USMLE Step 2 Psych

Q1057. A 25yo attempted to OD on sleeping pills after her boyfriend broke up with her. She tells the intern that he is so caring and competent and that she has never met such a doctor. She complains that no one understands her and that the only one who can really help her is the intern. What defense mechanism is this?

"A1057. Primitive Idealization; (external objects are unrealistically endowed with great power and are either ""all good"" or ""all bad."" All good objects are ideal and omnipotent; the badness of the others are also greatly inflated. Splitting difference has the abrupt shifting of an object from good to bad or visa-versa)"

Q147. What do the body dysmorphic disorder search for professionally?

"A147. Plastic Surgeons; Michael Jackson; patients cover/hide their ""deformities""; Usually young women"

Q539. What drugs are used to treat PTSD and why?; which drug class is NOT effective in PTSD?

"A539. Clonidine: to decrease the re-experiencing of PTSD; SSRIs: to reduce the ""numbness"" associated w PTSD; BZ not effective"

Q612. What are the 5 Axes in the Multiaxial Classification?

"A612. Axis I: Clinical Disorders, ""Chief complaint"";; Axis II: Personality Disorders,; Mental Retardation;; Axis III: General Medical Conditions;; Axis IV: Psychosocial and Environmental Problems;; Axis V: Global Assessment of Functioning"

Q635. A few days after starting neuroleptics a patient gets tachycardia, HTN, rigidity, agitation and a clouding of consciousness. His labs show an increased CK, Myoglobinuria, WBC and LFT. Dx?; Tx? (3 possible)

"A635. Dx: Neuroleptic Malignant Syndrome; Tx: ir could be ""BAD"" if you don't give either Bromocriptine, Amantidine or Dantrolene"

Q674. A 10yo boy was raped by his uncle. Whenever he thinks of the rape he goes to the sink and washes his hands 100 times. Dx?; First line Tx?

"A674. Post-Traumatic Stress Disorder (This is a ""Repetition Compulsion"" to decrease the boy's level of anxiety; it is a repetitive behavior that stems from an INCIDENT, not like OCD); First line Tx: SSRI"

Q770. A 42-year-old, unemployed laboratory technician is admitted to the hospital for nausea, vomiting, and abdominal pain. She tells the physician that she had been diagnosed in the past with disseminated lupus erythematosus and that she had Hodgkin disease. She seems worried that an extensive medical workup failed to confirm any of the previous diagnoses or find a cause of her actual symptoms. She insists on being given meperidine to relieve her pain. On examination, the only physical findings are scars and some abscesses on her thighs. She explains that she had been intentionally injured by the nurses in a previous hospital. What is the most likely diagnosis?

"A770. Factitious disorder; (the individual deliberately feigns the signs of a medical or mental disorder to assume the ""sick"" role. The symptoms are under voluntary control and cannot be explained by other underlying condition. External incentives for such behavior are usually absent. The disorder is severely incapacitating to the patients, since they usually have multiple hospitalizations and submit themselves to invasive procedures and surgeries. This is unlike Hypochondriasis which involves the excessive and pervasive preoccupation with the fear of having a serious illness based on a misinterpretation of bodily symptoms. It must be present at least 6 months and causes significant impairment in all areas of life)"

Q827. Name (4) Typical Antipsychotics

"A827. (""-AZINEs"") + Haloperidol:; ChlorpromAZINE;; ThioridAZINE;; FluphenAZINE;; Haloperadol"

Q828. What are the (2) suffixes (endings) for Atypical Antipsychotics?; Name (4) drugs

"A828. (""-APINE"") or (""-IDONE""):; ClozAPINE;; OlanzAPINE;; QuetiAPINE;; RisperIDONE;; (ZiprosIDONE)"

Q873. Dx:; child who is normal until the age of 2, then loses skills in language, behavior, bowel/bladder, play or motor

"A873. Childhood Disintegrative Disorder; (skills begin to ""Disintegrate"")"

Q874. Definition:; Coprolalia; what Dx is it seen in?

"A874. ""Cursing""; Tourette's Disorder"

"Q925. A 24yo woman has olfactory hallucinations several times a week for the past month. She smells burning rubber and rotting flesh. Her friends report seeing her ""staring off into space,"" although she is unaware of this behavior. She has no other psychiatric symptoms. She has a history of a concussion resulting from a car accident 1 year previously. Dx?; How is it coded?; Tx? (2 together)"

"A925. Dx: Psychosis caused by a General Medical Condition (Seizure disorder); Coded: ""Psychosis secondary to a general medical disorder"" in Axis I; ""Seizure disorder"" in Axis III; Tx:; 1. Underlying problem; 2. Antipsychotics for psychosis"

Q985. A 30yo woman presents with a chief complaint of being unable to finish a project. She had difficulty finishing college in 4 years as well. She is cannot pinpoint what is wrong with her. She has no long-term love relationship, although she would like to have one. Otherwise the patient has no psychiatric signs or symptoms. She has no psych History and her only medical problem is well-controlled HTN. She has no History of drug or ETOH use. Dx?; Tx?

"A985. Dx: Neurosis; (not a DSM-IV Dx, ""trouble working and loving""); Tx: Insight-oriented Psychotherapy"

Q001. What is akathisia?

A001. psychomotor agitation; shoes anxiety

Q002. How do you spot akathisia?

A002. patients is moving all the time and can't help it. Moving fingers or legs

Q003. Tx for Acathisia?

A003. 1) decrease dose; 2) B-blockers; 3) benzodiazepines

Q004. What is the difference between hallucination and illusion?

A004. illusions are what magicians do... Illusions are stimulus present but miss perception of them; Hallucination is no stimulus and perception

Q005. What are the MC hallucination types?

A005. Auditory 2/3's; Visual 1/3; Tactile; Smell

Q006. What pathology is involved with auditory hallucinations?

A006. schizophrenia; Psychotic Disorder

Q007. What is visual hallucination due to?

A007. Drugs; Organic Tumor of Visual pathways

Q008. What is tactile hallucination associated with?

A008. MC drugs; Cocaine; Alcohol Withdrawal (Delirium Tremens)

Q009. What pathology is associated with blunted/flat affect?

A009. Schizophrenia; Parkinson

Q010. What does it mean when the mood and affect are incongruent?

A010. the person says he is happy but his body language (affect) doesn't reflect it

Q011. What is associated with mood and affect incongruency?

A011. Psychotic Disorder

Q012. What is projection?

A012. wishes to someone else; she doesn't like me... (really I don't like her); You are cheating on me (really I am cheating on you)

Q013. What personality has projection?

A013. Paranoid Personality; all attacking them

Q014. What is denial?

A014. use to avoid painful; I didn't have a heart attack; Woman who's husband died but she cooks for 2 and places the table for two

Q015. Patient comes in with an MI?; Telemetry, patient takes medication with leads on himself. Patient says I didn't have a Heart Attack... What is the next step?

A015. DO NOT refer to psych; Confront denial; Interpret denial with dream analysis; Find out patients view about death; Do nothing; Answer is DO NOTHING; Patients defense mechanism is not interfering with Tx

Q016. If patient spits out pill, takes all I.V. lines out... Patient in denial then you need to?

A016. Ask the patient why

Q017. When patient thinks all good or all bad, Splitting... Which personality uses this?

A017. Borderline; good is idealized; bad is devalued; The morning staff is the best

Q018. What is somatization?

A018. Psychic converted to bodily symptoms

Q019. What personality is associated with somatization?

A019. Physical exam normal; Somatoform Disorders; 1) Hypochondriasis; 2) Body Dysmorphic

Q020. Tx of postpartum blues?

A020. no treatment

Q021. What is the Tx for postpartum depression?

A021. SSRIs; Antidepressants

Q022. What are the Tx for Postpartum Psychosis?

A022. Antipsychotics; Mood stabilizers; antidepressants

Q023. Stages of Death and Dying?; Stage I

A023. Shock and Denial; It's not possible

Q024. Stages of Death and Dying?; Stage II?

A024. Anger; Why me?

Q025. Stages of Death and Dying?; Stage III?

A025. Bargaining; Night before test going to pray

Q026. Stages of Death and Dying?; Stage IV?

A026. Depression

Q027. Stages of Death and Dying?; Stage V?

A027. Acceptance

Q028. Do the stages of death and dying are in what order?

A028. Not in order; It can be any stage, in any order

Q029. How long does the person need to have the symptoms to diagnose schizophrenia?

A029. 6 months

Q030. How is Schizophrenia different from other psychiatric problems?

A030. - It tends to affect all the aspects of an individuals life; worst prognosis; 1/3 don't go back to their normal state continue with Disease

Q031. What are the risk factors?

A031. men get Disease younger 15-25; women 25-35

Q032. What is the worst prognosis?

A032. the younger the patient gets a Disease the worst prognosis; so men have a worst prognosis

Q033. What is the neurotransmitter unbalance of schizophrenia?

A033. Increase levels of DOPA; Also serotonins; (New drugs work on both)

Q034. How do patients develop Schizophrenia? Theories?

A034. Double Bind; Mother talked to you like an adult but treated you like a baby; mixed message from mother; you don't know what to do... in a bind

Q035. Another theory is High EE family? Expressed Emotions

A035. A family that has high emotions (Italians?); family very critical, intrusive, emotional

Q036. What is important about High EE family and relapse?

A036. Chances are very high that you will relapse and return to hospital; you go back to the same environment

Q037. Viral Theory for Schizophrenia?

A037. They believe that viruses infect patients when they are born since lots of patients are born in winter and early spring

Q038. Downward Drift or Social Causation theory?

A038. Schizophrenia in low-socioeconomic status (low SES)

Q039. Social Causation Theory?

A039. Different stress levels; low SES with high stress

Q040. Prevalence vs. genetics?

A040. Monozygotic (47%)increase; Dizygotic 12%

Q041. What is schizophrenia percentage in the general population?

A041. 1%

Q042. One parent with schizophrenia what is the chance?

A042. 12%

Q043. Two schizophrenic parents??

A043. 40%

Q044. Monozygotic Twins?

A044. 47%

Q045. Dizygotic Twins?

A045. 12%

Q046. First-degree relative with schizophrenia?

A046. 12%

Q047. Second-degree relative with schizophrenia?

A047. 5-6% chance

Q048. What percentage was the chance for bipolar disorder? two parents having bipolar

A048. 50-75%

Q049. Symptoms of Schizophrenia?

A049. Auditory Hallucinations (2/3's); Visual Hallucinations; Bad voices; You are evil, terrible; kill yourself

Q050. Command voice hallucinations?

A050. Tell you to do things; most patients hears voice and don't pay attention to it; but there are some that do

Q051. What is a delusion?

A051. false belief; mostly bizarre; not believable (makes no sense in what they believe)

Q052. What is catatonia?

A052. not moving

Q053. What are negative symptoms?

A053. flat affect; social withdrawal; cognitive defects

Q054. Are Schizophrenics functional?

A054. No, usually lose jobs; Withdrawal

Q055. What is a saccadic eye movement?

A055. Irregularity of eye movements; REM like; trade mark (Pathognomonic)

Q056. What is another characteristic of schizophrenic behavior?

A056. Scanning behavior; Hypervigilance; (Paranoid)

Q057. What is a common finding in a CT scan of the head?; Or MRI

A057. Lateral and Third Ventricular Enlargement

Q058. What other patients have ventricular enlargement?

A058. Alzheimer patients have it

Q059. What is associated with ventricular enlargement?

A059. the larger the enlargement; the greater the negative symptoms; worst prognosis

Q060. What do you find in a PET scan?

A060. hypoactivity of frontal lobes; no areas of pickup; no red/yellow; black areas (frontal)

Q061. What is the frontal lobe responsible for?

A061. - personality; abstract thinking; higher order function; ability to change

Q062. What kind of answers do you get in abstract thinking?

A062. what does a rolling stone gathers no moss; it is rolling so nothing sticks

Q063. How is schizophrenia correlate with IQ?

A063. low IQ

Q064. Schizophrenia associated with problems in neuropsychological tests?

A064. problems in frontal lobe

Q065. What psychological tests are worst in Schizophrenia?

A065. Personality test; Projective tests are worst; since they will give bizarre answers; Ink blot

Q066. Tx of Schizophrenia?

A066. Antipsychotics; typical; newer atypicals

Q067. What is the first line tx of schizophrenia?

A067. Atypical Drugs; since less side effects; (better compliance)

Q068. What is special about the atypical drugs?

