psych: Mental Disorders (share)

The following are characteristics of delirium tremens, except for:

A) high risk for suicide

B) fluctuating confusion

C) signs of autonomic hyperactivity

D) tactile hallucinations

A) high risk for suicide

EXPLANATION

The symptoms of delirium tremens (signs of autonomic hyperactivity like hypertension, fever, tachycardia; global confusion, disorientation, perceptual disorders as a result of withdrawal from alcohol) make the person unable to make suicidal plans.

The person has clear consciousness. He can hear voices that are talking about him and threatening him. For the person, the voices seem to be reality and they are a very disturbing experience, which makes him feel intensely anxious. What do you think the diagnosis is?

A) delirium tremens

B) alcoholic hallucinosis

C) dementia

D) panic disorder

E) obsessive-compulsive disorder

B) alcoholic hallucinosis

EXPLANATION

Auditory hallucinations especially threatening voices and hearing dialogues that result in severe anxiety in the person without an altered level of consciousness are all characteristics of alcoholic hallucinosis.

The following are typical symptoms of delirium tremens, except for:

A) tonic-clonic (grand mal) seizures at onset

B) auditory hallucinations without an altered level of consciousness and disorientation

C) shaking, sweating

D) confusion

E) disorientation

B) auditory hallucinations without an altered level of consciousness and disorientation

EXPLANATION

Both consciousness and attention are altered in delirium tremens (global confusion) and disorientation is also present as the most characteristic symptoms.

Among the following, what are the interpersonal relationships of persons with alcohol problems characterised by the most?

A) a high number of reliable friends

B) simplicity of making friends

C) deep and close associations with certain persons

D) simple formation of social relations, but these are not durable

E) generosity, helpfulness, reliability

D) simple formation of social relations, but these are not durable

EXPLANATION

Persons with alcohol problems tend to make superficial friendships easily but they show as little endurance in social relations as in any other fields of life.

Delirium tremens due to alcohol withdrawal are to be treated with the following:

1) benzodiazepines

2) thiamine

3) potassium and magnesium preparations

4) disulfiram

A) only the 1st, 2nd and 3rd answers are correct

B) only the 1st and 3rd answers are correct

C) only the 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

A) only the 1st, 2nd and 3rd answers are correct

1) benzodiazepines

2) thiamine

3) potassium and magnesium preparations

EXPLANATION

In the treatment of delirium tremens benzodiazepines play a crucial role in alleviating both the autonomic symptoms and psychomotor restlessness and preventing seizures. The replacement of potassium and magnesium as well as thiamine is also essential since their concentrations in the blood are typically low in delirium tremens.

What is/are the most characteristic symptom(s) of delirium tremens?

1) tremor

2) sweating

3) confusion

4) perceptual disorders

A) only the 1st, 2nd and 3rd answers are correct

B) only the 1st and 3rd answers are correct

C) only the 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

E) all of the answers are correct

1) tremor

2) sweating

3) confusion

4) perceptual disorders

EXPLANATION

Delirium tremens is usually caused by withdrawal from alcohol. Its characteristic symptoms are global confusion, disorientation, perceptual disorders (hallucinations), tremor, sweating and other signs of autonomic hyperactivity.

Wernicke's encephalopathy is characterised by the following:

1) sudden onset

2) nystagmus and ophtalmoplegia

3) confusion

4) symmetrical and bilateral lesions in the thalamus, hypothalamus, corpus mammillares

A) only the1st, 2nd and 3rd answers are correct

B) only the 1st and 3rd answers are correct

C) only the 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

E) all of the answers are correct

1) sudden onset

2) nystagmus and ophtalmoplegia

3) confusion

4) symmetrical and bilateral lesions in the thalamus, hypothalamus, corpus mammillares

EXPLANATION

Wernicke's encephalopathy (Wernicke's disease) is a consequence of long-term alcohol abuse. It is associated with periaqueductal gray haemorrhages at the level of lamina quadrigemina (superior colliculus). Thiamine deficiency appears to be the most important etiological factor. Its onset is usually sudden and its most common symptoms are vertical nystagmus, opthalmoplegia, ataxia and confusion.

