EOR Psychiatry, Psych EOR

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Which class of medications do donepezil, rivastigmine and galantamine belong to?

Cholinersterase inhibitors.

Name 6 SSRI drugs.

*Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac)$$$$* Fluvoxamine (Luvox) Paroxetine (Paxil) *Sertraline (Zoloft)*

Name the three MOAIs.

*Phen-sel-tran*-ia (Pennsylvania) Phenelzine Selegiline Tranylcypromine

What is the nature of sedation as a side effect of APs? Which antipsychotics are associated with greatest degree of sedation?

- ALL antipsychotics are associated with some degree of sedation that is generally dose related and many patients become tolerant to sedative effects over time. *Low-potency 1st generation APs* and *clozapine* are the MOST sedating.

What are the two main classes of medication used for the management of alzheimers disease?

1. NMDA receptor antagonist 2. Cholinesterase inhibitors

What are 4 common medications and states that increase lithium levels?

1. NSAIDs 2. Thiazide dieuretics 3. dehydration 4. Impaired renal function.

What three things should be monitored in a patient on lithium therapy?

1. lithium levels 2. LFTs 3. creatinine

What are the 3 steps for treatment of AP induced akathisia?

1. reduce AP to lowest dose possible 2.If sxs continue but there are not other signs of EPS, add a beta blocker (If patients psych symptoms are well treated by their current AP, better to add a BB rather than switch APs) 3. If beta blockers are ineffective or patient cannot take BB, can try lorazepam.

In what 3 patients is Buproprion contraindicate for?

1. those with seizure d/o 2. eating disorder 3. currently on MAOI

What are the 3 core features of Lewy Body disease in tearms of cognition, psychotic features, and psychomotor features?

1. waxing and waning cognition, especially with attention and alertness 2. visual hallucinations (usuallly vivid and well formed) 3.Extrapyramidal signs at least one year after cognitive decline becomes evident.

How long does Haldol take to work on agitation?

20-30 minutes

What is the mechanism of action of cyprohepatadine?

5-HT2 blocker for serotonine syndrome

How many treatments of ECT are generally required?

6-12 over 2-3 week period

A 24-year-old male has an eight-month history of loose thought associations, social withdrawal, auditory hallucinations, and deterioration in his personal appearance and hygiene. Upon examination, he is noted to have a flat affect, perceptual distortions, and behaves like he is detached from his own actions. If chosen for treatment, which of the following medications would require weekly white blood cell count monitoring for the first six months? A Clozapine (Clozaril) B Haloperidol (Haldol) C Olanzapine (Zyprexa) D Risperidone (Risperdal) E Quetiapine (Seroquel)

A Clozapine Clozapine has a risk of agranulocytosis. While the risk is only 1%, weekly monitoring of the white blood cell count for the first six months, followed by monitoring of the white blood cell count every other week thereafter, is required. The other medications listed do not have the risk of agranulocytosis.

Which of the following are predictive or diagnostic of anorexia nervosa? A having a weight that is 85% less than predicted normal weight B homosexual orientation in females C promiscuity D menorrhagia

A Diagnostic criteria for anorexia nervosa include a weight loss to 85% of the required body weight. Homosexual orientation in men, not women, is considered a predisposing factor. Anorexia is associated with amenorrhea and decreased interest in sex.

What is flumazenil?

A very short acting benzodiazepine antagonist used for treating BZD overdose.

How do the first generation/typical antipsychotics compare to eachother as a class?

ALL have similar efficacy but vary in potency. (potency = action at D2 receptors)

What is the role of antipsychotics in Lewy Body Dementia?

APs including Quetiapine and clozapine are used for psychotic sxs but should be used at lowest effective dose and for shortest period of time possible due to risk of side effects

What is the classic liver enzymes ratio associated with excessive alcohol use?

AST:ALT ration of > 2:1 with elevated GGT

Positive sxs of schizophrenia are treated by action of medications in which pathway?

Actions in the mesolimbic pathway

Acute dystonia

Acute dystonias from neuroleptic medications consist of bizarre muscle spasms of the head, neck, and tongue.

What are four signs that prognosis of a shizoid pt is favorable?

Acute onset, good premorbid functioning, older age, and obvious precipitating factor

What type of disorder develops within 3 months of an identified stressor such as finances, going to school, divorce, or illness in their life. The stressor causes impairment in their job and relationships, but the symptoms resolve within 6 months. What is the most likely diagnosis? A depression B bereavement C post-traumatic stress disorder D personality disorder E adjustment disorder

Adjustment Disorder A response to a stressor that disturbs the mood of the patient causes impairment in function. The symptoms occur within 3 months of the stressor and last no longer than 6 months. Anxiety, depression, or combination is associated with adjustment disorders.

What neurocognitive disorder are adults with downsyndrome at increased rick of developing?

Adults with down syndrome at increased risk for developing alzheimers disease in midlife.

Between what ages does schizophrenia most commonly present? Does it generally appear earlier for men or women?

Ages 10 and 60 Men

A 45-year-old male comes to your primary care office complaining of recurrent panic attacks that have led to a disabling fear of being in places from which escape might be difficult, such as a bus or a train. He now finds he can barely leave his home. You diagnose him with panic disorder and which of the following complications? A Agoraphobia B Generalized anxiety disorder C Obsessive-compulsive disorder D Posttraumatic stress disorder E Social phobia

Agoraphobia A Agoraphobia (A) is a complication of panic disorder in which the attacks are associated with being in a crowd or around others. Generalized anxiety disorder (B) is a more overarching term, but does not necessarily include panic attacks. Obsessive-compulsive disorder (C) involves recurrent intrusive thoughts and rituals. Social phobia (E) is more focused on performance in normal social situations and post-traumatic stress (D) requires a traumatic trigger event.

What is the main side effect of clozapine? What kind of drug is it?

Agranulocytosis Atypical (SDA)

A 24-year-old male has an eight-month history of loose thought associations, social withdrawal, auditory hallucinations, and deterioration in his personal appearance and hygiene. Upon examination, he is noted to have a flat affect and perceptual distortions, and he behaves like he is detached from his own actions. He is started on a neuroleptic medication, and a few weeks later he is noted to pace frequently and seems to be unable to sit or stand still. What is the extrapyramidal symptom this patient is exhibiting called? A Acute dystonia B Akathisia C Drug-induced parkinsonism D Tardive dyskinesia E Verbigeration

Akathisia The symptom this patient is exhibiting is akathisia, the most common extrapyramidal symptom of the neuroleptic medications. Acute dystonias from neuroleptic medications consist of bizarre muscle spasms of the head, neck, and tongue. Drug-induced parkinsonism consists of the same symptoms as idiopathic parkinsonism, including signs of reduced facial and arm movements, festinating gait, rigidity, and pill-rolling tremor. Tardive dyskinesia usually appears months or years after starting neuroleptic medication, and consists of involuntary stereotyped movements of the face, mouth, tongue, trunk, and limbs. Verbigeration is a symptom of schizophrenia and other psychotic disorders that consists of repetition of senseless words or phrases, but is not a side effect of neuroleptic medication.

Which are the most likely antipsychotics to cause a dopmine bockade that results in hyperprolactinemia?

All the first generation APs and Risperidone

What class of medication is Remeron (Mirtazapine)?

Alpha-2 adrenergic receptor antagonist.

Which benzodiazepines are considered intermediate acting ie T1/2 6-20 hrs?

Alprazolam, Lorazepam, Oxazepam, and Temazepam

In terms of thought disorders, what is the difference between tangentiality and loosening of associations?

Although both are characterized by speech that is initially goal directed, in tangentiality the speech gradually deviates and an association between thoughts can be appreciated where as with LOA or derailement, the topics shift more rapidly and there is NO logical connection between topics.

What is the most widely used Tricyclic? What is a known side affect of this drug?

Amitripyline (Elavil) Has sedative effect

What class of medication is Venlafaxine aka Effexor? What 3 conditions/disorders is it commonly used for?

An SNRI Used for depression, anxiety (like GAD), and neuropathic pain

Your patient is a 22-year-old male who has experienced significant dysfunction for the past eight months. He exhibits only one symptom of schizophrenia, but that one symptom has been present for a significant part of each day. Which of the following would qualify the patient to be diagnosed with schizophrenia according to the DSM-IV TR? A A firm belief that someone is following him B An auditory hallucination in which two or more voices are conversing C A sensation that bugs are crawling on his skin D Refusal to go out without a hat, certain he will become ill without one E Speaking entirely in rhymes that are related but mostly nonsensical

An auditory hallucination in which two or more voices are conversing Generally, two or more characteristic symptoms of schizophrenia are required in order to make a diagnosis unless the one symptom present is a bizarre delusion or an auditory hallucination (B) that consists of either a running commentary or two voices conversing. Positive symptoms of schizophrenia also include disorganized or catatonic behavior and disorganized speech as well as delusions and hallucinations. Negative symptoms include affective flattening, alogia and avolition. (A) and (D) are both potentially delusions, but neither is particularly bizarre. A sensation of bugs on the skin (C, fomication) is a type of hallucination and speaking in rhyme (E) qualifies as disorganized speech. Each of these might count as one of the two required symptoms but would not be sufficient without a second symptom.

What are the 5 As of negative sxs in schizophrenia?

Anhedonia, affect (flat), alogia (poverty of speech), avolition (apathy), and attention (poor)

What are the three mot common complaints in someone with major depressive disorder?

Anhedonia, withdrawal from activities, and guilt

What % of weight are patients with anorexia unable to maintain?

Anorexic individuals are unable to maintain >85% of expected body weight for their height and frame.

Which antipsychotics are associated with the greatest degree of anticholinergic side effects?

Anticholinergic effect are especially prominent with weaker-binding aka *low pontency first generation APs* as well as with *clozpine*

Which medications can be used for therapy in huntington's?

Atypical antipsychotics and tetrabenazine (a monoamine depleter)

What medication class is somtimes used as an adjunct for PTSD to SSRIs?

Atypical/typical APs

A 19-year-old male is brought by his mother to your primary care office. She is at her wits' end as he has just gotten out of juvenile detention but continues to engage in the behaviors that resulted in his incarceration. He lies, cheats, steals, and seems to disregard the rights and needs of others to the point of endangering their safety. This pattern has been present since early childhood, since at least age four. He does not feel that there is a problem, but his family and others around him are disturbed by his attitudes and behaviors. What is the most likely diagnosis? A Antisocial personality disorder B Borderline personality disorder C Histrionic personality disorder D Narcissistic personality disorder E Schizoid personality disorder

Antisocial Personality disorder All personality disorders involve a persistent pattern of behavior in which there is a disturbance in impulse control, interpersonal behavior, interpretation of people and events, and/or emotional response that begins no later than adolescence. Antisocial PD involves a reckless disregard for others, usually manifesting in lawlessness, lying, cheating, and a lack of remorse. Borderline PD (B) involves interpersonal reactivity and impulsivity often focused on perceived abandonment. Histrionic PD (C) involves a need to be the center of attention, often manifesting in behavior that is theatrical or seductive. Narcissistic PD (D) involves a lack of empathy and grandiosity. Schizoid PD (E) involves symptoms similar to schizophrenia.

Antisocial personality disorder A All personality disorders involve a persistent pattern of behavior in which there is a disturbance in impulse control, interpersonal behavior, interpretation of people and events, and/or emotional response that begins no later than adolescence. Antisocial PD involves a reckless disregard for others, usually manifesting in lawlessness, lying, cheating, and a lack of remorse. Borderline PD (B) involves interpersonal reactivity and impulsivity often focused on perceived abandonment. Histrionic PD (C) involves a need to be the center of attention, often manifesting in behavior that is theatrical or seductive. Narcissistic PD (D) involves a lack of empathy and grandiosity. Schizoid PD (E) involves symptoms similar to schizophrenia.

Why are antipsychotics commonly used in alzheimers disease? what are they associated with?

Aps often used to treat agitation and aggression though they are associated with increase mortality in patient with dementia.

What is the amount of TCA that can be lethal in overdose?

As little as 1-2 grams

What greater degree of side effects are TCAs associated with?

Associated with greater degree of anticholinergic side effects

How long does behavior episode have to last to qualify as a manic episode?

At least on week or any duration if hospitalization is necessary.

What is the generic name for Strattera?

Atomoxetine

What is a benefit of atomoxetine vs stimulants?

Atomoxetive has less abuse potential

What are is the recommended pharm therapy for schizophrenia? Second line? What is a substitute for that second line treatment?

Atypicals (Serotonin and dopamine *agonists*) Clozapine is second line Haloperidol

A 26-year-old female is returning for a follow-up visit for gastroesophageal reflux disease. She has been seen in the office frequently over the past three months for symptoms associated with reflux, but she has also exhibited signs and symptoms that are consistent with a personality disorder. In particular, she is withdrawn, shy, introverted, and avoids close relationships. These signs are most consistent with which personality disorder? A Avoidant B Dependent C Histrionic D Schizoid E Schizotypal

Avoidant Avoidant personality disorder presents clinically as someone who fears rejection, overreacts to rejection and failure, and has poor social endeavors and low self-esteem. Signs of a dependant personality disorder include someone who lacks confidence and self-esteem, has difficulty making decisions, and is passive and overaccepting. Clinical findings of histrionic personality disorder include being dependent, immature, seductive, egocentric, vain, and emotionally labile. Schizotypal disorder is characterized by being superstitious, socially isolated, and suspicious, and having limited interpersonal ability, odd speech, and eccentric behaviors.

What are the 5 axis of the DSM-V?

