A 40-year-old man presents with problems remembering things at work. His children have told him that they find themselves having to repeat information in conversations with him. He has never had memory problems before but has had a stressful year since the death of his father. He is an otherwise very healthy man. He has had loss of appetite, insomnia, and a lot of guilt concerning his father’s death from a stroke.
What is the most likely cause of this patient’s memory problems?
Correct Answer D:
This patient, who has no known medical problems and is exhibiting symptoms of depression, is likely having memory problems as a result of a mood disorder. If concentration is impaired by a mood disorder, the patient will have difficulty getting new information into his or her short-term memory. This results in information not making it into long-term memory. Treatment of his mood should resolve his memory problems.
A. Though his father had a stroke, this is an unlikely cause due to his age and the absence of other physical findings.
B. This is a diagnosis of exclusion that requires a mood component to be ruled out, as well as other possible causes of dementia.
C. No medical conditions are present to support this.
A 44-year-old female comes to your office for a second opinion. She says she is being treated for bipolar disorder but doesn’t understand why she is hearing voices even when she is no longer depressed or manic. On reviewing her records you discover that she has auditory hallucinations and paranoia that never clear completely despite being without any mood symptoms for long periods of time.
You inform the patient that your diagnosis would be:
Correct Answer A:
A bipolar patient has psychosis only during a depression or mania. If psychotic symptoms are present despite full treatment of mood symptoms, the diagnosis is schizoaffective disorder. This impacts your treatment because the patient may need indefinite antipsychotic treatment.
B. This is the term for a chronic schizophrenic who has predominantly negative symptoms such as disorganization, flattened affect, or vegetative symptoms.
C. This is the term for the schizophrenic with the typical spectrum of hallucinations and delusions.
D. This is the term for the schizophrenic who has very disorganized speech, is difficult to understand, and has inappropriate emotional responses.
E. If psychotic symptoms are present when the patient is not depressed, this cannot be the diagnosis.
Which of the following is true of the biopsychosocial model of approaching illness?
The biopsychosocial model is an attempt to approach all patients in a comprehensive manner - approach that posits that biological, psychological (which entails thoughts, emotions, and behaviors), and social factors, all play a significant role in human functioning in the context of disease or illness. Reviews of their past medical history, family medical history, physical symptoms, the physical exam, and any laboratory or pathology findings are included in the biologic assessment. Reviews of coping skills, current motivations and goals, and personality traits that may affect the intensity or ability to adapt to the illness are included in the psychological assessment. The person’s family and community influences are included in the social assessment. Combined, these factors offer a better sense of how to understand and subsequently treat the problem that the patient is bring to the physician.
A 74-year-old male comes to your office for a routine checkup. He has been a patient of yours for many years and has never been a management problem. Near the end of the visit he tells you he is very angry at his neighbor. He has been able to hear all of his neighbor’s thoughts for the past week and believes the man has been monitoring him with hidden cameras. He further informs you that he has bought a shotgun and intends to shoot the man the next time he comes out to complain about his yard. When you ask him if he is serious about this he replies, “You bet I am.” After a prolonged discussion about this and repeated efforts to resolve the problem otherwise, he tells you, “I don’t care what happens to me legally, I’m going to shoot him in the leg and teach him a lesson.”
You are obligated to:
According to the Tarasoff decision you must report threats of violence where the patient has shown intent toward a specific person or persons. Every reasonable effort should be made to keep the patient in the office until the appropriate safe disposition is made. One should not put oneself in danger, however, to achieve this.
A. Reasons to break confidentiality include homicidal ideation, suicidal ideation, and report or evidence of child abuse.
B. You still have an obligation to protect public safety.
C. The patient could act on his plan by the time the consultation occurs, even if that was the very next day.
A 43 year old male patient presenting with hallucinations and delusions was prescribed chlorpromazine, a phenothiazine derivative for reduction of the positive symptoms of schizophrenia.
What is its mechanism of action as an antipsychotic?
Correct Answer C:
Chlorpromazine is an aliphatic phenothiazine antipsychotic which blocks postsynaptic mesolimbic dopaminergic receptors in the brain. Basically, it is a dopamine inhibitor, increases dopamine turnover in the brain, and stimulates prolactin release.
Chlorpromazine works on a variety of receptors in the central nervous system, producing anticholinergic, antidopaminergic, antihistaminic, and weak antiadrenergic effects.
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