The diagnostic criterion/criteria for alcohol dependence/alcohol use disorder is/are the following:

1) tolerance (need for increased amounts of alcohol to achieve desired effect)

2) characteristic withdrawal syndrome for alcohol when attempting to stop use

3) a great deal of time spent in activities necessary to obtain or to use alcohol and important social, occupational or recreational activities given up or reduced because of drinking

4) craving

A) only the 1st, 2nd and 3rd answers are correct

B) only the 1st and 3rd answers are correct

C) only the 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

E) all of the answers are correct

1) tolerance (need for increased amounts of alcohol to achieve desired effect)

2) characteristic withdrawal syndrome for alcohol when attempting to stop use

3) a great deal of time spent in activities necessary to obtain or to use alcohol and important social, occupational or recreational activities given up or reduced because of drinking

4) craving

EXPLANATION

Tolerance and withdrawal syndrome are the symptoms of physical dependence, whereas the dominance of activities necessary to obtain or to use alcohol and craving are the manifestation of psychological dependence.

The diagnostic criterion/criteria for alcohol abuse/alcohol use disorder is/are the following:

1) failure to fulfill major role obligations at work, school or home

2) alcohol use in situations in which it is physically hazardous

3) alcohol-related legal problems

4) continued alcohol use despite having persistent or recurrent social or interpersonal problems

A) only the1st, 2nd and 3rd answers are correct

B) only the 1st and 3rd answers are correct

C) only the 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

E) all of the answers are correct

1) failure to fulfill major role obligations at work, school or home

2) alcohol use in situations in which it is physically hazardous

3) alcohol-related legal problems

4) continued alcohol use despite having persistent or recurrent social or interpersonal problems

EXPLANATION

In alcohol abuse there is a continued maladaptive pattern of drinking despite social, occupational, legal, etc. problems caused by effects of alcohol and the criteria for alcohol dependence (tolerance, withdrawal syndrome, psychological dependence) are never met.

The following statement(s) is/are true for the neurobiology of alcohol use:

1) Alcohol affects several neurotransmitter systems.

2) Chronic alcohol use does not affect the operation of the reward system in the brainstem.

3) The endogenous opioid system plays a role in the appearance of euphoria following alcohol consumption.

4) Alcohol does not influence the operation of cortical areas (e.g. prefrontal cortex).

A) only the 1st, 2nd and 3rd answers are correct

B) only the 1st and 3rd answers are correct

C) only the 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

B) only the 1st and 3rd answers are correct

1) Alcohol affects several neurotransmitter systems.

3) The endogenous opioid system plays a role in the appearance of euphoria following alcohol consumption.

EXPLANATION

Chroninc alcohol use affects several neurotransmitter systems (glutamate, dopamine, endogenous opiates) resulting in affecting the physiological operation of brainstem pathways of reward, prefronatlcortex and hippocampus.

Which test(s) is/are to be performed to find the correct diagnosis?

A 16-year-old girl has arrived at the outpatient ward with her mother. In the past few months she has lost 15 kilos. She goes running every day. She has insomnia.

1) urine drug test

2) calculating body mass index

3) concentrations of thyroid hormones (blood test)

4) polysomnography

A) only the 1st, 2nd and 3rd answers are correct

B) only the 1st and 3rd answers are correct

C) only the 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

A) only the 1st, 2nd and 3rd answers are correct

1) urine drug test

2) calculating body mass index

3) concentrations of thyroid hormones (blood test)

EXPLANATION

The concentrations of thyroid hormones need to be determined to exlude hyperthyreosis. Stimulants are detectable in urine, therefore the urine drug test is also necessary. Anorexia nervosa is based on BMI, so that is to be calculated, as well. However, none of the above mentioned tests is diagnostic in itself.

What do you think his most likely diagnosis was?

An 18-year-old man arrived at the hospital on Sunday morning. He was accompanied by his friends. His symptoms were sweating, tachycardia, dilated pupils, psychomotor agitation. His behaviour was hostile, full of anger and he felt furious.

A) alcohol intoxication

B) heroin intoxication

C) acute psychotic state of schizophrenia

D) cocaine intoxication

E) none of the above

D) cocaine intoxication

EXPLANATION

The person's symptoms were characteristic signs of stimulant intoxication.

Among the following which is not a characteristic symptom of heroin overdose?

