Mental Health & Neurological Health Problems
[Buttaro Ch 247-250, Ch 188-203] Exam 2
A patient is diagnosed with panic disorder and begins taking a
... [Show More] selective serotonin
reuptake inhibitor medication. Six weeks later, the patient reports little relief from
symptoms. What will the provider do next to manage this patient?
a. Change the medication to buspirone
b. Discontinue the medication
c. Increase the medication dose
d. Refer to a mental health provider - d. Refer to a mental health provider
ANS: D
Patients taking SSRIs for anxiety disorders should see effects within 2 to 4 weeks. If
patients have not had good results in 4 to 6 weeks, the provider should change the
medication or refer to a mental health provider. Discontinuing an SSRI abruptly can
cause withdrawal symptoms. Increasing the medication dose will not improve the
effects. Buspirone is somewhat useful only for GAD.REF: Management
Which medication are useful in treating both obsessive-compulsive disorder and
PTSD?
Select all that apply.
a. Benzodiazepines
b. Buspirone
c. Selective serotonin reuptake inhibitors
d. Serotonin-norepinephrine reuptake inhibitors
e. Tricyclic antidepressants - ANS: C, D, E
SSRIs, SNRIs, and TCAs are useful in treating both OCD and PTSD.
Benzodiazepines and buspirone are not indicated for either disorder.REF: Table
247-1: Pharmacologic Management of Anxiety Disorders: Indications and
Considerations
A patient reports symptoms of restlessness, fatigue, and difficulty concentrating. The
provider determines that these symptoms occur in relation to many events and
concerns. What other things will the provider question this patient about?
a. Ability to manage social situations
b. Body image and eating habits
c. Headaches and bowel habits
d. Occupational performance - c. Headaches and bowel habits
ANS: C
This patient has symptoms consistent with generalized anxiety disorder (GAD) in
which feelings occur in relation to many events. Patients with GAD often have
headaches and irritable bowel syndrome. Phobias are linked to particular events and
often include social situations. Patients with OCD tend to have eating disorders and
difficulty with occupational and academic performance.REF: Clinical Presentation
A patient is seen in clinic 2 weeks after the death of a parent. The patient reports
feelings of sadness and hopelessness and a feeling that the parent is still present,
even to the point of hearing the parent's voice at times. What will the provider
determine from these findings?
a. There is a concern for hypermania.
b. There is a possibility of manic episodes.
c. These are concerning for depression.
d. These are normal grief responses. - d. These are normal grief responses.
ANS: D
These are short-lived symptoms at this point, lasting less than 2 months. Auditory
and sensory hallucinations only in relation to the deceased are normal during intense
grief. Hypermania is an acute, short-lived manic episode. Mania involves abnormal
elevation of a person's mood. Depression is present when symptoms of grief are
more severe and more prolonged.REF: Introduction/Table 248-1: Assessing
Symptoms of Grief and a Depressive Mood Episode
A college student is brought to clinic by a parent who is concerned about
increasingly bizarre behavior and poor school performance. The provider notes
difficulty engaging the patient in an organized conversation. The patient denies any
concerns about behavior. What will the provider do initially to manage this patient's
symptoms?
a. Admit the patient for inpatient treatment
b. Begin treatment with lithium or lamotrigine
c. Counsel the parent to report any symptoms of depression
d. Schedule an appointment with a psychiatrist - b. Begin treatment with lithium or
lamotrigine
ANS: B
Patients with symptoms of mania should begin treatment with a mood stabilizer and
the primary care provider should initiate treatment for an acute episode. It is not
necessary to admit as an inpatient unless there is indication of harm to the self or
others. The primary provider should refer for psychiatric evaluation, but should begin
medications as soon as possible.REF: Bipolar Disorder/Management
A patient is seen frequently over a 9-month period with somatic complaints that are
not related to physical disease. The primary provider notes that the patient has had a
15% weight loss in the previous 2 months and the patient reports difficulty sleeping.
