PRITE REVIEW 8/14/25

Which of the following side effects can result from stimulant medication treatment and warrants immediate discontinuation of the medication and a reassessment of the treatment plan?

• Hallucinations

• insomnia

• irritability

• decreased appetite

Answer explanation

Hallucinations are a serious side effect of stimulant medications that require immediate discontinuation and reassessment of the treatment plan, as they indicate a severe reaction. Other options, while concerning, do not necessitate such urgent action.

According to UpToDate, side effects of stimulants reported include dry mouth, insomnia, irritability, dysphoria, diminished appetite, weight loss, and headaches. Psychosis (including hallucinations) has been reported in individuals who misuse or take excessive amounts of stimulant medication and may be an indication that a stimulant is being misused. Some, but not all studies, report that in individuals with vulnerability to psychosis (mood disorder with psychosis/comorbid schizophrenia/hx of amphetamine induced psychosis), treatment with a psychostimulant med may increase the risk of psychosis. Psychosis is rare in clinical samples of adults with ADHD receiving stimulant treatment.

12 y/o male comes in for worsening attention, impulsivity, and hyperactivity. He is snoring at night and hard to wake in the AM. He has central adiposity, broad based neck, and enlarged tonsils. The physical exam is otherwise unremarkable. In a child with ADHD and sleep problems, What is the most accurate about ADHD and sleep in this patient?

• Correcting the underlying sleep disorder, can improve ADHD symptoms

• Correct ADHD first, then sleep issues

• Send child to pediatrician for further work up

• Sleep has nothing to do with ADHD

Answer explanation

In this case, the child's sleep disorder, indicated by snoring and difficulty waking, can exacerbate ADHD symptoms. Correcting the sleep issues may lead to improvement in attention and behavior, making this the most accurate statement.

According to UptoDate, OSA (Obstructive Sleep Apnea) in children presents with snoring, daytime behavioral problems, excessive daytime sleepiness, and noisy breathing.

The parent of a 43 y/o patient died 5 years ago from pancreatic cancer. Four years ago, the patient began to feel full after eating large fatty meals, fearing it was pancreatic cancer. Pt constantly weighs himself so that he is not losing weight. Now avoids going to doctor to avoid being diagnosed with cancer. No other psychiatric symptoms. What is the likely diagnosis?

• Generalized Anxiety disorder

• Illness anxiety disorder

• Somatic symptom disorder

• Adjustment disorder

Answer explanation

The patient exhibits excessive worry about having pancreatic cancer, despite no diagnosis. This aligns with illness anxiety disorder, characterized by preoccupation with having a serious illness, rather than generalized anxiety or somatic symptoms.

DSM5 TR criteria

-preoccupation with having or acquiring a serious illness

-somatic symptoms are not present, or if present are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (strong family history is present), the preoccupation is clearly excessive or disproportionate

-There is a high level of anxiety about health, and the individual is easily alarmed about personal health status

-The individual performs excessive health-related behaviors or exhibits maladaptive avoidance (avoids doc appointments/hospitals)

-Illness preoccupation has been present for at least six months, but the specific illness that is feared may change over that period of time

-The illness related preoccupation is not better explained by another mental disorder

(care seeking type vs care-avoidant type)

An 18 y/o female patient is restless, feels that her mind "goes blank", poor concentration, irritability, fatigue lasting >1 year. She was previously a good student up until 2-3 years ago. No substance use. Which of the following would be the correct diagnosis?

• Generalized Anxiety Disorder

• Adjustment disorder

• Obsessive Compulsive Disorder

• Panic disorder

Answer explanation

The patient's symptoms of restlessness, poor concentration, irritability, and fatigue lasting over a year align with Generalized Anxiety Disorder, which is characterized by excessive worry and anxiety about various aspects of life.

According to UpToDate, GAD involves individuals with excessive anxiety and worry that occur on more days than not for at least six months, are associated with somatic symptoms such as irritability, muscle tension, and sleep disturbance. This is not due to effects of substance of another medical condition, and cause clinically significant distress or impairment in life.

A 5 y/o child loses his mother to a motor vehicle accident. Several months later, the patient reports that his mother is watching him from the sky every day. What is this an example of?

• Delayed grief

• Prolonged grief

• Normal Grief

• Unipolar depression with psychotic features

Answer explanation

The child's belief that his mother is watching him from the sky reflects normal grief, a common response in children coping with loss.

According to UptoDate, research on childhood bereavement has found that following the death of a parent, children normally make efforts to maintain a connection to their deceased parent as a way to effectively cope with their loss.

A 58 y/o man has one week hx of intense feelings of sorrow and bitterness 6 months after his wife's death. He states "We would have been married 30 years this month." His daughter confirmed his level of functioning decreased one week ago. Symptoms include difficulty sleeping and poor appetite. No suicidal ideations. Physical exam normal. What is the likely diagnosis?

• Delayed grief

• Prolonged grief

• Normal Grief

• Major Depressive Disorder

Answer explanation

The man exhibits symptoms of intense sorrow and decreased functioning 6 months after his wife's death, indicating delayed grief. This is characterized by a significant emotional response occurring well after the loss.

According to UptoDate, The clinician should first pause, make eye contact, listen , and then offer condolences and validate grief symptoms.

The natural course of an untreated manic episode lasts approximately what length of time?

• 1 month

• 3 weeks

• 6 months

• 3 months

Answer explanation

An untreated manic episode typically lasts around 3 months. This duration is consistent with clinical observations, making 3 months the correct answer among the options provided.

A 32 y/o man with a two week hx of diarrhea, is anxious, and is NOT oriented to date/time. She has been taking a medication for a recent diagnosis of bipolar 1 disorder. She doubled her dose one month ago when she felt she was not getting better fast enough. What medication may have caused these symptoms.

• Lithium

• Buspirone

• Sertraline

• Mirtazapine

Answer explanation

According to UpToDate, Acute toxicity often presents with nausea, vomiting, and diarrhea; neurological findings are a late development.

The patient's doubled dose may have led to toxicity, explaining her symptoms.

A man drinks 12-15 cups of coffee a day. He experiences insomnia and headaches relieved by drinking coffee. He is experiencing irritability and poor concentration if he does not drink coffee. How can we taper him off the caffeine?

• There is no way to decrease his usage

• cut caffeine by 10% weekly

• cut caffeine by 25% weekly

• cut caffeine by 50% weekly

Answer explanation

Cutting caffeine by 25% weekly is a balanced approach that helps reduce withdrawal symptoms like irritability and headaches while allowing the body to adjust gradually, making it the most effective method for tapering off caffeine.

(Fun Fact)

According to UpToDate, Caffeine is associated with a reduced risk of Parkinson disease, Alzheimer's disease, alcoholic cirrhosis and gout. Both caffeinated and decaffeinated coffee are also associated with a lower risk of type 2 diabetes.

A patient who is dependent on cannabis had a period of canceling appointments frequently but is now showing up consistently. He acknowledges that the negative costs of marijuana outweigh the anxiolytic effect and is committed to altering his use. Patient is at what stage of change?

• Pre-contemplation

• Contemplation

• Maintenance

• Action/Willpower

Answer explanation

The patient recognizes the negative impacts of cannabis and is considering change, indicating he is in the contemplation stage. He acknowledges the need for change but has not yet fully committed to action.

Pre-contemplation: not acknowledging there is a problem that needs to be changed

Contemplation: acknowledging there is a problem, but not yet ready

Preparation: getting ready to change

Action: doing the change

Maintenance: maintaining the behavior

https://medicine.llu.edu/academics/resources/stages-change-model