A) dilated pupils

B) hypotension

C) hyporeflexia

D) coma

E) respiratory depression

A) dilated pupils

EXPLANATION

A heroin overdose may result in extremely small pupils, sometimes as small as head of a pin ("pinpoint pupils").

Among the following substances which may cause physical dependence?

A) benzodiazepines

B) opiates

C) alcohol

D) all of the above

E) none of the above

D) all of the above

EXPLANATION

All of the above mentioned substance are capable of causing physical dependence as a result of chronic use.

The following statements are true except for:

A) Besides "classical drugs" there are a lot of synthetic, so-called designer drugs that have been used recently.

B) Standard urine drug tests are incapable of detecting designer drugs.

C) Synthetic amphetamines, sytnthetic opioids and synthetic cannabionids are all designer drugs.

D) Pathomechanism and possible adverse effects of designer drugs are clearly known.

E) There is an inappropriate legal regulation regarding the use of designer drugs.

D) Pathomechanism and possible adverse effects of designer drugs are clearly known.

EXPLANATION

In most of the cases, neither the pathomechanism, nor the effects and adverse effects of designer drugs are known.

The following play(s) a role in the long-term treatment of substance-related mental disorders:

1) self-help groups (Narcotics Anonymous)

2) rehabilitation centres and therapeutic communities

3) social skills training and improving coping skills

4) family interventions and community-based interventions

A) only the 1st, 2nd and 3rd answers are correct

B) only the 1st and 3rd answers are correct

C) only the 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

E) all of the answers are correct

1) self-help groups (Narcotics Anonymous)

2) rehabilitation centres and therapeutic communities

3) social skills training and improving coping skills

4) family interventions and community-based interventions

EXPLANATION

The long-term treatment of substance abuse and dependence is to be complex and individually tailored involving as many of the above mentioned psychosocial interventions as possible since all of them may have a role in the therapy

Rapid cycling is a special form of bipolar disorder, this means that:

A) the patient has flight of ideas

B) the case isn't characterized by anxiety

C) 4 relapses during a period of 5 years

D) Disease episodes follow each other rapidly, the patient has at least 4 different episodes in one year

E) considerable psychomotor agitation

D) Disease episodes follow each other rapidly, the patient has at least 4 different episodes in one year

EXPLANATION

Explanation: The definition of rapid cycling is 4 episodes within one year.

Which is the most common delusion in depression?

A) delusion of theft

B) delusion of guilt and self-accusation

C) erotomania delusion

D) delusions of reference

B) delusion of guilt and self-accusation

EXPLANATION

Delusions are observed in some cases of depression. These delusions are holothymic, fitting into the themes of the depression. Common delusions include hypochondriacal delusions or delusions of guilt.

The longitudinal disease course of affective psychoses is characterized by:

A) circularly returning disease episodes

B) slow progression

C) acute worsening of condition alternating with slow progression

D) single episode

E) in the case of a rapid cycle course, an asymptomatic free interval never appears

A) circularly returning disease episodes

EXPLANATION

Affective psychoses are characterized by circularly returning episodes, symptoms usually resemble symptoms of the previous episode.

The following statements are true for bipolar disorder, except:

A) it often runs in families

B) all manic episodes are followed by depression

C) equal distribution between sexes

D) usually begins in young adulthood, in most cases with a major depressive or mixed episode

E) increased risk of substance abuse and suicide

B) all manic episodes are followed by depression

EXPLANATION

It is not a necessary criterion of bipolar affective disorder that all episodes have to be followed by an episode of opposite direction.

A 41-year-old man reports listlessness, unhappiness, concentration difficulties and fatigue that have persisted for two years. He never had suicidal thoughts. It takes some effort, but it gets the job done.

A) Psychotic depression

B) Schizophrenia

C) Bipolar depression

D) Dysthymia

E) Cyclothymia

D) Dysthymia

EXPLANATION

The chronic dissatisfaction, unhappiness, low self-esteem makes dysthymia the most probable diagnosis. 

Symptoms of mania, except for

1) aggression

2) grandiosity

3) secondary incoherence

4) increased critical insight

A) only the1st, 2nd and 3rd answers are correct

B) only the 1st and 3rd answers are correct

C) only the 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

D) only the 4th answer is correct

4) increased critical insight

EXPLANATION

Explanation: Mania is characterized by the decrease of critical insight, not the increase, the other 3 symptoms are very typical.

