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 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 4: 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 5: 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 5

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

Answer: Venlafaxine (SNRI)

Common Mental Disorders Flashcard 2 of 5

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 5

Question: Opioid withdrawal presents with pupillary _____

Answer: dilation

Common Mental Disorders Flashcard 4 of 5

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 5

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

Answer: Nicotine withdrawal