A068. both positive and negative symptoms

Q069. What symptoms do the typical antipsychotics cover?

A069. Only positive symptoms

Q070. What is the theory of therapy?

A070. the sicker the patient the less intrusive the therapy; the sicker the patient the more intrusive therapy

Q071. What is the most intrusive therapy?

A071. Psychoanalisis; therapist sits behind you; patient says whatever is on their mind free association

Q072. What is supportive psychotherapy?

A072. how is your job; the sickest patient since you want to gain their trust

Q073. What is differential diagnosis for Schizophrenia?

A073. Rule out organic; Drugs (psychostimulants cocaine/amphetamine); Looks paranoid/scanning the room

Q074. What is the first test?

A074. Urine test; Cocaine stays in body for 3-4 days

Q075. What does hallucinogens produce?

A075. LSD; Alcohol withdrawal

Q076. What other medical condition is associated with bizarre disorders, hallucinations in the brain?

A076. Temporal Lobe Epilepsy/Seizures

Q077. What other psychiatric disorders are part of the differential?

A077. Personality; Schizoaffective

Q078. What other disorders are involved?

A078. Malingering; Factitious Disorder (physical and psychological symptoms)

Q079. How long do mood disorders last in schizophrenia?

A079. brief/short; so different

Q080. What are some medical causes of schizophrenia like?

A080. - HIV (psychotic); Steroids (rage); tumors; CVAs

Q081. What personality disorder is involved in the differential?

A081. - Schizotypal; Schizoid (short live psychotic episodes); Borderline (short live psychotic episodes); they go back to normal though; functioning patients in society

Q082. Types of Schizophrenia?

A082. - Paranoid; Disorganized type; Catatonic Type; Undifferentiated type; Residual

Q083. What is the MC type of Schizophrenia?

A083. Paranoid Type; Later in Life (so better prognosis)

Q084. What is characteristic of Disorganized type?

A084. Bizarre behavior; dressed inappropriate; making faces; laughing; making animal noises; masturbating in public

Q085. What is the prognosis of disorganized type?

A085. they have the worst prognosis since they get it a young age; <25 y.o.

Q086. What is the hallmark of Residual type?

A086. Negative symptoms; flat affect, anhedonia, attention deficit, isolation; they don't hear voices (but they use to probably)

Q087. What is the theme in Paranoid Schizophrenia?

A087. Persecution

Q088. What is the theme catatonic type?

A088. psychomotor; excitation or not moving

Q089. What is the theme of disorganized type of schizophrenia?

A089. Weird; everything is weird/bizarre; look/talk/behave

Q090. What is the theme of Residual type?

A090. No hallucinations/delusions; Homeless; Negative Symptoms

Q091. What is the theme for Undifferentiated type?

A091. not clear

Q092. What is the schizophreniform disorder?

A092. duration of symptoms is 3 months; hallucination (auditory); delusions (bizarre); disorganized speech; negative symptoms; Duration needs to be less than 6 months

Q093. What is the prognosis of schizophreniform disorder?

A093. Better than schizophrenia since the duration is less

Q094. What is a risk factor of schizophreniform disorder?

A094. Suicide

Q095. What is the tx? How long is the Tx

A095. Antipsychotics; 3-6 months

Q096. What is schizoaffective disorder?

A096. Waste paperbasquet patient; Mood symptoms; Psychotic Symptoms; can differentiate patient; pure garabage; both mood disorder and schizophrenia; major depression, mania

Q097. What is better major depression or schizophrenia?

A097. better is to have major depression; better prognosis

Q098. Major Depression vs. Schizoaffective Disease?

A098. Major depression has a better prognosis; all mood

Q099. Schizoaffective vs. schizophrenia?

A099. Schizoaffective is better prognosis; since has mood disorder

Q100. Family history of Mood Disorder vs. Psychotic Disorders?

A100. History of Mood Disorder has a better prognosis on the patient

Q1000. Where is the brain lesion:; a 17yo male cannot remember anything that happened after he had a bout of encephalitis, but he has no difficulty with remote memories

A1000. Hippocampus; (Herpes encephalitis causes bilateral lesions in the hippocampus causing anterograde amnesia and damages the amygdala causing Kluver-Bucy syndrome)

Q1001. A patient is diagnosed with Wernicke-Korsakoff's syndrome. What part of the brain is affected?

A1001. Mammillary bodies; (dependent on Thiamine)

Q1002. Stimulation of what nucleus reduces appetite?; A dysfunction in this nucleus, causing hyperphagia, is seen in what syndrome?; Which nucleus stimulates appetite?; A dysfunction or ablation of this nucleus can lead to what?

A1002. Reduces eating: Ventromedial nuclei; dysfunction = Prader-willi; Increases eating: Lateral nuclei; dysfunction = fatal Anorexia

Q1003. A 70yo with a dementing disorder dies in a car accident. During the last 5 years his personality changed dramatically. Path exam of the brain shows frontal-temporal atrophy, gliosis of frontal lobe white matter, intracellular inclusions and swollen neurons. Dx?

A1003. Pick's Disease

Q1004. A young man smells burnt rubber, then turns his head and upper body to the right, makes chewing movements and fumbles with his clothes. This lasts one minute and he appears dazed. Dx?; where is the problem?

A1004. Partial Complex Seizure; Location: Temporal lobe

Q1005. What psychiatric disorder is assoc with Cushing's syndrome?

A1005. Depression

Q1006. a 40yo cognitive functions have deteriorated in the past couple years to the point that she needs a nursing home. Since this began she has become depressed, irritated and is prone to aggressive outbursts. She also has irregular, purposeless and asymmetrical movements of her face, limbs and trunk which get worse when she is upset. Her MRI shows atrophy of the caudal nuclei and putamen. Dx?

A1006. Huntington's Disease

Q1007. A healthy 62yo male undergoes a corneal transplant. Three months later he is profoundly demented and his EEG shows periodic bursts of electrical activity superimposed on a slow background. Dx?

A1007. Creutzfeldt-Jakob Disease

Q1008. A 64yo man completely ignores the left side of his body. He also has difficulty with simple calculations. Where is the lesion?

A1008. Parietal Lobe

Q1009. What Drug:; A woman who is treated with an antipsychotic develops an uneven pigmentation over her arms, shoulders and face with a trip to the beach

A1009. Chlorpromazine; (side effect of low-potency neuroleptics)

Q101. Tx for Schizoaffective Disease?

A101. Tx with Schizo part with antipsychotic and Antidepressant; First Antipsychotic since worse symptoms treated first; If you start with mood tx then you worsen the psychosis

Q1010. Drug of Choice:; a patient with schizophrenia has multiple relapse due to non-compliance

A1010. Haloperidol decanoate; (injectable medications are effective in decreasing the rate of relapse)

Q1011. what are the (2) atypical antipsychotics that are proven to be useful for the negative symptoms?

A1011. Clozapine; Olanzepine

Q1012. Dx:; A delusional disorder that develops in a person who is in a close relationship with another person that has a psychotic disorder with delusions

A1012. Shared Psychotic disorder

Q1013. Dx:; Atrophy of the Caudate

A1013. Huntington's Disease

Q1014. DOC:; 1. Melancholic Depression; 2. Atypical Depression

A1014. 1. TCAs; 2. MAOIs

Q1015. (2) drugs used to Tx hyperarousal Sx of PTSD

A1015. 1. Clonidine (alpha-2-agonist); 2. Beta-blocker

Q1016. What medical condition is commonly confused with Conversion disorder?

A1016. Multiple Sclerosis

Q1017. For a Dx of Hypochondriasis, how long do the Sx need to be present?

A1017. 6 months

Q1018. what medication that helps with anxiety can lead to sexual dysfunction?; (2)

A1018. 1. Propanolol; 2. SSRI

Q1019. A 27yo female with a history of bipolar disorder is admitted to the hospital in a manic state. She is 4 weeks pregnant and refuses to take any medication associated with birth deformities in humans. Which medication is appropriate?

A1019. Olanzapine; (atypical antipsychotic approved for short-term mania use)

Q102. Delusional disorder?

A102. Scenario is possible; Delusions are believable; like wife trying to kill patient

Q1020. Neuro Dx:; Hippocampal atrophy

A1020. Alzheimer's Disease

Q1021. Neuro Dx:; Occipital Hypoprofusion

A1021. Lewey Body Disease

Q1022. A 19-year-old man is brought to the emergency room by his distraught parents, worried about his vomiting and profuse diarrhea. On arrival, his pupils are dilated, his blood pressure is 175/105, and his muscles are twitching. His parents report that these symptoms started two hours earlier. For the past couple of days he has been home-bound due to a sprained ankle and, during this time, he has been increasingly anxious and restless, has been yawning incessantly and has had a runny nose. Dx?

A1022. Heroin withdrawal

Q1023. Tx for mild Opioid withdrawal Sx?; for general Opioid withdrawal?

A1023. mild Sx: Clonidine; normal Sx: Naloxone

Q1024. Tx for Alcohol withdrawal

A1024. Diazepam

Q1025. MOA of cocaine

A1025. inhibits the reuptake of NT in the synapse

Q1026. what is the therapeutic intervention most likely to be effective in PCP intoxication?

A1026. Isolate patient in a quiet, dimly lit room to minimize sensory input

Q1027. According to the cognitive model Depression is a consequence of what?

A1027. Maladaptive negative beliefs

Q1028. What does Cognitive psychotherapy focus on?

A1028. Faulty ideas and beliefs

Q1029. The parents of a 20-year-old man recently diagnosed with paranoid schizophrenia are having difficulty dealing with their son's decline in function. Once an honor student with many friends and an active social life, he now spends his days barricaded in his room, surveying the street with binoculars, watching out for his "enemies."; What is a helpful family therapy intervention?

A1029. Teaching the parents about the importance of reducing expressed emotions in the family transactions

Q103. Delusion Disorder patients characteristic?

A103. Reliable; no impairment of level of fx; thoughts are logical and coherent

Q1030. A 34-year-old mathematician; is in psychoanalytic psychotherapy because of anxiety, depression, and marital problems, which seemed to begin shortly after the death of his mother. They had an intensely dependent and ambivalent relationship with each other. When the patient discusses his mother and her death, he is unemotional and detached. This is an example of what defense mechanism?

A1030. Isolation of Affect; (splitting off the affective component, usually unpleasant, from an idea or thought)

Q1031. Defense mechanism:; A man visits his domineering and demanding elderly mother at her nursing home. When she starts browbeating him for his "lack of devotion," he has a sudden urge to shout at her. The next day, when he talks with his therapist about his visit, he minimizes the impact of his mother's constant badgering and has no memory of his brief moment of rebellion.

A1031. Repression

Q1032. Defense Mechanism:; A 34-year-old auto mechanic has a lifelong grudge against his more successful older brother, who, in his eyes, was their parents' favorite, but he has a hard time admitting it even to himself. Instead, he tells his friends that his brother envies his good looks and his success with women.

A1032. Projection; (the attribution of one person's unacceptable impulses or feelings to others; in this case it is Jealousy)

Q1033. A man who has psychotic depression is placed on imipramine and perphenazine. When he develops Parkinsonian symptoms, benztropine mesylate 2 mg per day is added to the medications he already receives. One week later, his wife reports that the patient has become unusually forgetful and that he appears disoriented when he gets up during the night to use the bathroom. On physical examination, the man appears slightly flushed, his skin and palms are dry, and he is tachycardic. He cannot remember the date and has trouble concentrating. Dx?

A1033. Anticholinergic syndrome; (Phenothiazides, TCAs and anti-parkinson agents all have anticholinergic properties; the acton becomes additive when administered together)

Q1034. A middle-aged man with depression takes daily doses of warfarin as prophylaxis for pulmonary embolism. His doctor is baffled because the patient's warfarin dose needs to be readjusted almost every week to maintain an optimal level of anticoagulation. What antidepressant can cause this effect on Warfarin?

A1034. SSRIs; (specifically Sertraline, Paroxetine, and Fluvoxamine); (they can displace warfarin from their binding sites, increasing the levels of biologically active warfarin)

Q1035. An 8-year-old boy with ADHD has been constantly clearing his throat and blinking his eyes for the past three weeks, since he was placed on methylphenidate. These symptoms have been present, on and off, for several years, but they have been greatly worsened by the stimulant. What medication can be used to treat both ADHD symptoms and tics?

