Case Studies: Stahl's Essential Psychopharmacology: Guide to CME Posttest Questions

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Original release date: May 1, 2011

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1.

A patient with bipolar disorder has been taking valproate with only partial control of depressive symptoms, and his clinician elects to add lamotrigine. Compared to lamotrigine monotherapy, what adjustment should be made to the lamotrigine titration schedule in the presence of valproate?

  1. Titration scheduled should be halved

  2. Titration schedule should be doubled

  3. Titration schedule should be the same as for lamotrigine monotherapy

2.

A 22-year-old man with a history of cognitive and social delay has just been diagnosed with schizophrenia. In early elementary school his language development was normal but he had difficulty reading and was diagnosed with a learning disability. He had increased academic difficulty beginning in high school but did graduate and began working at a supermarket. However, he began to exhibit difficulty functioning, including disorganization and deterioration in communication, which led to his dismissal from his job. Six months later he experienced a psychotic episode and was diagnosed with schizophrenia. What pattern of cognitive functioning would you expect for this patient over the long-term course of his illness?

  1. Progressive decline in cognitive functioning beyond what is expected with normal aging

  2. No further decline in cognitive functioning beyond what is expected with normal aging

3.

Antipsychotic-induced parkinsonism will generally reverse:

  1. A couple days after antipsychotic discontinuation

  2. 1–2 weeks following antipsychotic discontinuation

  3. 2–6 months following antipsychotic discontinuation

4.

Results of recent studies regarding the classical discontinuity hypothesis for schizophrenia and affective disorders have:

  1. Consistently supported the hypothesis

  2. Consistently rejected the hypothesis

  3. Been mixed

5.

Which of the following are approved treatments for resistant depression?

  1. Aripiprazole

  2. Quetiapine

  3. Selegiline

  4. A and B

  5. A and C

  6. A, B, and C

6.

Which of the following has the least risk of causing a movement disorder?

  1. Aripiprazole

  2. Clozapine

  3. Quetiapine

  4. Risperidone

7.

Which of the following have hallucinations associated with them?

  1. Schizophrenia

  2. Schizophrenia and OCD

  3. Schizophrenia, OCD, and delusional disorder

8.

When a patient is not responding to clozapine, which of the following is the best strategy to take?

  1. Raise the dose

  2. Ensure that plasma levels are between 200–300 ng/ml

  3. Ensure that plasma levels are between 400–600 ng/ml

9.

Which of the following is true regarding the use of atypical antipsychotics in elderly patients?

  1. Atypical antipsychotics are contraindicated in all elderly patients

  2. There is a warning regarding use of atypical antipsychotics in all elderly patients

  3. Atypical antipsychotics are contraindicated in elderly patients with dementia-related psychosis

  4. There is a warning regarding use of atypical antipsychotics in elderly patients with dementia-related psychosis

10.

A 44-year-old woman with treatment-resistant depression is going to begin treatment with transcranial magnetic stimulation. What is the typical duration of treatment for this method?

  1. 2 sessions a month for 3–6 months

  2. 1 session a week for 8–12 weeks

  3. 5 sessions a week for 4–6 weeks

  4. 1 session a day for 1–2 weeks

11.

Which of the following foods should be avoided for patients taking oral doses of MAOIs?

  1. Aged cheeses and tap beers

  2. Processed meat and canned or bottled beers

  3. Fresh poultry and baker’s yeast

12.

Hypertension is a contraindication for treatment with:

  1. Lithium

  2. MAO inhibitors

  3. Lithium and MAO inhibitors

  4. Neither lithium nor MAO inhibitors

13.

Cognitive symptoms of depression may best be alleviated by boosting which neurotransmitters in the prefrontal cortex?

  1. Norepinephrine and serotonin

  2. Serotonin and dopamine

  3. Dopamine and norepinephrine

14.

Before initiating venlafaxine treatment, and throughout the treatment, you should monitor for:

  1. Change in blood pressure

  2. Diabetes

  3. Parkinsonism

  4. Weight gain

15.

A 33-year-old woman with a major depressive episode is prescribed paroxetine. Three weeks later she buys $40,000 worth of clothes and electronics in three days; her boyfriend says that she is staying up all night claiming to be working on “a project that will change the world.” She is diagnosed with antidepressant-induced mania/hypomania. Guidelines for treating antidepressant-induced mania/hypomania are:

  1. Prescribe a mood stabilizer for one year, then discontinue gradually while monitoring

  2. Prescribe a mood stabilizer indefinitely

  3. There are no clear guidelines

16.