Axis I- All mental disorders, major syndroms, and substance abuse Axis II- Personality disorders Axis III- Any general medical condition/physical disorder Axis IV- Psychosocial.environmental Axis V- The GAF (global assessment of functioning)...rating system to quantify functional level

B An auditory hallucination in which two or more voices are conversing B Generally, two or more characteristic symptoms of schizophrenia are required in order to make a diagnosis unless the one symptom present is a bizarre delusion or an auditory hallucination (B) that consists of either a running commentary or two voices conversing. Positive symptoms of schizophrenia also include disorganized or catatonic behavior and disorganized speech as well as delusions and hallucinations. Negative symptoms include affective flattening, alogia and avolition. (A) and (D) are both potentially delusions, but neither is particularly bizarre. A sensation of bugs on the skin (C, fomication) is a type of hallucination and speaking in rhyme (E) qualifies as disorganized speech. Each of these might count as one of the two required symptoms but would not be sufficient without a second symptom.

A 24-year-old male has an eight-month history of loose thought associations, social withdrawal, auditory hallucinations, and deterioration in his personal appearance and hygiene. Upon examination, he is noted to have a flat affect and perceptual distortions, and he behaves like he is detached from his own actions. He is started on a neuroleptic medication, and a few weeks later he is noted to pace frequently and seems to be unable to sit or stand still. What is the extrapyramidal symptom this patient is exhibiting called? A Acute dystonia B Akathisia C Drug-induced parkinsonism D Tardive dyskinesia E Verbigeration

B akathisia The symptom this patient is exhibiting is akathisia, the most common extrapyramidal symptom of the neuroleptic medications. Acute dystonias from neuroleptic medications consist of bizarre muscle spasms of the head, neck, and tongue. Drug-induced parkinsonism consists of the same symptoms as idiopathic parkinsonism, including signs of reduced facial and arm movements, festinating gait, rigidity, and pill-rolling tremor. Tardive dyskinesia usually appears months or years after starting neuroleptic medication, and consists of involuntary stereotyped movements of the face, mouth, tongue, trunk, and limbs. Verbigeration is a symptom of schizophrenia and other psychotic disorders that consists of repetition of senseless words or phrases, but is not a side effect of neuroleptic medication.

A 24-year-old man presenting to the clinic 1 week ago was diagnosed with depression and subsequently prescribed 10 mg/day of fluoxetine. He unexpectedly shows up today and states that he is not experiencing any improvement since starting the medication. What is the best treatment option at this time? A double the dose of fluoxetine to 20 mg/day B maintain the current dose of fluoxetine and comfort the patient that the medication may still take at least 1 to 2 more weeks to work C discontinue the fluoxetine and start sertraline D discontinue the fluoxetine and start amitriptyline E maintain the current dose of fluoxetine and add phenelzine to the medication regimen

B maintain the current dose of fluoxetine and comfort the patient that the medication may still take at least 1 to 2 more weeks to work B Alleviation of symptoms associated with depression is typically slow in onset following initiation with SSRIs. Fluoxetine, for instance, can take anywhere between 2 to 6 weeks to achieve substantial benefit when used for depression. After just 1 week of therapy, there is little justification to increase the current dose or switch to another SSRI such as sertraline. Switching the patient to a TCA such as amitriptyline at this point would further delay symptom relief, as TCAs can take several weeks to produce improvement. Compared to SSRIs, TCAs are also more likely to create unwanted side effects such as weight gain, orthostatic hypotension, and constipation. Combining an SSRI with a monoamine oxidase inhibitor (MAOI) such as phenelzine can cause serotonin syndrome that can be lethal. In order to avoid interaction between SSRIs and MAOIs, it is recommended that at least 4 to 5 weeks pass after discontinuing one and starting the other.

A 16-year-old girl presents to the clinic complaining of strong desires to sleep at inappropriate times. She is very concerned because she "felt paralyzed" while falling asleep on the couch last night. Which of the following is the best diagnostic test to confirm this patient's diagnosis? A CT of the head B multiple sleep latency test C Tensilon test D thyroid stimulating hormone E polysomnography

B multiple sleep latency test Narcolepsy is characterized by hypersomnolence, loss of muscle tone prior to sleep, hallucinations upon initiating or arising from sleep, and episodes of sleep paralysis. The diagnostic test that is used in conjunction with clinical history to establish the diagnosis is the multiple sleep latency test. The Tensilon test is utilized to assess for the presence of myasthenia gravis. Polysomnography can be useful in excluding other sleep disorders, but it does not assess sleep latency time necessary to support the diagnosis of narcolepsy.

How does DSM rate the severity of a substance use disorder?

Based on how many criteria are present, NOT fact that individual uses the substance while alone nor the frequency of use.

What is the main use of Buspirone?

Because it is not considered as effective as other options so it is generally used in combination with other agents for tx of GAD such as SSRIs.

Why is lorazepam used in combination with haloperidol for treatment of acute psychosis in a patient?

Because lorazepam or any benzo, with an AP reduces the amout of AP needed and protects against dystonic reactions.

Why are low potency typical APs more lethal compared to high potency APs in overdose?

Because low potentcy have greater antiadrenergic effects and thus overdose can cause more serious side effects including QTc prolongation, heart block and ventricular tachycardia.

Why are TCAs assocaited with cardiac conduction abnormalities?

Because they blcok sodium channels in the myocardium leading to conduction slowing

Why are SNRIs beneficial in some depressive patients with neuropathy?

Because they possess serotonin reuptake AND norepi reuptake inhibition. This can help with some pain conditions

Why does a patient taking MAOIs need to stay away from tyramine rich foods?

Because tyramine is an intermediate in conversion of tyrosine to norepinephrine and increased levels of norepi in combination with MAOIs can result in hypertensive crisis.

Before what age can you NOT diagnose a persone with Antisocial personality d/o?

Before the age 18, most will go under conduct disorder

What is a commonly shared feature of bipolar disorder and ADHD in pediatric patients? A disruptive B obsessed with ideas C behavior problems D impaired concentration E insomnia

Behavior Problems Behavior problems are a commonly shared feature of pediatric ADHD and bipolar disease. Disruptive and impulsive behaviors are a shared feature of conduct disorder. Disruptive behavior and being annoying to others can be found with oppositional defiant disorder; impaired attention and concentration can be found in major depression. Bipolar patients are obsessed with ideas while ADHD and conduct disorder patients are not.

What is a commonly shared feature of bipolar disorder and ADHD in pediatric patients? A disruptive B obsessed with ideas C behavior problems D impaired concentration E insomnia

Behavior problems C Behavior problems are a commonly shared feature of pediatric ADHD and bipolar disease. Disruptive and impulsive behaviors are a shared feature of conduct disorder. Disruptive behavior and being annoying to others can be found with oppositional defiant disorder; impaired attention and concentration can be found in major depression. Bipolar patients are obsessed with ideas while ADHD and conduct disorder patients are not.

What is the first line treatment for EPS due to APs?

Benztropine! anticholingeric

A 58-year-old male comes to your primary care office complaining of sadness, insomnia, loss of appetite, weight loss, and feelings of guilt or hopelessness for the past month. On further questioning you find that his wife of 30 years died of breast cancer shortly before the onset of symptoms. Which of the following is the most likely diagnosis? A Bereavement B Dysthymia C Depressive episode D Depressed mood E Major depression

Bereavement A Bereavement (A) is the normal grief response experienced after a significant loss and includes all the symptoms of depression and, by definition, lasts no longer than two months, although many will suffer from some symptoms for longer. Dysthymia (B) is a longstanding depressed mood for at least two years but not meeting the full criteria for a depressive episode (C). Major depression (E) requires at least one depressive episode, which requires at least five of the symptoms, one of which is depressed mood (D).

What type of dementia are acetylcholinesterase inhibitors such as donepezil and galantamine best for?

Best for mild to moderate dementia.

Which major psychiatric disorder has the highest genetic link?

Bipolar I disorder

What is the primary difference in the definition of Bipolar I vs Bipolar II?

Bipolar I includes only manic episodes, whereas bipolar II includes manic AND hypomanic episodes

What is the cause of EPS associated with use of typical/first generation APs?

Blcokade of doapmine pathways in the nigrostriatum.

A 25-year-old man states that he feels sad all of the time, he feels lonely, and all of his relationships seem to fail. His last relationship ended just a few weeks ago and only lasted about 9 weeks. He says his relationships always start out great. He and his love interest will spend endless hours together discussing every detail of their lives. A few weeks into the relationship, things always change. His girlfriends always pull away from him, and they stop respecting his needs. He often tells his girlfriends that if they leave him, he will kill himself. These threats are frequently followed by intense displays of anger. He has been hospitalized 1 time for overdosing on medication and 2 times for superficial cuts to his arm. When asked about his parents, the man states that he rarely speaks with them. They do not seem to understand him or care about him as much as they do his siblings. Although the man went to college for a while, he never seemed able to settle on a major. He has a poor work history, and he frequently changes careers. He states that sometimes the jobs seem like more than he can handle, and he just wants something that does not require so much concentration. He further explains that he does not feel like getting up in the morning, and he has difficulty forcing himself to go to work. He frequently has difficulty sleeping and often spends hours tossing and turning in bed. He says he gets up in the morning feeling just as tired as he was when he went to bed. In accordance with the DSM-IV, what is the Axis II diagnosis for this patient? Answer Choices 1 Dysthymic disorder 2 Histrionic personality disorder 3 Dependent personality disorder 4 Major depressive disorder 5 Borderline personality disorder

Borderline personality disorder Axis II diagnoses consist of personality disorders and mental retardation. The symptoms in this case study suggest that the client may have dysthymic disorder, which is an Axis I diagnosis. Major depressive disorder is also an Axis I diagnosis. The most appropriate Axis II diagnosis for this client is borderline personality disorder. This client is experiencing unstable personal relationships, an unstable sense of self, unpredictable and unstable moods, and difficulty controlling his anger. He also expresses a sense of devaluation in his personal relationships. The case study shows that the client has made suicidal threats and attempts in order to manipulate others or make them feel guilty. All of these symptoms are characteristic of borderline personality disorder. Borderline personality disorder can be differentiated from dependent personality by the fact that those with borderline personality react to abandonment with an outward expression of anger; those with dependent personality disorder, however, react to abandonment with increased submissiveness. Borderline personality disorder can also be differentiated from histrionic personality disorder by the fact that those with borderline personality disorder are often self-destructive and display angry disruptions in close relationships; in contrast, those with histrionic personality disorder do not.

How do first generation APs compare to second generation APs in terms of efficacy?

Both are equally effective for positive symptoms and neither very effective for negative symptoms

What is the brand name of Modafinil? What disorder is it used for?

Brand name: Provigil. FDA approved for narcolepsy and shows to reduce number of sleep attacks and lessen cataplexy.

What do we call it when a patient has a psychotic episode lasting longer than a day but shorter than a month, with no previous hx of such orders?

Brief psychotic disorder

What is the drug of choice per the FDA for depressive d/o with seasonal pattern?

Bupropion

Your patient is a 26-year-old male in whom you've diagnosed major depression. You wish to start him on pharmacologic therapy, but he expresses significant concern regarding sexual side effects. Which of the following depression medications is an option that will reduce the risk of sexual dysfunction? A Bupropion B Citalopram C Fluoxetine D Paroxetine E Venlafaxine

Bupropion A The correct answer is bupropion (A). All the SSRIs, including citalopram (B), fluoxetine (C), and paroxetine (D), as well as venlafaxine (E), which is a combination serotonin and norepinephrine reuptake inhibitor (SNRI), have high rates of sexual side effects for men and women. Bupropion is a norepinephrine and dopamine reuptake inhibitor and can be helpful in averting or reducing both sexual side effects and weight gain. It is also indicated for smoking cessation.

Which nonnicotine related agent has been approved by the FDA as a first-line medication in the treatment of smoking cessation? A nortriptyline B clonidine C bupropion D fluoxetine

Bupropion Bupropion SR has been approved by the U.S. Food and Drug Administration (FDA) for smoking cessation. The drug has been successful in doubling cessation rates. Side effects include dry mouth, agitation, insomnia, and headache.

Which nonnicotine related agent has been approved by the FDA as a first-line medication in the treatment of smoking cessation? A nortriptyline B clonidine C bupropion D fluoxetine

Bupropion C Bupropion SR has been approved by the U.S. Food and Drug Administration (FDA) for smoking cessation. The drug has been successful in doubling cessation rates. Side effects include dry mouth, agitation, insomnia, and headache.

Bupropion The correct answer is bupropion (A). All the SSRIs, including citalopram (B), fluoxetine (C), and paroxetine (D), as well as venlafaxine (E), which is a combination serotonin and norepinephrine reuptake inhibitor (SNRI), have high rates of sexual side effects for men and women. Bupropion is a norepinephrine and dopamine reuptake inhibitor and can be helpful in averting or reducing both sexual side effects and weight gain. It is also indicated for smoking cessation.

What class of medication is buproprion?

Bupropion aka Wellbutrin is a D2-norepinephrine reuptake inhibitor

What is the recommended treatment for major depression with atypical features?

Buproprion or SSRI

What is the only SSRI approved for treatment of OCD?

Fluvoxamine (Luvox)

Which disorder is characterized by episodes of hypomania and depression for greater than 2 years? A dysthymia B major depressive disorder C cyclothymia D bipolar E mood disorder

C Cyclothymia Cyclothymia is characterized by symptoms of depression and hypomania for at least 2 years. Symptoms are milder than a regular depressive or manic episode. Occasionally, patients will have regular depressive or manic symptoms at which time they need to be reclassified as bipolar.

