Which one of the following criteria is most likely to signify that an individual has bulimia nervosa rather than anorexia nervosa?
Correct Answer B:
The key clinical finding in bulimia nervosa is not, as is often assumed, vomiting. Binge eating is the sine qua non for bulimia. Temporary relief of the associated depressed mood and self-deprecating thoughts is achieved by methods intended to rid the body of the effects of calories. More than 80% of patients with bulimia nervosa engage in self induced vomiting or laxative or diuretic abuse for this purpose. The other options listed are DSM-IV criteria used to establish the diagnosis of anorexia nervosa.
A patient with a fear of heights is brought to the top of a tall building and required to remain there as long as necessary for the anxiety to dissipate.
This is an example of:
Correct Answer D:
Flooding is a psychotherapeutic technique used to help patients heal their traumatic memories. It works by exposing the patient to their painful memories, with the goal of reintegrating their repressed emotions with their current awareness.
'Flooding' is an effective form of treatment for phobias amongst other psychopathologies. It works on the behaviorist principles of classical conditioning. According to classical conditioning we learn through associations so if we have a phobia it is because we associate the feared object or stimulus with something negative.
If we were using flooding to treat a phobia we would expose a person to vast amounts of the feared stimulus. Example, if a person was scared of spiders we might lock them in a room full of spiders. The idea is that whilst a person will be initially very anxious, the body cannot stay anxious forever. When nothing bad happens the person will begin to calm down and so from that moment on associate a feeling of calm with the previously feared object.
A 17-year-old white female comes to your office accompanied by her mother. In the last 8 months she has withdrawn from a swimming team activities and has quit her part time job as a restaurant hostess. Her mother says that she no longer goes out with her friends, or wants to help with church volunteer events, as she used to. Their family relationship remains strong, she sleeps well, and she continues independent running and cycling.
Which one of the following would be appropriate as initial treatment?
Paroxetine has emerged as the drug of choice for treatment of social phobias. Also known as social anxiety disorder, social phobias characteristically cause fear of situations that may lead to embarrassing scrutiny. Patients learn to avoid situations where they feel others may notice them such as church gatherings, classroom settings, and other group events.
→ Lithium and haloperidol are used for more severe psychiatric disturbances
→ Alprazolam would be best reserved for secondary use because of the possibility of dependency
→ Trazodone is approved for treatment of depression, but its strong sedative properties make it inappropriate in this scenario
A 10-year-old boy is brought to your office by his mother. He has had stomachaches, headaches, and crying spells since school started in the fall. His mother reports this being most severe on Monday mornings while getting ready for school. He feels fine in the afternoons, evenings, and over the weekends, but continues to have physical complaints on school mornings, requesting to stay home from school. He has good friends at school and has never been a discipline problem. After further medical history is obtained and a physical exam is done there is no obvious medication explanation for his symptoms.
The most likely diagnosis is:
Correct Answer C:
School phobia is characterized by symptoms being most severe in the morning while getting ready for school. Typically the child’s somatic symptoms and feelings of distress are most severe after a long weekend away from school, and they tend to reduce as the child progresses through their day at school. It is necessary to determine if there is a justified fear such as the child being bullied or teased. If no medical or situational explanation is found, it is important to keep the child attending school as much as possible. If the child faces the anxiety consistently, it will likely extinguish and the school phobia will resolve.
A. Depression may lead to a school avoidance over time, but other symptoms of depression should be present throughout the day and on weekends.
B. Truant children will readily leave the home claiming they are going to school.
D. Antisocial personality disorder cannot be diagnosed before the age of 18 and is characterized by a disregard for and a violation of others’ rights.
E. Conduct disorder is the appropriate term for antisocial characteristics before the age of 18; however, the history doesn’t support a discipline problem.
A 23-year-old female presents to her employee health services complaining of severe anxiety. She reports symptoms of shortness of breath, sweaty palms, shakiness, and lightheadedness over the past few weeks. She states that she has a work-related presentation scheduled that week as well as an office holiday party that she is expected to attend. She admits that she worries excessively that she will do something to embarrass herself in either of these situations. She has avoided office parties in the past because she thinks others will scrutinize her appearance or behavior. She is distressed because she has few friends and prefers to stay at home rather than go out and meet new people.
Select the single most appropriate diagnosis for this patient:
Correct Answer A:
Social phobia is an anxiety disorder of persistent fear that one or more social situations will result in humiliation of the individual or scrutiny by others. Affected individuals avoid social or performance situations in fear they will embarrass themselves or be judged as anxious or stupid. Individuals with social anxiety usually experience physical symptoms of anxiety and marked anticipatory anxiety far in advance of upcoming social situations.
B. Social withdrawal is common with depression but is usually associated with a lack of interest rather than fear of social situations.
C. Paranoia is marked by fear that someone will do something untoward to the individual, not that they will be humiliated.
D. Simple phobia is marked and persistent fear of a clearly discernible, circumscribed object or situation, and exposure leads to immediate anxiety response, for example, social situations related to crowds or being in an enclosed space.
E. Agoraphobia is characterized by avoidance of situations due to fear the individual will have incapacitating panic-like symptoms or fear of losing control.
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