A1035. Clonidine; (Alpha-2 adrenergic agonist that is helpful in the treatment of Tourette's disorder and in the Tx for kids that develop ADHD with tics from other stimulants)

Q1036. For several weeks, a 72yo retired physician with Parkinson's disease and mild dementia has been talking about "those horrible people that come to bother me every night." He is convinced that someone is plotting against him and has nailed his window shut for fear of intruders. More recently he has started showing signs of thought disorder, mostly in the evening and at night. What antipsychotic med is least likely to worsen; the patient's Parkinsonism?

A1036. Clozapine; (preferred Tx for psychotic Sx in a person with Parkinsons)

Q1037. A 72-year-old man with a long history of recurrent psychotic depression is hospitalized during a relapse. He has prostatic hypertrophy coronary heart disease, and recurrent orthostatic hypotension. Which is the most appropriate antipsychotic medication for this patient?

A1037. Haloperidol; (high-potency neuroleptics have low anticholinergic side effects)

Q1038. what medication class can be a sedative, but actually supresses REM?

A1038. TCAs

Q1039. what OTC med can cause severe HTN crisis in someone taking a MAOI?

A1039. Pseudoephedrine; (a synpathomimetic agent)

Q104. Delusional vs. Schizophrenia?

A104. Non-bizarre delusion 1 month; schizophernics not working; not functioning

Q1040. what is the most worrisome cardiovascular AE of a TCA?

A1040. Slowing of cardiac conduction

Q1041. what do Cyproeptadine, Bethanecol, Amantidine, Bupropion and Yohimbine have in common with relation to an SSRI side effect?

A1041. all reverse the effects of SSRI Sexual Dysfunction

Q1042. Tx for Serotonin Syndrome

A1042. Stop medications

Q1043. a 61yo male is broght to the ED b/c his family states that he has been yelling, spitting and pulling other peoples noses and ears unexpectedly. He also began using foul language and is openly promiscuous. He has no medical or psych Hx. The patient's uncle had similar behavior and died shortly after being placed in a nursing home. During the exam the patient has trouble finding his words and keeps repeating the doctors commands while giggling inappropriately. Dx?

A1043. Pick's Disease; (a frontotemporal dementia that presents with behavioral changes initially)

"Q1044. Thought disturbance example after being asked how the patient got to the hospital:; ""I was reading a great book at home and after I finished it I drove myself to the hospital"""

A1044. Circumstantiality

"Q1045. Thought disturbance example after being asked how the patient got to the hospital:; ""I started driving but I was thinking about my history. History books are great. I once wrote a paper on Alexander the Great. I do well in college."""

A1045. Flight of Ideas

"Q1046. Thought disturbance example after being asked how the patient got to the hospital:; ""I really like history books and I was reading one at home today while eating tuna fish."""

A1046. Tangentiality

"Q1047. Thought disturbance example after being asked how the patient got to the hospital:; ""The spy in the book I was reading was real, and he was watching me through the pages. He knew who I was."""

A1047. Loose Associations

Q1048. MC side effect of Olanzapine

A1048. Sedation (30%)

"Q1049. In what psychiatric disorder will you find ""Leaden Paralysis""?; Drug class of choice?"

A1049. Major Depressive disorder with Atypical features; DOC: MAOIs

Q105. What are the types of delusional disorders?

A105. erotomanic; jealous; grandiose; somatic; mixed

Q1050. when does Stranger anxiety develop fully in infants?

A1050. 8 months (32 weeks)

Q1051. A 35yo woman with bipolar disorder has noticed an increase in appetite with significant weight gain as well as hair loss. Her thyroid panel is normal. What bipolar medication was she prescribed?

A1051. Valproic Acid; (common AE are nausea, sedation, weight gain, transient hair loss and increased LFTs; rare AE are hepatitis, pancreatitis, and decreased platelets and platelet functions)

Q1052. What are the (8)* stages and ages of Erikson's stages of Ego development?

A1052. TAG It RISE:; 0 - 18 months: Trust vs. Mistrust; 18m - 3 years: Autonomy vs. Shame; 3 - 5 years: Initiative vs. Guilt; 5 - 13 years: Industry vs. Inferiority; 13 - 21 years: Identity vs. Role Confusion; 21 - 35 years: Intimacy vs. Isolation; 35 - 60 years: Generativity vs. Stagnation; 60+ years: Ego Integrity vs. Despair

Q1053. a 22yo woman with a history of depression is found groggy and minimally responsive in her home. On exam she is obtunded and complains of blurry vision. She has enlarged pupils and PVCs with a rate of 120. A Foley is placed and yields 800ml of urine. An overdose is presumed. What drug did she take?

A1053. TCA; (prominent anticholinergic properties - mydriasis, urinary retention and tachycardia; also TCAs cause arrhythmias)

Q1054. What is the initial step in management of a patient with delirium?

A1054. Protect the patient from unintentional harm

Q1055. A 52yo woman with a history of mitral valve prolapse, MI and DM has been recently Dx with panic disorder. She is obese, has a history of alcohol dependence and frequent history of Hypoglycemia due to poor control of blood sugar. What condition has a demonstrated association with panic disorder?

A1055. Alcohol Dependence; (ETOH and substance dependence occurs in about 20 - 40% of all patients with panic disorder)

Q1056. A 50yo woman presents with paresthesias, gait disturbance, motor weakness and visual defects. Dx?; What is affected in the Brain?

A1056. Multiple Sclerosis; brain: Focal demyelination and Gliosis of Periventricular white matter; (generally begins before age 55 and more common in females)

Q1058. What (2) types of disorders use Hypnosis as a form of treatment?

A1058. 1. Conversion disorder; 2. Dissociative disorder

Q1059. Another name for Childhood Disintegrative disorder?

A1059. Heller Syndrome

Q106. What are erotomanic delusional disorder?

A106. Patient believe that a famous person is in love with them; brad pitt; Billy Jean think Michael Jackson made the song for her; Stalker

Q1060. An adolescent male presents with hypersomnia, hyperphagia, sexual disinhibition and some psychosis. Dx?

A1060. Kleine-Levin syndrome; remember: Calvin KLEIN's male models like sex, sleep and food)

Q1061. What chromosome is Wilson's Disease?

A1061. Chromosome 13

"Q1062. Which medication that begins with the letter ""P"" is for ADHD and contra-indicated in Tourettes?; Which with the letter ""P"" is for Tourettes and contra- indicated in ADHD?"

A1062. ADHD: Pimoline; Tourettes: Pimozide; (Alphabetical)

Q1063. what are the only (2) meds can be used in both ADHD and Tourettes?; (MOA)

A1063. 1. Clonidine; 2. Guanfacine; (both are alpha-2-agonists)

Q1064. Dx:; A child with hyperactivity, poor attention, depression, irritability, seizures and a severe language disorder.

A1064. Landau-Kleffner syndrome (LKS); (rare childhood epilepsy that results in severe language disorder); [LKS = Language-Killing and Seizures]

Q1065. Dx:; mental retardation, aggression, impulsivity, possible seizures and hamartomas in the brain, kidney, heart and skin

A1065. Tuberous Sclerosis; (autosomal dominant)

Q1066. what is the only FDA approved SSRI Tx for depression in kids?

A1066. Fluoxetine

Q1067. what SSRI has the greatest increase in suicidal rates in kids?

A1067. Paroxetine

Q1068. Dx:; repeated regurgitation and rechewing of the regurgitated food; How long must it be present?

A1068. Rumination; (present for 1 month)

Q1069. Dx:; a hereditary disease with the onset in childhood, characterized by dystonia, rigidity, difficulty with gait and speech, seizures and retinitis pigmentosa. Iron deposits are seen in the globus pallidus.

A1069. Hallervorden-Spatz

Q107. MC type of Delusional Disorder?

A107. Persecutory Delusional Disorder

Q1070. What is the number 1 predisposing factor of Narcolepsy?; what HLA is it associated with?

A1070. #1 factor: Dx in a first-degree relative; HLA-DR2

Q1071. Drug that treats Tourettes, Schizophrenia and Chronic Psychosis and has the AE of prolongation of QT intervals; (as well as TD and EPS)

A1071. Pimozide

Q1072. A 53yo man admitted to the inpatient psych unit for Tx of Bipolar disorder was found lying in the hallway. He is conscious but confused and the staff said has been sedated and confused for the past 24 hours. He was admitted one week ago and restarted on a bipolar med. Then 3 days ago he developed an upper respiratory infection and was treated with an Abx. Dx?

A1072. Carbamazepine Toxicity; (the antibiotic inhibited the metabolism causing patient's Sx)

Q1073. How is Psychoanalytic Psychotherapy different from other forms of BT with respect to focus and time?; (2)

A1073. Focus: the Past (ex: early childhood); Time: Multiple sessions per week are common

Q1074. What drug withdrawal necessitates admission to the hospital (more then any other street drug)?

A1074. Barbiturates; (withdrawal can lead to death)

Q1075. Fluoxetine

A1075. SSRI; decrease appetite, insomnia headache tremor Serotonin Syndrome (fever, myoclonus, mental status change, arrhythmia) used with MAOI

Q1076. Sertraline

A1076. SSRI; decrease appetite, insomnia headache tremor Serotonin Syndrome (fever, myoclonus, mental status change, arrhythmia) used with MAOI

Q1077. Paroxetine

A1077. SSRI; decrease appetite, insomnia headache tremor Serotonin Syndrome (fever, myoclonus, mental status change, arrhythmia) used with MAOI

Q1078. Citalopram

A1078. SSRI; decrease appetite, insomnia headache tremor Serotonin Syndrome (fever, myoclonus, mental status change, arrhythmia) used with MAOI

Q1079. Escitalopram

A1079. SSRI; decrease appetite, insomnia headache tremor Serotonin Syndrome (fever, myoclonus, mental status change, arrhythmia) used with MAOI

Q108. MC type of schizophrenia?

A108. Paranoid

Q1080. Buproprion

A1080. Atypical Antidepressants; treat OCD, pain, migraine; risk of seizures,; no sex side effect

Q1081. Venlafaxine

A1081. Atypical Antidepressant. for OCD, migraine; side: diastolic HTN

Q1082. Mirtazapine

A1082. Atypical Antidepressants; treat OCD pain migraine; Side: Weight gain, sedation

Q1083. Nefazodone

A1083. Atypical Antidepressants; treat OCD pain migraine; Side: sedation, headache, dry mouth

Q1084. Trazodone

A1084. Atypical Antidepressants; treat OCD, pain, migraine; Sleep and erectile dysfunction. Side: sedating, priapism

Q1085. Nortriptyline

A1085. TCA; Lethal with overdose owing to cardiac conduction arrhythmias (QT); Anticholinergic effects (dry mouth, constipation, urinary retention)

Q1086. Despiramine

A1086. TCA; Lethal with overdose owing to cardiac conduction arrhythmias (QT); Anticholinergic effects (dry mouth, constipation, urinary retention)

Q1087. Amitriptyline

A1087. TCA; Lethal with overdose owing to cardiac conduction arrhythmias (QT); Anticholinergic effects (dry mouth, constipation, urinary retention)

Q1088. Imipramine

A1088. TCA; Lethal with overdose owing to cardiac conduction arrhythmias (QT); Anticholinergic effects (dry mouth, constipation, urinary retention)

Q1089. Tranylcypromine

A1089. Depression MAOI; hypertensive crisis if taken with high Tyramine foods (cheese wine); Sexual side effects

Q109. What are the risk factors for delusional disorder?

