Common Mental Disorders

Common Mental Disorders UK Medical PG Question 1: A 27-year-old woman presents with amenorrhea, weight loss, and excessive exercise. Her BMI is 16 kg/m². She has bradycardia and hypotension. What is the most serious immediate risk?

• A. Osteoporosis
• B. Cardiac arrhythmias (Correct Answer)
• C. Renal failure
• D. Hypothermia
• E. Electrolyte imbalance

Common Mental Disorders Explanation: ***Cardiac arrhythmias*** - The profound state of starvation, signaled by severe **bradycardia** and **hypotension**, places the patient at high immediate risk for sudden cardiac death due to fatal dysrhythmias (e.g., **Torsades de Pointes**). - Chronic malnutrition causes **myocardial atrophy** and increased susceptibility to electrical instability, often compounded by underlying electrolyte defects. *Osteoporosis* - This is a significant **long-term complication** of anorexia nervosa resulting from chronic **hypoestrogenism** and malnutrition, not the most serious immediate life threat. - While important for long-term morbidity, bone demineralization does not contribute to the acute risk of sudden death seen with cardiac compromise. *Renal failure* - **Acute kidney injury** (AKI) resulting from severe dehydration and prerenal failure can occur, but it is typically not the first or most immediate cause of sudden mortality in acute severe anorexia. - Hypoperfusion due to hypotension, while present, does not pose as immediate a fatal threat as underlying **myocardial compromise**. *Hypothermia* - Severe underweight and compromised thermoregulation lead to **hypothermia**, especially in restrictive anorexia. - Although concerning and requiring intensive care, hypothermia is typically less frequently the direct and immediate cause of sudden mortality compared to cardiac electrical instability. *Electrolyte imbalance* - Although crucial, electrolyte imbalances (especially **hypokalemia** and **hypophosphatemia** during refeeding) are primarily the **causes** or contributing factors. - **Cardiac arrhythmias** are the ultimate *outcome* of these imbalances, representing the most serious and immediate threat to life.

Common Mental Disorders UK Medical PG Question 2: A 40-year-old woman presents with recurrent episodes of palpitations, sweating, and tremor lasting 10-15 minutes. These occur 2-3 times per week with no obvious trigger. Physical examination and ECG during an episode are normal. What is the most likely diagnosis?

• A. Hyperthyroidism
• B. Panic disorder (Correct Answer)
• C. Cardiac arrhythmia
• D. Pheochromocytoma
• E. Caffeine excess

Common Mental Disorders Explanation: ***Panic disorder***- The sudden, recurrent, brief attacks (10–15 minutes) of intense fear with physical symptoms like **palpitations**, **sweating**, and **tremor**, in the absence of an underlying medical condition (normal ECG), are characteristic of a **panic attack**.- The unpredictable nature ("no obvious trigger") and recurrence (2–3 times per week) fulfill the diagnostic criteria for **Panic Disorder**.*Hyperthyroidism*- While hyperthyroidism causes symptoms like **palpitations**, **sweating**, and **tremor**, these are typically persistent and chronic, not episodic and brief (10-15 minutes) as described.- A physical examination would likely reveal additional signs such as **goiter**, **exophthalmos**, or sustained **tachycardia**, which are absent here.*Cardiac arrhythmia*- Arrhythmias, even paroxysmal ones (e.g., PSVT), almost always cause demonstrable **ECG changes** (e.g., tachycardia, rhythm irregularity) during an episode, which are explicitly stated as normal in this patient.- The prominence of diffuse **sweating** and **tremor** alongside palpitations, in the context of a normal ECG, points away from a primary cardiac etiology.*Pheochromocytoma*- Paroxysms due to pheochromocytoma (episodic catecholamine release) typically involve severe, episodic **hypertension** and intense **headaches** along with palpitations, findings not mentioned in this clinically normal presentation.- While attacks can mimic panic, the underlying pathology often results in profound physiological changes (e.g., significant BP surge) that would likely be detected or at least suspected during physical examination.*Caffeine excess*- Symptoms from caffeine excess are often continuous or predictable based on **recent high consumption**, rather than occurring spontaneously 2–3 times per week with "no obvious trigger."- Significant caffeine intoxication would usually present with more sustained **tremor**, **restlessness**, or high resting heart rate, symptoms inconsistent with a completely normal physical exam.