Potential complications of untreated affective disorders:

1) suicide

2) pseudologia phantastica

3) alcohol dependence

4) vascular dementia

5) social dysfunction and isolation

6) bulimia

7) tardive dyskinesia

A) only the 1st, 2nd and 3rd answers are correct

B) only the 1st and 3rd answers are correct

C) only the 1st, 3rd and 5th answers are correct

D) only the 2nd, 3rd and 5th answers are correct

E) only the 1st, 2nd, 3rd, 5th and 7th answers are correct

F) only the 2nd, 3rd, 6th and 7th answers are correct

G) all of the answers are correct

C) only the 1st, 3rd and 5th answers are correct

1) suicide

3) alcohol dependence

5) social dysfunction and isolation

EXPLANATION

Affective disorders are often accompanied by suicide, alcohol abuse and social dysfunction, especially when no treatment is received.

What are the features of bipolar disorder type II.?

1) Mixed affective episodes are not typical during the course of the disease.

2) Psychotic symptoms may be seen during manic episodes.

3) Manic symptoms are classified as bipolar II. confused only by antidepressant treatment.

4) Episodes of hyperthymia only reach the level of hypomania, and usually don't require hospitalization.

A) only the1st, 2nd and 3rd answers are correct

B) only the 1st and 3rd answers are correct

C) only the 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

D) only the 4th answer is correct

4) Episodes of hyperthymia only reach the level of hypomania, and usually don't require hospitalization.

EXPLANATION

Bipolar disorder type II, is characterized by less severe hypomanic episodes, alternating with periods of severe depression.

Somatic symptoms of depression:

1) insomnia

2) delusions of guilt and self-accusation

3) decreased appetite

4) concentration problems

A) only the1st, 2nd and 3rd answers are correct

B) only the 1st and 3rd answers are correct

C) only the 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

B) only the 1st and 3rd answers are correct

1) insomnia

3) decreased appetite

EXPLANATION

Explanation: insomnia and decreased appetite are typical somatic symptoms in depression, the other two symptoms also occur frequently but aren't somatic.

Which of the following symptoms are typical for the manic condition?

1) distractibility and increased self-esteem

2) holothym megalomaniac doxmas

3) increased activity and decreased need for sleep

4) agitation is not characteristic

A) only the1st, 2nd and 3rd answers are correct

B) only the 1st and 3rd answers are correct

C) only the 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

A) only the1st, 2nd and 3rd answers are correct

1) distractibility and increased self-esteem

2) holothym megalomaniac doxmas

3) increased activity and decreased need for sleep

EXPLANATION

The manic state is characterized by a high degree of dispersion, increased self-esteem, increased activity, decreased need for sleep, megalomaniac doxamas, and agitation.

Which of the following medications can cause manic symptoms?

1) cocaine, speed (metamphetamin)

2) corticosteroids

3) bupropion

4) haloperidol

A) only the1st, 2nd and 3rd answers are correct

B) only the 1st and 3rd answers are correct

C) only the 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

A) only the1st, 2nd and 3rd answers are correct

1) cocaine, speed (metamphetamin)

2) corticosteroids

3) bupropion

Sleep pattern in major depression is characterized by the following changes:

1) nightmares related to traumatic memories

2) awakening happens earlier than usual

3) 4th phase sleep (delta-phase) is increased

4) decreased REM-latency

A) only the1st, 2nd and 3rd answers are correct

B) only the 1st and 3rd answers are correct

C) only the 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

C) only the 2nd and 4th answers are correct

2) awakening happens earlier than usual

4) decreased REM-latency

EXPLANATION

Typical changes during sleep in MDD patients include early sleep onset, wakening, and decreased REM-latency. Nightmares related to traumatic memories are chararacteristic for PTSD.

Which disorders should be considered while establishing a differential diagnosis for affective disorders?

1) expansive intracranial process

2) thyroid gland dysfunction

3) schizophrenia

4) adult ADHD (attention deficit and hyperactivity disorder)

A) only the 1st, 2nd and 3rd answers are correct

B) only the 1st and 3rd answers are correct

C) only the 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

E) all of the answers are correct

1) expansive intracranial process

2) thyroid gland dysfunction

3) schizophrenia

4) adult ADHD (attention deficit and hyperactivity disorder)

EXPLANATION

All of these conditions might cause affective symptoms and resemble affective disorders, therefore all of them should be considered during the differential diagnostic process.