A109. - onset about 40 years; Prognosis better; women (MC); recent immigration

Q1090. Phenelzine

A1090. MAOI; Hypertensive crisis with high tyramine; Sexual side effects

Q1091. TCA side effects

A1091. Convulsions, Coma Cardiac Arrhythmias

Q1092. Haloperidol

A1092. typical antipsychotics; Extrapyramidal symptoms (EPS); Hyperprolactinemia; Anticholinergic Effects( DRY mouth, urine, constipation); Neuroleptic malignant syndrome (fever, muscle rigid, autonomic instability, clouded consciousness)

Q1093. Droperidol

A1093. typical antipsychotics; Extrapyramidal symp (EPS); Hyperprolactinemia; Anticholinergic Effects( DRY mouth, urine, constipation); Neuroleptic malignant syndrome (fever, muscle rigid, autonomic instability, clouded consciousness)

Q1094. Fluphenazine

A1094. typical antipsychotics; Extrapyramidal symp (EPS); Hyperprolactinemia; Anticholinergic Effects( DRY mouth, urine, constipation); Neuroleptic malignant syndrome (fever, muscle rigid, autonomic instability, clouded consciousness)

Q1095. Quetiapine

A1095. typical antipsychotics; Extrapyramidal symp (EPS); Hyperprolactinemia; Anticholinergic Effects( DRY mouth, urine, constipation); Neuroleptic malignant syndrome (fever, muscle rigid, autonomic instability, clouded consciousness)

Q1096. Olanzapine

A1096. typical antipsychotics; Extrapyramidal symp (EPS); Hyperprolactinemia; Anticholinergic Effects( DRY mouth, urine, constipation); Neuroleptic malignant syndrome (fever, muscle rigid, autonomic instability, clouded consciousness)

Q1097. Ziprasidone

A1097. typical antipsychotics; Extrapyramidal symp (EPS); Hyperprolactinemia; Anticholinergic Effects( DRY mouth, urine, constipation); Neuroleptic malignant syndrome (fever, muscle rigid, autonomic instability, clouded consciousness)

Q1098. Aripiprazole

A1098. typical antipsychotics; Extrapyramidal symp (EPS); Hyperprolactinemia; Anticholinergic Effects( DRY mouth, urine, constipation); Neuroleptic malignant syndrome (fever, muscle rigid, autonomic instability, clouded consciousness)

Q1099. Clozapine use

A1099. reserved for treatment of resistance and severe tardive dyskinesia

Q110. Which part of the brain is affected in delusional disorder?

A110. - limbic system; or basal ganglia

Q1100. Lithium

A1100. Mood Stabilizer; acute mania; prophylaxis of mania and depression in bipolar; augmentation of depression treatment

Q1101. Lithium Side

A1101. Thirs polyuria tremor weight gain hypothyroidism, nephrotoxicity, ataxia, dysarthria, delirium, nausea diarrhea, seizures. Narrow therapeutic window.

Q1102. Carbamazepine

A1102. second line mood stabilizer, anticonvulsant; Side: Skin rash, leukopenia, AV block, Aplastic anemia, Stevens-Johnson syndrome

Q1103. Valproic acid

A1103. most widely used drug for bipolar and acute mania; side: Tremor, sedation, ataxia, alopecia, weight grain, thrombocytopenia, hepatotoxicity, agranulocytosis

Q1104. Lamotrigine

A1104. Mood stabilizer for treatment refractory patient; side: ataxia, blurred vision, GI distress, Steven Johnson syndrome

Q1105. Buspirone

A1105. generalized anxiety disorder OCD PTSD; side: seizures with chronic use. No tolerance, dependence or withdrawal.

Q1106. general anxiety disorder treatment

A1106. Buspirone, SSRI

Q1107. Performance anxiety treatment

A1107. B-blockers

Q1108. FLumazenil

A1108. Antidote to benzodiazepine intoxication; side: sedation, nausea, dizziness, vomiting, pain

Q111. What is the Tx of Delusional Patient?

A111. Not really Tx; unless stalker; antipsychotics; Delusions very hard to treat; Try to give individual psychotherapy; get the patient trust; Confront the delusion

Q112. What is brief psychotic disorder?

A112. hallucination; delusion; Disorganized speech; very similar to schizophrenia

Q113. What is responding to internal stimuli?

A113. Turn their head as if to listen to someone

Q114. How long does the brief psychotic disorder?

A114. Symptoms last 1 day but <30 days

Q115. If symptoms last for more than 6 weeks?

A115. Schizophreniform

Q116. If psychotic symptoms last for 7 months or more?

A116. Schizophrenia

Q117. What are the risk factors of brief psychotic sx?

A117. Low SES; Accident and hear voices; Pat in a fire and then he hear voices

Q118. Tx for Brief Psychotic Disorder?

A118. Hospitalized; 1st line antipsychotics; also treat with

Q119. Haloperidol vs. Risperidone?

A119. Always choose Risperidone; Less Side Effects

Q120. What is the key to somatoform disorder?

A120. think they have something wrong; present physical symptoms with no medical explanations

Q121. What problems do the somatoform patients have?

A121. Always complaining; so problems in social and occupational activities

Q122. What is somatization disorder?

A122. very easy; 8 or more symptoms; 4 pains (GI, pseudoneurological, shortness of breath, ringing in my ear, heart racing, pain during sex); more women than men

Q123. Classic somatoform patient?

A123. Young female from Low SES; begins by age 30

Q124. What is it associated with?

A124. Personality Disorder; Long complicated medical histories

Q125. Never choose answer?

A125. There is nothing wrong with you; never refer patient to another doctor

Q126. What do you need to do with somatoform disorder?

A126. regular check-ups; single physician; Tx: Psychotherapy; need to fix their head; get their trust

Q127. Differential for Somatoform?; medical

A127. MS; Myasthenia Gravis; SLE; AIDS; Thyroid; Chronic Systemic Infection

Q128. What is the differential for somatoform (psychiatric)?

A128. depression; anxiety; schizophrenia

Q129. What is conversion disorder?

A129. Patient experience a stressor; and then has symptoms; voluntary muscle; or sensory control

Q130. Classical conversion disorder?

A130. Patient hears something bad and can't hear; patient sees something terrible and can't see; Patient wants to hit somebody in the head and becomes paralyzed

Q131. What personalities are associated with conversion disorder?

A131. dependent personality; passive-aggressive; antisocial; histrionic; young female low SES

Q132. Psychiatric and physical symptoms?

A132. neurological voluntary or sensory; usually paralysis (paresthesia); sensory mutism, blindness; Pseudoseizures

Q133. What is a real clue for conversion disorder?

A133. la belle indifference,; the beautiful indifference; the patient doesn't share; unconcerned about disorder

Q134. What does identification or model?

A134. knew someone that was paralyzed or blind; but patient doesn't hurt themselves; they don't hit themselves on walls

Q135. Tx of conversion?

A135. Psychotherapy; Also Amotal interview; Amobarbital; tells the truth; truth serum

Q136. What is associated with conversion?

A136. Malingering

Q137. What is the difference of somatization vs. hypochondriasis patient?

A137. the hypochondriasis says they have a headache and you do a MRI or CT scan normal; but they still believe they have a brain tumor

Q138. What are the characteristics of hypochondriasis?

A138. young patients; equal male/fem

Q139. What is the age of onset of hypochondriasis?

A139. 20-30 year old

Q140. Tx of Patient with hypochondriasis?

A140. Psychotherapy

Q141. Somatoform pain disorder involves?

A141. Pain

Q142. Risk Factors/Etiology?

A142. Late in life; At least in 1 or more anatomic sites; pain is very distressing

Q143. Etiology of pain?

A143. psychological factors; often submitted to surgery

Q144. Best Tx for Pain Somatoform?

A144. BEST: Psychotherapy; Anti-depressants since patient have mood disorder; hypnosis, etc

Q145. Differential Diagnosis for Pain Somatoform?

A145. Muscle contraction; Headaches

Q146. What is body dysmorphic disorder?

A146. Patient who believes a part of his body is miss-shaped; defective, abnormal

Q148. What Neurotransmitter is linked to Body dysmorphic Disorder?

A148. Serotonin

Q149. What is the TX for body dysmorphic disorder?

A149. SSRIs; plus psychotherapy (individualized)

Q150. Symptom production?

A150. Do you know as a patient where the symptoms are coming from

Q151. What is symptom motivation?

A151. What do you know/drives these symptoms forward

Q152. Symptom production of somatoform?

A152. Unconscious; No...

Q153. Symptom motivation for somatoform?

A153. No; Unconscious; not trying to lie or be deceitful

Q154. Factitious Disorder?

A154. Patients who have conscious productions of symptoms; medical or mental; faking both; fever, chills, pain, patient says it had blood in urine; (they will prick their finger when given pee cup)

Q155. What is another factitious disorder case? mental

A155. Patient says they hear voices; they want to be admitted to hospital and get treated; swallow glass, spoon, forks

Q156. Factitious Disorder person?

A156. Physician Assistant; Nurse or Pharmacist; Cardiologist (even if results are negative); Psychiatrists

Q157. Patient history includes what?

A157. Child abuse; Patient was sick a lot in childhood

Q158. What is a common physical finding of factitious disorder?

A158. typically dridiron abdomen from multiple surgeries

Q159. What is a characteristic after being diagnosed?

A159. they leave to another hospital; enraged; they will move to another state, city

Q160. Doctor must be aware of what condition?

A160. countertransference; since it is a patient nobody wants

Q161. What personality is associated with factitious disorder?

A161. Antisocial (they lie a lot); histrionic(need for attention); schizophrenia(bizarre behavior); malingering; Ganser Sx

Q162. What is Ganser Syndrome involved in factitious disorder?

A162. usually prison inmates; nearmissed answer to questions; what is the color of the sky? red; How many feet does a cat have? 8

Q163. What is malingering characterized?

A163. Usually mother that fakes all symptoms of the child; notice blood in urine; mother places blood (from prick on finger) in the urine cup to get admitted; Child Abuse; REPORT TO AUTHORITIES

Q164. What is characteristic of malingering?

A164. Injecting fecal matter in I.V. hitting children; suffocating them; place hidden cameras in patient room

Q165. Is malingering conscious?

A165. Yes; they don't know why; symptom production conscious; symptom motivation unconscious

Q166. Risk Factors for malingering?

A166. Malingering seen in prison; in order to get out of prison; factory and military settings also; to get out

Q167. What are the physical and psychiatric symptoms?

A167. complain a lot; exaggerate; they are preoccupied with gain rather than alleviation of symptoms

Q168. Is malingering a mental disorder?

A168. no; it is not a mental disorder

Q169. Tx of Malingering?

A169. not a mental disorder; so must avoid confronting the patient; anger the patient; establish patient-relation

Q170. Malingering?; Production?; Motivation?

A170. Production conscious; Motivation conscious; intentional; patient wants to deceive you

Q171. What do you look in the question for somatoform dis.?

A171. no alteration of physical; work-up tests negative

Q172. What must be present in malingering?

A172. lawsuit; avoiding prison; trying to get out of military; look for a gain

Q173. What must be present in factitious dis.?

A173. Physical findings; or Psychological Findings; will find glucose or blood in urine

Q174. If the question says lost of symptoms? If it is just pain?

A174. Somatization; pain disorder

Q175. if you complain of only one part of your body?

A175. body dysmorphic

Q176. if patient has some traumatic experience and then develops symptoms?

A176. conversion disorder

Q177. if patient thinks he's got an illness and still not convinced even after surgical/tests done?

A177. hypochondriasis

Q178. Impulses vs. compulsive?

A178. Impulse you feel ok after you do it - egosyntonic; Compulsive you feel terrible afterward... egodystonic

Q179. What Neurotransmitter is involved with impulses?

A179. Serotonin; very violent behavior

Q180. Patient with intermittent explosive disorder? (IED)

A180. Reaction is out of proportion; Driving and a cab cuts you off; Patient says that he injured somebody's neck because someone took his potato chips

Q181. What sex is IED seen?

A181. men

Q182. What is in a patient history of IED?

A182. Head Trauma History

Q183. What are the levels of neurotransmitters in IED?

A183. Linked to low levels of serotonin; low level of 5-HIAA; abnormalities of lymbic system

Q184. As the years progress what happens to IED?

A184. Symptoms become better

Q185. Tx of Patients with I Explosive Disorder?

A185. anticonvulsant; antipsychotics; beta blockers; SSRIs some what helpful; group psychotherapy

Q186. Differential Diagnosis of IED?

A186. Epilepsy; Brain Tumors; Endocrine Disorder

Q187. What personality disorder is a differential diagnosis?

A187. Antisocial; Borderline; Schizophrenia; Substance Intoxication; all lead to violent behavior

Q188. What other condition is associated with kleptomania?

A188. Bulimia strongly associated

Q189. What is a personality disorder?

A189. maladaptive pattern of behavior; behavior done all of our life; Patient doesn't think he has a problem

Q190. Are personality Disorders egosyntonic or egodystonic?

A190. Egosyntonic; that's why suggesting treatment to them is not successful; patients don't want to be treated

Q191. When do you usually diagnose a personality disorder?

A191. adulthood; since personality still changing

Q192. Which is the only personality disorder that you need to give this person after 18?

