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A55-year-old man with no history of mental illness presents with recent onset
of disorientation, fluctuating mental status, abnormal autonomic signs, poor
coordination, tremor, and seeing "little men" in his bedroom. He has no known
history of substance abuse. What is the most likely diagnosis?
A. Schizophrenia
B. Dementia associated with Parkinson's disease
C. Delirium
D. Depression with psychotic features
E. Delusional disorder
3. Which of the following drugs would be the least favorable treatment for a
patient with bulimia nervosa without comorbidities?
A. Ziprasidone (Geodon)
B. Aripiprazole (Abilify)
C. Olanzapine (Zyprexa)
D. Quetiapine (Seroquel)
E. Risperidone (Risperdal)
A. Venlafaxine (Effexor)
B. Fluoxetine (Prozac, Sarafem)
C. Sertraline (Zoloft)
D. Diazepam (Valium)
E. Citalopram HBr (Celexa)
A. Lorazepam (Ativan)
B. Ziprasidone (Valium)
C. Droperidol (Inapsine)
D. Haloperidol (Haldol)
E. Propofol (Diprivan)
8. All the following factors signal potential risk for suicide, except:
ANSWERS
3 - C. Tricyclic antidepressants carry a risk for lethal overdose but have been
used to treat bulimia nervosa. Fluoxetine, topiramate, and cognitive-behavioral
therapy have all demonstrated some efficacy for this condition. Carbamazepine
has not produced impressive results in patients with bulimia nervosa without
comorbidities. It has been used in those with comorbid bipolar disorder, however.
4 - C. Olanzapine has been associated with the most weight gain. A lesser
amount of weight is gained with quetiapine and risperidone, and ziprasidone and
aripiprazole are associated with the least weight gain.
5 - D. Antidepressant drugs are often the best choice for patients with chronic
anxiety disorders. They can be given long-term, without risking dependence.
Diazepam is excellent for relieving anxiety for the short-term, but it carries too
high a risk of dependence when used for an extended time. For most acute
anxiety conditions, therapy with one of the benzodiazepines lasts up to 6 weeks,
with tapering and discontinuance during the next 2 weeks.
8 - C. Suicide risk is lower in persons who are married and have children and
stable support systems. Sudden symptom relief in a patient who recently felt
hopeless and/or helpless can indicate a decision to commit suicide. Having a
specific plan, lethal means, history of suicide attempts, absence of an emotional
support system, and a history of severe mental illness are all risk factors for
suicide. The risk of suicide is high among patients with schizophrenia.
9 - E. All the other options suggest the possibility of imminent violence. Although
it is difficult to predict future violence, a history of violent behavior is the single
best predictor. Major depressive disorder is not a specific indicator of potential
subsequent violence.