What type of pharmacological agent would be used as a first-line medication to treat obsessive compulsive disorder? A risperidone B lonazepam C fluvoxamine D trazadone E venlafaxine

C Fluvoxamine, paroxetine, and sertraline are all approved for the treatment of obsessive compulsive disorder. Use of an SSRI in combination with behavioral therapy is recommended.

Your patient is a 42-year-old female diagnosed with depression. She has taken two different serotonin reuptake inhibitors (SSRIs) at the usual dosage, each for 3 weeks, and reports again that there have been no ill effects but that she doesn't feel that this medication has helped either. What is the most likely problem with her therapy? A She has a genetic resistance to the medication B The dosage was too low C The medication was discontinued too soon D The wrong diagnosis was made E The wrong medication was given

C The medication was discontinued too soon C Treatments for depression generally require from 2 to 6 weeks of therapy in before effects can be evaluated (C). Too low a dose (B) is another common problem, but an increase in dose should not be considered until the medication has had time to take effect. The effect of these agents can be highly variable from one individual to another, but no specific genetic resistance (A) is known. There is always a possibility of making the wrong diagnosis (D), but there is no indication of this from the information given, and SSRIs are the first line therapy for depression (E), best combined with counseling.

What is the risk of a patient having prolonged prolactinemia secondary to their antipsychotic medication?

Chronic hyperprolactinemia associated with osteoporosis and increases risk of hip fracture.

What are the two common first generation low potency typical antipsychotics?

Chlorpromazine (thorazine) and Thoridazine (Mellaril)

Which two antipsychotic medications are associated with retinal deposits/pigmentation

Chlorpromazine and thioridazine

What is the first line treatment for chronic insomnia?

CBT

What is the nonpharmacologic therapy for OCD?

CBT

Which type of psychotherapy is most appropriate for anxiety disorders?

CBT

What is first line treatment for OCD?

CBT and SSRIs (higher doses than used for depression)

What medications can be used for treatment augmentation if SSRI only moderately effective for OCD?

Can augment with a second generation AP

What is unique about dosing SSRIs in premenstrual dysphoric disorder?

Can be dosed either as daily therapy or during the luteal phase only treatment ie starting on cycle day 14 and stopping upon menses or shortly thereafter.

How can the sexual dysfunction side effects associated with antidepressant be treated?

Can be treamtn by reducing the dose, changing to non SSRI, or augmenting regimen with Bupropion.

What is a major advantage of Acamprosate?

Can be used in patients with liver disease.

What is a serious adverse effect of flumazenil?

Can precipitate seizures.

Which mood stabilizer should patients with HLA-1502 polymorphism avoid?

Carbamezapine due to risk of SJS/TENs

Which mood stabilizer is a associated with autoinduction of its own metabolism?

Carbamezapine is one of few mood stabilizers that is associated with autoinduction ie increased metablism of itself which thus required increased dosing

What are 3 major contraindications to taking disulfuram?

Cardiac disease, pregnancy, and psychosis

What are the 3 Cs in terms of serious adverse side effects of TCAs?

Cardiotoxicity, convulsions, and coma.

What is the difference between cataplexy and catalepsy?

Cataplexy: sudden loss of muscle tone usually with raised emotional state Catalepsy: rigid fixed posture and muscle tone

What is the rarest form of schizophrenia? Define it.

Catatonic Schizophrenia Motor imobility, excessive motor mobility, extreme negatism or mutism, peculiar movements, *echolalia or echopraxia*

What is the DSM 5 term for stuttering disorder?

Childhood onset fluency disorder

Which children with ADHD should avoid taking stimulants?

Children with tics or family history of tics because stimulants are associated with a nincrease risk of developing ticks.

A patient presents to the clinic with a family member. Upon obtaining history from the patient, he responds with excessive details of his symptoms and the reason for his visit. He is unable to answer a question directly without signification elaboration. What problem does this patient have? A circumstantiality B derailment C incoherence D tangentiality

Circumstantiality

Circumstantiality is seen in someone who eventually gets to the point after a delay in the thought process.

What are the two cheapest SSRIs?

Citalopram (Celexa) Escitalopram (Lexapro)

You are asked to see a patient who was admitted to the hospital. Upon attempts to obtain a history, you notice the patient states words that sound similar, but do not have the same meaning. He also does some rhyming of his words. What type of thought process would this be? A flight of ideas B circumstantiality C looseness of association D word salad E clanging

Clanging E Clanging is a disturbance in thought in which the person selects words that are similar by sound, but do not mean the same. Sometimes the person will rhyme the words. Flight of ideas is rapid transitioning between subjects, but tends to be connected. Looseness of association is when a person changes subjects, but there is no connection between the subjects. Circumstantiality is where the person has a point and eventually gets to that point, but with delay in the thought process. Word salad is a mixture of words that have no sense.

Which tricyclic antidepressant is commonly used for OCD?

Clomipramine

Which benzodiazepine should not be used by a patient with renal dysfunction?

Clonazepam

Which commonly used benzodiazepines have a slow rate of absorption?

Clonazepam and the LOTs (only temazepam is in a HARD capsule)

What is a benefit of clonidine for treatment of ADHD vs stimulants?

Clonidine can be effective for the insomnia associated with stimulant medications.

Clozapine Clozapine has a risk of agranulocytosis. While the risk is only 1%, weekly monitoring of the white blood cell count for the first six months, followed by monitoring of the white blood cell count every other week thereafter, is required. The other medications listed do not have the risk of agranulocytosis.

Which APs are most highly associated with problems related to metabolic syndrome?

Clozapine and olanzapine (zyprexa)

Which antipsychotic is most strongly assocaited with sialorrhea? What is the treatment?

Clozapine, anticholinergic agent such as atropine drops

A patient who is intoxicated presents to the emergency department. On ocular exam, you notice mydriasis. Which substance could he have been using? A sedatives B PCP C opioids D cocaine

Cocaine Patients intoxicated with cocaine present with mydriasis. In opioid intoxication, the pupils are constricted. PCP intoxication is associated with nystagmus

A 17-year-old male is brought to your Emergency Department by his girlfriend. She states that he has been behaving strangely for the last three days, with rapidly fluctuating moods ranging from euphoric to irritable and paranoid. The patient states that he is fine, just a little nervous about an upcoming test in school. His pulse is 126 beats per minute, BP 182/106, pupils are widely dilated, and he is diaphoretic. What is his most likely diagnosis? A Acute anxiety B Bipolar disorder C Cocaine intoxication D Heroin intoxication E Thyrotoxicosis

Cocaine Intoxication This patient's presentation with tachycardia, hypertension, diaphoresis, and mydriasis along with the behavioral changes is consistent with cocaine intoxication (C). His physical symptoms could be explained by thyrotoxicosis (E), but he has no history of hyperthyroid symptoms such as weight loss and it would not explain the mydriasis. Acute anxiety (A) or bipolar disorder (B) might explain some of the mood changes but would not account for all of his physical signs. Heroin withdrawal (D) would cause some similar symptoms, but intoxication would cause somnolence and pinpoint pupils.

What is the order of decline in terms of Huntington's?

Cognitive decline and behavioral changes can precede onset of motor sxs by up to 15 years.

What class of medication is Donepezil?

Cognitive enhacer, acetylcholinesterase inhibitor.

What class of medication is memantine and what is its MOA?

Cognitive enhacner, NMDA recptor antagonist for MOD-SEVERE dementia (use with cholinesterase inhibitors)

Which of the symptoms that develo with Normal Pressure Hydrocephalus is least likely to improve even after treatment?

Cognitve impairment

DSM endorses a criteria based approach that requires three conditions be met...what are those conditions?

Condition not caused directly by any drug Psychiatric disorder no directly caused by medical condition There is significant impairment of social functioning, occupational functioning, or both

What is the treatment of anxiety in the elderly?

Consider treating with SSRI since anxiety may be due to unrecognized depression. Dont given benzos - no proved efficacy in elderly.

What is included in the Mini-Cog? What results are indicative of cognitive impairment?

Consists of 3 item recall and clock-drawing task. Cognitive impairement indicated by... 1. Inability to recall any of the words after 3 minutes OR 2. only one to two items recalled with an abnormal clock drawing. thus there is NO diagnostic cognitive impairment if a patient does remeber only one word and has a normal clock drawing.

A Folstein score below what is suggestive fo cognitive impairment vs indicative of definitve cognitive impairment?

Folstein MMSE score < 25 is suggestive of cognitive impairment where as < 20 is indicative of definitive impairment

Verbigeration

Verbigeration is a symptom of schizophrenia and other psychotic disorders that consists of repetition of senseless words or phrases, but is not a side effect of neuroleptic medication.

What is the correlation between level of sedation and degree of seizure threshold with antipsychotics?

Found that generally, the more sedating the antipsychotic, the more it lowers the seizure threshold. Seizures most common with low-potency first generation APs and clozapine.

What is the most common INHERITED cause of intellectual disability?

Fragile X Syndrome

What is the treatment for PCP?

Geneally supportive therapy ie benzos for agitation, anxiety, or muscle spasms in addition to APs if psychotic symptoms present.

What is a adverse side effect unique to venlafaxine when given at high doses?

Increased blood pressure

Which disorder is characterized by episodes of hypomania and depression for greater than 2 years? A dysthymia B major depressive disorder C cyclothymia D bipolar E mood disorder

Cyclothymia Cyclothymia is characterized by symptoms of depression and hypomania for at least 2 years. Symptoms are milder than a regular depressive or manic episode. Occasionally, patients will have regular depressive or manic symptoms at which time they need to be reclassified as bipolar.

Define cyclothymic disorder.

Cyclothymic disorder is recurrent episodes of subsyndromal depression and mania. Must occur for greater than 2 years. Occasionally, these cases proliferate into full blown mania and depression- warranting bipolar diagnosis

What is the treatment for severe serotonin syndrome?

Cyproheptadine

Your patient is a 4-year-old boy whose father brings him to your primary care office concerned about behavioral problems. He cannot seem to sit still in school. He seems to have a great deal of difficulty focusing for any length of time. Which of the following is required in order to make the diagnosis of attention deficit/hyperactivity disorder (ADHD) according to the DSM-IV-TR? A He exhibit more symptoms of inattention than hyperactivity B He must be at least 10-years-old C He behaves aggressively towards others on at least some occasions D Some impairment from the symptoms is present in two or more settings E Symptoms of inattention be present on a daily basis for 3 months

D Some impairment from the symptoms is present in two or more settings D The diagnosis of ADHD requires symptoms of both hyperactivity/impulsivity and of inattention (D). It does not require more or more prominent symptoms (A) of one or the other. Aggression (C) is seldom involved, although the impulsivity may manifest as lack of concern for others. The symptoms must be present before the age of seven (B) and must have been present for at least 6 months (E).

A 37-year-old woman under your care is diagnosed with bipolar I disorder. As part of her drug regimen, you prescribe lithium carbonate as long-term maintenance therapy. Which of the following would be most appropriate to perform or order prior to the initiation of lithium carbonate? A electrocardiogram B fasting plasma glucose C liver function tests D serum creatinine E urine culture

D serum creatinine Patients on chronic lithium carbonate therapy have an approximate 10% to 20% risk of developing renal problems such as glomerulosclerosis, tubular atrophy, or interstitial nephritis. Each of these conditions can lead to filtration problems and a subsequent rise in serum creatinine. Hence, it is advised to obtain a baseline serum creatinine prior to administering lithium carbonate to follow any changes that may occur in renal function during therapy. It is also advised that lithium carbonate be avoided in patients with pre-existing renal disease.

What is the treatment for neuroleptic malignant syndrome?

Dantrolene or bromocriptine

What diagnosis should be given to a patient who has nonbizarre delusions for at least a month and no other symptoms? A schizoaffective disorder B delusional disorder C brief psychotic disorder D schizophreniform disorder

Delusional Disorder A delusional disorder presents with nonbizarre delusions for at least a month. The disorder does not present with any other symptoms related to schizophrenia or a mood disorder. A brief psychotic disorder has symptoms that last for 1 day to 1 month. Schizophreniform has symptoms that last at least a month, but no longer than 6 months. In schizoaffective disorders, depression or mania develop along with schizophrenic symptoms

At least two of the following (list, please) must be present, as well as an impairment to social functioning, for how long for schizophrenia diagnosis? DDDHN

Delusions Disorganized Speech Disorganized speech Hallucinations Negative symptoms 1 month or longer

Majorly depressed patients over the age of 50 are more likely to possess what psychotic symptoms (as compared to their younger counterparts)?

Delusions and paranoia

What is the diagnostic criteria for Persistent Depressive D/O aka dysthymia?

Depressed mood for the majority of the time, most days, for at least 2 YEARS

A 73-year-old man is brought into your office by his adult children with a concern of memory loss. They report their father's memory has been declining since the death of their mother a few months ago but are now concerned because he is losing weight, sleeping during the daytime, and is not keeping up with current events like he usually does. This type of behavior is most associated with which of the following? A Pick disease B Creutzfeldt-Jakob disease C depression D Alzheimer disease E vitamin B12 deficiency

Depression This patient's symptoms are most consistent with situational depression over the loss of his spouse. Transient memory problems can be a component of depression as a result of decreased attention and interest. Dementia is a progressive impairment of higher cognitive function, and initially, the patient's social graces are preserved. It has many causes, of which Pick disease, Creutzfeldt-Jakob disease, and Alzheimer disease are irreversible. Vitamin B 12 deficiency can cause reversible form of cognitive impairment, in which the elderly are susceptible, so serum analysis of vitamin B 12 should be performed in diagnostic evaluations of dementia in this population.