A192. Antisocial after 18; Conduct Disorder if younger than 18

Q193. Cluster A is what?

A193. Eccentric; Peculiar; Weird

Q194. What is cluster B?

A194. Theatrical; Dramatic/Emotional; Dissociative; Forget their name, who they are; Preoccupation with rejection

Q195. What is cluster C?

A195. Anxious or Fearful cluster; Sensitive to rejection; Rigid (their way or the highway)

Q196. What is a higher prevalence in Male PDs?

A196. antisocial; narcisitic; adulthood only; others can be diagnosed in adolescence

Q197. What PD is mostly seen in women?

A197. borderline; histrionic

Q198. What happens to the mood disorders in adulthood?

A198. they get worse

Q199. What happens to symptoms for violent behavior as the patient reaches adulthood and gets older?

A199. they get better with time

Q200. What is the Tx for PDs?

A200. Psychotherapy; individual; if psychotherapy not working; anxious (anti-anxiety); depression (anti-depressant)

Q201. Diff. Diagnosis for PDs?

A201. Mood disorder; Adjustment Disorder

Q202. What is the defense mechanism of paranoid personality Disorder?

A202. projection

Q203. What is common among paranoid?

A203. Immigrants; Deaf people

Q204. What is the difference between paranoid and schizophrenia?

A204. 3 things to focus; duration of symptoms; level of functioning; psychosis; personality disorder is a long time; level of function is normal in PDs; Psychosis in PDs is not present

Q205. What is schizoid personality?

A205. Loner; Person who goes to movies, vacation by themselves

Q206. Where do the schizoid's work?

A206. night jobs; park ranger; lab work

Q207. What is schizotypal?

A207. most strange; resembles to schizophrenia; dress, talk, think, looks; is strange

Q208. What is the difference between schizotypal vs. schizophrenic?

A208. schizotypal all their life with symptoms; when stressor is maximal they become psychotic; schizophrenics very seldom recover from their psychosis to normal

Q209. What problems do schizotypal PD have?

A209. social relationships; thought distortions; eccentric; isolated

Q210. What are the clues of schizotypal?

A210. magical thinking; magical caps (lucky pencil); lucky shirt

Q211. What is a common symptom of schizotypal?

A211. Illusions; misperceive things

Q212. What is Illusion vs. hallucination?

A212. sensory stimuli in Illusion

Q213. Histrionics what class?

A213. Cluster B; dramatic and emotional cluster

Q214. What is characteristic of histrionics?

A214. Over the top; very colorful, exaggerated talking, dress, behavior; want to be the center of attention; Sexually Seductive

Q215. What is the borderline personality?

A215. very unstable; problem with affect; impulsive; use drugs, sexually promiscuous, gambling; mood swings

Q216. What is very characteristic of borderline PDs?

A216. Chronic feelings of emptiness or boredom; Emotional numbness; clue for suicidal gestures; women who constantly cut themselves; wants to feel pain

Q217. What is in the history of borderline PDs?

A217. child abuse; splitting; Fatal Attraction

Q218. Psychotic or Neurotic?

A218. Psychotic you loose sense of reality; Borderlines go back after having a brief episode of psychosis

Q219. What is the characteristic of antisocial?

A219. don't care about the rules; egodystonic; ignore rules; lie and steal

Q220. Is antisocial inherited?

A220. Yes, superEgo; usually one parent also antisocial

Q221. What is the last one in the cluster B?

A221. Narcissistic PD; they are the best; smartness, brightest; convinced they are special

Q222. Narcissistic expects what?

A222. admiration; want special treatment; don't accept criticism; when they get older they get depressed; fragile self-esteem; actors; Physicians (neurosurgeon)

Q223. What does Cluster C involved?

A223. Fearful; Anxious

Q224. What is the first personality of Cluster C?

A224. Avoidant; not go getters; restrained in relationships

Q225. What is the main issue of avoidant PDs?

A225. afraid of rejection; avoid all kinds of rejection; phobias: social; restraint in everything; sensitive to criticism

Q226. If patient with criticism:; 1) angry; 2) don't care; 3) freak out/very depressed/ very sensitive

A226. Dx?; 1) Narcissistic; 2) Schizoid; 3) Avoidant

Q227. What is the difference between schizoid vs. avoidant?

A227. Schizoid wants to be alone; Avoidant is alone because they feel inadequate and don't want to be rejected

Q228. Another PD in cluster C?

A228. Dependant Personality; In abusive relationships; can't be alone; need to be told what to do; subordinate; constantly need advice

Q229. What happens when they get a promotion?

A229. they don't want it; don't want to assume responsibility; woman beaten by husband; they are unable to make decisions/make it on their own

Q230. What is characteristic of dependant disorder?

A230. Classic abusive relationship

Q231. What is the obsessive compulsive development?

A231. anal retentive; anally fixated; orderly; Perfectionistic; in control; class assignment (excellent); i'll do all the work; they make lists for everything

Q232. What are associated features with obsessive compulsive?

A232. indecisive; dysphoria (sad, mood down); angry; social inhibition; problem with interpersonal

Q233. Do not confuse Obsessive compulsive Disorder than obsessive compulsive personality disorder (behavior)?

A233. Person riddled with obsession; linked to serotonin; OCD they were normal before then develop disease; Pharmacotherapy; people with OCD don't function; People with OCPD (obsessive personality disorder) disorder function since Adolescence; Tx: Psychotherapy

Q234. Tx for OCPD?

A234. Psychotherapy

Q235. Tx for OCD?

A235. Pharmacotherapy

Q236. What is sexual identity?

A236. based on person's sexual characteristics; genitalia external/internal; objective

Q237. What is gender identity?

A237. has nothing to do with packet; from the neck up; inside your head; what you think you are; subjective; by age 3

Q238. Who determines gender identity?

A238. The parents; they dress you like a boy; or they dress you like a girl

Q239. What is gender role?

A239. Based on external behavior; reflect the person's inner sense of gender identity; act like a boy

Q240. What is sexual orientation?

A240. who you choose to love; object; heterosexual; homosexual; bisexual; asexual

Q241. Is there excessive masturbation?

A241. only if it interferes with normal everyday life

Q242. What is Homosexuality?

A242. variant of human sexuality

Q243. What causes homosexuality?

A243. genetics; monocygotic twins 50%; greater than dizygotic

Q244. What is more stable?

A244. female more stable homosexual relations

Q245. Do homosexuals have more mental illnesses?

A245. NO. No higher incidence of Pedophilia

Q246. What is the definition of paraphilias?

A246. recurrent sexual arousing from:; 1) humiliation/suffering; 2) nonliving objects; 3) non-consenting partners

Q247. How long do paraphilias last?

A247. more than 6 months

Q248. What is characteristic in the life of paraphilias?

A248. they become impaired in their level of functioning; loose their jobs, etc...

Q249. What is exhibitionist?

A249. expose oneself to strangers

Q250. What is fetishism?

A250. use of nonliving objects usually associated with the human body; panties, shoes

Q251. What is a frotteurism?

A251. rubs himself against another nonconsenting partners

Q252. What is the MC paraphilia?

A252. pedophilia

Q253. What is pedophilia?

A253. urges or arousal toward prepubescent; age <16

Q254. What if person has sex with >16 yo?

A254. statutory rape

Q255. What is a voyeurism?

A255. pepping tom; observing an unsuspecting person who is engagin in sexual activity, disrobing

Q256. What is a Masocichst? and Sadist?

A256. Masochist involves in inflicting pain/humiliation; sadist is the one who receive the inflicting pain

Q257. What is transvestic fetishism?

A257. cross-dressing

Q258. What sexual tendency is seen in transvestite fetishism?

A258. heterosexual men

Q259. What is the Tx for paraphilia?

A259. Antiandrogens; also SSRIs

Q260. What is the MCC of periodical middle age man impotence?

A260. Alcohol

Q261. MCC of psychological impotence?

A261. Fear of failure; man is afraid of not getting the erection

Q262. MC Medical cause of impotence?

A262. Diabetes M.

Q263. What do old anti-psychotic drugs attach to?

A263. D2

Q264. Newer anti-psychotic drugs bind to what?

A264. D4

Q265. What do old anti-psychotic drugs SIDE EFFECT?

A265. block muscarinic receptors: dry mouth, blurry vision, urinary retention, confusion, hallucination

Q266. What other Symptoms Do you expect with histamine block?

A266. sedation and weight gain

Q267. What symptoms Do you get with alpha block?

A267. orthostatic hypotension

Q268. What are the older antipsychotics?

A268. -

Q269. What antipsychotic gives your retinitis pigmentosa?

A269. thioridizine eye

Q270. What happens when you block the mesolimbic tract?

A270. reduce psychotic symptoms

Q271. What happens when you block nigrostriatal block?

A271. increase tremors, Parkinson's EPS symptoms!

Q272. What tract does clozapine block?

A272. Mesolimbic Tract

Q273. What does a block in the tuberoinfundibilar block?

A273. no galactorrhea, gynecomastia, amenorrhea

Q274. Patient with psychotic, what tx?

A274. olanzapine (atypical any)

Q275. If all other drugs fail what is next tx?

A275. clozapine (agranulocytosis be careful)

Q276. If patient Is noncompliant?

A276. 1st choice haloperidol or fluphenazine depot decanoid form

Q277. Patient Is agitated?

A277. use IM forms (typicals)

Q278. How do antipsychotic medication work?

A278. block dopamine receptors; old D2; new D4

Q279. What do new antipsychotics work as well as D4?

A279. they work on serotonin as well; 5HT3

Q280. What are some other effects of antipsychotics?

A280. 1) block central and peripheral cholinergic receptors; 2) histaminic block; 3) alpha-block

Q281. What are the symptoms of muscarinic block?

A281. urinary retention; dry mouth; blurry vision; constipation; confusion; hallucinations

Q282. If you are going to prescribe to the elderly what do you avoid?

A282. avoid drugs with muscarinic block

Q283. Where do new antipsychotics work on?

A283. D4 more and also serotonin 5HT3

Q284. What do antipsychotics block?

A284. muscarinic block, alpha block, histamine block

Q285. What is an important SIDE EFFECT of antipsychotics?

A285. sedation and weight gain (histamine blockade); hypotension (alpha block); dry mouth, urinary retention, constipation, confused, blurry vision (muscarinic block)

Q286. Where do antipsychotics work on?

A286. Dopamine; D2 and D4 receptors; Old work on D2; new on D4

Q287. What are the side-effects of histamine blockade?

A287. weight gain and sedation

Q288. What do you find with alpha blockade?

A288. hypotension; so be careful on the elderly; they might fall and break a hip

Q289. Main groups for antipsychotics?

A289. typicals D2 antagonists only low-potency: Clopromazine; High-potency: Haloperidol; old drugs D2: Haloperidol, Thioridazine, Olanzapine, fluphenazine; new drugs Risperidone

Q290. Of the newer drugs, which one of these cause movement side effects of antipsychotics? EPS symptoms?

A290. Risperidone is the answer

Q291. WHat are the multiple receptor antagonist work on?

A291. D2, D4 and Serotonin 5HT

Q292. What are the new antipsychotics multiple receptors?

A292. clozapine; olanzapine; quetiapine

Q293. What does the D2 blockade cause?

A293. EPS symptoms

Q294. What decreases EPS symptoms?

A294. D4 receptors

Q295. What are the indications of antipsychotics?

A295. E.R. patients get agitated

Q296. Which one in the E.R. antipsychotics?

A296. Haloperidol; since it comes in I.V. high-potency; easier to give them a shot

Q297. DOC for schizophrenia?

A297. antipsychotics

Q298. Tx for agitation for schizophrenia, mood disorders, psychoses, delusional disorders, brief psychotic disorders, schizophreniform disorder?

A298. antipsychotics

Q299. Why do you avoid giving elderly diazepam?

A299. makes them more confused; problems with their memory

Q300. What is another name for Dopamine?

A300. Prolactin Inhibitory Factor; PIF

Q301. What happens when you inhibit dopamine with antipsychotics?

A301. PIF is not there; so prolactin goes up

Q302. What happens when prolactin goes up?

A302. galactorrhea, gynecomastia, amenorrhea

Q303. What does dopamine block?

A303. tuberoinfundibular tract; mesolymbic / mesocortical tract; nigrostriatal tract; all involved

Q304. What happens when you block tuberoinfundibular block?

A304. prolactin increases

Q305. What are other SIDE EFFECT of the older antipsychotics?