Common Mental Disorders UK Medical PG Question 3: A 60-year-old man presents with progressive memory loss and behavioral changes over 8 months. MRI shows frontotemporal atrophy. What is the most likely diagnosis?

• A. Alzheimer's disease
• B. Vascular dementia
• C. Frontotemporal dementia (Correct Answer)
• D. Lewy body dementia
• E. Normal pressure hydrocephalus

Common Mental Disorders Explanation: ***Frontotemporal dementia*** - The clinical presentation of **progressive memory loss** and prominent **behavioral changes** over 8 months, coupled with specific **frontotemporal atrophy** on MRI, is highly characteristic of frontotemporal dementia. - This condition is characterized by early and prominent changes in personality, behavior, or language, often preceding significant memory deficits, which aligns with the described behavioral changes. *Alzheimer's disease* - While memory loss is a primary feature, Alzheimer's typically presents with **medial temporal lobe atrophy** (e.g., hippocampus) rather than predominantly frontotemporal atrophy on MRI. - Behavioral changes usually emerge later in the course of Alzheimer's, whereas they are often a presenting and prominent symptom in frontotemporal dementia. *Vascular dementia* - This type of dementia often presents with a **step-wise cognitive decline** and is associated with cerebrovascular disease and focal neurological signs. - MRI would typically show evidence of **infarcts** or **ischemic changes**, not specific frontotemporal atrophy in isolation, making it less likely. *Lewy body dementia* - Key features include **fluctuating cognition**, **recurrent visual hallucinations**, and **parkinsonism**. - While memory loss and behavioral changes occur, the absence of these characteristic features and the specific finding of frontotemporal atrophy do not support this diagnosis. *Normal pressure hydrocephalus* - This condition presents with a classic triad of **gait disturbance**, **urinary incontinence**, and **dementia** (often executive dysfunction). - MRI would reveal **ventriculomegaly** with normal or mildly increased CSF pressure, not selective frontotemporal atrophy.

Common Mental Disorders UK Medical PG Question 4: A 53-year-old woman presents with progressive memory loss and personality changes over 8 months. MRI shows frontotemporal atrophy. CSF shows elevated tau but normal amyloid-β42. What is the most likely diagnosis?

• A. Alzheimer's disease
• B. Frontotemporal dementia (Correct Answer)
• C. Lewy body dementia
• D. Vascular dementia
• E. Creutzfeldt-Jakob disease

Common Mental Disorders Explanation: ***Frontotemporal dementia***- The clinical presentation of progressive **personality changes** and prominent **frontotemporal atrophy** on MRI is highly specific for FTD, particularly the behavioral variant (bvFTD).- The CSF profile of **elevated tau** with **normal amyloid-β42** is consistent with FTD, as amyloid-β42 is typically normal, unlike in Alzheimer's disease.*Alzheimer's disease*- AD typically begins with profound **episodic memory loss**, and early atrophy is usually centered in the **medial temporal lobes** (hippocampi), not primarily frontotemporal.- The CSF profile for established AD usually shows **low amyloid-β42** (due to amyloid plaque deposition) and high tau/phospho-tau; this patient's *normal* amyloid-β42 makes typical AD pathology less likely.*Lewy body dementia*- This diagnosis requires at least two of the following core features: **fluctuating cognition**, recurrent detailed **visual hallucinations**, or spontaneous **parkinsonism**, none of which are detailed here.- While atrophy can occur, profound frontotemporal atrophy and primary personality change are less characteristic of LBD compared to FTD.*Vascular dementia*- Vascular dementia is strongly associated with cerebrovascular risk factors and typically demonstrates **stepwise decline** or imaging evidence of multiple **infarcts** or extensive white matter disease.- The smooth progression over 8 months, coupled with atrophy focused specifically on the frontal lobes rather than diffuse vascular damage, argues against this diagnosis.*Creutzfeldt-Jakob disease*- CJD usually presents with very **rapid progression** (weeks to a few months) leading quickly to death, often accompanied by **myoclonus** (involuntary jerking).- Although CJD can present atypically, the 8-month course is too protracted for classic CJD, and the lack of characteristic MRI findings (e.g., DWI hyperintensities) makes it improbable.

