Common Mental Disorders Practice Questions

Q: 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?

Panic disorder. ***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.

Q: 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?

Dissociative disorder. ***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.

Q: 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?

Anorexia nervosa. ***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.

Question 1

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?

Accepted Answer

Panic disorder

Answer

Generalized anxiety disorder

Answer

Social anxiety disorder

Answer

Hyperthyroidism

Answer

Pheochromocytoma

Question 2

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?

Accepted Answer

Dissociative disorder

Answer

Panic disorder

Answer

Schizophrenia

Answer

Depression

Answer

Anxiety disorder

Question 3

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?

Accepted Answer

Panic disorder

Answer

Hyperthyroidism

Answer

Cardiac arrhythmia

Answer

Pheochromocytoma

Answer

Caffeine excess

Question 4

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?

Accepted Answer

Anorexia nervosa

Answer

Hyperthyroidism

Answer

Depression

Answer

Celiac disease

Answer

Addison's disease

Question 5

A 60-year-old woman with treatment-resistant depression has been referred for electroconvulsive therapy (ECT) after failing adequate trials of four different antidepressants including augmentation strategies. She has severe depression with psychomotor retardation, significant weight loss, and pervasive guilt. Her family is concerned about potential cognitive side effects of ECT. They ask about factors that might be modified to minimise cognitive adverse effects while maintaining treatment efficacy. Which modification would most effectively reduce cognitive side effects while preserving antidepressant efficacy?

Accepted Answer

Using unilateral electrode placement on the non-dominant hemisphere rather than bilateral placement

Answer

Reducing the electrical dose to just above seizure threshold regardless of electrode placement

Answer

Extending the interval between treatments from twice weekly to once weekly throughout the course

Answer

Using ultra-brief pulse width stimulation with bilateral electrode placement

Answer

Limiting the total number of ECT sessions to a maximum of 6 treatments

Common Mental Disorders — MCQs

Common Mental Disorders — MCQs

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