A305. photosensitivity; Retinitis pigmentosa

Q306. What antipsychotics produces retinitis pigmentosa?

A306. thioridizine

Q307. What are other problems with thioridazine?

A307. cardiac conduction problems

Q308. What are SIDE EFFECT of clozapine?

A308. agranulocytosis

Q309. What happens when dopa blocks mesolymbic tract?

A309. reduce psychotic symptoms; decrease psychosis

Q310. What happens when you block nigrostriatal tract?

A310. increase in movement disorders; tremors, Parkinsonian disease

Q311. What does clozapine block?

A311. mesolimbic; no EPS (nigrostriatal); no amenorrhea, no galatorrhea, no gynecomastia (tuberinfundibular)

Q312. Does clozapine cause amenorrhea, galactorrhea, gynecomastia, EPS symptoms?

A312. NO!; only blocks mesolimbic tract; reducing psychosis

Q313. What are the types of movement disorders?

A313. acute dystonia; parkinsonism; tardive dyskinesia

Q314. Which movement disorder is the first one to appear?

A314. acute dystonia

Q315. When does acute dystonia appear?

A315. occurs within hours or days of treatment; patients get really scared

Q316. Why do patients get scared with acute dystonia?

A316. its a muscle spasms; cant' move

Q317. What happens to Ach when Dopamine is high?

A317. Ach decreases; antagonists

Q318. What are first choice drugs of psychosis?

A318. Olanzapine,; Quetiapine,; Ziprasidone

Q319. What are the SIDE EFFECT of Olanzapine, quetiapine, ziprasidone?

A319. Weight gain and sedation

Q320. What is the SIDE EFFECT of clozapine?

A320. agranulocytosis

Q321. What are the SIDE EFFECT of ziprasidone?

A321. prolongation of QT interval

Q322. What patients have a contraindication of ziprasidone?

A322. arrhythmias

Q323. What are the SIDE EFFECT of Olanzapine and Clozapine?

A323. Cause Diabetes

Q324. What patients have a contraindication of Olanzapine/Clozapine?

A324. DM

Q325. What antipsychotics are used to tx non-compliant patients?

A325. haloperidol and fluphenazil

Q326. Why do haloperidol and fluphenazil are prolonged in their action?

A326. they have the decanoid form; I.M. deposit

Q327. Is Tardive Dyskinesia reversible or irreversible for Step 2 USMLE?

A327. Irreversible

Q328. Antidepressants are used to Tx what?

A328. Mood disorders, adjustment disorders, psychotic disorders

Q329. What are other uses for antidepressants?

A329. anxiety disorders; bulimia

Q330. Why is anxiety treated with antidepressants?

A330. use same neurotransmitter

Q331. What percentage of patient with depression have anxiety?

A331. 90% of the patients have anxiety with depression

Q332. Why are antidepressants used to tx bulimia?

A332. act on same neurotransmitter; serotonin

Q333. Why do antidepressants work on impulse control disorders?

A333. serotonin

Q334. What are amitriptyline of TCA (tricyclics) commonly used for?

A334. Enuresis

Q335. If the patient has depression he will surely have?

A335. anxiety

Q336. What is used for chronic pain?

A336. amitriptyline

Q337. Why is amitriptyline used for chronic pain?

A337. amitriptyline increases endorphins; increase endogenous opiates; patients complain less of pain

Q338. Which ones are dangerous in OD?

A338. specially TCA

Q339. Patient comes after OD of TCA, what do they need to be attached to?

A339. cardiac monitor; causes conduction problems

Q340. What is the effect/toxicity of TCAs Overdose?

A340. heart conduction problems

Q341. How do TCAs work?

A341. block the reuptake of neurotransmitter (serotonin and NE, and dopamine); work by down regulation of beta adrenergic receptors

Q342. How do the MAO inhibitors work?

A342. work on the enzyme that metabolizes Serotonin, NE, Dopa; doesn't break down the neurotransmitters; so more NE, Ser, DOPA

Q343. Where do the SSRIs work?

A343. they only block the reuptake of serotonin

Q344. Why do you choose an SSRI instead of TCA or MAO?

A344. because of less SIDE EFFECT

Q345. What is the first line of antidepressants?

A345. SSRIs; cleaner, patient like it, less SIDE EFFECT

Q346. What other receptors are blocked with TCAs?

A346. muscarinic receptors are blocked

Q347. What do you expect with the TCA muscarinic block?

A347. sedation; dry mouth; blurry vision; urinary retention

Q348. What are other two receptors that TCA block?

A348. Histamine and alpha receptors

Q349. What happens when you give TCAs and block alpha receptors?

A349. hypotension

Q350. What happens when you give TCAs and block histamine?

A350. sedation and weight gain

Q351. Which TCA is the worst cause it gives you the most SIDE EFFECT?

A351. amitriptyline; takes you on a bad trip!

Q352. What patient would be a relative contraindication for giving him amitriptyline?

A352. 90 yo, demented, with glaucoma, and prostathic hyperthrophy... why? hypotension, urinary retention, blurry vision (might fall)

Q353. TCA stands for?

A353. T for upTake blocker; T is for hisTamine blocker; C is for musCarinic blocker; A is for alpha blocker

Q354. Which drugs are the fastest of the TCAs?

A354. nortryptiline and disipramine; less SIDE EFFECT

Q355. What are antidepressants used for?

A355. Tx: depression,; depression in Bipolar Dis. ALL anxiety dis.

Q356. What is the efficacy of antidepressants?

A356. 70%

Q357. Which drugs are used first?

A357. Newer ones; SSRIs

Q358. Which antidepressants are more dangerous?

A358. usually older ones; TCAs; more SIDE EFFECT

Q359. How long do we keep patients before we know the antidepressants are working?

A359. they start working until 4-6 weeks

Q360. What is the MCC of drug failure?

A360. the time doctors try the drugs less than 4-6 weeks. Need to maximize doze and maximize dose switching

Q361. When do you stop antidepressants?

A361. if SIDE EFFECT are not tolerated by patient

Q362. If you have a patient not responding you need to give another medication in order to boost 1st antidepressants?

A362. Lithium or Thyroxine; or even Amphetamine like drugs

Q363. How long do we keep patients on antidepressants?

A363. Tx should continue for 6 months to 1 year; since they relapse

Q364. What antidepressant drugs cause the most sedation?

A364. Doxapine, amytriptiline, trazodone

Q365. What is the use of doxapine and trazodone?

A365. give it to patients at night so they can sleep; causes sedation; (antidepressant)

Q366. Which antidepressants cause less sedation?

A366. Cleaner ones, newer less SIDE EFFECT; Desipramine, protrityline and SSRIs

Q367. Which antidepressant causes most Hypotension?

A367. TCAs

Q368. Which TCA causes the most hypotension?

A368. amitriptyline

Q369. Which is Best TCA for antidepressants?

A369. Nortriptyline and Desipramine

Q370. Which antidepressant drug has the worst anticholinergic?

A370. amitriptyline

Q371. Which antidepressant has less anticholinergic effects?

A371. nortriptyline and desipramine; also SSRIs since they only work on serotonin

Q372. What do you have to remember about the TCAs and the heart?

A372. prolong the QRS interval; need to do a EKG

Q373. What is the effects of antidepressant and seizures?

A373. lower the seizure threshold

Q374. Which TCA causes the most seizures?

A374. maprotaline

Q375. Does bupoprion cause seizures?

A375. no

Q376. Do women with bulimia have a high incidence of seizures?

A376. yes

Q377. Do antidepressants cause sexual dysfunction?

A377. yes all of them cause

Q378. What are the sexual dysfunction SIDE Effects caused by antidepressants?

A378. anorgasmia; decrease libido; delayed ejaculation; priapism

Q379. What antidepressant causes anorgasmia and decrease libido? also delayed ejaculation

A379. SSRIs

Q380. What antidepressant causes priapism?

A380. trazodone

Q381. Which one of the SSRIs causes less sexual dysfunction?

A381. citalopram; bupoprion

Q382. What is priapism?

A382. prolonged and painful erections

Q383. What are the SSRIs?

A383. Fluoxetine; Paroxetine; Sertraline; Fluvoxamine; Citalopram

Q384. SSRI with least sexual SIDE EFFECT?

A384. citalopram

Q385. Why are SSRIs used to Tx OCD?

A385. serotonin involved; panic as well as bulimia

Q386. What are the SIDE EFFECT of SSRIs?

A386. patient agitation

Q387. What do you tell a patient that gets agitated when taking SSRI?

A387. tell them to take it at night

Q388. What if a patient feels sedation of SSRIs?

A388. take the SSRI at night to take advantage of the SIDE EFFECT

Q389. What are all the SIDE EFFECT of SSRI?

A389. agitation; sedation; diarrhea; nausea; sexual dysfunction

Q390. What is trazodone called?

A390. heterocyclic antidepressant; off shoot of TCA family; used for its sedation effect; used in insomnia

Q391. Where does fenazodome works?

A391. NE and serotonin; more like an SSRIs

Q392. What is bupoprion used for tx what age patients?

A392. older patients less SIDE EFFECT

Q393. What neurotransmitter is involved when using Bupoprion?

A393. dopamine

Q394. What is bupoprion similar to?

A394. Zyban; used as Wellbutrin; dose is different

Q395. Why is dopamine associated with smoking cessation?

A395. Dopamine is linked to reward centers; endorphins; decrease the pleasure

Q396. What is bupoprion use to Tx?

A396. smoking cessation

Q397. What drug blocks the pleasure of alcohol?

A397. naltrexone

Q398. What is venlafaxine similar to?

A398. SSRI

Q399. What is mirtazapine similar to and SIDE EFFECT?

A399. SSRI; lots of Sedation

Q400. What are TCAs divided into?

A400. tertiary and secondary

Q401. What are the tertiary TCAs?

A401. imipramine; amitriptyline; doxepin; clomipramine; trimipramine

Q402. What are the secondary TCAs?

A402. desipramine; nortriptyline; protriptyline

Q403. What happens when imipramine is broken down from its tertiary form?

A403. it converts into its active form desipramine secondary form

Q404. When amitriptyline breaks down, what does it form?

A404. nortriptyline; the secondary active form

Q405. Which ones are cleaner talking about SIDE EFFECT between tertiary and secondary?

A405. secondary don't have that many SIDE EFFECT since they are the active form of the drug; no intermediates; less SIDE EFFECT

Q406. What is a problem for all TCAs?

A406. they have a therapeutic window; the drug has to fall within range to be effective

Q407. What is the efficacy of TCA drugs?

A407. mood disorders

Q408. Which drug can be used to tx panic?

A408. imipramine

Q409. What is clomipramine used for?

A409. OCD; works most on serotonin

Q410. What is amytriptyline used for?

A410. Chronic Pain

Q411. Why are MAOIs are not used in a regular basis?

A411. Can't eat foods rich in Tyramine; will cause a reaction of increase blood pressure

Q412. What foods should you avoid if taking MAOIs?

A412. - red wine; aged cheeses; chocolate; sausages; nuts; pickled products; herring; white wine ok, processed cheeses ok

Q413. What is the best tx for depression?

A413. ECT

Q414. Is ECT the MC tx for depression?

A414. no

Q415. Why is ECT not used as first line for depression?

A415. nobody wants ECT

Q416. When is ECT prescribed?

A416. severely depressed/suicidal tendencies; 1)patient still tries to kill himself; 2) patient has not responded on TCA,MAIO, Lithium, Amphetamine like drugs

Q417. Is ECT used only for depression?

A417. no, also:; schizophrenia

Q418. In synthesis when do you use ECT?

A418. typically when all other conventional therapies have failed

Q419. Are there any absolute contraindications of ECT use?

A419. none

Q420. What is the only situation you have to be careful with the use of ECT?

A420. only in a case of increase intracranial pressure; since ECT increase pressure

Q421. What is another case in a patient with depression which you might be inclined to use ECT?

A421. when the patient has received ECT previously with success

Q422. What is the only problem with ECT?

A422. some memory loss

Q423. What is the characteristic of the memory loss with ECT?

A423. transient

Q424. What does transient memory loss mean?

A424. when the Tx is over, your memory comes back

Q425. What are some of the complications of ECT?

A425. anesthesia; induced paralysis

Q426. Do you need a seizure in order for ECT to work?

A426. no

Q427. What is the typical course of ECT?

