Review and Integration of psychological Disorders - PowerPoint Presentation

1. Review and Integration of psychological Disorders October 31, 20181:00- -3:00 pmDavid Trotter, PHDR. Lisa Popp, PhdMichael Blanton, PhD

2. objectivesGiven a clinical vignette, identify key components in the stem that determine “the best answer” that allows you to:Provide the diagnosis given the symptomology of a psychopathological disorder.Given the symptomology of a psychopathology, identify the drug of choice for treatment of the disorder.Given the symptomology of a psychopathology, identify the mechanism of action/and or associated receptors, or major contraindication for use of the drug of choice for treatment of the disorder (AKA nth order questions).

3. Cognitive disorders

4. 1. A 78-year-old female is brought to your office by her daughter. The patient lives in an assisted living facility, and per her daughter “does pretty well normally.” However, over the past few days the patient had been disoriented, disorganized, and forgetful. In fact, when the daughter picked her up this morning, the patient did not recognize her and accused her of trying to kidnap her. Also, a nurse’s aide told the daughter that the patient was “talking to dead relatives” in the middle of the night. Her temperature is 104o F. Your initial diagnosis is? Schizophrenia Delirium due to polypharmacy Delirium due to a urinary tract infection Pick’s Disease Amnestic disorder

5. key points in the stem?Rationales for correct and incorrect answers?

6. 2. A 78-year-old female is brought to your office by her daughter. The patient lives in an assisted living facility, and per her daughter “does pretty well normally.” However, over the past 12 hours the patient had been disoriented, confused, irritable, and has developed a tremor. In fact, when the daughter picked her up this morning, the patient screamed at her and irrationally accused her of trying to kidnap her. Also, a nurse’s aide told the daughter that the patient was “talking to dead relatives” in the middle of the night. While the patient has a history of heavy drinking, the daughter says she has not consumed alcohol in the past few days. Your initial diagnosis is?Delirium TremensAlzheimer’s Hepatic Encephalopathy Embolic strokeAlcohol Withdrawal

7. key points in the stem?Rationales for correct and incorrect answers?

8. 3. A 67-year-old man presents to your clinic with his wife. His wife has been urging him to see a doctor for months because “his short term memory has been terrible.” Specifically, while he has no problem remembering things that happened before his MI, he has difficulty remembering things like recent events and conversations. The patient has a PMH if an MI (1 year ago), cardiac catheterization, hypertension, hyperlipidemia, and Type 2 DM. His hypertension and hyperlipidemia are currently under control with medications, but his most recent A1C (1 month ago) was 11.2. Given only the above information, which diagnosis would be at the top of your differential?Major Depressive DisorderMajor Neurocognitive Disorder due to Alzheimer’sMajor Neurocognitive Disorder due to Another Medical ConditionDelirium

9. key points in the stem?Rationales for correct and incorrect answers?

10. Psychotic disorders

11. 4. Evelyn is a 27-year-old female who presents to your clinic due to insomnia. She states that following the death of her grandfather 10 months ago, she has difficulty falling and staying asleep, and is averaging about 5 hours a night. Additionally, she reports that she has been losing weight, has little energy, and finds it difficult to read because she “just can’t concentrate.” Finally, with all that is going on, she reports just not being interested in doing things, has not been going to work, and spends most of her day at home watching TV. Given her presentation, what diagnosis is most likely? Major Depressive Disorder Persistent Depressive DisorderAdjustment Disorder with Depressed MoodInsomniaBipolar Disorder Type 1

12. key points in the stem?Rationales for correct and incorrect answers?

13. 5. Evelyn is a 27-year-old female who presents to your clinic due to insomnia. She states that following the death of her grandfather 10 months ago, she has difficulty falling and staying asleep, and is averaging about 5 hours a night. Additionally, she reports that she has been losing weight, has little energy, and finds it difficult to read because she “just can’t concentrate.” Finally, with all that is going on, she reports just not being interested in doing things, has not been going to work, and spends most of her day at home watching TV. Given her presentation, what drug listed below is the best choice to alleviate her symptoms? Phenytoin (Dilantin®)Procaine Fentanyl (Fentora®)Amitriptyline (Elavil®)Lamotrigine (Lamictal®)

14. key points in the stem?Rationales for correct and incorrect answers?

15. 6. A 35-year-old female presents to the the ER after an MVA. Other than a few scratches on her face from broken glass and smelling strongly of alcohol, her physical exam, labs, and imaging are all normal. While the patient is difficult to interview because she is easily distracted and is speaking very rapidly, the doctor finds out that she got into the MVA because she was “racing” down the freeway in a new car she purchased this morning. Also, over the past 3 days she has needed little sleep. She denies a history of depression. She is admitted for observation because the doctor does not think she is safe to go home given her behavior. Given this information, what is the most likely diagnosis?Alcohol Use DisorderBipolar 1 DisorderBipolar 2 DisorderCyclothymic Disorder

16. key points in the stem?Rationales for correct and incorrect answers?

17. 7. A 26-year-old male presents to your clinic with his mother. His mother stated that about 6 months ago her son started “acting a little weird” because he thought that some people he worked with were spying on him and stealing from his work locker. As a result he socialized less and less. However, about a month ago he became “really paranoid” about people spying on him, he quit his job, and began “tearing apart” his room looking for cameras and microphones. On examination you find his hygiene poor and his speech tangential. What is the most likely diagnosis? Schizotypal Personality DisorderSchizoaffective DisorderSchizophreniformSchizophreniaDelusional Disorder

18. key points in the stem?Rationales for correct and incorrect answers?