Derailment

Derailment is when a patient skips to another subject. This mainly occurs if a topic is brought up that the patient does not wish to discuss.

How is desvenlafaxine (Pristiq) related to venlafaxine (Effexor)? What benefit is seen as compared to venlafaxine?

Dezvenlafaxine is an active metabolite of venlafaxine. It is more expensive and has no known benefit over venlafaxine

What is required for a diganosis of Parkinsons?

Diagnosis required presence of bradykinesia and either a tremor or rigidity

What are the two common long acting benzodiazepines?

Diazepam and clonazepam

What somatic delusion is common in majorly depressed patient over the age of 50?

Diffuse body rotting from cancer

Pt presents with unusual speech and flat affect...what type of schizophrenia?

Disorganized schizophrenia

What effect does Buspirone have when taken with alcohol or other CNS depressants?

Does NOT pontentiate CNS depression and has low potential for abuse or addiction

What is the first line treatment for restless leg syndrome once iron stores have been optimized?

Dopamine agonist and benzodiazepines

Why is lithium considered the gold standard treatment therapy for bipolar disorder?

Due to reduction of suicide risk

What is the most widely used SNRI?

Duloxetine (Cymbalta)

What anxiety disorder is Duloxetine show to be effective for vs. which is it not?

Duloxetine indicated for use in GAD but not well studied for panic disorder

What is a way that you can distinguish amphetamine intoxication from cocaine intoxication?

Duration of the high. The effects of a single dose f amphetamine last about 4-6 hrs vs effects from a dose of cocaine rarely last > 2hrs

A 33-year-old woman presents with a 3-year history of a persistent, unfluctuating depressed mood. She also notes persistent insomnia, poor concentration, and very little appetite. She denies previous similar symptoms, substance abuse, current prescriptive drug use, and has had no change in her overall life circumstances. She remains functional at work and in most relationships. On the basis of the information presented, what is the most likely diagnosis? A dysthymic disorder B premenstrual dysphoric disorder C major depressive disorder D cyclothymic disorder

Dysthymic Disorder The main historical component that points to this diagnosis is the long-term (equal to or greater than 2 years), unfluctuating symptoms without mention of manic or hypomanic symptoms that would be typical of cyclothymic disorders. No variances with menstrual cycles are mentioned. Major depressive disorder is generally associated with more intense symptoms, including suicidal ideation, and only requires a 2-week duration of symptoms to diagnose

A 24-year-old woman comes to your office complaining of episodic chest pains that have been occurring over the past several months. She experiences shortness of breath with each occurrence and feels like "I'm going to die." She denies cough, fever, or sputum production and has noticed the episodes occur when she is in a crowd. Her current examination is normal and she feels well between episodes. You suspect panic disorder, but want to rule out the most likely organic causes. Which of the following tests will you include in your initial work-up? A Arterial blood gases B CBC C Chest x-ray D Sputum culture E Urine toxicology screen

E The differential diagnosis of panic disorder includes many cardiac, pulmonary, and endocrine conditions, but in a young woman without any symptoms or signs between episodes, drug use, as detected on a urine toxicology screen (E), is the most likely cause. An EKG might also be considered to rule out a cardiac cause. CBC (B) and sputum culture (D) might be helpful if infection is a consideration, but she has no fever or other signs of infection. Chest x-ray (C) and blood gases (A) would not be helpful without symptoms or signs suggesting particular etiologies.

What treatment type is typically regarded as the single most effective treatment for psychotic depression?

ECT

What is a NON-pharmacotherapy that can be used as treatment for depression in the elderly?

ECT - safe and effective

What cardiac abnormality is lithium associated with causing?

Ebstein anomaly.

What are the subtypes of delusion disorder?

Eromatic- someone is in love Somatic- pain that has no basis Jealous- partner infidelity Persecutory- Someone is chasing Grandiose- inflated self-woth

List a few behaviors that someone may be portraying in a manic episode.

Excessive spending, resignation from job, sexually acting out, and grandiosity

What is Tancreanial magnetic stimulation FDA approved for treatment of? What is the most common side effect?

FDA approved for depression. Most common side effect is headache at application sight

Seasonal depressive disorder typically occur when?

Fall and winter months

What class of medication is Hydroxyzine? What is it used for?

First generation antihistamine. Anxiolytic seful for patients who want quick acting, short term meds but cannot take BDZs.

What is the first line medication for Tourette's syndrome? Second line?

First line = clonidine (or guanfacine also an alpha 2 agonist) Secondy line: antipsychotics though only for severe cases.

What is the first line vs. second line treatment for ADHD?

First line = stimulants Second line = atomoxetine (Norepinephrine reutake inhibitor)

What are the seven symptoms regarded as *negative* in psychotic episodes?

Flat affect, apathy, poor grooming, social withdrawal, anhedonia, poor eye contact, poverty speech

If a patient comes in with a suspected overdose of an unknown drug, which treatment should NOT be initiated immediately?

Flumazenil! Should not be used in a paitne twith unknown cause of assumed drug overdose without further history because can lower seizure threshold

What is the treatment for separation anxiety disorder?

Generally initially just CBT and family therapy though +/- SSRIs

What is the role of psychopharmacotherapy in autism spectrum disorder?

Generally used for symptomat management and only after behaviorl and environmental interventions are in placed and have been optimized.

What type of medication is ziprasidone? What is its brand name?

Geodon - 2nd gen AP

When in the treatment of OCD do guidelines recommend augmenting treatment with a second generation AP?

Guidelines recommend augmenting treatment with a 2nd gen AP if patient has a moderate response to SSRI. However, if patient did not respond to SSRI, should consider trial of a different SSRI or switching to clomipramine

A 25-year-old male has a history of schizophrenia, and was brought to the emergency department by ambulance after he was found wandering along the highway. Which of the following is considered a positive symptom of schizophrenia? A Catatonia B Diminished sociability C Hallucinations D Poverty of speech E Restricted affect

Hallucinations Hallucinations, delusions, and formal thought disorders are classified as positive symptoms of schizophrenia. Negative symptoms of schizophrenia include restricted affect, diminished sociability, and poverty of speech. Catatonia describes a state in which a person is withdrawn and shows minimal bodily movement, or one in which there is severe excitement and the person shows purposeless and stereotyped movements.

What three symptoms are regarded as *positive* in psychotic episodes?

Hallucinations, bizarre behavior, delusions

What is an advantage and a disadvanatage of the SSRI citalopram?

Has fewest drug drug interactions of the SSRIs but associated with dose dependent QTc prolongation. (same as escitalopram)

What is the rate of absorption and elimination of diazepam?

Has rapid absorption and redistribution but slow elimination

Which 1st generation APs are considered high potency? Which are considered low potency?

High potency = haloperidol and fluphenazine low potency = chlorpromazine, thioridazine

What SSRI side effect is most important to remember for Cardiolgists? For men?

Hyponatremia ED

How should you manage a patient with cocaine intoxication?

If only mild to moderately agitation can use reassurance and benzos though if severly agitates and/or psychotic consider an antipsyhotic such as haloperidol.

What potentially lethal side effect can occur with MAOIs taken it combination with sympathomimetics?

If taken with sympathomimetics such as cocaine or pseudoephedrine can result in hypertensive crisis. *also with tyramine risk foods

What is the relationship between the T1/2 of zolpidem, zaleplon, and eszopiclone?

In order from longest to shortest T1/2 if goes eszoplicone then zolpidem and then zalepolon

What differentiates schizoaffective disorder from mood disorder with psychotic fxs?

In schizoaffective, delusions or hallucinations are present for 2 weeks in ABSENCE of mood d/o symptoms

how does social anxiety disorder differ from avoidant personality disorder?

In social anxiety disorder the patient is fearful of embarrassment in a particular setting where as in avoidan PD the person has an overall fear of rejection and sense of inadequacy

What time do we recommend antidepressants be taken and why?

In the morning because they tend to be "activating" (stimulating) and could hinder sleep.

Inability to speak 200 words by what age would possibly qualify as a speech delay?

Inability to speak 200 words by age 3

Which are the secondary amines of the TCAs? How do they compare to the medications that are tertiary amines?

Includes nortriptyline and Desipramine. They are the metabolite of teriaty amines and for that reason have less anticholinergic/antihistamine side effects.

Which of the following is the primary mechanism by which benzodiazepines exert their sedative and anxiolytic effects? A acting as dopamine receptor agonists B acting as NMDA receptor antagonists C acting as serotonin receptor antagonists D decreasing reuptake of serotonin and norepinephrine E increasing GABAA receptor-mediated chloride conductance

Increasing GABAA receptor-mediated chloride conductance Benzodiazepines bind to GABA A receptors, which consist of many peripheral subunits that form chloride channels at their core. GABA is one of the major inhibitory neurotransmitters in the brain; hence, benzodiazepines enhance this inhibitory influence to produce sedation and calm

What is the MOA of Atomoxetine (aka Strattera)?

Inhibits presynaptive norepinephrine reuptake and thus NOT classified as a stimulant.

What is the rate of absorption and elimination of Alprazolam?

Intermediate absorption and elimintation

What type of reaction is neuropletpic malignant syndrome NOT?

It is NOT an allergic reaction.

What is the role of Levodopa-carbidopa for Parkinsonisms seen in Lewy Body dementia?

LC not as effective as it is in idiopathic Parkinson's and can sometimes end up exacerbating psychosis or REM sleep behavior disorder

What is Melancholic depression and what is the recommended treatment?

Lack of mood, depressive symptoms, and generally vegetative state ECT, TCAs, and SNRIs are *preferred*, but SSRIs are often prescribed and work effectively

What is the relationship between lamotrigine and valporic acid?

Lamotrigine DECREASES valproate levels while valproate INCREASES lamotrigine levels.

Treatment for alcohol withdrawl in hospital

Librium and ativan

How do the lower potency typical antipsychotics compared in terms of side effects to the high potency APs?

Low potency typical APs have higher incidence of antiadrenergic, anticholinergic, and antihistamine side effects where as high pontency typicals have higher incidence of EPS and possibly NMS

What is a side effect associated with ALL APs?

Lower seizure threshold

When do premenstrual depressive symptoms being to manifest in reference to the physiologic menstrual progression?

Luteal phase

Which biogenic amines are preferentially deactivated by MAO-A vs. MAO-B?

MAO-A preferentially deactivates serotonin and norepinephrine whereas MAO-B preferentiatlly deactivates phenethylamonie. Both act on dopamine and typramine to the same degree.

In which specific condition are MAOIs considered more effective than TCAs?

MAOIs are considered more effective than TCAs for treating depression with atypical features.

What is the most common coexisting psychiatric disorder with body dysmorphia?

Major depression disorder

A 32-year-old woman comes to your office for contraception. She has divorced her husband two weeks ago and is now dating several new boyfriends. She states she has started a new company just over a week ago and has sunk all of her money into it. Although she knows that businesses like hers have not done well lately, she is certain the market is about to shift in her favor. She states she must hurry and get back to work, that she hasn't even had time to sleep for over a week. She speaks very rapidly and is pacing back and forth, seemingly unable to sit still. Conversation is difficult as she is easily distractible. She denies use of drugs or alcohol. She also denies any history of depression. What is her most likely diagnosis? A Bipolar disorder B Delusional disorder C Hypomanic episode D Manic episode E Neurosis

Manic episode D The patient described is exhibiting behaviors consistent with a manic episode (D). Her symptoms have been present for over a week and are impairing her ability to function, so it is not hypomania (C). As she has no clear history of depression, it is likely that she will have a depressive episode in the future, which will allow for a diagnosis of bipolar disorder (A). She does exhibit grandiosity, but there are no clear delusions (B). Neurosis (E) is a more general term for cognitive distress including some form of anxiety.

Manic episode The patient described is exhibiting behaviors consistent with a manic episode (D). Her symptoms have been present for over a week and are impairing her ability to function, so it is not hypomania (C). As she has no clear history of depression, it is likely that she will have a depressive episode in the future, which will allow for a diagnosis of bipolar disorder (A). She does exhibit grandiosity, but there are no clear delusions (B). Neurosis (E) is a more general term for cognitive distress including some form of anxiety.

What is the acronym DIGFAST in reference to and what does it stand for?

Manic episode symptoms: Distractibility Insomnia Grandiosity Flight of ideas Agitation Sexual risk Talkative

What opioid cessation therapy is best for use in pregnancy?

Methadone

What medication can be used cautiously as adjunct to antidepressant for depression in the elderly?

Methylphenidate (aka Ritalin) at very low dose if drepression is severe and/or psychomotor retardation is an issue.

What class of medication is Mirtazapine? What mental illness is it commonly used for?

Mirtazapine aka Remeron is an alpha 2 adrenergic receptor antagonist used in depression.

What antidepressant is espcially useful in the elderly for increaseing appetitie and helping with sleep?

Mirtazapine aka Remeron.

What two labs must be obtained before initiating treatment with carbamezapine?

Must assess CBC since drug assocaited with agranulocytosis as well as LFTs because it is metabolized primarily by the liver

How long must a patient continue to get weekly blood draws while on clozaril?

Must get blood draws every week for the first 6 months.

Per criteria, before what age must onset of symptoms occur for a diagnosis of ADHD?

Must have symptom onset prior to age 12, although can diagnose retrospectively.

What is the mutated gene in Fragile X syndrome?

Mutated FMR-1 gener.

What class of medication is memantine?

NMDA receptor antagonist

What medication should NOT be used in delirium not due to alcohol withdrawal for agitation or any other such symptoms?

NO BENZODIAZEPINES!!! they can cause, worsen, or prolong delirium.

What treatment is needed for cocaine withdrawal?

