A 45-year-old man presents to the emergency room with a temperature of 105°F, tachycardia, arrhythmia, vomiting, diarrhea, and dehydration. He was noted to have been recently ill with pneumonia but was thought to be recovering. Thyrotoxicosis

A 29-year-old woman presents to the emergency room because she is unable to that move her head, which remains tilted off to one side. (A lateral flexion contracture of the cervical spine musculature.)Acute dystonic reaction

A 32-year-old woman presents with restlessness and motor agitation. When questioned, she notes 1 feel like 1 have to move.” She denies auditory or visual hallucinations. • Akathisia

Benzodiazepines, barbiturates, and many anticonvulsants exert their influence through which of the following types of receptors?

A 32-year-old man is brought to the emergency room unresponsive. Shortly after arriving at the emergency room, he stops breathing. The patient‟s friends state that the patient has a long history of depression and anxiety and is taking fluoxetine. They state that just prior to the man becoming unresponsive, he was at a party and was drinking alcohol, though they did not think that he drank more than two or three drinks. The patient‟s toxicology screen reveals, in addition to the substances listed above, the presence of cocaine, benzodiazepines, and marijuana. What is the most likely reason that this patient stopped breathing?

The observation that levodopa (a drug used to treat Parkinson disease) can cause mania and psychosis in some patients supports which neurochemical theory of psychiatric behavior?

A 17-year-old boy is brought to the emergency room by his friends after he “took a few pills” at a party and developed physical symptoms, including his neck twisting to one side, his eyes rolling upward, and his tongue hanging out of his mouth. The patient responds immediately to 50 mg of diphenhydramine intramuscularly with the resolution of all physical symptoms. Which of the following substances is most likely to have caused the symptoms?

28-year-old woman comes to her psychiatrist for a renewal of her prescription for haloperidol. She has been on this drug for 6 months after she was hospitalized for a psychotic episode. She complains to the psychiatrist about a white milky discharge from both of her breasts. What is the mechanism of action which is causing this medicationinduced Aeffect?

A 69-year-old man with a diagnosis of delirium has symptoms of psychosis that include: frightening auditory and visual hallucinations and paranoid delusions. Which of the following medications should be chosen first for this man‟s symptoms?

A29-year-old man is brought to the hospital because he was found tinning around on the streets with no shoes on in the middle of winter, screaming to everyone that he was going to be elected president. Upon admission to the hospital, he was stabilized on olanzapine and lithium and then discharged home. Assuming the patient is maintained on the olanzapine and the lithium, which of the following tests should be performed at least once per year?

An 85-year-old man is brought to the psychiatrist by his wife. She states that for the last 4 months, since the death of his son, the patient has been unable to sleep, has lost 20 lb, has crying spells, and in the last week has been starting to talk about suicide. She notes that he has numerous other medical problems, including prostatic hypertrophy, hypertension, insulin-dependent diabetes, and a history of myocardial infarction. Which of the following medications is most appropriate for the treatment of this patient?

A 32-year-old man is started on Lithiumafter being diagnosed with bipolar disorder. His psychiatrist explains the risks and benefits of the drag and tells the patient that the drug can affect several organs in the body and he will need blood tests every 6 months. Which of the following labs should be drawn that often on this patient?

A 12-year-old boy is very distraught because every time he thinks or hears the word God or passes in front of a church, swear words pop into his mind against his will. He also feels compelled to repeat the end of every sentence twice and to count to 20 before answering any question. If he is interrupted, he has to start from the beginning. Which of the following medications has been proven effective with this disorder?

A 36-year-old man is admitted to the hospital after a suicide attempt, in which he swallowed his entire bottle of lithium pills. In the emergency room, he is noted to be stuporous, with a lithium level of 4.5 meq/L. His urine output is noted to be less than onehalf what would normally be expected for a patient of his age. Which of the following procedures should be performed next?

A 5 2-year-old woman is brought to the emergency room after her husband finds her unresponsive at home. The patient left behind a suicide note, and two empty bottles of pills (sertraline and iorazepam) plus an empty bottle of vodka were found next to the patient. In the emergency room the patient‟s vital signs are: blood pressure 90/60 mm Hg, pulse 60 beats/minute, respirations 6 breaths/minute. Which of the following medications is most likely to be helpful in the emergency room setting in this situation? a. Acamprosate b. Zolpidem c. Flumazenil d. LAAM e. Disulfiram 121. A 48-year-old woman with a past history of recurrent psychotic depression is admitted to a locked ward during a relapse. On the day of admission, she is placed on nortriptyline 50 mg and risperidone 2 mg at bedtime. Ten days later, the patient reports with great concern that her nipples are leaking. Which class of medications is most commonly known to cause this condition?

Which of the following mechanisms is responsible for the condition in the previous vignette?

Which of the following mechanisms is responsible for the condition in the previous vignette?

A 72-year-old man develops acute retention and blurred vision after taking an antidepressant for 3 days. Which of the following medications is most likely to cause such side effects?

A 72-year-old man develops acute retention and blurred vision after taking an antidepressant for 3 days. Which of the following medications is most likely to cause such side effects?

