Psychiatry Psychiatric Symptoms Associated with Parkinson’s Disease: Review Questions William R. Marchand, MD Dr. Marchand is an assistant professor of psychiatry and acting associate director, Department of Veterans Affairs VISN 19 MIRECC, University of Utah, Salt Lake City, UT. This work was supported by the Veterans Administration VISN 19 MIRECC. Choose the single best answer for each question.
	1. A 45-year-old woman presents to her primary care physician with her husband. She reports a 6-month history of feeling “slowed down,” feeling like she has no energy, a diminished ability to think and concentrate, and excessive sleeping. Her husband reports that her facial expressions have changed; she rarely smiles and her face seems expressionless. The patient’s posture has become stooped and she is slow at completing tasks. She denies feeling depressed but states that she has lost interest in activities she had previously enjoyed and seems unable to enjoy life. What is this patient’s most likely diagnosis? Dementia of the Alzheimer’s type with early onset Major depression Parkinson’s disease Schizoaffective disorder Click here to compare your answer. 2. A 68-year-old woman with Parkinson’s disease has developed drug-induced psychosis from treatment with dopamine agonists. Her neurologist attempts to lower the dose of the dopaminergic agent, but this increases parkinsonian symptoms of bradykinesia, rigidity, and resting tremor. Of the following, which agent would be appropriate to treat this patient’s psychotic symptoms? Haloperidol Quetiapine Trifluoperazine Thiothixene Click here to compare your answer. 3. A 65-year-old man with well-controlled Parkinson’s disease presents to his primary care physician reporting a 3-month history of symptoms of depression, including dysphoria, anhedonia, insomnia, anorexia, and fatigue. The patient is diagnosed with mild major depression and treatment with an antidepressant is recommended. However, the patient inquires about nonpharmacologic options to treat his depression. Which of the following is the most appropriate recommendation? Encourage the patient to take the antidepressant No treatment Refer for cognitive behavioral therapy (CBT) Refer for psychodynamic psychotherapy Click here to compare your answer. 4. A 61-year-old man is referred to a neurologist by his primary care physician for evaluation of possible Parkinson’s disease. The patient denies any significant medical history other than ongoing mental health treatment. He states that he has been taking a “nerve medication” for many years but cannot remember the name of the medication or his psychiatric diagnosis. The patient has had problems with hearing voices in the past. Neurologic examination reveals a resting tremor, cogwheel rigidity, and bradykinesia. Which of the following must be completed as part of this patient’s evaluation? Determine what psychiatric medication the patient is taking Referral to an endocrinologist Referral to a psychiatrist Referral for psychological testing Click here to compare your answer.		5. Which of the following must always be completed as part of the initial evaluation of a patient with Parkinson’s disease? Chest radiograph Evaluation for depression Measurement of prolactin level Urine protein electrophoresis Click here to compare your answer. 6. A 67-year-old man with poorly controlled Parkinson’s disease is referred to a neurologist for management. During the initial evaluation, the neurologist determines that the patient also has comorbid depression. The depression is mild, and the patient denies suicidal ideation. He has no other significant medical history. Complete blood count, thyroid-stimulating hormone (TSH) level, and chemistry panel are normal. The neurologist initiates pramipexole to control the patient’s parkinsonian symptoms. What is the most appropriate initial step in managing this patient’s depression? Initiate buspirone Initiate a selective serotonin reuptake inhibitor (SSRI) No treatment is required Optimize treatment with pramipexole, then reevaluate depressive symptoms Click here to compare your answer. 7. A 62-year-old woman with Parkinson’s disease tells her neurologist that she has been feeling depressed for approximately 6 months. She also reports constipation, cold skin, and weakness. The patient asks her neurologist for an antidepressant. Which of the following should be completed before a treatment decision is made? Magnetic resonance imaging of the brain Psychological testing Referral for a psychiatric evaluation TSH level Click here to compare your answer. 8. A 67-year-old man with a history of Parkinson’s disease treated with selegiline is diagnosed with comorbid major depression by his primary care physician. The physician considers prescribing an SSRI. Of the following, which adverse event may occur as a result of adding an SSRI to this patient’s treatment regimen? Serotonin syndrome Sleepwalking disorder Tardive dyskinesia Trichotillomania Click here to compare your answer. 9. A 65-year-old man presents to the emergency department complaining of a sore throat, fever, and weakness. He states that he has Parkinson’s disease and says that he started hearing voices about 1 year ago and was given medication to treat this problem. He does not remember the name of his current medication, but reports that he has his blood drawn frequently. Which of the following would be most important to rule out? Agranulocytosis Dystonia Lithium toxicity Streptococcal pharyngitis Click here to compare your answer.
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