A 34-year-old woman with fibromyalgia, generalized anxiety disorder, and depression is currently taking several psychotropic medications, including alprazolam, duloxetine, hydrocodone/acetaminophen, and pregabalin. She continues to have residual pain, anxiety, and mood symptoms. Her clinician is considering simplifying her medication regimen and plans to discontinue the medication with the least evidence of efficacy for her disorders. Which of the following should be discontinued?

Your 16-year-old son is thrilled when he wins the 100-meter dash in an important high school competition. This “natural high” is most likely associated with inducing dopamine release in his mesolimbic pathway and in his

An excitatory signal is received at the dendrite of a pyramidal glutamate neuron. When the signal is released from the incoming presynaptic dopaminergic axon, it is received as an inhibitory signal. However, this signal is not integrated properly with other incoming signals to that neuron. Which is the most likely site at which the error of integrating this signal with other incoming signals occurred?

Harold, a 74-year-old patient, is brought to your office by his daughter, who reports that her father has been exhibiting several concerning symptoms over the past year. Comprehensive questioning reveals that his symptoms are: trouble remembering familiar things, such as telephone numbers commonly dialed; not recognizing some close family members who visit often; and difficulty performing writing tasks. The patient’s motor function appears to be unaffected. Although not definitive, these symptoms are most likely indicative of which type of dementia?

Peter, a 35-year-old stockbroker, has been advised by his supervisor to come and see you, the company mental health consultant. His supervisor is complaining that he often comes to appointments late, is inappropriately fidgety, interrupts people during meetings, has been offensive towards coworkers, and has been known to party excessively on weeknights. Peter asserts that he is just fine; he has a lot of projects on his mind and is simply standing up for himself when speaking with others. He likes to go out in the evenings to unwind. Recognizing probable attention deficit hyperactivity disorder (ADHD), you interview both the patient and his work buddy, who is a longtime friend. How would you start your questions?

A 24-year-old male initially presents with acute auditory hallucinations and is treated with medication. Four days later he arrives at your office for evaluation. You observe that he is neatly dressed, avoids eye contact, and gives very short answers to your initial questions. Which of the following questions would be most beneficial for determining his degree of negative symptoms?

A 25-year-old woman has recently been diagnosed with bipolar disorder, 6 years after her symptoms began. She has had no mood stabilizing treatment in that time. According to the kindling model and allostatic load hypothesis, what progressive pattern of illness would you expect this patient to have exhibited over the course of the last 6 years?

Denise is a 32-year-old patient with shift work disorder who reports that she is having difficulty in her job as a pastry chef due to excessive sleepiness during her shift. Which of the following is a potential therapeutic mechanism to promote wakefulness?