PRIMARY CARE MANAGEMENT OF
ADOLESCENTS AND ADULTS GUIDE FINAL
2026 EXAMPREP PRACTICE SET SOLUTION
QUESTIONS WITH FULL ANSWERS
◉ Indications Electroconvulsive Therapy (ECT)- Severe or
Treatment resistant depression Answer: MDD that is treatment
resistant (failed >=2 antidepressants)
Depression with psychotic features- (delusions, hallucinations)
Severe Suicidal ideation or self harm risk requiring rapid
intervention
◉ Indications for ECT- Bipolar Disorder Answer: Severe depressive
episodes
Acute manic episodes resistant to medications
Bipolar disorder with catatonia or psychosis
◉ Indications for ECT- Schizophrenia or schizoaffective disorder
Answer: Catatonic Schizophrenia (first line treatment)
Treatment resistant schizophrenia with severe symptoms
,◉ Indications for ECT- Catatonia Answer: Seen in mood disorders,
schizophrenia, or medical conditions
Most effective treatment for catatonia
◉ Indications for ECT- Neuroleptic Malignant Syndrome (NMS)
Answer: If medications (e.g., benzos, dopamine agonists) fail, ECT
can be lifesaving
◉ Indications for ECT- Parkinson's Disease Answer: Used for severe
depression in Parkinson's. Helps motor symptoms in some cases.
◉ When is ECT considered over medications? Answer: Rapid
symptom relief is needed (SI, severe catatonia)
Medications have failed (treatment resistant)
Intolerable side effects from medications (severe weight gain,
metabolic issues)
Patients cannot take medications (pregnant, elderly with organ
failure)
◉ Contraindications for ECT Answer: Recent stroke or increased ICP
Uncontrolled hypertension or cardiac arrythmias
Severe osteoporosis (due to seizure induced muscle contractions)
,◉ Bipolar I Disorder (BP-1)- Diagnostic Criteria Answer: At least one
manic episode (can have depression but not required for diagnosis)
Manic episode(>=1 week) with severe impairment (hospitalization,
psychosis, or major dysfunction)
Depression is common but not required for diagnosis
Mood episodes can include psychotic features (delusions,
hallucinations)
Need >=3 manic symptoms for diagnosis
◉ Manic symptoms Answer: Elevated or irritable mood
Grandiosity
Decreased need for sleep
Pressured speech
Flight of ideas/racing thoughts
Risky behaviors
Increased goal directed activity or agitation
◉ Bipolar II Disorder (BP-II)- Diagnostic Criteria Answer:
Hypomanic episode + Major Depressive Episodes (NO FULL MANIA)
At least one hypomanic episode (>=4 days)
At least one major depressive episode (>=2 weeks)
, NO history of mania
Less severe impairment than BP-I (no hospitalizations or psychosis
in hypomania)
◉ Hypomanic Symptoms (Mild Mania) Answer: Similar to mania but
less severe and does not cause major dysfunction
Increased energy, confidence, sociability, creativity, or productivity
No psychotic symptoms.
BP-II is often misdiagnosed as unipolar depression because
hypomania is not always recognized.
◉ Cyclothymic Disorder (Cyclothymia)- Diagnostic Criteria Answer:
Chronic, fluctuating mood instability (mild highs and lows for >=2
years).
Numerous hypomanic and depressive symptoms >=2 years (1 year
in children/adolescents)
Symptoms never meet full criteria for hypomania, mania, r major
depression
ADOLESCENTS AND ADULTS GUIDE FINAL
2026 EXAMPREP PRACTICE SET SOLUTION
QUESTIONS WITH FULL ANSWERS
◉ Indications Electroconvulsive Therapy (ECT)- Severe or
Treatment resistant depression Answer: MDD that is treatment
resistant (failed >=2 antidepressants)
Depression with psychotic features- (delusions, hallucinations)
Severe Suicidal ideation or self harm risk requiring rapid
intervention
◉ Indications for ECT- Bipolar Disorder Answer: Severe depressive
episodes
Acute manic episodes resistant to medications
Bipolar disorder with catatonia or psychosis
◉ Indications for ECT- Schizophrenia or schizoaffective disorder
Answer: Catatonic Schizophrenia (first line treatment)
Treatment resistant schizophrenia with severe symptoms
,◉ Indications for ECT- Catatonia Answer: Seen in mood disorders,
schizophrenia, or medical conditions
Most effective treatment for catatonia
◉ Indications for ECT- Neuroleptic Malignant Syndrome (NMS)
Answer: If medications (e.g., benzos, dopamine agonists) fail, ECT
can be lifesaving
◉ Indications for ECT- Parkinson's Disease Answer: Used for severe
depression in Parkinson's. Helps motor symptoms in some cases.
◉ When is ECT considered over medications? Answer: Rapid
symptom relief is needed (SI, severe catatonia)
Medications have failed (treatment resistant)
Intolerable side effects from medications (severe weight gain,
metabolic issues)
Patients cannot take medications (pregnant, elderly with organ
failure)
◉ Contraindications for ECT Answer: Recent stroke or increased ICP
Uncontrolled hypertension or cardiac arrythmias
Severe osteoporosis (due to seizure induced muscle contractions)
,◉ Bipolar I Disorder (BP-1)- Diagnostic Criteria Answer: At least one
manic episode (can have depression but not required for diagnosis)
Manic episode(>=1 week) with severe impairment (hospitalization,
psychosis, or major dysfunction)
Depression is common but not required for diagnosis
Mood episodes can include psychotic features (delusions,
hallucinations)
Need >=3 manic symptoms for diagnosis
◉ Manic symptoms Answer: Elevated or irritable mood
Grandiosity
Decreased need for sleep
Pressured speech
Flight of ideas/racing thoughts
Risky behaviors
Increased goal directed activity or agitation
◉ Bipolar II Disorder (BP-II)- Diagnostic Criteria Answer:
Hypomanic episode + Major Depressive Episodes (NO FULL MANIA)
At least one hypomanic episode (>=4 days)
At least one major depressive episode (>=2 weeks)
, NO history of mania
Less severe impairment than BP-I (no hospitalizations or psychosis
in hypomania)
◉ Hypomanic Symptoms (Mild Mania) Answer: Similar to mania but
less severe and does not cause major dysfunction
Increased energy, confidence, sociability, creativity, or productivity
No psychotic symptoms.
BP-II is often misdiagnosed as unipolar depression because
hypomania is not always recognized.
◉ Cyclothymic Disorder (Cyclothymia)- Diagnostic Criteria Answer:
Chronic, fluctuating mood instability (mild highs and lows for >=2
years).
Numerous hypomanic and depressive symptoms >=2 years (1 year
in children/adolescents)
Symptoms never meet full criteria for hypomania, mania, r major
depression