Common Mental Disorders UK Medical PG Question 5: A 43-year-old woman presents with episodes of severe anxiety, palpitations, and sweating. These occur unpredictably and last 10-15 minutes. Between episodes she feels well. What is the most likely diagnosis?

• A. Generalized anxiety disorder
• B. Panic disorder (Correct Answer)
• C. Social anxiety disorder
• D. Hyperthyroidism
• E. Pheochromocytoma

Common Mental Disorders Explanation: ***Panic disorder***- The patient is presenting with classic symptoms of a **panic attack**: discrete, unexpected episodes of intense fear accompanied by physical symptoms (palpitations, sweating) that peak rapidly (usually within 10 minutes) and then resolve.- A **Panic disorder** diagnosis requires recurrent unexpected panic attacks, followed by worry about future attacks or significant behavioral changes related to the attacks.*Generalized anxiety disorder*- GAD involves **chronic, pervasive, excessive worry** about numerous events or activities, often lasting for at least six months.- The symptoms are persistent instability rather than the acute, time-limited, discrete episodes described in this clinical vignette.*Social anxiety disorder*- This disorder involves intense fear or anxiety specifically related to **social or performance situations** where the individual may be exposed to scrutiny by others.- The patient's episodes are described as **unpredictable** and not tied to specific social contexts, making this diagnosis unlikely.*Hyperthyroidism*- While **hyperthyroidism** can cause anxiety-like symptoms (nervousness, palpitations, sweating) due to elevated metabolism, these symptoms are typically **persistent** rather than occurring as short, discrete attacks.- Diagnosis is confirmed by laboratory evidence (e.g., low **TSH**).*Pheochromocytoma*- This neuroendocrine tumor causes episodes of anxiety, palpitations, and sweating due to **catecholamine surges**.- Paroxysms are often associated with life-threatening **hypertensive crises** and severe headaches, which are not mentioned, and panic disorder is statistically much more common for this presentation.

Common Mental Disorders UK Medical PG Question 6: A 28-year-old woman presents with episodes of palpitations, sweating, and tremor lasting 15 minutes. These occur 2-3 times weekly. Physical examination is normal between episodes. What is the most likely diagnosis?

• A. Hyperthyroidism
• B. Panic disorder (Correct Answer)
• C. Pheochromocytoma
• D. Cardiac arrhythmia
• E. Hypoglycemia

Common Mental Disorders Explanation: ***Panic disorder*** - The clinical picture describes classic **panic attacks**, which are abrupt, time-limited episodes of intense fear or discomfort peaking within minutes and involving symptoms like **palpitations**, sweating, and tremor.- Panic disorder is the most likely diagnosis when such recurrent, unexpected attacks occur and the physical examination is **unremarkable** between episodes.*Hyperthyroidism* - Symptoms of hyperthyroidism, such as palpitations and tremor, are typically **persistent** and chronic, not brief, self-limiting episodes lasting only 15 minutes.- A physical examination would likely reveal persistent findings like **tachycardia** or *goiter*, which are noted to be normal in this patient between episodes.*Pheochromocytoma* - Although this condition causes episodic symptoms (paroxysms) mimicking anxiety, they are often associated with severe, paroxysmal **hypertension** and are usually less frequent than 2-3 times per week.- Given the high prevalence of anxiety disorders, **panic disorder** is epidemiologically the most likely diagnosis compared to this rare tumor, before requiring biochemical confirmation.*Cardiac arrhythmia* - While some arrhythmias cause palpitations, episodes that spontaneously resolve in precisely 15 minutes and recur frequently without evidence of **structural heart disease** are less typical of primary arrhythmia.- Significant recurrent arrhythmias often present with more alarming red-flag symptoms such as **syncope** or chest pain, which are not mentioned here.*Hypoglycemia* - Symptoms typically occur in association with **fasting** or excessive insulin/medication and are usually characterized by both adrenergic symptoms (sweating) and neuroglycopenic symptoms (e.g., confusion).- The episodic nature, unrelated to food intake or diabetic status (implied), and consistency of the 15-minute duration favor an **autonomic surge** related to anxiety over a metabolic cause.