19. 8. A 26-year-old male presents to your clinic with his mother. His mother stated that about 6 months ago her son started “acting a little weird” because he thought that some people he worked with were spying on him and stealing from his work locker. As a result he socialized less and less. However, about a month ago he became worse. His affect became flat, his motivation to start or continue projects he had planned decreased. He began speaking less and has almost stopped interacting with others. On examination you find his hygiene poor and when you force him to speak, his speech is disorganized. What is your proposed drug treatment for this patient?Risperidone (Risperdal®)Chlorpromazine (Thorazine®)Valproic Acid (Depakene®) Clozapine (Clozaril®)Lithium

20. key points in the stem?Rationales for correct and incorrect answers?

21. The next set of questions contain a similar stem, but are more difficult because they are advanced degree questions….

22. Adrenergic aMuscarinic M1GABAASerotonin 5HTTRPV1 9. A 26-year-old male presents to your clinic with his mother. His mother stated that about 6 months ago her son started “acting a little weird” because he thought that some people he worked with were spying on him and stealing from his work locker. As a result he socialized less and less. However, about a month ago he became worse. His affect became flat, his motivation to start or continue projects he had planned decreased. He began speaking less and has almost stopped interacting with others. On examination you find his hygiene poor and when you force him to speak, his speech is disorganized. The drug of choice used to treat this patient’s symptoms targets which receptor?

23. key points in the stem?Rationales for correct and incorrect answers?

24. 10. A 26-year-old male presents to your clinic with his mother. His mother stated that about 6 months ago her son started “acting a little weird” because he thought that some people he worked with were spying on him and stealing from his work locker. As a result he socialized less and less. However, about a month ago he became worse. His affect became flat, his motivation to start or continue projects he had planned decreased. He began speaking less and has almost stopped interacting with others. On examination you find his hygiene poor and when you force him to speak, his speech is disorganized. You provide drug X, one of the most prescribed drugs for your patient’s condition. The patient is concerned about adverse side effects, particularly because of a history of diabetes in his family. What adverse effects listed below is the best answer for this class of the drug.Weight gainTardive dyskinesiaAgranulocytosisgynomastiaPseudoparkinsonism

25. key points in the stem?Rationales for correct and incorrect answers?

26. Anxiety and related disorders

27. 11. Peter is a 47-year-old male combat veteran with a PMH of asthma, hypertension, and hyperlipidemia. He presents to the ER in the middle of the night via ambulance, and is complaining of chest pain, shortness of breath, a lump in his throat, tachycardia, sweating, and he feels like he is dying. He stated that these symptoms woke him from his sleep. You give him a full cardiac workup (e.g. labs, imaging), and everything looks normal. What mental health diagnosis should be at the top of your differential? Generalized Anxiety DisorderPanic DisorderPost Traumatic Stress DisorderObsessive-Compulsive DisorderAgoraphobia

28. key points in the stem?Rationales for correct and incorrect answers?

29. 12. Peter is a 47-year-old male combat veteran with a PMH of asthma, hypertension, and hyperlipidemia. He presents to the ER in the middle of the night via ambulance, and is complaining of chest pain, shortness of breath, a lump in his throat, tachycardia, sweating, and he feels like it his dying. He stated that he had nightmare about “something” that happened during the Gulf War that woke him up, and then he noticed that he was having these symptoms. You give him a full cardiac workup (e.g. labs, imaging), and everything looks normal. During the exam the patient appears anxious about being touched, and wants to have his back to the wall. What mental health diagnosis should be at the top of your differential? Generalized Anxiety DisorderPanic DisorderPost Traumatic Stress DisorderObsessive-Compulsive DisorderAgoraphobia

30. key points in the stem?Rationales for correct and incorrect answers?

31. 13. Peter is a 47-year-old male combat veteran with a PMH of asthma, hypertension, and hyperlipidemia. He presents to the ER in the middle of the night via ambulance, and is complaining of chest pain, shortness of breath, a lump in his throat, tachycardia, sweating, and he feels like he is dying. He stated that these symptoms woke him from his sleep. You give him a full cardiac workup (e.g. labs, imaging), and everything looks normal. What is the mechanism of action for the DOC used to treat the patient’s mental health disorder? SERT inhibitorNa++ & Ca++ channel inhibitorsOpiate agonist that does not cross BBNa++ channel blockers

32. key points in the stem?Rationales for correct and incorrect answers?

33. 14. Peter is a 47-year-old male combat veteran with a PMH of asthma, hypertension, and hyperlipidemia. He presents to the ER in the middle of the night via ambulance, and is complaining of chest pain, shortness of breath, a lump in his throat, tachycardia, sweating, and he feels like it his dying. He stated that he had nightmare about “something” that happened during the Gulf War that woke him up, and then he noticed that he was having these symptoms. You give him a full cardiac workup (e.g. labs, imaging), and everything looks normal. During the exam the patient appears anxious about being touched, and wants to have his back to the wall. What drug listed below would you use to treat the patient’s mental health disorder? Sufentanil (Sufenta®)Paroxetine (Paxil®)Chlorpromazine (Thorazine®)Zolpidem (Ambien®)Ziprasidone (Geodon®)

34. key points in the stem?Rationales for correct and incorrect answers?

35. The endQuestions?