In monozygotic twins schizophrenia has a concordance rate of:
Correct Answer D:
Schizophrenia is deemed a multifactorial pathology involving both genetic and environmental factors. With respect to genetics, there is a 40-50% concordance rate in monozygous twins; 10-15% in dizygous twins; and, 40% concordance if both parents have schizophrenia. Concordance means the probability that a pair of individuals will both have a certain characteristic, given that one of the pair has the characteristic.
A 37-year-old female has been having problems at work for about 30 months now. She admits having occasional episodes of hyperactivity and euphoria that usually last 2-3 days. These were preceded by episodes of sadness and inability to cooperate with her colleagues in spite of trying hard to do her best.
What is the most likely diagnosis?
Correct Answer C:
According to the DSM-V, cyclothymic disorder (choice C) is characterized by the presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode, for at least 2 years (in children and adolescents, the duration must be at least 1 year). During this 2-year period (1 year in children and adolescents), the patient does not go without the symptoms for more than 2 months at a time.
Compared to more serious mood disorders, the mood symptoms of cyclothymia are mild. Depressive symptoms in cyclothymic disorder never reach the criteria for major depression. Elevated mood never reaches the definition for mania.
Diagnosis is clinical and based on history. Management consists primarily of education, although some patients with functional impairment require drug therapy.
→ Bipolar disorder (choice A) is a mood disorder that is characterized by episodes of mania, hypomania, and major depression. DSM-V diagnostic criterion A for hypomanic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least four consecutive days and present most of the day, nearly every day. DSM-V diagnostic criterion A for manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least one week and present most of the day, nearly every day (or any duration if hospitalization is necessary). This patient's episodes last less than 4 days.
→ Persistent Depressive Disorder (choice B), formerly known as Dysthymic Disorder, is a chronic condition characterized by depressive symptoms that occur for most of the day, more days than not, for at least 2 years.
→ Masked depression (choice D) is an endogenous or psychogenic depressive state in which the somatic symptoms predominate while the psychical symptoms are only present in the background.
→ Factitious disorder (choice E) refers to the psychiatric condition in which a patient deliberately produces or falsifies symptoms of illness for the sole purpose of assuming the sick role. Patients with factitious disorder waste precious time and resources through unnecessary hospital admissions, expensive investigatory tests, and sometimes, lengthy hospital stays.
A patient has experienced a 3-year-history of cycles of elevated moods that alternate with feelings of loss of interest and sadness.
Which of the following disorders would she likely be diagnosed with?
Cyclothymic disorder is a chronic disorder characterized by hypomanic and mini-depressive periods that last a few days, follow an irregular course, and are less severe than in bipolar disorder. Diagnosis is clinical and based on history (at least 2 years). Management consists primarily of education, although some patients with functional impairment require drug therapy.
Cyclothymic disorder is commonly a precursor of bipolar II disorder. However, it can also occur as extreme moodiness without becoming a major mood disorder. In chronic hypomania, a form rarely seen clinically, elated periods predominate, with habitual reduction of sleep to < 6 hours. People with this form are constantly over cheerful, self assured, over energetic, full of plans, improvident, over involved, they rush off with restless impulses and accost people.
Patients with Anorexia Nervosa may present with all of the following, except:
Correct Answer B:
Anorexic patients refuse to maintain body weight at or above a minimally normal weight for age and height (usually less than 85% of ideal body weight). Patient will have an intense fear of gaining weight or becoming fat.
Physical examination may reveal hypothermia, peripheral edema, thinning hair, and obvious emaciation. Behaviorally, a patient may demonstrate a flat affect and display psychomotor retardation, especially in the later stages of the disease.
Review of systems is often positive for constipation, early satiety, hypothermia, nausea, hair loss, and fatigue. Vital sign abnormalities may include hypothermia, bradycardia, and hypotension. Cardiac examination may reveal the mid systolic click of mitral valve prolapse. Patients with purging behavior may have parotid gland hypertrophy, dental enamel erosion and, in extreme cases, seizures from electrolyte disturbances. Dermatologic examination reveals dry skin, lanugo (a fine, downy covering of hair on the extremities), and poor skin turgor.
Which of the following would you typically not find in anorexia nervosa?
Correct Answer A:
Anorexia nervosa is characterized by a relentless pursuit of thinness, a morbid fear of obesity, a refusal to maintain a minimally normal body weight, and, in women, amenorrhea.
Common physical findings include bradycardia, low BP, hypothermia, lanugo hair or slight hirsutism, and edema. Even patients who appear cachectic tend to remain very active (including pursuing vigorous exercise programs), are free of symptoms of nutritional deficiencies, and have no unusual susceptibility to infections.
Diagnosis is clinical. Treatment is with cognitive-behavioral therapy; olanzapine may help with weight gain, and SSRIs, especially fluoxetine, may help prevent relapse.
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