Common Mental Disorders UK Medical PG Question 7: A 30-year-old woman presents with episodes of feeling detached from herself and her surroundings, as if watching herself from outside her body. These episodes last 10-15 minutes and cause significant distress. What is the most likely diagnosis?

• A. Panic disorder
• B. Dissociative disorder (Correct Answer)
• C. Schizophrenia
• D. Depression
• E. Anxiety disorder

Common Mental Disorders Explanation: ***Dissociative disorder***- The presenting symptoms of feeling detached from oneself (**depersonalization**) and surroundings (**derealization**) are pathognomonic features of **Depersonalization/Derealization Disorder**, a type of dissociative disorder.- These episodic experiences, lasting 10-15 minutes and causing distress, clearly align with the diagnostic criteria for this condition.*Panic disorder*- Characterized by recurrent, unexpected **panic attacks** that include severe physical symptoms like **palpitations**, shortness of breath, and chest pain, peaking within minutes.- Although depersonalization/derealization can occur during a panic attack, the core complaint here is pure detachment, not an overwhelming surge of **physical anxiety** or intense fear.*Schizophrenia*- Schizophrenia is primarily characterized by **psychotic symptoms** such as **hallucinations** (e.g., auditory) and **delusions**, which are absent in this presentation.- The disorder requires a minimum duration of symptoms and active phase criteria (e.g., disorganized speech or behavior) distinct from isolated episodic detachment.*Depression*- Core features of depression involve persistent **depressed mood** and **anhedonia** (loss of pleasure or interest), along with changes in sleep, appetite, and energy.- While sometimes associated with severe mental illness, episodic dissociation is not the defining criterion for Major Depressive Disorder.*Anxiety disorder*- This term is broad, but common diagnoses like Generalized Anxiety Disorder (GAD) involve persistent, excessive, and uncontrollable **worry** about various life events.- The clinical picture involves profound subjective detachment rather than chronic high levels of pervasive **anxiety** or restlessness.

Common Mental Disorders UK Medical PG Question 8: A 34-year-old woman presents with recurrent episodes of palpitations, anxiety, and tremor lasting 10-15 minutes. These occur 2-3 times per week with no obvious trigger. Physical examination and ECG during an episode are normal. What is the most likely diagnosis?

• A. Hyperthyroidism
• B. Panic disorder (Correct Answer)
• C. Cardiac arrhythmia
• D. Pheochromocytoma
• E. Caffeine excess

Common Mental Disorders Explanation: ***Panic disorder***- This is supported by the recurrent, unprovoked episodes of intense **anxiety**, **palpitations**, and **tremor**, consistent with **panic attacks**.- Panic attacks are typically brief, peaking within 10 minutes and resolving within 30 minutes, and are associated with a **normal physical examination** and **ECG** during the episode.*Hyperthyroidism*- Symptoms like palpitations and tremor in **hyperthyroidism** are usually constant and persistent, not brief and episodic (10-15 minutes).- Hyperthyroidism is associated with other signs like **weight loss**, heat intolerance, and requires abnormal **thyroid function tests (TFTs)** for diagnosis.*Cardiac arrhythmia*- Although the patient reports palpitations, a true **cardiac arrhythmia** would typically manifest with identifiable changes on the **ECG performed during the episode**.- The **normal ECG** during the episode makes a significant arrhythmia less likely, and sustained arrhythmias suggest an underlying electrical instability or **structural heart disease**.*Pheochromocytoma*- This condition causes episodic symptoms (paroxysms) but classically includes severe, pounding **headache**, diaphoresis, and marked, though transient, **hypertension**, which are critical differentiating factors not noted here.- Diagnosis relies on demonstrating elevated plasma or urinary **metanephrines**, which would be pursued if more typical features were present.*Caffeine excess*- Symptoms due to **caffeine excess** would have a clear, identifiable trigger (recent high caffeine consumption), which contradicts the finding of "no obvious trigger" in this patient history.- Caffeine-induced anxiety and palpitations would typically resolve reliably upon reducing or eliminating **caffeine** from the diet.

