Psychiatry

A 34-year-old man presents via telehealth for a follow-up visit. Over the past four weeks, he has experienced persistent low mood, hypersomnia, extreme fatigue, and a loss of interest in his usual activities. Five years ago, he was hospitalized for an episode characterized by grandiosity, pressured speech, and a significantly decreased need for sleep. He has not taken any medications for the past six months. Which of the following are appropriate pharmacological treatments for this patient's current condition? (Select all that apply)

A 45-year-old man is diagnosed with a first episode of severe, non-psychotic major depressive disorder. He is medically healthy and has no previous psychiatric treatment history. According to standard stepped-care guidelines for major depressive disorder, arrange the following therapeutic management steps in the most appropriate chronological sequence, assuming the patient exhibits only a partial response to each consecutive intervention.

A 78-year-old woman with a 6-year history of Alzheimer disease is brought to the clinic for a routine follow-up. Her family asks the physician about the natural progression of the disease to help them prepare for future care needs. The physician explains the typical chronological decline expected in this condition. Arrange the following clinical features in the correct chronological sequence that they typically appear during the natural course of Alzheimer disease, from earliest to latest.

An emergency department physician evaluates a 31-year-old man who presents with a 4-week history of severe depressed mood, hypersomnia, and a 6-kg (13.2-lb) weight gain. He recently took a leave of absence from his job as an accountant because he "lacks the mental energy to look at spreadsheets." Review of his electronic medical record reveals a prior hospitalization one year ago for acute agitation, pressured speech, and decreased need for sleep lasting 10 days; during that admission, he was convinced he had discovered a secret formula for infinite energy. He currently takes no medications and has no other medical conditions. Vital signs are within normal limits. Laboratory evaluation shows a normal comprehensive metabolic panel, negative urine toxicology screen, and a normal thyroid-stimulating hormone (TSH) level. The physician is formulating a comprehensive management plan. Which of the following statements regarding the diagnosis and management of this patient are correct? (Select all that apply)

A 30-year-old woman is evaluated in the clinic 2 weeks after surviving a severe house fire. She reports experiencing frequent, distressing nightmares about the fire, hypervigilance, and a new inability to experience positive emotions. She actively avoids anything that reminds her of the event, including cooking and candles. Her past psychiatric history is significant for Bipolar I disorder, which is currently stable, and a history of treatment-resistant depression for which she takes phenelzine. She asks what can be done to manage her current distressing symptoms. Which of the following are the most appropriate management steps for this patient? (Select two)

A 46-year-old woman is evaluated in the psychiatric clinic for an acute bipolar depressive episode. She has a history of bipolar I disorder with multiple past hospitalizations for severe mania. Her medical history includes hypertension, chronic lower back pain, and Hashimoto thyroiditis. Her current medications are lisinopril, naproxen (taken daily), and levothyroxine. Laboratory studies show a normal serum creatinine with an estimated glomerular filtration rate (eGFR) of 95 mL/min/1.73m² and a normal thyroid-stimulating hormone (TSH) level. The psychiatrist plans to initiate lithium carbonate for her current depressive episode and for long-term maintenance.

Which of the following are appropriate steps in the management of this patient prior to or during the initiation of lithium therapy? (Select all that apply)

A 29-year-old woman presents to the primary care clinic reporting a 6-week history of depressed mood, profound fatigue, and an inability to concentrate at work. She notes that her appetite has significantly increased, leading to a 4-kg (8.8-lb) weight gain. She often sleeps for 12 hours a night but still wakes up feeling unrefreshed, and states that her arms and legs frequently feel "like lead." Her medical history is unremarkable, and she takes no medications. Her vital signs are within normal limits. She recalls experiencing a similar episode of depression during her first year of college, which eventually resolved without treatment. The physician is considering initiating pharmacotherapy for her symptoms. Which of the following is the most appropriate next step in management?

A 23-year-old woman comes to the clinic reporting profound sadness, low energy, and poor concentration over the past 6 weeks. She sleeps up to 12 hours a day and has lost interest in her usual hobbies. Her medical history is notable for a psychiatric hospitalization three years ago. At that time, she experienced a two-week period of feeling 'invincible,' requiring only 2 to 3 hours of sleep per night, and impulsively spending her entire savings on luxury handbags. Her current vital signs and physical examination are unremarkable. Laboratory results, including a complete blood count, comprehensive metabolic panel, and thyroid-stimulating hormone (TSH) level, are within normal limits. Which of the following is the most appropriate initial medication for this patient's current symptoms?

A 21-year-old male university student is evaluated in the student health center for worsening fatigue, hypersomnia, and feelings of worthlessness over the past month. He states that he is failing his classes and feels "it would be better if I just went to sleep and never woke up." Review of his medical record reveals a prior psychiatric hospitalization at age 19 for a week-long episode of decreased need for sleep, grandiosity, and reckless spending. He currently takes no medications and uses no illicit substances. The physician is formulating a comprehensive management plan. Which of the following statements regarding his diagnosis and pharmacological management are correct? Select all that apply.