NONE. Withdrawal is NOT life threatening and there is no specific treatment needed though severe psych symptoms may warrant hospitalization.

What effect do NSAIDs have on lithium levels? What are the exceptions

NSAIDs decrease lithium excretion thus INCREASE levels. Exception are slindac and aspirin

A 22-year-old male presents with his girlfriend. She is concerned because of her boyfriend's behavior and she feels that he needs help. During the visit, you learn that the behaviors of concern include excessive demands for attention and grandiosity. He is also preoccupied with power and shows little interest in others. What is the most likely classification of this personality disorder? A Antisocial B Avoidant C Histrionic D Narcissistic E Schizoid

Narcissistic D This patient is exhibiting all of the characteristics of narcissistic personality disorder. Antisocial personality disorder is characterized by selfishness, callousness, promiscuousness, and impulsive behavior, and an inability to learn from experience and legal problems. Avoidant personality disorder presents clinically as someone who fears rejection, overreacts to rejection and failure, and has poor social endeavors and low self-esteem. Clinical findings of histrionic personality disorder include being dependent, immature, seductive, egocentric, vain, and emotionally labile. Schizoid personality disorder is characterized by shyness, introversion, being withdrawn, and avoiding close relationships.

Narcissistic This patient is exhibiting all of the characteristics of narcissistic personality disorder. Antisocial personality disorder is characterized by selfishness, callousness, promiscuousness, and impulsive behavior, and an inability to learn from experience and legal problems. Avoidant personality disorder presents clinically as someone who fears rejection, overreacts to rejection and failure, and has poor social endeavors and low self-esteem. Clinical findings of histrionic personality disorder include being dependent, immature, seductive, egocentric, vain, and emotionally labile. Schizoid personality disorder is characterized by shyness, introversion, being withdrawn, and avoiding close relationships.

What is the indicated use for Modafinil?

Narcolepsy

What is the recommended treatment for hallucinationsin the elederly that do not interfere with care or bother the patient?

No treatment recommended

What is the class and MAO of Buspirone?

Non-BZD anxiolytic Partial agonist at serotonin receptors with slower onset of action then benzos.

What is delusion disorder?

Nonbizarre delusions that last at least one month Nonbizarre is qualified as situations that occur in real life

Why is Trazadone not generally used a monotherapy for depression?

Not used due to risk of orthostatic hypotensions at high doses.

Which two other medication classes besides SSRIs have been shown to reduce symptoms of premenstrual dysphoric disorder?

OCPs and GnRH agonist.

What is a characteristic of Oppositional Definant Disorder that distinguishes it from Conduct disorder?

ODD does NOT involve physsical aggression or violation of others basic rights.

A 23-year-old female presents with a history of rigid thought patterns and a need for control. She sees herself as a perfectionist. She discloses that she feels a need to check the locks on her doors at home once every 30 minutes. She is consumed with these thoughts about locking the doors. What is the most likely classification for her personality disorder? A Histrionic B Narcissistic C Obsessive-compulsive D Paranoid E Schizotypal

Obsessive Compulsive Clinical findings of obsessive-compulsive disorder include being a perfectionist, egocentric, and indecisive, with rigid thought patterns and need for control. Clinical findings of histrionic personality disorder include being dependent, immature, seductive, egocentric, vain, and emotionally labile. Narcissistic personality disorder presents with the clinical findings of grandiosity, a preoccupation with power, lacking interest in others, and excessive demands for attention. Clinical findings of someone who has paranoid personality disorder would include defensiveness, being overly sensitive, secretive, suspicious, hyper-alert, and with a limited emotional response. Schizotypal clinical findings include being superstitious, socially isolated, and suspicious, and having limited personality ability, odd speech, and eccentric behaviors.

Obsessive-compulsive C Clinical findings of obsessive-compulsive disorder include being a perfectionist, egocentric, and indecisive, with rigid thought patterns and need for control. Clinical findings of histrionic personality disorder include being dependent, immature, seductive, egocentric, vain, and emotionally labile. Narcissistic personality disorder presents with the clinical findings of grandiosity, a preoccupation with power, lacking interest in others, and excessive demands for attention. Clinical findings of someone who has paranoid personality disorder would include defensiveness, being overly sensitive, secretive, suspicious, hyper-alert, and with a limited emotional response. Schizotypal clinical findings include being superstitious, socially isolated, and suspicious, and having limited personality ability, odd speech, and eccentric behaviors.

How does oxcabazepine compare to carbamezapine?

Oxcarbazepine is just as effective but usually better tolerated and associated with less risk of rash and hepatic toxicity.

What is usually required for treatment of acute dystonic reactions secondary to AP treatment?

Often required IV or IM anticholinergic agent.

What is the recommended treatment for psychotic depression?

Olanzapine and an SSRI

What is a major risk factor for developing TD with AP treatment?

Old age

What is conversion disorder? What is first line treatment?

One or more nuerological disorders that cannot be explained clinically. This is ypically a tic, involuntary movements, sensory. Behavioral therapy with insightful psychoanalysis

In what specific circumstances is GI evacuation ie gastric lavage with induction of emesis and charcoal indicated in tx of EtOH intoxication?

Only indicate if a significant amout of EtOH was ingested in the preceding 30-60 minutes.

What is the use of medications in ODD?

Only used for comorbid disorder e.g depression, ADHD

What is Naltrexone?

Opioid antagonist used in alchohol cessation

What receptor blockage determines the degree of orthostatic hypertension experienced with APs? What is a way to decrease the occurence of orthostatic hypotension when dosing the medication?

Orthostatic hypertension with APs assocaited with degree of alpha 1 antagonism. Particularly seen with the low potency 1st generation APs and clozapine. Careful dose titration can help patients become tolerant to the effect

That rare but serious adverse effect is valproic acid treatment assocaited with?

Pancreatitis

A phobia is an excessive fear of an object or place that leads to or can be preceded by: A panic attack B depression C hallucinations D delusions E confabulations

Panic Attack A Patients who have a phobia realize it is an irrational fear and try to avoid whatever they have the fear of. In attempts to avoid the "problem," patients can develop anxiety or panic attacks

What type of schizophrenia is the most common? Define it.

Paranoid schizophrenia Persecutory or grandiose delusions OR auditory halucinations

What class of medication is Buspirone?

Partial 5HT1/D2 agonist often used as adjunct for anxiety treatment. (Not effective monotherapy)

What is the diagnostic criteria for schizophrenia?

Patient must have two or more of the listed symptoms for at least one month, one of which has to be delusions, hallucinations, or disorganized speech.

What is residual schizophrenia?

Patients no longer have psychotic symptoms but do have blunted affect or odd behavior

What is PANDAS?

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (w.g GABHS infection assocaited with development of Tourette's

What is one of the most serious potential risks of SSRI exposure during pregancy?

Persistent pulmonary hypertension

What is the rare but serious adverse side effect that patients should be made aware of before starting lamotrigine? What can help minimize the risk of developing this side effect?

Possibility of Steven's Johnson syndrome. Risk can be decreased by starting at low doses of lamotrigine and increasing slowly and not combining with valproate.

What factor in a patient presentation automatically precludes a psychiatric diagnosis?

Presence of a drug on toxicology screen, especially if the patient can confirm they started the drug before symptoms occured

What is one of the best prognostic signs in a child with Autism Spectrum Disorder?

Presence of functional language by age 5

What is the mechanism of action of MAOIs?

Prevent inactivation of biogenic amines such as norepinephrine, serotonin, dopamine and tyramine.

What is a rare but serious adverse side effect associated with Trazadone?

Priaprism

What primitive, or immature, defense mechanism is demonstrated by a patient who attributes their own, unacknowledged, feelings onto others while they search for perceived wrongdoings, no matter how small? A acting out B isolation C projection D splitting

Projection C These patients are sensitive to any criticism and are constantly searching for any insult or mistreatments, no matter how small or unintentional they may be. Confrontation is to be avoided as it is only counterproductive and will reinforce their beliefs. This is commonly seen in paranoid personality disorders.

What are two important relative contraindications to ECT therapy?

Space occupying brain lesions or MI in past 6 months

What types of hallucinations are commonly associated with substance-induced psychotic d/o as opposed to true psychologic disorders?

Visual hallucinations in the absence of auditory hallucinations are commonly associated with substanced-induced psychotic disorder but are rare in other psychological disorders.

What are the three advantages to newer antidepressant medications (SSRI, SNRI)?

Well tolerated, lower chance of lethal OD, and starting dose is at therapeutic levels

What classes of medications can be considered if first line agents are ineffective in anxiety disorders?

TCAs and MAOIs though bad side effect profile.

What affect to TCAs have on HR vs BP?

TCAs have a tendencey to increase HR but lower BP

What is the mechanism of action of TCAs?

TCAs inhibit the reuptake of norepinephrine and serotonin to increase the availablity at the synapse

When do the movements of tardive dyskinesia generally become most prominent?

TD movements most evident when patients are aroused but ease during relaxation and disappear during sleep.

True or false: Major depressive disorder often presents as diurnal with the pt feeling progressively better as the day goes on..?

TRUE

Tangentiality

Tangentiality is a disturbance in thought causing the person to start a train of thought, but never getting to the point.

Tardive dyskinesia

Tardive dyskinesia usually appears months or years after starting neuroleptic medication, and consists of involuntary stereotyped movements of the face, mouth, tongue, trunk, and limbs.

Schizophreniform disorder is...

When someone has the same symptoms as schizophrenia, but symptoms last between 1 and 6 months

When is hospitalization suggested for schizophrenics?

When they have suicidal ideation, are a threat to themselves or others, or are unable to care for themselves

Somatic pain disorders occur more often in what demographic?

Women, younger, lower socioeconomic status

What is the mainstay of therapy for litium toxicity?

Supportive therapy! consider gastric lavage if patient presenting within 1 hr of ingestion as well as FLUIDS!

A 60-year-old woman is referred to you for depressed mood, crying episodes, and an inability to sleep. She says that she has had these episodes before and was treated with antidepressant therapy. Her daughter also says that there is a family history of this behavior. She has no significant medical problems and has had this current mood for 6 weeks. What would this be suggestive of? Answer Choices 1 Bipolar disorder 2 Major depression, recurrent 3 Major depression 4 Depressed mood 5 Adjustment reaction

major depression, recurrent There are several indicators of a major depression in older adults. A major depressive disorder must consist of several symptoms for at least 2 weeks. These are: depressed mood, decreased interest in normal activities, significant weight loss or gain, insomnia or hyper-sleeping, psychomotor agitation or retardation, feelings of worthlessness or guilt, and/or poor concentration and possible passive or direct suicidal threats. Depressed mood is an indicator, but not a diagnosis. Treatment of major depression in older adults is most successful with a combination of antidepressant medications plus interpersonal supportive psychotherapy. Behavioral, cognitive, and family therapies have shown less promising results. Also, brief or short therapy has shown to be as effective or more effective as long-term psychotherapy. Also, most insurance programs do not fund long-term therapies. ECT (or electroconvulsive) therapy is a treatment of choice in the elderly if they do not respond to antidepressants or have a vegetative type depression. Major depression, recurrent is a term used to indicate that the older adult has had a previous episode and was treated. In diagnosing major depression, it is very important to do a complete medical examination and take a history first; doing so will rule out possible physical causes before drugs are prescribed. In treating depression, older adults usually do not want to see a psychiatrist unless it is indicated, and most older adults see their primary physician first. Psychiatrists are usually brought in to consult or act as a liaison to the primary physician. Bipolar disorder is characterized by 1 or more maleic episodes or mixed with maleic and depressive episodes. There is usually grandiosity, a decreased need for sleep, psychomotor agitation, and excessive involvement with pleasurable activities such as sex, spending, or traveling. Older adults with adjustment reactions usually have much less severe symptoms, and these usually occur after a major stress such as a death, change in residence, or other psychosocial stressors.

A 24-year-old male has an eight-month history of loose thought associations, social withdrawal, auditory hallucinations and deterioration in personal appearance and hygiene. Upon examination, he is noted to have a flat affect and perceptual distortions, and he behaves like he is detached from his own actions. Which of the following medications, if chosen for treatment, is known to be associated with lens changes and would require an eye examination to detect cataracts every six months? A Chlorpromazine (Thorazine) B Haloperidol (Haldol) C Quetiapine (Seroquel) D Risperidone (Risperdal) E Ziprasidone (Geodon)

Quetiapine (Seroquel) Quetiapine is the only medication listed that is associated with lens changes, and an eye examination every six months, starting at the initiation of treatment, is recommended.

What side effects are associated with atomoxetine?

Rare but serious liver toxicity and possible increase SI in children and adolescents.

What is Cotard syndrome?

Rare mental illness in which the sufferer believes they are dead, dying, putrefying, or have lost blood or body parts

Which of the following is a common adverse effect associated with the use of stimulants such as methylphenidate for attention-deficit hyperactivity disorder (ADHD)? A diarrhea B hypoglycemia C hypotension D paresthesias E reduced appetite

Reduced Appetite Stimulants (eg, amphetamines, methyl-phenidate) are considered first-line therapy in the majority of cases of ADHD. Both amphetamines and methylphenidate block dopamine and norepinephrine reuptake, while amphetamines also stimulate norepinephrine release. Elevated levels of CNS norepinephrine have been associated with an anorexigenic effect, leading to reduce caloric intake.

What is the phase of schizophrenia inbetween psychotic episodes?