A427. 10-15 treatments

Q428. What tests are done before ECT administration?

A428. CT-scan; rule out tumors that increase intracraneal pressure; x-rays of bodies (fractures that haven't healed)

Q429. What are the mood stabilizer medications?

A429. lithium (bipolar); divalproex; carbamazepine; topiramate; lamotrigine; gabapentine

Q430. What are some of the symptoms treated with mood stabilizers?

A430. Bipolar; impulse control disorder; violence/agitation/agression/impatience

Q431. What are the indications of lithium?

A431. bipolar disorder; schizoaffective disorders; also mood disorders; (augment response to medication)

Q432. What is lithium not perfect?

A432. Has a narrow margin or safety

Q433. What does narrow margin of safety mean?

A433. constantly have to monitor lithium in blood; check blood levels since it could become toxic/lethal

Q434. What is the most common SIDE EFFECT of lithium?

A434. tremor, shaking; diarrhea; headaches; worsen acne; gain weight; conduction problems

Q435. What test is essential to perform before administering lithium?

A435. TSH before starting lithium

Q436. What are other major SIDE EFFECT of Lithium?

A436. leukocytosis; polyuria; polydipsia; Nephrogenic DI

Q437. What is the most important SIDE EFFECT for Lithium?

A437. teratogenic; cardiac malformations

Q438. What are the teratogenic effects of lithium on the fetus?

A438. cardiac malformations; Epstein's anomaly; (tricuspid valve affected)

Q439. What test do you give a woman that is young and needs to start lithium Tx?

A439. Test pack; pregnancy test

Q440. What advice do you give the female patient if they are on lithium?

A440. make sure not to get pregnant while on lithium; if she does get pregnant she should stop lithium immediately

Q441. What is the therapeutic index of lithium?

A441. 0.6-1.3 or 1.5; you should keep it at 1; the higher the dose, the higher the SIDE Effects

Q442. What is a recommendation to ALL patients on Lithium?

A442. drinks lots of fluids; if patient becomes dehydrated, then toxic levels may accumulate in plasma; hyponatremia increases toxicity; lithium follows sodium

Q443. What is the Tx of Choice for Lithium at toxic levels above 2.0?

A443. Dialysis

Q444. What are some SIDE EFFECT of lithium at high doses?

A444. Seizures/Coma; Ataxia

Q445. What is one of the first indications that lithium levels are high?

A445. gait disturbances (Ataxia)

Q446. What is valproex used for?

A446. bipolar; rapid cyclers (within days); mania/depression

Q447. When do you use valproex?

A447. - when lithium is not working; when lithium is contraindicated (ie. thyroid disease)

Q448. How many days does valproex take to reach desired effect?

A448. 10-14 days

Q449. What are the SIDE EFFECT of divalproex?

A449. sedation; cognitive impairment; tremors (like lithium); GI disturbances

Q450. What is the difference in toxicity of valproex?

A450. hepatotoxicity; lithium (nephrotoxic)

Q451. What test do you request before administering divalproex?

A451. liver function tests; hepatic function panel

Q452. What is the teratogenicity of valproex?

A452. Spina Bifida; shape of the letter V

Q453. What is second line of bipolar?

A453. carbamazepine; also valproate (divalproex)

Q454. Tx of Choice for bipolar disorder?

A454. Lithium (if lithium not there divalproex); last resort carbamazepine

Q455. What toxicity does carbamazepine produce?

A455. hepatic toxicity

Q456. What are SIDE EFFECT of carbamazepine?

A456. rashes; agranulocytosis

Q457. What are two drugs that cause agranulocytosis?

A457. carbamazepine and clozapine

Q458. What are the other mood stabilizers?

A458. lamotrigine; gabapentin; topiramate; not as effective

Q459. What is different about topiramate?

A459. helps patients reduce weight

Q460. Patient comes in with mania... tx?

A460. mood stabilizer; lithium

Q461. If a patient has acute mania (emergency) can't wait two weeks to calm him down?

A461. benzodiazepines; antipsychotic

Q462. What are the anxiolytics?

A462. benzodiazepines

Q463. MOA of anxiolytics/benzodiazepines?

A463. work on GABA receptors; open Cl- channels increasing the frequency

Q464. What are other uses of benzodiazepines other than anxiety?

A464. insomnia specially in the elderly

Q465. Where does buspirone work?

A465. buspirone maybe works on serotonin

Q466. What is buspirone used for?

A466. Generalized Anxiety Disorder (GAD); Social Phobias

Q467. What is the Treatment for adjustment disorder? anxious

A467. benzos with psychotherapy

Q468. What is the Treatment for Panic Disorder? anxiety

A468. Benzos, SSRIs

Q469. What is the Treatment of OCD?

A469. SSRIs

Q470. What is MC used for social phobias?

A470. SSRIs

Q471. What do you adjust with the elderly on Treatment with benzos?

A471. lower the dosage; sedation, memory problems, confusion

Q472. What DDI (drug-drug interaction) is lethal with benzos?

A472. alcohol; potentiates benzos; respiratory arrest (diaphragm paralysis)

Q473. What is the problem with taking benzos?

A473. Very Addictive

Q474. What are the SIDE Effects of benzos?

A474. sedation, memory problems, confusion; impairment of cognitive and motor performance; abuse; possible teratogenicity

Q475. Is buspirone addictive?

A475. no

Q476. What is buspirone the DOC for?

A476. GAD (generalized anxiety disorder)

Q477. Patient alcoholic that needs to be placed on anti-anxiety medication?

A477. then better to place him on buspirone since not addictive/no withdrawal symptoms; patient is going to drink and might have DDI with benzo+alcohol

Q478. What is the only SIDE EFFECT of buspirone?

A478. cabezon; complain some patients headache

Q479. Tx for Depression? A) fluoxetine or b) nortriptiline?

A479. fluoxetine; SSRI

Q480. Tx for Depression?; Nortryptiline or Amitriptyline?

A480. Nortriptyline; less SIDE EFFECT; safer

Q481. Patient with bipolar disorder who has kidney problems?

A481. not lithium; but valproic acid (metabolized in liver)

Q482. What 3 test do you ask for if patient needs to start lithium?

A482. Pregnancy Test; Thyroid (TSH); Kidney function; regular blood work

Q483. Tx for panic disorder? general and specific...

A483. any benzos but specifically alprazolam; ALPRAZOLAM (ZANAX)

Q484. What drug is used for the prevention of alcohol withdrawal?

A484. benzo... chlordiazepoxide (taper dose)

Q485. What other drug besides chlordiazepoxide is used on alcohol withdrawal?

A485. safe detox with oxazepam; (out the liver)

Q486. Which benzo doesn't go through CP450?

A486. oxazepam; temazepam; lorazepam

Q487. Patient comes in with alcohol abuse, while in E.R. he becomes agitated? What benzo do you use?

A487. Oxazepam, temazepam, or lorazepam; lorazepam is I.V. or I.M.

Q488. acute dystonia

A488. involuntary muscle contraction, torticollis

Q489. Akathisia

A489. Subjective/objective restlessness; treat: propranolol. Benzodiazepines, anticholinergics

Q490. Dyskinesia

A490. Pseudoparkinsonism (shuffled gait cogwheel rigidity).

Q491. Tardive dyskinesia

A491. Stereotypic oral facial movements. Dopamine receptor sensitization. irreversible.

Q492. Treat acute dystonia

A492. treat: anticholinergic or diphenhydramine or benztropine and antipsychotic with.

Q493. Voyeurism

A493. observing unsuspecting person unclothed

Q494. fetishism

A494. use non living objects

Q495. Transvestic fetishism

A495. cross dress for sexual arousal

Q496. frotteurism

A496. touching or rubbing against nonconsenting person

Q497. sexual sadism

A497. sexually aroused from inflicting suffering

Q498. Is it true that when you ask a patient about suicide you are provoking their interest?

A498. NO. this is completely a false belief.

Q499. How do you ask questions about suicide?

A499. 1) suicide ideation; 2) intent; 3) plan; SIIP

Q500. When do patient that have a previous suicide attempt will try to commit suicide again?

A500. within 3 months of 1st attempt

Q501. What is suicidal behavior?

A501. they go to the doctor; Dr. doesn't find depression

Q502. What are the risk factors for suicide?

A502. - previous attempts; hopelessness; illness (medical or psychiatric) HIV/Cancer/dialysis; Drug abuse

Q503. What is the MCC of death for adolescents?

A503. motor vehicle accidents; they believe they are not accidents but suicide attempts; after drinking alcohol

Q504. What sex is more predominant for suicide successful attempts?

A504. men; men more likely to

Q505. What sex has more attempts of suicide?

A505. women; because they are less successful

Q506. What is the #1 method of death for suicide men/women?

A506. guns=men; pills=women

Q507. Cotard syndrome

A507. Severe Niliistic delusion; psychosis associated with severe depression

Q508. Schizotypal personality

A508. Odd behacoir, perception, appearance, magical thinking, ideas of reference

Q509. fibromusclular dysplasia

A509. low K, nigh CO2; Hyperaldosteronism; mid age female; captopril renal scan,; MRA of renal arteries; CT angiogram

Q510. HTN med that causes depression

A510. B-blocker; also causes:

Q511. Negativism

A511. catatonic symptom; motiveless resistance to all attempts to be moved or all instructions

Q512. signs of catatonia

A512. stupor,; negativism,; rigidity,; posturing,; mutism,; stereotypes,; mannerisms,; wazy flexibility,; catatonic excitement.

Q513. cataplexy

A513. temp loss of muscle tone; weakness from emotional state; associated with narcolepsy

Q514. Echopraxi

A514. pathological imitations of movements of another person seen in catatonia, delirium dementia

Q515. Stereotypy

A515. repetitive fixed pattern of physical action, movement or speech

Q516. NORMAL PRESSURE HYDROCEPHALUS

A516. URINARY incontinence, gait ataxia; dementia

Q517. polyuria vomiting diarrhea

A517. water intoxication

Q518. delusions, and psychoses after taking ulcer meds

A518. Cimetidine

Q519. delirium in patient with heart failure meds

A519. digoxin

Q520. Which anti-depressants can --> delirium; how to treat this?

A520. MAOI; IV BZ (lorazepam is a good one, b/c there is a short t 1/2)

Q521. how many days should you wait to give an SSRI, in a patient that has been previously treated with MAOI?

A521. 14 days

Q522. what is used to treat atypical depression?

A522. MOAI

Q523. which etoh detox drugs are metabolized by the liver?

A523. chlordiazepoxide (librim); diazepam

Q524. which Etoh detoxifying drug is good to give to someone w impaired liver function?

A524. oxazepam (serax)

Q525. what effect do SSRIs have on post-synaptic 5HT-2 receptors?

A525. Down-regulates them

Q526. which NSAID does not interfere with lithium metabolism?

A526. ASA

Q527. what decreases lithium excretion?

A527. Metronidazole; ACE inhibitors; Tetracycline; Thiazide diuretics; NSAIDS (not ASA); CCBs

Q528. what increases lithium clearance?

A528. Theophillline; Acetazolamide; Caffeine; Osmotic diuresis

Q529. side effects of lithium?

A529. nephrogenic DI; hypothyroid; leukocytosis; tremors; acne; sedation; arrhythmias; T wave flattening/inversion

Q530. What med can exacerbate tics?

A530. mehtylphenidate

Q531. what is the MOA of treating Tourrette's?

A531. D2 antagonism (antipsychotics)

Q532. what drugs can be used to treat OCD?

A532. Clomipramine; Fluvoxamine

Q533. What decreases impulsiveness in Borderline PD?

A533. SSRI (especially fluoxetine); haloperidol

Q534. If looking for immediate relief of GAD, what class of meds should be given?

A534. BZ

Q535. Effect of lithium in pregnancy?; %?

A535. Epstein's; 7.7%

Q536. mood stabilizer that has causes fetal abnormalities if given during pregnancy?

A536. clonazepam

Q537. What meds can be given to delirious patients?

A537. low-dose atypical antipsychotics; low-dose haldol

Q538. why do atypical antipsychotic meds --> orthostatic hypotension?

A538. alpha 1 blockade

Q540. What is the 1st line med for panic disorder?; other drugs to treat panic disorder?

A540. fluvoxamine; imipramine and phenelzine can also be used, but less desirable d/t side effects

Q541. which mood stabilizer --> pancreatitis?

A541. valproic acid

Q542. how long should patients be treated for 1st episode of depression?