Patients with severe depression are most probably:

1) moria

2) stupor

3) belle indifference

4) suicidal ideation

A) only the 1st, 2nd and 3rd answers are correct

B) only the 1st and 3rd answers are correct

C) only the 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

C) only the 2nd and 4th answers are correct

2) stupor

4) suicidal ideation

EXPLANATION

Stupor and suicidal ideation can be symptoms of severe depression. Moria is a symptom of damage to the frontal lobe. La belle indifference is a symptom of conversion disorders.

Characteristics of dysthymia:

1) chronic fatigue

2) low self-esteem

3) insomnia

4) hypersomnia

A) only the1st, 2nd and 3rd answers are correct

B) only the 1st and 3rd answers are correct

C) only the 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

E) all of the answers are correct

1) chronic fatigue

2) low self-esteem

3) insomnia

4) hypersomnia

EXPLANATION

Dysthymia is characterized by chronic fatigue, low self-esteem, insomnia and/or hypersomnia.

A 22-year-old university student suddenly demonstrates elevated mood at the end of an exam period, his appearance becomes markable and bold, his behavior is careless, he has no critical insight. He is active all the time, spends a lot of money, doesn't feel tired for more than one week. He has no illness insight, he describes his condition as "superhappy". Which are probable diagnoses:

1) narcissistic personality disorder

2) acute schizophreniform psychosis

3) emotionally unstable personality disorder

4) manic or hypomanic episode

A) only the1st, 2nd and 3rd answers are correct

B) only the 1st and 3rd answers are correct

C) only the 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

D) only the 4th answer is correct

4) manic or hypomanic episode

EXPLANATION

Explanation: the pressured psychomotor speed, the reckless behavior, the increased unnecessary spending, and the elevated mood are very typical for mania.

Typical symptoms of depression:

1) decreased capability to concentrate

2) self-accusatory thoughts

3) weight loss

4) perceptual disturbances

A) only the1st, 2nd and 3rd answers are correct

B) only the 1st and 3rd answers are correct

C) only the 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

A) only the1st, 2nd and 3rd answers are correct

1) decreased capability to concentrate

2) self-accusatory thoughts

3) weight loss

EXPLANATION

concentration problems, weight loss and self-accusatory thoughts are very typical in depression, perceptual disturbances (i.e. hallucinations) are very uncommon.

Who gave schizophrenia its name?

A) Emil Kraepelin

B) Eugen Bleuler

C) William Cullen

D) Kurt Schneider

E) Karl Kleist

B) Eugen Bleuler

EXPLANATION

E. Bleuler considered the presence of schisms between thought, emotion and behaviour the essence of the disorder. In 1911, he labelled it schizophrenia uniting the Greek roots szkidzein (to split) and frenosz (mind).

The following are the negative symptoms of schizophrenia except for:

A) apathy

B) alogia

C) lack of motivation

D) delusional guilt, sin, worthlessness

E) social withdrawal

D) delusional guilt, sin, worthlessness

EXPLANATION

delusions belong to the group of positive symptoms, regardless of their content.

The diagnosis of schizophrenia is primarily based on:

A) clinical observation and the analysis of symptoms

B) alterations in biological markers

C) the Rorschach test

D) Positive and Negative Syndrome Scale

E) the MAWI test (the Hungarian version of Wechsler Adult Intelligence Scale)

A) clinical observation and the analysis of symptoms

EXPLANATION

The diagnosis is based on the thorough exploration of symptoms of perception, behaviour and motor activity. Projective and personality tests may indicate abnormalities present in schizophrenia, but the contribution to diagnosis is low. Up to date, there is no laboratory test for schizophrenia.

The following are characteristic of the prodromal phase of schizophrenia, except for:

A) it usually begins following puberty

B) presence of changes in perceptual experiences, behaviour, performance

C) progressively intensifying symptoms

D) paranoid doxamas that also alter behavior

E) it can also last for 2-5 years

D) paranoid doxamas that also alter behavior

EXPLANATION

In the prodromal phase of the disease, severe psychotic symptoms do not exist.