Residual

You meet with a 15-year-old boy who has a diagnosis within the autism spectrum disorder. The patient is accompanied by his mother. This patient is considered high functioning: he attends a public school, goes to daily cognitive/behavioral sessions, and he attends weekly counseling sessions with a provider who specializes in treating adolescent patients with the diagnosis that is within the autism spectrum disorder. Despite this fact, mom states she has noted a significant increase in episodes of what she can only describe as temper tantrums; severe irritability and quickly changing moods are also present. These occurrences have gotten so severe that they have begun to disrupt his daily activities. Question Ico-delete Highlights What is the only pharmacologic agent approved by the US Food and Drug Administration (FDA) to treat irritability in children and adolescents with autism spectrum disorder? Answer Choices 1 Sertraline 2 Paroxetine 3 Atomoxetine 4 Clonidine 5 Risperidone

Risperidone Adolescents classified as having a diagnosis within the autism spectrum disorder (ASD) will have varying degrees of impairment in their social and behavioral function. Family education, behavioral and educational interventions, and counseling have a significant place in this treatment plan. Pharmacotherapy may be considered, but it should be used as adjunctive therapy to those mentioned above. In 2006 the US Food and Drug Administration (FDA) approved risperidone, an atypical antipsychotic, in the oral disintegrating tablet form, for the symptomatic treatment of irritability in both children and adolescents with autism spectrum disorder. This is considered the first FDA approved drug treatment for behaviors specifically associated with ASD, and it has been used off-label for many years for these symptoms. Other symptoms that risperidone could be considered to help treat in patients with ASD include aggression and deliberate self-injury. When beginning any pharmacotherapy for these patients, having a "start low and go slow" regimen is strongly recommended, with consistent follow-up visits for evaluation of alleviation of the symptoms. Such pharmacologic agents as selective serotonin reuptake inhibitor (SSRI), such as sertraline or fluoxetine, are generally introduced to help alleviate anxiety symptoms. The patient in the above scenario is currently not experiencing or expressing any excessive anxiety. Although paroxetine is a type of SSRI that is used to treat patients with depression, obsessive-compulsive disorder, anxiety disorder, post-traumatic stress disorder, or premenstrual dysphoric disorder, it is currently not a recommended first-line treatment option for symptomatic behavior in ASD patients. Patients who express symptoms consistent with hyperactivity and inattention should be treated with methylphenidate, atomoxetine, or clonidine; this is not consistent with the symptoms that were discussed in this patient.

What medication is FDA approved for symptomatic treatment of irritability in children and adolescents with autism?

Risperidone also used for aggression and deliberate self-injury

What are the only two antipsychotics FDA approved for use in autism?

Risperidone and aripiprazole

Citalopram (Celexa) is what type of drug and what side effect is it noted to have?

SSRI and can cause QT prolongation

What is the first line treatment for premenstrual dysphoric disorder?

SSRIs

What medication commonly first line for anxiety disorders is NOT very effective for hoarding d/o?

SSRIs

Which class of medications is considered first line for treatment of anxiety disorders?

SSRIs

What are the four types of antidepressive medications?

SSRIs and SNRIs Tricyclics Monoamine oxidase inhibitors Other

What medications are sometimes used for treatment of psychiatric premature ejaculation?

SSRIs and TCAs

What effect can SSRIS have on warfarin levels?

SSRIs increase warfarin levels.

What class of medications are first line for PTSD?

SSRIs/SNRIs

Define dysthymia.

Sadness, loss of interest, and withdrawal from activities for greater than two years Typically symptoms are milder but longer lasting than those in major depressive disorder

What appear to be the safest SSRIs to use with warfarin, vs. the most dangerous?

Safest = sertraline and citalopram dangerous = fluvoxamin and fluoxetine

What schedule are the stimulant class of medications?

Schedule II drugs due to high potential for abuse

"Emotional Freezing," according to the DSM-IV, is characterized by solitary activities, constricted affect, and deficits in communication; it can easily be erroneously diagnosed as what personality disorder? Answer Choices 1 Paranoid 2 Schizoid 3 Schizotypical 4 Delusional 5 Antisocial

Schizoid Different cultural backgrounds, defensive behaviors, and interpersonal styles are often erroneously misdiagnosed and labeled schizoid. The DSM-IV criteria for Schizoid Personality Disorder is marked by a failure to enjoy or desire close relationships, a preference for solitary activities, a lack of close friends, very little emotion, and generally flat affect.

Serum Creatinine Patients on chronic lithium carbonate therapy have an approximate 10% to 20% risk of developing renal problems such as glomerulosclerosis, tubular atrophy, or interstitial nephritis. Each of these conditions can lead to filtration problems and a subsequent rise in serum creatinine. Hence, it is advised to obtain a baseline serum creatinine prior to administering lithium carbonate to follow any changes that may occur in renal function during therapy. It is also advised that lithium carbonate be avoided in patients with pre-existing renal disease.

While interviewing a 29-year-old computer programmer, you find that he denies any close friends or prior sexual relationships and has no interest in developing them. He describes little enjoyment in any activities except role play video games. He denies past emotional difficulties or stressors. His exam reveals a flat affect throughout the visit but is otherwise normal. Which is the most likely diagnosis in this scenario? A antisocial personality disorder B adjustment disorder C seasonal affective disorder D schizoid personality disorder

Schizoid Personality Disorder A patient with ambivalence toward sexual relationships, no close contacts, and no desire for either, along with anhedonism and flat affect are typical for this disorder. The preference for solitary activities and use of fantasy furthers this picture. The lack of aggressiveness and risk-taking behavior lessons the antisocial diagnosis. The patient denied any precipitating event that would lend the problem to an adjustment disorder and the lack of variance, seasonal or otherwise, lessens the seasonal affective disorder diagnosis.

What is the first line treatment of schizoaffective disorder?

Second generation antipsychotics with lithium or SSRI as adjunct tx *Paliperidone*

What is a common adverse effect of Clonidine?

Sedation common

What class of medication is remelteon?

Selective melatonin agonist that does not carry risk of tolerance or dependence.

What type of medication is quetiapine? What is the brand name?

Seroquel - atypical/second gen. AP

What life threatening condition is cyproheptadine used for?

Serotonin syndrome

What is the pharm treatment for body dysmorhpia? How long and generally how much is needed?

Serotonin-modulating drugs SSRIs are effective- fluoxetine, clomipramine Usually higher doses and for about 12 weeks

What are the three most common symptoms seen in conversion disorder? After behavioral therapy, what medicinal therapy is warrants? What demographic is this more common in?

Shifting paralysis, blindness, and mutism Short acting anxiolytics *Women*

When are the best times to check a patients blood levels after starting them on lithium?

Should be checked 5 days after initiating the drug, then every 2-3 days until therapeutic level is reached.

What should you do if a patient is developing signs of metabolic syndrome while on a second generation AP?

Should consider swtiching to a first generation or a more "weight neutral" AP such as aripiprazole (abilify), or ziprasidone (geodon)

How long should you wait after stopping fluoexetine before starting an MAOI?

Should wait 5-6 weeks due to long half life of fluoxetine unlike other antidepressant which you wait at least 2 weeks.

What anxiety disorder is Buspirone shown to be effective for vs. which is it not?

Shown to be effective for GAD but not for panic disorder

What does SIG E CAPS stand for?

Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor activity, Suicidal ideation

What is the treatment for a TCA overdose?

Sodium bicarbonate

Your patient is a 26-year-old mother of two young children whose second child was just delivered two weeks ago and she is breast-feeding. She complains of insomnia and depression. She denies the use of any drugs or alcohol. You would like to hold off on pharmacologic therapy unless her symptoms progress. Which of the following will be your first line of treatment? A Encourage more time with the baby B Encourage her to begin planning to get back to work C Promote adequate sleep D Suggest she get out of the house more often E Suggest her husband help more around the house

Solution C The correct answer is to promote adequate sleep (C). Postpartum "blues" are very common. Depression can occur in some cases, but most resolve without therapy. When required, SSRIs may be used even when a woman is breast feeding, though no studies have been done.

A 38-year-old female is at a follow-up visit for hypertension. She is accompanied by her husband. During the clinical visit the patient is noted to be passive, letting her husband do most of the talking. She also appears to lack confidence and self-esteem. The husband ends up making the decisions, and she is over-accepting of his dominance. What is the most likely classification of this personality disorder? A Avoidant B Borderline C Dependent D Histrionic E Schizotypal

The clinical findings of dependent personality disorder are the most consistent with the given clinical scenario. Avoidant personality disorder presents clinically as someone who fears rejection, overreacts to rejection and failure, has poor social endeavors, and low self-esteem. Borderline personality disorder clinical findings include impulsiveness, unstable and intense interpersonal relationships, lack of self control, suicidal ideations, aggressive behavior, and a high drug abuse rate. Clinical findings of histrionic personality disorder include being dependent, immature, seductive, egocentric, vain, and emotionally labile. Schizotypal clinical findings include being superstitious, socially isolated, and suspicious, and having limited personality ability, odd speech and eccentric behaviors.

In body dysmorphia, the most common location of attention is where?

The face

When do the majority of people taking Clozapine develop agranulocytosis? Which groups are at greater risk?

The majority will develop agranulocytosis within the first 3 months of starting treatment. Risk increases with older age, female sex, and Asian race.

What is the therapeutic range of lithium vs. the toxic range?

Therapeutic levels at 0.6 - 1.2 grams and toxic at levels > 1.5 g, potentially lethal at > 2 g.

Which antipsychotics are most strongly assocaited with prologation of ventricular repolarization aka QT interval prolongation?

Thioridazine and ziprasidone (Geodon) which is dose dependent, however ALL APs carry risk.

In which patients is Mirtazapine (Remeron) especially useful as an antidepressant treatment?

Those with the main side effects of decreased appetite and insomnia

What is the theorized mechanism of action of Acamprosate?

Thought to modulate glutamate transmission and FDA approved for postwithdrawal maintenance of alcohol abstinence.

Negative sxs of schizophrenia arrise from dysfunction in which brain pathway?

Thought to occur due to decreased dopaminergic action in the mesocortical pathyway.

What condition are stimulant medications such as those used in ADHD associated with precipitating in children?

Tics

What is the mechanism of Varenicline?

Varenicline aka Chantix is a alpha/beta nicotinic cholinergic receptor partial agonists that mimics action of nicotine, reduce reqarding aspects and preventing withdrawal symptoms.

What is the treatment for akathisia secondary to antipsychotic treatment?

Treatment can be with dosage reduction or the addition of a low dose beta blocker ie 20-80mg per day

A 52-year-old male, who is a known alcoholic, is admitted to the hospital for GI bleed. Librium is ordered, but he must be monitored for early signs of alcohol withdrawal as his total daily intake of alcohol prior to admission is unknown. Which of the following symptoms might occur as an early sign of withdrawal rather than a later sign? A Delusions B Hallucinations C Nausea and vomiting D Seizures E Tremulousness

Tremulousness Tremulousness (E) and agitation are early signs of alcohol withdrawal, occurring within the first few hours. These symptoms can progress to nausea and vomiting (C) along with hallucinations (B), delusions (A), and seizures (D) after several hours. Seizures generally occur 12-48 hours after the last drink and full delirium tremens occurs after 48-72 hours.

Which benzodiazepines are very shorti acting ie T1/2 < 6 hrs?

Triazolam and midazolam.

What NON-antidepressant medication taken in combination with SSRI puts patient at rigsk for serotonin syndrome?

Triptans

For ADHD, what is the recommended next step in treatment if a patient does not respond to a certain stimulant medication.

Try a different stimulant medication before moving on to another class

How long before or after use of MAOI should a patient avoid taking an SSRI?

Two weeks (before and/or after)

The risk of extrapyramidal side effects (pseudoparkinsonism) and tardive dyskinesia is associated with which class of medications? A amphetamines B benzodiazepines C monoamine oxidase inhibitors (MAOIs) D tricyclic antidepressants (TCAs) E typical (first-generation) antipsychotics

Typical (first generation) antipsychotics Typical antipsychotics (eg, haloperidol, chlorpromazine, fluphenazine) can produce pseudoparkinsonism via blockade of dopamine (D 2 ) receptors in the nigrostriatum. Symptoms can include akinesia, bradykinesia, mask-like facial expression, tremor, cogwheel rigidity, and postural abnormalities. Tardive dyskinesia may also occur, as the reported incidence with first generation antipsychotics ranges from 0.5% to 62%.

Most postpartum depressions begin when?

Typically, signs of depression being DURING pregnancy or up to 4 weeks after delivery

How does the course of sexual dysfunction side effects with SSRIs differ from that of other associated side effects?

Unlike other side effects od SSRIs, sexual dysfunction is less likely to diminish orresolve with time

What is the role of BBs in anxiety disorders?

Used for panic attacks and performance anxiety

What is the role of tetrabenazine in Huntington's disease?

Used to help diminish chorea. Reversible monoamin depleter

A 24-year-old male has an eight-month history of loose thought associations, social withdrawal, auditory hallucinations, and deterioration in his personal appearance and hygiene. Upon examination, he is noted to have a flat affect, perceptual distortions, and behaves like he is detached from his own actions. Which of the following medications used in treatment of this disease has the risk of prolonging the QTc interval? A Aripiprazole (Abilify) B Chlorpromazine (Thorazine) C Loxapine (Loxitane) D Quetiapine (Seroquel) E Ziprasidone (Geodon)

Ziprasidone (Geodon) Ziprasidone is the only medication of the ones listed that is known to prolong the QTc interval. An ECG is recommended for patients at risk for cardiac sequelae

A 24-year-old male has an eight-month history of loose thought associations, social withdrawal, auditory hallucinations, and deterioration in his personal appearance and hygiene. Upon examination, he is noted to have a flat affect, perceptual distortions, and behaves like he is detached from his own actions. An atypical antipsychotic medication is chosen for this patient. Which of the following medications is classified as an atypical antipsychotic? A Chlorpromazine (Thorazine) B Haloperidol (Haldol) C Loxapine (Loxitane) D Molindone (Moban) E Olanzapine (Zyprexa)

Zyprexa Olanzapine is the only atypical antipsychotic listed in the given answers. The remainder of the medications listed are typical antipsychotic medications.