Common Mental Disorders UK Medical PG Question 9: A 27-year-old woman presents with amenorrhea, weight loss, and excessive exercise. She has fine lanugo hair and her BMI is 16 kg/m². She denies having an eating disorder. What is the most likely diagnosis?

• A. Hyperthyroidism
• B. Anorexia nervosa (Correct Answer)
• C. Depression
• D. Celiac disease
• E. Addison's disease

Common Mental Disorders Explanation: ***Anorexia nervosa***- The combination of **severe underweight** (BMI 16 kg/m²), **amenorrhea**, deliberate **excessive exercise**, and the presence of **lanugo hair** (a sign of severe caloric deficit/starvation) is classic for Anorexia Nervosa.- Denial of an eating disorder, despite clear clinical indications, is a common psychological feature of this psychiatric condition.*Hyperthyroidism*- While hyperthyroidism causes weight loss and sometimes amenorrhea, it is characterized by symptoms of **hypermetabolism** like **tachycardia**, tremor, anxiety, and intolerance to heat.- It would not typically involve the specific psychological drive for **excessive exercise** seen in this presentation, nor is **lanugo hair** a typical finding.*Depression*- Depression can cause significant weight loss, but this is usually due to **anorexia** (loss of appetite), not the intense **deliberate restriction** and **driven excessive exercise** seen in this patient.- The presence of severe physical signs of starvation, such as **lanugo hair** at this BMI, points toward a primary eating disorder rather than depression alone.*Celiac disease*- Celiac disease causes weight loss due to malabsorption, typically accompanied by **gastrointestinal symptoms** such as chronic diarrhea, abdominal pain, or **steatorrhea**.- This diagnosis lacks the specific behavioral components of **body image distortion** and pathological restriction/excessive exercise central to Anorexia Nervosa.*Addison's disease*- Addison's disease (primary adrenal insufficiency) can cause unexplained weight loss and amenorrhea, but the hallmark is **hyperpigmentation** (especially in skin folds and mucous membranes) and specific electrolyte abnormalities (**hyponatremia** and **hyperkalemia**).- This patient lacks these adrenal features, and the clinical picture is dominated by the behavioral components of starvation.

Common Mental Disorders Flashcard 1 of 10

Question: What is the pharmacological management of PTSD? _____ or SSRI

Answer: Venlafaxine (SNRI)

Common Mental Disorders Flashcard 2 of 10

Question: What is the first & second-line pharmacological mangement of GAD? _____

Answer: 1st = SSRI 2nd = SNRI 3rd = pregabalin considered

Common Mental Disorders Flashcard 3 of 10

Question: What is the pharmacological management of smoking cessation to reduce cravings? _____ or varenicline, or bupropion

Answer: Nicotine Replacement Therapy (NRT)

Common Mental Disorders Flashcard 4 of 10

Question: Most likely diagnosis in a patient with track marks presenting with N&V, diarrhoea, myalgia, pilorection ("goosebumps"), mydriasis & yawning? Basic observations show tachycardia and hypertension. _____

Answer: Opioid withdrawal

Common Mental Disorders Flashcard 5 of 10

Question: Most likely diagnosis in a patient with irritability, anxiety, restlessness, & weight gain after stopping smoking? _____

Answer: Nicotine withdrawal

Common Mental Disorders Flashcard 6 of 10

Question: Opioid withdrawal presents with pupillary _____

Answer: dilation

Common Mental Disorders Flashcard 7 of 10

Question: Alcohol is a _____

Answer: depressant

Common Mental Disorders Flashcard 8 of 10

Question: Naltrexone is a(n) _____ antagonist

Answer: μ-opioid

Common Mental Disorders Flashcard 9 of 10

Question: NRT for smoking cessation is used best by _____

Answer: combining the patch with a short-acting preparation (nicotine lozenge, gum, inhalator, nasal spray etc)

Common Mental Disorders Flashcard 10 of 10

Question: What is the general management of opioid dependence? _____

Answer: Refer to drug services