The spouse tells the provider that the patient seems tired all the time and is irritable
with other family members. What will the provider do initially?
a. Perform a suicide risk assessment
b. Prescribe a selective serotonin reuptake inhibitor
c. Refer the patient for psychotherapy
d. Suggest cognitive-behavioral therapy - a. Perform a suicide risk assessment
ANS: A
For any patients with symptoms of depression, the initial action is to perform a
thorough assessment and evaluate potential suicide risk. SSRIs can be prescribed
once a diagnosis is determined according to diagnostic criteria. Psychotherapy and
cognitive-behavioral therapy may also be prescribed.REF: Depression/Clinical
Presentation/Management
A patient is brought to the emergency department who is experiencing disorientation,
confusion, and fever. The patient describes visual and auditory hallucinations. The
patient's spouse states that the patient had several drinks 12 hours prior to passing
out. A blood alcohol level is 0.2%. What is the recommended treatment?
a. Benzodiazepines
b. Intravenous fluids and rest
c. Naloxone
d. Phenobarbital - a. Benzodiazepines
ANS: A
This patient is showing symptoms of major alcohol withdrawal and should be treated
with a benzodiazepine, which is the safest, most effective drug to treat alcohol
detoxification. Without medications, the patient may develop seizures and delirium
tremens or may die. Naloxone is used for narcotics. Phenobarbital is used to treat
seizures.REF: Alcohol Abuse/Management
A college student is brought to the emergency department by a roommate who is
concerned about symptoms of extreme restlessness, nausea, and vomiting. The
provider notes elevations of the pulse and blood pressure and pupillary dilation,
along with hyperactive bowel sounds. The provider suspects withdrawal from which
substance?
a. Alcohol
b. Cocaine
c. LSD
d. Opioids - d. Opioids
ANS: D
This patient has symptoms consistent with opioid withdrawal, which causes
restlessness, hyperactive bowel sounds, pupillary dilation, and changes in vital
signs. Alcohol withdrawal involves tremors, confusion, and hallucinations. Cocaine
withdrawal causes muscle tension, teeth clenching, and blurred vision. LSD
symptoms cause hallucinations.REF: Opioids
A 17-year-old male is brought to the clinic by a parent who is concerned that the
patient has become more isolated and withdrawn and expresses suspicions that his
teachers hate him and want him to fail. What will the provider tell this parent?
a. The adolescent should be evaluated by a psychiatrist.
b. The adolescent should be given a trial of antipsychotic medications.
c. These are common adolescent behaviors and will eventually go away.
d. These signs are diagnostic for schizophrenia. - a. The adolescent should be
evaluated by a psychiatrist.
ANS: A
These signs, along with a family history of psychosis can be predictive of
schizophrenia, so referral for psychiatric evaluation should be made. Unless
symptoms are present longer than a month and the patient is diagnosed,
antipsychotic medications are not indicated. Without evaluation, these behaviors
should not be dismissed as normal. While these signs may raise concerns for
schizophrenia, they are not diagnostic.
REF: Clinical Presentation
A young male patient is reported to be more withdrawn from his peers than usual
and has dropped out of college and quit his job within the last 5 months. The parent
is concerned that the patient may have schizophrenia because a maternal uncle has
the disease. What will the provider do next?
a. Ask about the patient's speech and thinking patterns
b. Consider treatment with antipsychotic medications
c. Reassure that classic symptoms of schizophrenia are not present
d. Refer the patient for inpatient psychiatric treatment - a. Ask about the patient's
speech and thinking patterns
ANS: A
In order to diagnose schizophrenia, one or more of the positive signs of delusions,
hallucinations, or disorganized speech must be present. Unless there is a definitive
diagnosis, hospitalization and treatment are not indicated. The patient has some
signs of schizophrenia, so further evaluation is necessary before reassurance can be
made.
REF: Box 250-1: Diagnostic Criteria for Schizophrenia
Which are considered "negative" symptoms of schizophrenia?
Select all that apply.
a. Auditory hallucinations
b. Delusions of persecution
c. Impaired self care
d. Poor school performance
e. Withdrawing from peers - ANS: C, D, E
Negative symptoms are those related to decrease or loss of normal functions and
may include social withdrawal, impaired self care, and poor school performance.
Hallucinations and delusional beliefs are things added to normal behaviors and are
considered positive symptoms of schizophrenia.
REF: Clinical Presentation/Positive Symptoms/Negative Symptoms
What are some common goals of neuropsychiatric evaluation?
Select all that apply.
a. To definitively diagnose neurobehavioral disorders
b. To determine the need for neurosurgical procedures
c. To evaluate cognition when neuro-diagnostic tests are normal
d. To help identify rehabilitation goals in brain-injured patients
e. To monitor changes in symptoms over time - ANS: C, D, E
Neuropsychological testing is performed to evaluate cognition when other diagnostic
tests may be normal, to help identify rehabilitation goals for brain-injured patients,
and to monitor changes in patients over time. Because they are one piece of the
diagnostic workup, they do not definitively diagnose disorders or determine the need
for surgical procedures.REF: Box 188-2: Neuropsychological Assessment Goals
What is an important purpose of conducting an interview prior to beginning
neuropsychological testing on an older adult suspected of having dementia? CONTINUES... [Show Less]