The presence of diabetes is a contraindication to treatment with:

  1. Clozapine

  2. Olanzapine

  3. All atypical antipsychotics

  4. No atypical antipsychotics

17.

Which of the following is true regarding medication use for bipolar disorder during pregnancy?

  1. Lithium has known teratogenic effects and is not a preferred treatment

  2. Valproate has known teratogenic effects and is not a preferred treatment

  3. Olanzapine has known teratogenic effects and is not a preferred treatment

  4. A and B

  5. A, B, and C

18.

Which of the following classes of medications have black box warnings stating that they should not be prescribed to children under the age of 12?

  1. Antidepressants

  2. Antipsychotics

  3. Benzodiazepines

  4. A and C

  5. None of the above

19.

The course of bipolar illness in children and adolescents as compared to adults generally consists of:

  1. Acute episodes characterized by irritability

  2. Acute episodes characterized by euphoria

  3. Chronic symptoms characterized by irritability

  4. Chronic symptoms characterized by euphoria

20.

When a patient has mood symptoms resulting from a personality disorder, medication treatment by itself is not likely to provide substantial benefit.

  1. True

  2. False

21.

Chronic pain with no known injury is most likely attributable to:

  1. Central sensitization of brain and spinal cord pain circuits

  2. Somatization of psychological symptoms

  3. Either of the above

22.

I commit to making the following change(s) in my practice as a result of participating in this activity:

  1. I will stay up-to-date on the risks of using atypical antipsychotics in the elderly.

  2. I will consider atypical antipsychotics in difficult-to-treat aggressive cases after discussing the risks and benefits with the patient.

  3. I will remain up-to-date on the research discussing how to treat behavioral symptoms associated with dementia.

  4. A and B

  5. A and C

  6. B and C

  7. I will make all of the above changes (A, B, and C).

  8. I am already doing all of the above.

23.

I commit to making the following change(s) in my practice as a result of participating in this activity:

  1. I will consider prescribing antidepressants to children if the case warrants it.

  2. I will follow up religiously with patients who are on antidepressants and may be suicidal.

  3. I will review all medication dosing instructions with patient and family to ensure proper compliance.

  4. A and B

  5. A and C

  6. B and C

  7. I will make all of the above changes (A, B, and C).

  8. I am already doing all of the above.

24.

I commit to making the following change(s) in my practice as a result of participating in this activity:

  1. I will check therapeutic drug levels before suggesting novel, less-evidenced treatments

  2. I will consider ECT for difficult-to-treat cases of depression.

  3. I will consider high doses of antidepressants for difficult-to-treat cases.

  4. A and B

  5. A and C

  6. B and C

  7. I will make all of the above changes (A, B, and C).

  8. I am already doing all of the above.

25.

I commit to making the following change(s) in my practice as a result of participating in this activity:

  1. I will try to overcome cultural and language barriers when dealing with difficult cases.

  2. I will track mood and motor problems when they present simultaneously.

  3. I will review all medication dosing instructions with patient and family to ensure proper compliance.

  4. A and B

  5. A and C

  6. B and C

  7. I will make all of the above changes (A, B, and C).

  8. I am already doing all of the above.

26.

I commit to making the following change(s) in my practice as a result of participating in this activity:

  1. I will combine two diagnoses such as a mood disorder and a psychotic disorder in certain cases

  2. I will treat complicated cases as evolving cases, and re-diagnose them periodically

  3. I will add mood stabilizers to antipsychotics to treat affective symptoms

  4. A and B

  5. A and C

  6. B and C

  7. I will make all of the above changes (A, B, and C).

  8. I am already doing all of the above.

27.

I commit to making the following change(s) in my practice as a result of participating in this activity:

  1. I will involve family members in the treatment of my patients.

  2. I will offer alternative options for family members who are too emotionally involved.

  3. I will make every attempt possible to reduce suicidality in my patients.

  4. A and B

  5. A and C

  6. B and C

  7. I will make all of the above changes (A, B, and C).

  8. I am already doing all of the above.

 

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