A 29-year-old woman with a previous diagnosis of bipolar disorder is hospitalized during an acute manic episode. She is elated, sexually provocative, and speaks very fast, jumping from one subject to another. She tells the nurses that she has been chosen by God to be “the second virgin Mary.” BUN, creatinine, electrolytes, TSH, and an ECG are within normal limits. Treatment with lithium is begun. Within what time interval does this medication come to steady state with regular administration?

A mentally retarded male adolescent who has been increasingly aggressive and agitated receives several consecutive IM doses of haloperidol. totaling 30 mg in 24 hours, as a chemical restraint. The next day, he is rigid, confused, and unresponsive. His blood pressure is 150/95 mm Hg, his pulse is 110 beats/minute, and his temperature is 38.9°C (102°F). Both his WBC count and CPK levels are very high. Which of the following is the most likely diagnosis?

Which of the following medications can be effective in treating the condition in the vignette above?

A 7-year-old boy who wets the bed at least three times a week and has not responded to appropriate behavioral interventions is diagnosed with ADHD. Which of the following medications is indicated to treat both disorders?

An 18-year-old man is admitted to a locked psychiatric unit after he assaulted his father. He is convinced that his family members have been replaced with malevolent aliens and hears several voices that comment on his actions and call him demeaning names. Two days after initiating treatment. he develops a painful spasm of the neck muscles and his eyes are forced into an upward gaze. Dystonia

A 55-year-old man was diagnosed with a mental illness at the age of 20. At that time, he was noted to have hallucinations of two men commenting on his behavior and delusions that God was going to punish him for not finishing college. Once started on medications, the hallucinations and delusions lessened, though he remained socially isolative and apathetic. After 35 years on the same medication, he has a coarse, pill-rolling tremor that worsens at rest and improves during voluntary movements.Parkinsonian tremor

A 32-year-old man is diagnosed with a major depression. He and his psychiatrist discuss starting an antidepressant. The patient is concerned about the chance for impairment of his ability to get an erection on these kinds of medications. Which of the following medications should the patient be started on to treat his depression but avoid these symptoms?

A 4-year-old boy is brought to the physician by his parents because he experiences episodes of waking in the middle of the night and screaming. The parents state that when they get to the boy‟s room during one of these episodes, they find him in his bed, thrashing wildly, his eyes wide open. He pushes them away when they try to comfort him. After 2 minutes, the boy suddenly falls asleep, and the next day he has no memory of the episode. Which of the following medications should be the first choice to treat this disorder?

Which of the following antipsychotic agents is least likely to be associated with weight gain?

A 22-year-old man started on a typical antipsychotic finds it difficult to sit still and has to move his legs constantly. How is this phenomenon best defined?

A 40-year-old man with treatment-resistant schizophrenia was recently started on a typical antipsychotic. He presents 7 days later with fever, motor rigidity, confusion and diaphoresis. The most likely diagnosis is:

28-year-old woman with a 5-year history of bipolar affective disorder, currently in remission, attends the out-patient clinic to discuss suitable medications that she could use during pregnancy. Which of the following medications would be the least safe to prescribe to a woman who is planning a pregnancy?

Which of the following is the least likely side-effect of tricyclic antidepressants?

Which of the following has the most clearly defined therapeutic range?

Which of the following symptoms is related to lithium toxicity?

High plasma levels of clozapine lead to an increased risk of which of the following?

Which of the following is true about tricyclic antidepressants?

Which of the following is not a common adverse event that needs to be considered before choosing an antipsychotic drug?

A patient who was recently started on a new antipsychotic medication has returned to the clinic reporting a tremor. Which of the following receptors is likely to be involved?

How long after neuroleptic malignant syndrome develops can a rechallenge with an antipsychotic be done?

Antipsychotic medications are associated with all the following except:

A 60-year-old woman attends the out-patient clinic reporting feeling dizzy when she gets up in the morning and when standing from a sitting position. She has been treated with sertraline for a depressive illness and was recently started on quetiapine for the symptomatic treatment of anxiety. Which of the following is the most likely cause of her symptoms?

Which of the following is not true regarding neuroleptic malignant syndrome?

A 40-year-old man with a diagnosis of bipolar affective disorder, currently in remission for 8 years on maintenance therapy with lithium carbonate, presents to the emergency department with features of lithium toxicity. Which of the following is most likely to have precipitated such a presentation?

A 40-year-old man with a 15-year history of paranoid schizophrenia attends the clinic and reports the recent re-emergence of auditory hallucinations. He had been stable while treated with clozapine and amisulpride. You learn that he has recently begun smoking after a 5-year period of abstinence. Which of the following would you expect to see?

Which of the following is an indication for use of a long-acting injectable (depot) antipsychotic?

Gastrointestinal upset is a common early side-effect when using SSRIs. Which mechanism of receptor action is most responsible for this effect?

Which of the following effects is mediated by the D2 receptor activity of antipsychotics?

A 25-year-old man with a diagnosis of paranoid schizophrenia has experienced a psychotic relapse. He is hospitalised and started on a new antipsychotic medication. Which of the following adverse events associated with antipsychotics is thought to increase the risk of suicide?

A 25-year-old man with a history of rapid-cycling bipolar affective disorder has recently started taking lamotrigine, in combination with his maintenance mood stabiliser, for the treatment of a depressive episode. He is commenced at a normal titration rate of lamotrigine but presents to the clinic with evidence of lamotrigine toxicity. Which of the following medications would be associated with increased serum lamotrigine levels?