1. you are called for to consult on a 42-year-old woman with alcohol dependence who is complaining of severe depressive symptoms despite 5 days of abstinence. In the initial stage of the interview she noted that she had “ always been depressed” and believed that she “drank to cope with the depression”. Her current complaint included a prominent sadness that had persisted for several weeks, difficulties concentrating, initial and terminal insomnia, and a feeling of hopelessness and guilt. What is the most approximate next step to distinguish between alcohol-induced depression and an independent major depressive episode?
A. Antidepressant treatment.
B. Intensive psychotherapy.
C. Proton emission tomography(PET)scan.
D. Chronological history.
E. Trial of ECT.
2. After initiating lithium therapy when should the plasma level be checked?
A. 12 hours
B. 12–24 hours
C. 24–48 hours
D. 3–5 days
E. 5–7 days
3. Which of the following statements relates to buspirone?
A. Is a cyclopyrrolone compound
B. Side-effects include sedation
C. Can cause hyperprolactinaemia
D. Can be administered to patients with epilepsy
E. Is useful in the treatment of panic disorder
4. A 2-year-old young girl uses only one word – 'Daddy' – to everyone she encounters. You are asked to diagnose if she has any delay in language development or any other psychological factor causing this behaviour. It does not appear to be a form of stammering or stuttering. She has normal psychomotor development and the examination is otherwise entirely normal. How would you best describe her present state of language?
A. Over-extension
B.Under-extension
C. Telegraphic word
D. Holophrases
E. Grammatical morphemes
1 comment:
1. Answer: D
In an effort to distinguish between an alcohol-induced mood disorder and an independent major depressive episode, a timeline-based chronological history should be obtained. This should focus on the age of onset of this patient’s alcohol dependence, periods of abstinence that extended for several months or more since the onset of dependence, and the ages of occurrence of clear major depressive episodes lasting several weeks or more at a time.
Heavy intake of alcohol over several days results in many of the symptoms observed in major depressive disorder, but the intense sadness markedly improves within days to 1 month of abstinence. 80% of alcoholic patients report histories of intense depression, including 30 to 40% who were depressed for 2 or more weeks at a time. However, when information from patients and resource people was carefully evaluated, only 5% of alcoholic men and 10% of alcoholic women ever had depressions that met the criteria for major depressive disorder when they had not been drinking heavily.
Clinical data reveal that when even severe depression develops in alcoholic people, they are likely to improve fairly rapidly without medications or intensive psychotherapy aimed at the depressive symptoms. A recent study of almost 200 alcoholic men found that although 40% had severe levels of depression after one week of abstinence, these symptoms markedly improved in all but 5% after 3 additional weeks of sobriety. At the end of several weeks to 1 month, most alcoholic patients are left with mood swings or intermittent symptoms of sadness that can resemble cyclothymic disorder or dysthymic disorder. ECT is indicated only in depression resistant to all other treatment
2. Answer: E
ECG, thyroid function tests, renal function tests and U&Es should be checked prior to starting lithium treatment. The plasma level should be checked after 5–7 days, and then every 5–7 days until the required level is reached. Once stable, the level should be checked every 3–6 months, and thyroid function and U&Es should be checked every 6 months
3. Answer: C
Buspirone is an azapirone, a chemically and pharmacologically distinct class of drugs. It is an effective treatment for generalised anxiety disorder, especially for people who are sensitive to cognitive impairment. Adverse effects include headache, excitement, palpitations, nervousness, dizziness, confusion, sweating, fatigue and nausea. Prolactin levels may rise due to stimulation of the pituitary gland. This effect is dose-dependent and reversible on stopping the drug. It is contraindicated in patients with epilepsy.
4. Answer: A
Over-extension is an error of applying verbal labels too broadly. It usually appears at the age of 2–3 years and is a normal stage of language development. It is not an indication of stammering, stuttering or other organic problems in language development. An over-extension is a generalisation made on only one category such as 'daddy': it is a form of misusing a specific word as a general term. The appearance of over-extension is caused by perceptual features such as similarity and homogeneity.
In contrast to over-extension, under-extension is the narrow application of a verbal label, eg 'cat' is used only for the family's cat(s).
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