During a routine wellness visit, a 28-year-old female patient presents with vague somatic complaints. She arrives wearing a deeply plunging neckline and a theatrical feather boa. Throughout the interview, she is exceptionally flirtatious with the male medical student and refers to the attending physician as her "absolute favorite doctor in the entire universe" despite this being their first meeting. Her speech is impressionistic and lacks detail; when asked to describe her diet, she says it is "glorious and perfectly balanced" without providing any specifics. Her medical history is unremarkable. Which of the following statements regarding this patient's most likely underlying psychiatric condition are true? (Select all that apply)

A 45-year-old man with no prior psychiatric history is diagnosed with Major Depressive Disorder. Over the next two years, his condition proves difficult to manage, requiring escalating interventions based on his varying levels of therapeutic response at each stage. According to evidence-based guidelines for stepped-care psychiatric management, arrange the following clinical interventions in the most appropriate chronological order, progressing from initial presentation to the management of severe treatment-resistant depression.

A 21-year-old college student presents to the student health center seeking help for extreme distress. For the past 4 months, he has experienced intrusive, distressing fears of contracting a fatal pathogen, leading him to wash his hands with bleach up to 30 times a day. He acknowledges that his fears are likely exaggerated but states the anxiety is unbearable unless he washes. His hands are severely excoriated and erythematous. Two days ago, an urgent care physician diagnosed a soft tissue infection on his right hand (confirmed methicillin-resistant Staphylococcus aureus) and prescribed a 10-day course of oral linezolid. During the interview, the patient appears visibly depressed and reports feeling hopeless. Upon further psychiatric history, he reveals that a year ago, he had a distinct one-month period where he slept only 2 hours nightly, spoke so rapidly that friends could not understand him, and engaged in reckless hypersexual behavior. He is not taking any other medications. Which of the following are the most appropriate management steps for his psychiatric symptoms? (Select 2 options)

A 21-year-old university student is evaluated at the student health center at the insistence of his roommate. The roommate is concerned because the patient spends most of his time alone in their shared apartment, intensely studying 'crystal energy fields' and claiming to occasionally perceive auras around people. However, the patient acknowledges that these auras might just be his imagination. During the clinical interview, the patient avoids eye contact and appears highly anxious. He wears a heavy winter trench coat despite it being the middle of summer. His speech is circumstantial and rich in unusual metaphors, yet he remains goal-directed. He explicitly denies hearing voices when no one is present or believing that others are conspiring against him. The patient states he has felt like an 'outsider' for as long as he can remember and has never had close friends. There is no history of distinct depressive or manic episodes. Which of the following is the most likely diagnosis?

A 26-year-old male graduate student presents to the university health center complaining of severe sadness, lack of motivation, and poor concentration over the past 5 weeks. He states he has completely lost interest in his coursework and hobbies, which is highly unusual for him. He struggles to get out of bed, sleeping up to 14 hours a day, and reports a 5 kg (11 lb) weight gain during this time. Medical history is unremarkable, and he takes no medications. Physical examination reveals psychomotor retardation and a blunted affect, but vital signs and the remainder of the examination are within normal limits. He denies any suicidal ideation. The patient requests an antidepressant medication to help him "get back on track." Which of the following is the most appropriate next step in the clinical evaluation or management of this patient?

Match each specific substance of abuse with its most characteristic clinical presentation and associated findings.

Match each patient's clinical presentation with the most likely personality disorder diagnosis.

Match each patient's clinical presentation with the most appropriate next step in psychopharmacologic or procedural management.

Match each patient's clinical presentation to the most appropriate DSM-5 diagnosis based on their specific symptom profile and duration.

Match each clinical presentation of an antipsychotic-induced adverse effect to the primary pharmacological mechanism of its most appropriate targeted medical treatment.

A 34-year-old man comes to the psychiatry clinic reporting a 6-week history of worsening depressed mood, anhedonia, and profound fatigue. He states he is sleeping up to 14 hours a day and has gained 6 kg (13.2 lb) during this period. The patient has a history of a seizure disorder that has been well controlled on carbamazepine for the past 8 years. Five years ago, he was prescribed sertraline by his primary care physician for a depressive episode; three weeks later, he developed grandiosity, decreased need for sleep, pressured speech, and reckless spending. This resulted in a psychiatric hospitalization. He required inpatient observation and treatment with antipsychotics for 3 weeks, long after the sertraline was discontinued, before his symptoms fully resolved. He has not taken any psychiatric medications since that time. Vital signs are within normal limits. Physical examination reveals no abnormalities. Serum chemistry panel, complete blood count, and thyroid-stimulating hormone (TSH) levels are within normal reference ranges. Which of the following is the most appropriate next step in the pharmacologic management of this patient's current symptoms?