What are the 3 main traits that distinguish a hypomanic episode from a manic episode?

a hypomanic episode is... 1. NOT characterized by impairment in social or occupational functioning 2. does NOT require hospitalization 3. NOT associated with psychotic features.

What is the treatment for barbiturate overdose?

alkanize the urine with sodium bicarbonate to promote renal excretion.

What class of medicaiton is Prazosin. What is its role in PTSD?

alpha 1 receptor agonist that is most beneficial for symptoms of nightmares and hypervigilance

What medications are sometimes use in stead of or as adjuncts to stimulants in treatment of ADHD?

alpha 2 agonists e.g clonidine and guanfacine

What is the MOA of phentolamine? What serious adverse reaction is it used for?

alpha blocker used for treatment of hypertensive crisis in patient taking MAOIs (shown to be more effective and safer than BB or CCBs)

What defines cyclothymic d/o?

alternating periouds of hypomania and mild-to-moderate depressive symptms that do NOT meet full criteria for major depressive episode, for at least 2 YEARS

A 19-year-old woman is forced to seek medical attention by her parents. She is 5'5" in height and weighs 100 lbs. Her parents tell you that she has been dieting seriously for the last 6 months and refuses to eat most meals with the rest of the family. Normally, she eats only small amounts of vegetables and an occasional piece of fruit. Recently though, she has started stuffing herself with junk food for an entire evening, crying herself to sleep, and then exercising ferociously every night for the next week. Her parents say that they are tired of arguing with her about her thinking that she's too fat. Recent complaints of hypothermia, amenorrhea, and fainting spells led them to seek medical care for her. What disorder does this woman display? Answer Choices 1 Bulimia nervosa 2 Anorexia nervosa 3 Pica 4 Rumination 5 Eating disorder NOS

anorexia nervosa Anorexia nervosa is characterized by" A refusal to maintain a minimally normal body weight (defined as 85% of what is expected) An intense fear of gaining weight A disturbance in one's subjective experience of body weight or shape A denial of the seriousness of low weight and self-starvation In females, amenorrhea for at least 3 consecutive cycles 90% of patients reported with this disorder are female, although incidence in males is growing somewhat This case shows evidence of binge eating, but it is considered "binge-eating/purging type" of anorexia and not bulimia; this is due to the low body weight. The purging common to bulimia (self-induced vomiting, misuse of laxatives and diuretics, or enemas) can be present in anorexia also, as may other inappropriate compensatory behaviors (fasting, excessive exercise). Pica and rumination are usually seen earlier in childhood; they involve, respectively, the eating of nonnutritive substances and the regurgitation and rechewing of food. The NOS designation would be used if not all the criteria for any specific eating disorder were met. In this case, it would have been used if all the criteria for anorexia nervosa were met except that she still had regular menses. Refer to the image - anorexic perception. Much research has found that anorexics have a highly distorted perception of what they see in the mirror, which is similar to what happens in body dysmorphic disorder. However, when this distortion occurs only with reference to "fatness," it is classified as an eating disorder.

A 14-year-old girl is brought to the office by her mother. She passed out at gymnastics practice yesterday, and her mother is concerned. She sustained no head injury and regained consciousness immediately. She admits to some dizziness, but states that otherwise she feels fine and is eager to return to practice. The patient appears thin despite wearing baggy clothes. On examination, her skin is dry and cool to touch. There is soft downy hair covering her body. Heart rhythm is regular, but she is mildly tachycardic and slightly hypotensive. Neurological examination is normal. Question What is the likely diagnosis? Answer Choices 1 Cushing's syndrome 2 Addison's disease 3 Anorexia nervosa 4 Bulimia nervosa 5 Absence seizure

anorexia nervosa Anorexia nervosa is correct. The patient is a thin-appearing female who had an episode of syncope. This paired with the presence of soft downy hair over her body (lanugo) is highly suggestive of anorexia nervosa. Participation in sports where thin body image is idealized, such as gymnastics, puts an individual at increased risk for anorexia nervosa. This patient requires careful intervention in order to avoid the complications of anorexia nervosa, including death. Cushing's syndrome is incorrect. Cushing's syndrome is associated with high levels of cortisol. It causes symptoms such as weight gain, striae, round face, fatigue, and poor wound healing. Addison's disease is incorrect. Addison's disease is due to insufficient production of cortisol by the adrenal glands. It is associated with symptoms such as fatigue, nausea, vomiting, and hyperpigmentation of the skin. Bulimia nervosa is incorrect. Patients with bulimia nervosa do not typically experience extreme weight loss. Patients are more likely to present with dental erosion (due to frequent vomiting) and enlargement of the parotid salivary glands. Lanugo would not be present in a patient with bulimia nervosa. Absence seizure is incorrect. The patient did not suffer any seizure-like activity and has symptoms suggestive of anorexia nervosa.

What is the mechanism of PCP?

antagonizes NMDA receptors and activates dopaminergic neurons

What are the "HAM" side effects?

antiHistamine = sedation, and weight gain antiAdrenergic = hypotension antiMuscarinic = dry mouth, blurred vision, urinary retention, constipation. Seen with TCAs and low potency APs

What is the recommended treatment for delusional disorder even though there is limited evidence?

antipsychotics

Which two antipsychotics do NOT cause hyperprolactinemia?

aripiprazole (Abilify) and quetiapine (Seroquel)

Which two 2nd generation APs are considered "weight neutral"?

aripiprazole (abilify), ziprasidone (geodon)

A patient describes a desire for close relationships and to be more successful at work. However, she views herself as being undesirable and inferior. Because of these feelings she avoids social activities and extra occupational projects out of fear of criticism, rejection, and embarrassment. Which diagnosis would best fit this description? A avoidant personality disorder B borderline personality disorder C histrionic personality disorder D schizoid personality disorder

avoidant PD A An individual with avoidant personality disorder differs from schizoid in that they desire interaction and closeness but are unable to overcome their deep seated self-beliefs and fears. They tend to be less impulsive and more stable than borderline personality disorder patients and have less of a need to be the center of attention than those with histrionic personality disorders.

What is the receptor physiology behind why ketamine causes psychosis?

because NMDA antagonist

Why do asians experience nausea and flushing with ingestion of alcohol?

because they have less ALDEHYDE dehydrogenase which results in build-up of acetylaldehyde like with people who take disulfuram.

Which drugs should be avoided in patients experiencing delirium?

benzodiazepines and anticholinergics

Which palsy is highly associated with Wenicke's encephalopathy?

bilateral abducens nerve palsy

What childhood psychiatric disorder corresponds with the clinical picture of cyclic expansiveness, aggressiveness, and impulsivity? Answer Choices 1 Major depression 2 Schizophrenia 3 Bipolar illness 4 Substance abuse 5 Enuresis

bipolar Patients with bipolar disorder have at least 1 manic episode, which is characterized by abnormally elevated, expansive, or irritable mood that lasts at least 1 week or requires hospitalization. Patients may or may not experience depression. Hypomania is similar to mania, but the episodes are less severe.

What is the treatment for neuroleptic malignant syndrome?

bromocriptine, dantrolene.

What is the role of clonidine, atomoxetine, and stimulant medications in autism?

can be used for symptoms of hyperactivity and inattention

What is the treatment for Lewy Body dementia?

cholinesterase inhibitors e.g donepezil, rivastigmine, galantamine.

What type of sexual dysfunction is attributed to SSRIs?

decreased libido, anorgasmia, and delayed ejaculation.

What side effects occur secondary to hyperprolactinemia?

decreased libido, galactorrhea, gynecomastia, impotence, and amenorrhea.

What defines Capgras syndrome?

delusion whereby patient believes people familar to them have been replaced by imposters.

A 24-year-old male is brought to the clinic by his mother, who is concerned because her son believes that a local TV news anchor is in love with him. The mother states that this thought has been persistent for the last two to three months, and that he goes around town telling everyone about their relationship; however, she knows that her son does not even know the TV news anchor. The mother notes that this belief has not impaired his daily functioning, but has significantly affected his social functioning. The patient is exhibiting signs most consistent with which of the following psychiatric disorders? A Delusional disorder B Histrionic disorder C Paranoid disorder D Schizoid disorder E Schizotypal disorder

delusional disorder A This patient is exhibiting signs most consistent with delusional disorder. Delusional disorder is a psychosis in which the person has persistent beliefs that are non-bizarre, such as being persecuted, being related to or loved by a well-known person, or that their partner is unfaithful. In this disorder, the delusions tend not to affect the patient's intellectual and occupational activities, but social and marital functioning are significantly affected. Clinical findings of histrionic personality disorder include being dependent, immature, seductive, egocentric, vain, and emotionally labile. Clinical findings of someone who has paranoid personality disorder would include defensiveness, being overly sensitive, secretive, suspicious, and hyper-alert, and having a limited emotional response. Schizoid personality disorder is characterized by shyness, introversion, being withdrawn, and avoiding close relationships. Schizotypal disorder is characterized by being superstitious, socially isolated, and suspicious, with limited interpersonal ability, odd speech, and eccentric behaviors.

dependent C The clinical findings of dependent personality disorder are the most consistent with the given clinical scenario. Avoidant personality disorder presents clinically as someone who fears rejection, overreacts to rejection and failure, has poor social endeavors, and low self-esteem. Borderline personality disorder clinical findings include impulsiveness, unstable and intense interpersonal relationships, lack of self control, suicidal ideations, aggressive behavior, and a high drug abuse rate. Clinical findings of histrionic personality disorder include being dependent, immature, seductive, egocentric, vain, and emotionally labile. Schizotypal clinical findings include being superstitious, socially isolated, and suspicious, and having limited personality ability, odd speech and eccentric behaviors.

What adverse side effect is chlorpromazine associated with?

deposits in the lens and cornea.

depression C This patient's symptoms are most consistent with situational depression over the loss of his spouse. Transient memory problems can be a component of depression as a result of decreased attention and interest. Dementia is a progressive impairment of higher cognitive function, and initially, the patient's social graces are preserved. It has many causes, of which Pick disease, Creutzfeldt-Jakob disease, and Alzheimer disease are irreversible. Vitamin B 12 deficiency can cause reversible form of cognitive impairment, in which the elderly are susceptible, so serum analysis of vitamin B 12 should be performed in diagnostic evaluations of dementia in this population

What 3 conditions is Duloxetine (Cymbalta) commonly used for?

depression, neuropathic pain, and fibromyalgia

What are the symptoms of anticholinergic toxicity?

dilated pupils, dry or flushed skin, agitation, confusion, and tachycardia

What class of medicaiton is bromocriptine? what medical emergency is it used in?

direct dopamine receptor agonist effects used in NMS because can overcome AP induced D2 receptor blockade.

What is the effect of drantrolene? What serious medical emergency is it used in?

direct muscle relaxant use in NMS

Mr. Smith leaves home and does not return nor does he go to work. A friend of Mr. Smith sees him in another state while on vacation. When he approaches Mr. Smith, he does not recognize him and has a total different demeanor. What type of disorder does Mr. Smith have? A amnesia B dissociative fugue C schizophrenia D dissociative identity disorder E depersonalization

dissociative fugue Dissociative or psychogenic fugue is precipitated by a stressful event that causes the patient to develop amnesia, leave home, and assume another identity.

Why are TCAs associated with cardiovascular side effects?

due to antiadrenergic properties.

A 13-year-old boy is diagnosed with Autism Spectrum Disorder. The boy repeats phrases in a parrot-like fashion; he repeats whatever he hears, but comprehension is absent. What condition is exhibited by the child in the above description? Answer Choices 1 Paraphasia 2 Echolalia 3 Alexia 4 Apraxia 5 Agraphia

echolalia Echolalia is a pathological, parrot-like, and apparently senseless repetition or echoing of a word or phrase spoken by a person or heard on TV; the repetition/echoing is done without actual comprehension. This is also referred to as echophrasia. Echolalia occurs in autism, catatonic schizophrenia, Gilles de la Tourette's Syndrome, and in transcortical aphasia. Paraphasia is a type of aphasia. The substitution of a similar sounding word for another word is called paraphasia. With paraphasia, the words can also be jumbled. Alexia is the inability to read and understand written language. Alexia is word blindness or text blindness. Alexia is also called optical aphasia or visual aphasia. Apraxia refers to the condition where a patient has difficulty performing a learned motor activity despite having the understanding, muscular capacity, coordination, and normal sensations to do so. A patient with apraxia cannot execute the purposeful movement. A writing disturbance is called agraphia. It is the inability to express thought in written language that is not due to mechanical dysfunction.

What sign on MRI of the brain is suggestive of neurosyphilis and other chronic brain infections?

enhancement of meninges at the base of the brain

What reversible but distressing adverse side effect is associated with divalproex sodium?

hair loss

The parents of a 3-year-old boy are worried about his delayed language development; they tell you that the boy always appears to be "in his own little world". You are told that his previous doctor diagnosed the child with autism. The parents want a second opinion. What finding correlates strongly with autism? Answer Choices 1 Ability to develop peer relationships 2 Ability for spontaneous play 3 Communication through gestures 4 Microcephaly 5 Stereotypical hand flapping

hand flapping Restrictive and stereotyped patterns of behavior such as hand flapping are common in autistic children; of the choices given, this finding most correlates with autism. The diagnosis of autism would require impaired social interaction, such as failure to develop peer relationships. A lack of varied, spontaneous play is common in autism. A child who is able to communicate through gestures is unlikely to be autistic. In fact, an autistic child has an absence of any type of communication and has a qualitative impairment of communication with delay in, or complete lack of, development of the spoken language. Microcephaly is uncommon in autism; however, macrocephaly is prevalent in autism.

