most likely culprit? Aripiprazole Divalproex Quetiapine Risperidone

Risperidone

A 27-year-old woman presents to the clinic with a depressed mood for the past 3 years. She reports that during the same period she has slept more than usual and had difficulty concentrating. The symptoms occur most days, and during the past 3 years, she has never gone more than 1 week without symptoms. Which of the following is a common side effect of the first-line pharmacologic class used to treat the suspected diagnosis? Constipation Hair loss Sexual dysfunction Weight loss

Sexual Dysfunction

A 32-year-old man presents to the therapist at his family's request. He reports that his family is frequently concerned because he does not desire social relationships. He reports that he works as a scientist alone in a laboratory. His hobbies include hunting and fishing alone. Which of the following personality disorders is the most likely diagnosis? Antisocial Avoidant Paranoid Schizoid

Schizoid marked by social withdrawal and no desire for close relationships

A 24-year-old man presents to the psychiatry clinic with his wife for follow-up. He was brought to the emergency department 3 months ago after the police found him blocking traffic on the highway and telling drivers that the apocalypse was coming. At that time, he says he could hear voices telling him to save the world. His wife reports that these behaviors began abruptly 3 months ago after his father died, and he was subsequently treated in a psychiatric hospital, where his symptoms improved. However, he has been withdrawn with a flat affect since then and has not been able to function well enough to find a job. The patient had a negative medical workup near the onset of symptoms, and it included a negative drug test result. He reports no depressed mood. Which of the following is the most likely diagnosis? Bipolar disorder type I Brief psychotic disorder Schizophrenia Schizophreniform disorder

Schizophreniform Disorder Symptoms lasting >1 month - <6 months

A 35-year-old man presents with a persistent pattern of odd behavior since early adulthood. He often believes that people talking on the radio have special messages for him. In addition, he has few close friends, pervasive suspicion of others, and social anxiety. Which of the following personality disorders does this individual most likely have? Avoidant Paranoid Schizoid Schizotypal

Schizotypal marked by cognitive-perceptual abnormalities, oddness or disorganized behavior, and interpersonal difficulties.

A 42-year-old woman presents to the office for her annual physical. When taking the patient's sexual history, she indicates she sometimes uses self-strangulation or self-suffocation to enhance her sexual arousal when masturbating. She stops herself before losing consciousness. She mentions she recently found a new sexual partner who will strangle her and humiliate her in public with her consent, as she finds it sexually arousing. Which of the following is the most likely diagnosis? Frotteurism Sexual masochism Sexual sadism Voyeurism

Sexual Masochism aroused by being made to suffer Sadism = aroused by inflicting suffering on another person

A 26-year-old veteran presents with recurrent thoughts about an event that occurred while he was in the military. He reports that he avoids crowds and has flashbacks of the event occurring, which are disturbing to him. Considering the most likely diagnosis, which of the following would be the most common clinical manifestation? Amnesia Depersonalization Sleep disturbance Somatic symptoms

Sleep Disturbance

A 33-year-old woman presents to the clinic with chronic fatigue and headaches. You review the patient's prior medical records and see that she has been evaluated by seven different clinicians for these symptoms and has had extensive laboratory testing, a magnetic resonance imaging of her brain, and a lumbar puncture that did not reveal any abnormalities. The headaches have been diagnosed as tension-type headaches. She reports that she spends hours each day researching these symptoms, which has made it difficult to keep a job or socialize. Which of the following is the most likely diagnosis? Factitious disorder Generalized anxiety disorder Illness anxiety disorder Somatic symptom disorder

Somatic Symptom Disorder Symptoms are core finding

A 25-year-old woman with a history of substance use disorder presents to the office for follow-up evaluation. She was started on sertraline and titrated to a dose of 200 mg daily after struggling with symptoms of excessive worry, fatigue, and insomnia. She has tolerated the medication at this dosage for the past 8 weeks but has only noted partial improvement in her anxiety symptoms. What would be an appropriate intervention at this time? Continue sertraline for 6 months and then reassess Start adjunctive treatment with buspirone Supplement sertraline with lorazepam up to three times daily as needed Taper off sertraline and change to fluoxetine

Start adjunctive treatment with buspirone Buspirone = second line treatment for generalized anxiety disorder Patients who have a partial response to a first-line medication can receive adjunctive therapy with either buspirone, as was observed in this patient, or pregabalin.

A 34-year-old man presents to a therapist for couples therapy at the insistence of his wife. He reports the problem with their relationship is that she does not show him the respect he deserves as the most prestigious attorney in town. His wife reports he lacks empathy and has a constant need to be admired. Which of the following additional features supports a diagnosis of the suspected personality disorder? Difficulty making everyday decisions without excessive advice Preoccupation with details, rules, lists, and organization Superficial and exploitative relationships Taking pleasure in few activities

Superficial and exploitative relationships Narcissistic personality disorder

A 5-year-old boy presents to the clinic with his father who reports persistent behavioral issues since age 4 that have been recently worsening. The patient's father is concerned about daily temper tantrums and disobedient behavior at home, including arguing with his parents and deliberately annoying his siblings. He also reports teacher concerns about irritable mood and disregard for classroom rules on an almost daily basis. Which of the following interventions is most appropriate for this patient given the most likely diagnosis? Assess psychosocial situation and parent training Begin cognitive behavioral therapy Begin pharmacological treatment with stimulant medication Refer for inpatient evaluation and treatment

assess psychosocial situation and parent training Oppositional defiant Disorder (ODD)

A 4-year-old boy presents with his mother for his yearly checkup. The patient has a diagnosis of autism spectrum disorder, and his mother reports that, despite at-home treatment, he continues to have difficulty with verbal communication, outbursts of emotion, and socializing with peers. Which of the following has been shown to improve outcomes in children with autism? Early behavioral and educational interventions Pharmacotherapy Psychotherapy Supplementation with vitamin B6 and magnesium

early behavioral and educational interventions Goals of treatment: improving adaptive/social/play skills, improving communication, decrease negative/nonfunctional behaviors, and increasing academic and cognitive function

A 19-year-old woman presents with concerns about attending a work event. She reports she is afraid she will do or say something embarrassing, and she has been worrying about attending the event since its announcement. She reports that, for the last 2 years, she has had difficulty making friends and avoids any gatherings because she is worried people will notice her nervousness. Which of the following is the most likely diagnosis? Agoraphobia Panic disorder Performance anxiety disorder Social anxiety disorder

social anxiety disorder intense fear of embarrassment or humiliation in social situations