What medication can be used for moderate symptoms of opiod intoxication?

if only moderate can consider clonidine for sutonomic signs and symptoms of w/d, NSAIDs for pain instead of metahdone or buprenorphine.

What is the mechanism of action of the medication Orlistat?

inhibits pancreatic lipase thus decreasing the amoutn of fat absorned by the GI tract

What is a major adverse side effect associated with topiramate?

kidney stones

In what portion of the brain is the majority of norepinephrine neurons located?

locus ceruleus

What type of elctrolyte acid base imbalance may be present in patients with eating disorder that take part in vomiting?

hypochloremic hypokalemic metabolic alkalosis

What electrolyte imbalance in an alcoholic can predispose them to seizures and thus be corrected?

hypomagnesemia.

How is IQ calculated?

mental age / chronological age x 100

Which medications are recommended for mild to moderate alzheimer's disease vs moderate to severe disease?

mild to moderate = cholinesterase inhibitors moderate to severe = NMDA receptor antagonist

What defines an illusion?

misperception or misinterpretation of a real sensory stimulus

What two symptoms must a patient have at least one of for a diagnosis of MDD?

must have at least 5 symptoms from list, one of which has to be either depressed mood most of the time or anhedonia.

A person with an exaggerated sense of entitlement and uniqueness and who believes they can only be understood by people of significance is described to you by a colleague. They go on to state the person is arrogant, is lacking in empathy, and can be manipulative with relationships. What personality disorder best fits this scenario? A histrionic B narcissistic C antisocial

narcissistic B The scenario represents a typical "snapshot" of this diagnosis. These persons typically have fantasies of unlimited success and have a strong need for admiration from others. They can be jealous of others but commonly assume that others are extremely jealous of them. Treatment is made difficult as they do not accept criticism or any attack on their "narcissistic supply."

A mid-level manager complains that he is having problems at work because his employees just will not take the care he does in doing their jobs. Consequently, he says, he fears that their lack of interest in their work will prevent him from getting ahead because his attention to detail and devotion are not seen by his boss when overall production is low. Probing reveals that there are actually more problems here than just the attitudes of this man's employees. His attention to detail often gets in the way, and it prevents work from being accomplished in a timely manner. You formulate further questions to determine if this man might have what personality disorder? Answer Choices 1 Obsessive-compulsive 2 Narcissistic 3 Borderline 4 Dependent 5 Avoidant

obsessive compulsive Obsessive-compulsive personality disorder is characterized by a lifelong pattern of being preoccupied with perfectionism, orderliness, and control. Individuals with obsessive-compulsive disorder have difficulty being open with others, they are unable to be flexible because it means giving up control, and their perfectionism usually makes them very inefficient in their accomplishments. Other symptoms include excessive devotion to work or to other tasks, being overly conscientious about moral or ethical issues, and having restricted expression of affect. The major features of narcissistic personality disorder are grandiosity (an inflated sense of self importance), a need for admiration, and a lack of empathy for others. If criticized, the narcissistic individual often reacts with rage, and he/she often exploits others. Feelings of grandiosity usually preoccupy the individual, and there is often a profound sense of entitlement. Borderline personality disorder is most often associated with a pattern of unstable interpersonal relationships. Self-image is poor, affect is often labile or depressed, and these individuals are highly impulsive - especially with regard to self-destructive behaviors. Individuals with borderline personality disorder are chronically bored and empty feeling. They alternate between overly idealizing others and devaluing them. Their emotions are intense. Although individuals with borderline personality disorder are said to have a need to be taken care of, they have difficulty accepting the help of others because they mistrust their intentions. Individuals with dependent personality disorder, on the other hand, tend be clingy and submissive in their behaviors because their need to be taken care of is so pervasive. They have difficulty making everyday decisions without consulting others, and they agree with others even if they believe the person to be wrong due to their intense fear of rejection. They have difficulty doing things on their own, and their most pervasive fear is that of being abandoned. Avoidant personality disorder is characterized by social inhibition and feelings of inadequacy. Individuals who suffer from this disorder are extremely sensitive to negative feedback from others. They avoid social activities due to their fear of having to participate.

What defines rapid cycling in bipolar I d/o?

occurence of four or more mood espisodes in 1 yr

What is the most common side effect of MAOIs?

orthostatic hypotension

A 30-year-old man presents with periodic sensations of choking, numbness in his feet, tingling in his legs, cold sweats, and dizziness. He reveals that he used to feel this way as a child whenever he went to the mall with his mother. These feelings have been increasing over the past few years. The patient's episodes occur while checking out at the grocery store, while driving or walking over bridges, and while looking out his 19th-floor office window. What psychiatric diagnosis fits this patient best, after ruling out substance use and any precipitating medical condition? Answer Choices 1 Panic disorder with agoraphobia 2 Social Phobia 3 Posttraumatic stress disorder 4 Generalized anxiety disorder 5 Obsessive-compulsive disorder

panic attack with agoraphobia All of the answer choices are anxiety disorders, i.e., they present as anxiety far out of proportion to the actual situation. What distinguishes them is the pattern of each disorder's symptomatic manifestation. Panic disorder with agoraphobia is described as panic attacks not due to direct physiological effects of a substance or general medical condition. Phobias manifest as intense anxiety that is routinely elicited by specific situations (crowds, escalators, standing in lines, high places) or the presence of specific things (bees, water, snakes, spiders). A social phobia is a marked and persistent fear of 1 or more social performance situations in which the person is exposed to unfamiliar people or the possible scrutiny of others. Posttraumatic stress disorder would only be indicated if all of the fearful situations were related to the same general traumatic event(s). Generalized anxiety disorder is "free-floating" and not relative to specific situations. Obsessive-compulsive disorder involves behavioral or ideational loops that seem intended to "ward off" the experience of anxiety.

What is required in the criteria for a diagnosis of panic disorder in addition to patient having panic attacks?

patient must have panic attacks followed by 1 month of more of continuous worry about having another attack or their consequences and or maladaptive behavior changes e.g avoidance of psssible trigger.

A 15-year-old female comes into your office with multiple symptoms of an eating disorder. What is the single feature that would lead you to diagnose anorexia rather than bulimia or binge eating disorder? A Binge eating behaviors B Compensatory measures such as purging C Preoccupation with body weight D Refusal to maintain normal body weight E Strict focus on dietary intake

refusal to maintain normal body weight D The diagnosis of anorexia requires that the patient refuse to maintain a normal body weight (D). All the other behaviors mentioned (A, B, C, E) may be shared between anorexia and bulimia. People with binge eating disorder (not fully recognized in the DSM IV-TR) display binge eating without compensatory measures, resulting in obesity.

What symptoms and signs characterize pseudoparkinsonism? What is the treatment?

remulousness in the hands and arms, rigidity in the arms and shoulder, bradykinesia, akinesia, hypersalivation, maksed facies, and shuffling gait. Treated by reducing AP dosage or adding an anticholinergic agent such as benztroping or diphenhydramine.

What is negativism?

resistance to any and all attempts to have the patient move or allow themself to be moved.

What adverse side effect is Thoridazine (Mellaril) associated with?

retinal deposits that can progres to blindness.

A 30-year-old woman has been acting strangely for several weeks. She attends conscientiously and regularly to her work in an insurance office, but lately she has been talking about her co-workers "plotting against her". She claims that she is the sole possessor of a digital encryption key that, if discovered by the wrong people, could result in the collapse of the entire U.S. economy. Despite the dangerous implications of this belief, if it were true, she appears to be oddly unaffected by it. In the absence of evidence of substance abuse or of a precipitating general medical condition, what psychiatric diagnosis might be suggested at this time? Answer Choices 1 Dementia 2 Schizophreniform disorder 3 Schizophrenia 4 Autism 5 Hypomania

schizophreniform disorder Schizophreniform disorder has symptoms in common with schizophrenia: Delusions (unrealistic beliefs, e.g., grandeur, persecution) Hallucinations (unrealistic sensations or perceptions) Disorganized speech Disorganized or catatonic behavior Negative symptoms (flattened affect, alogia, avolition) The primary difference between the 2 is duration. Schizophreniform disorder is diagnosed when psychotic signs have been present less than 6 months. Consequently, it is often designated as a "provisional" diagnosis. Dementia is always correlated with a physiological condition. Autism is a developmental disorder that is primarily neuromuscular and is evident from early childhood. Hypomania refers to a disorder of elevated or irritable mood. Hallucinations and delusions are not symptoms of dementia, autism, or hypomania.

What is the role of antidepressants in bipolar disorder? How should they be dosed?

should only be used as adjunctive tx when depressive episodes develop during maintenance with a mood stabilizer. There is a high rate of antidepressant indurced mania so antidepressant should be tapered and d/c as soon as depressive sxs remit.

A surgery resident moves into a new apartment. His new roommate is a healthy 28-year-old man. With some embarrassment, the roommate asks for medical advice for a problem he has not yet discussed with any doctor. He reports that he is unable to urinate in a public urinal; however, he experiences no difficulty at home. What is the most likely diagnosis? Answer Choices 1 Agoraphobia 2 Generalized anxiety disorder 3 Obsessive-compulsive disorder 4 Benign prostatic hypertrophy 5 Social phobia 6 Stress reaction

social phobia A phobia is an intense, irrational and persistent fear of a specific object, activity, or situation. Social phobia involves such a fear of being embarrassed or humiliated while in social situations. Many men are uncomfortable urinating in public restrooms because of the lack of privacy. This rarely manifests as anything more than a mild apprehension; however, the degree of apprehension in this patient is obviously very high, and it qualifies the situation as a social phobia. Agoraphobia is a fear of open spaces. In generalized anxiety disorder, anxiety dominates the clinical symptoms. In obsessive-compulsive disorder, patients experience recurrent, intrusive thoughts (obsessions) that are relieved to some extent by engaging in repetitive, ritualistic behaviors (compulsions). In the case of benign prostatic hypertrophy, hesitancy and inability to urinate does not improve in the absence of an audience. A stress disorder rarely manifests in such a manner. There are no other symptoms related to stress.

What is the natural course of Premenstrual Dysphoric d/o?

sxs may worsen prior to menopause but cease thereafter.

What three constituents of symptoms are needed for major depressive disorder diagnosis?

syndrome of mood, physical, and cognitive impairments

What is the course of SSRI dicontinuation syndrome? What treatment is required?

syndrome that can occur within 1-3 days of abruptly stopping an SSRI though is it NOT lethal! However, restarting the patient back on the SSRI and then initiating a taper is a reasonable choice

typical (1st generation) anti-psychotics E Typical antipsychotics (eg, haloperidol, chlorpromazine, fluphenazine) can produce pseudoparkinsonism via blockade of dopamine (D 2 ) receptors in the nigrostriatum. Symptoms can include akinesia, bradykinesia, mask-like facial expression, tremor, cogwheel rigidity, and postural abnormalities. Tardive dyskinesia may also occur, as the reported incidence with first generation antipsychotics ranges from 0.5% to 62%.

What is a parasomnia?

unusualy sleep-related behaviors in contrast to dysomnias which are characterized by insufficient, excessive, or altered sleep behaviors.

Generally, patients who are malingering: A use illness to attain a goal B have avoidant personalities C follow prescribed treatment regimens D have a history that agrees with their physical symptoms

use illness to attain a goal A Patients who are malingerers do not want to improve until their goal is met. Goals may be financial, occupational, or legal. These patients will act differently when they think they are not being observed. They may fake their symptoms in order to be admitted to a hospital or to obtain drugs. These patients have an antisocial personality disorder.

Generally, patients who are malingering: A use illness to attain a goal B have avoidant personalities C follow prescribed treatment regimens D have a history that agrees with their physical symptoms

use illness to attain a goal Patients who are malingerers do not want to improve until their goal is met. Goals may be financial, occupational, or legal. These patients will act differently when they think they are not being observed. They may fake their symptoms in order to be admitted to a hospital or to obtain drugs. These patients have an antisocial personality disorder.

When do the earliest symptoms of alcohol withdrawal usually begin?

usually start witin 6-24 hrs after patients last drink.

What is the second most common caruse of major neurocognitive disease?

vascular cognitive impairment

What first line antidepressant should NOT be used in patients with history of HTN?

venlafaxine

What criteria for autism spectrum disorder is no longer listed in the DSM 5?

verbal language deficites no longer seperate criterion in DSM 5 for ASD

What black box warning appears on Atomoxetine aka Straterra?

warning about the possibility of suicidal ideation.

A 24-year-old male has an eight-month history of loose thought associations, social withdrawal, auditory hallucinations, and deterioration in his personal appearance and hygiene. Upon examination, he is noted to have a flat affect, perceptual distortions, and behaves like he is detached from his own actions. An atypical antipsychotic medication is chosen for this patient. Which of the following medications is classified as an atypical antipsychotic? A Chlorpromazine (Thorazine) B Haloperidol (Haldol) C Loxapine (Loxitane) D Molindone (Moban) E Olanzapine (Zyprexa)

zyprexa Olanzapine is the only atypical antipsychotic listed in the given answers. The remainder of the medications listed are typical antipsychotic medications.

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