A542. at least 6 mos, usually 8-12 mos to prevent relapse

Q543. how to treat drooling associated with clozapine?

A543. anti-cholinergic

Q544. how to treat clozapine induced tachycardia?

A544. propanolol

Q545. which of the atypical anti-psychotics are least likely to increase cholesterol or cause DM?

A545. aripiprazole; ziprasadone

Q546. which antidepression is used to treat depression and diabetic neuropathy?

A546. duloxetine

Q547. what is the most common underlying cause for post-partum psychosis?

A547. underlying bipolar I disorder

Q548. cortisol levels in MDD?; catecholamine levels?; sex hormones?; immune function?

A548. increased (50% fail dexamethasone suppression test); decreased; decreased; decreased

Q549. which of the psych disorder has the strongest genetic association?

A549. bipolar I

Q550. manifestations of porphyria?

A550. mania/psychosis + abdominal pain

Q551. organic changes seen in Kluver-Bucy syndrome

A551. bilateral damage to amygdala

Q552. what effect does starvation have on:; BUN; cortisol; TSH response; GH

A552. increased; increased; normal; increased

Q553. what is the relationship between MDD and TSH?

A553. 1/3 of patients have no increase in TSH wiht TRH administration

Q554. what is cluster of sx seen in normal pressure hydrocephalus?

A554. ataxia; confusion; incontinence

Q555. length of time sx need to be present in PTSD?; acute stress disorder?

A555. >4 wks; <4 wks

Q556. long term tx for Borderline PD?

A556. therapy and steady social support

Q557. how does insight relate to psychosis?

A557. if patients have insight into their delusions/hallucinations, etc, they are not psychotic

Q558. what fraction of patients with MDD respond to placebo?

A558. 1/3

Q559. what is the clinical course expected in a schizophrenic not on meds?

A559. unknown

Q560. in men 30-50 yo, what % of impotence is related to physiologic reasons?

A560. 10%

Q561. what is the % likelihood of a patient developing schizophrenia if:; 1 parent has schizo; both parents have schizo; MZ twin has schizo

A561. 12%; 40%; 50%

Q562. other than +/- sx of schizophrenia, what behavioral can be seen

A562. short-term memory deficits; unstable smooth eye pursuit; can't habituate to repeated stimulus

Q563. causes of delirium

A563. Impaired delivery of brain substrates; Metabolic; Drug; Endocrinopathy; Liver disease; Infrastructure; Renal failure; Infection; Oxygen; UTI; Sensory deprivation

Q564. changes in sleep structure in elderly

A564. increased REM episodes (but duration is shorter) --> decreased total REM sleep; non-REM is increased (increased stage I and II, with decrease in stages III and IV); increased awakenings after sleep onset

Q565. what changes in sleep are seen in depressed young patients

A565. increased REM; decreased REM latency; decreased REM towards morning; less than 25% delta sleep; increased nighttime awakening

Q566. what is normal % of REM in YA?; REM latency?; REM pattern?; percentage delta?; nighttime awakenings

A566. 25%; 90 min; increased REM towards AM; 35%; 1-3

Q567. what EEG pattern is seen in stage 1 of sleep?

A567. theta

Q568. what EEG pattern is seen in stage 2 of sleep?

A568. sleep spindle; K complex

Q569. what EEG pattern is seen in stage 3 of sleep?

A569. delta waves

Q570. what EEG pattern is seen in stage 4 of sleep?

A570. delta waves

Q571. what EEG pattern is seen in REM?

A571. sawtooth; beta; alpha; theta

Q572. what stage of sleep do sleep terrors, sleep walking, and bedwetting occur?

A572. stages 3 and 4

Q573. what stage of sleep do nightmares occur?

A573. REM

Q574. what stage of sleep do night terrors occur?

A574. stages 3/4

Q575. when in sleep does bruxim occur

A575. stage 2

Q576. what is Kleine-Levin syndrome

A576. recurrent periods of excessive sleepiness daily for 1+ months; sleepiness not relieved by daytime naps; often accompanied by hyperphagia

Q577. what is localized amnesia?

A577. memory loss occurring during a particular time period, especially after a traumatic event

Q578. what is selective amnesia/

A578. can't remember certain aspects of an event

Q579. what is Cotard syndrome

A579. delusion that nothing exists; feeling that body is disintegrated or that they are dead

Q580. what is Fregoli syndrome?

A580. person takes the form of many other people/creatures

Q581. what is physiologically occurring in a person with OCD

A581. increased metabolism in caudate nucleus, frontal lobe, and cigulum

Q582. what is circumlocution?

A582. word substitution

Q583. what structures shrink in schizophrenia

A583. hippocampus; parahyoppocampal gyrus; amygdala

Q584. what is verbigeration

A584. repetitive meaningless talking

Q585. what is glossolalia

A585. ability to speak new language suddenly

Q586. si/sx of Wernicke's encephalopathy

A586. CN VI palsy (bilateral); horizontal nystagmus; ataxia; global confusion

Q587. what is oculogyric crisis?

A587. acute dystonia reaction with spasm of extraocular muscles

Q588. what is trismus?

A588. spasm of jaw muscles

Q589. can hallucinations + delusions = delusional disorder

A589. NO

Q590. sx of tertiary syphilis

A590. sensory ataxia; positive Romberg; decreased vibration/proprioception in lower extremities; decreased DTR; pupil abnormalities

Q591. mens rea

A591. criminal intent

Q592. actus rea

A592. criminal act

Q593. schizophrenia, residual type

A593. absence of + sx

Q594. testamentary capacity

A594. competence required to write a will; 1. ability to understand the writing/signing of will; 2. knowledge of potential heirs; 3. understanding extent of one's assets; 4. Lack of undue influence; 5. Absence of delusions compromising rational thought

Q595. what --> not guilty by reason of insanity

A595. can't appreciate wrongfulness of act; can't conform to conduct laws

Q596. habeus corpus

A596. due process

Q597. parens patriae

A597. state cares for people that can't care for themselves

Q598. informed consent requires:

A598. 1. mental competency; 2. voluntary choice; 3. risk-benefit analysis; 4. alternative tx options

Q599. what makes someone an emancipated minor

A599. married; have kids; in military; self-supporting

Q600. when is parental consent not required for a minor:

A600. OB care; STD tx; substance abuse

Q601. what type of therapy is useful in bulimia

A601. CBT

Q602. rumination disorder

A602. repeated regurgitation and rechewing of food >1 month following normal functioning; seen when there are multiple caregivers

Q603. how to confirm rumination disorder

A603. esophageal pH

Q604. what is the #1 cause of hallucination in children

A604. substance induced

Q605. common side effects from fluoxetine

A605. H/A and nausea

Q606. describe progression with Rette disorder

A606. normal prenatal and perinatal development, till about 5 months; then, decreased head growth, stereotyped hand movement and decreased social interaction; MR

Q607. what is the first line tx for Tourette's

A607. Clonidine (also good for ADHD, so good when there is comorbidity)

Q608. medical tx for enuresis

A608. imipramine

Q609. what happens to brain of anorexic patient

A609. ventricles enlarge

Q610. #1 side effect from clonidine

A610. sedation

Q611. what illness is associated with psychiatric issues

A611. strep --> OCD and Tourette's

Q613. What is the most commonly known (preventable) cause of Mental retardation?

A613. Fetal Alcohol Syndrome

Q614. (2) MC genetic causes of Mental Retardation

A614. Down's Syndrome; Fragile-X Syndrome

Q615. Define the (4) levels of mental retardation with IQ and brief summary

A615. 70-50 IQ: Mild - self-supporting (6th grade level); 49-35 IQ: Moderate - Trainable but needs supervision; (2nd grade level); 34-20 IQ: Severe - can learn to communicate; basic habits; < 20 IQ: Profound - needs highly structured environment

Q616. (2) possible causes of specific Learning Disorders

A616. Focal Cerebral Injury; or Neurodevelopmental Defect

Q617. MC Learning Disorder

A617. Reading Disorder; (more common in boys)

Q618. (4) Pervasive Developmental Disorders

A618. Autistic disorder;; Rett's disorder;; Childhood Disintegrative disorder;; Asperger's disorder

Q619. What are the (3) basic signs of Autism?

A619. 1. impairment in Social interaction (failure to develop social smile, eye-to-eye gaze, etc); 2. impairment in Communication; 3. Restrictive, Repetitive or stereotyped patterns of behavior, interests or activities (preoccupation of an interest, inflexible adherence to rituals, whole body rocking, etc)

Q620. A female with normal development the first 5 months after birth, then head circumference decreases, skills are lost such as language, social interactions and appropriate gait. Dx?

A620. Rett's disorder

Q621. What are the (2) Serotonin receptor agonists and antagonists?; Use?

A621. Trazodone; Nafazodone; Use: Anti-depressants

Q622. What is the NE-DA reuptake inhibitor used for depression?; (generic and trade name)

A622. Bupropion (Wellbutrin)

Q623. What is the difference b/t Typical and Atypical Antipsychotics with relation to NT?

A623. Typical = Dopamine Antagonists; Atypical = Dopamine and Serotonin Antagonists

Q624. Aside from Schizophrenia, what are (5)* other uses for Haloperidol?

A624. PHAT T:; PCP overdose;; Huntington's Disease (and other movement disorders);; Acute Mania;; Tx-resistant Bipolar disorder;; Tourette's disorder

Q625. What dopamine tracts are responsible for the patient's psychosis? (2); Where in the brain does it arise from?; What is the only drug that treats just these two tracts without affecting the others?

A625. Mesocortical and Mesolimbic tracts; from Ventral Tegmental area of the brain; Clozapine; (only works on these tracts)

Q626. What is the only Atypical antipsychotic not also approved for Bipolar disorder?

A626. Clozapine

Q627. what is a possible side effect of blocking the tubuloinfundibular tract of Dopamine (using any type of dopamine blocker aside from Clozapine)?

A627. Increased Prolactin levels; (Glactorrhea, amenorrhea and gynecomastia can occur; it is usually a side effect of Typical antipsychotics)

Q628. A patient from Europe moved to the USA and needed to be placed on antidepressant medication. The physician gave him a SSRI without knowing of his previous medication. Within a few days the patient began to become restless, confused, hyperthermic and have severe muscle rigidity. Dx?

A628. Serotonin Syndrome; (from mixing a SSRI and a MAOI)

Q629. Aside from blocking Dopamine, what else is blocked with the use of Antipsychotics? (5)

A629. Muscarinic receptors (causing anticholinergic sx);; Alpha receptors (causing hypotension);; NE uptake;; Serotonin receptors;; Histamine receptors (sedation)

Q630. What are the adverse Metabolic effects of Atypical antipsychotics?; (3)

A630. Weight Gain;; Adult-onset Diabetes;; Dyslipidemia

Q631. What is the evolution of Extra-Pyramidal Symptom side effects of Antipsychotics in hours, days, weeks and months?

A631. 4 hours: Acute Dystonia; 4 days: Akinesia; 4 weeks: Akathisia; 4 months: Tardive Dyskinesia; (often irreversible)

Q632. A man that just began taking medication for schizophrenia begins to get muscle spasms in his head and neck and rolling of his eyes upward. Dx?; Tx?

A632. Acute Dystonia; Tx: Anticholinergic; (Benztropine)

Q633. How do you treat neuroleptic-induced Parkinsonism?; (2)

A633. 1. Oral Anticholinergics; 2. Amantidine; (a DA releasing agent)

Q634. A few weeks after starting neuroleptics a patient begins to get an inner restlessness in his legs and cant remain still. Dx?; Tx? (2 possible)

A634. Dx: Akathisia; Tx:; 1. Beta-blocker; 2. Benzodiazepine

Q636. An elderly woman on neuroleptics for a few years begins to get involuntary movements of the tongue, face, neck and upper extremities. Dx?; Tx?

A636. Dx: Tardive Dyskinesia; (often irreversible); Tx: (no cure); 1. Don't abruptly stop meds, switch to atypicals; 2. give Clozapine to help Sx

Q637. What neuroleptic (antipsychotic) drug causes Agranulocytosis?; What must every patient do on this durg?

A637. Clozapine; Patient must have Weekly WBC; (never use as first line due to AE...only in patient who has failed other medication and has a lot of negative Sx)

Q638. what type of Sx do Typical and Atypical antipsychotics treat?

A638. Typical: Positive Sx only; (DA receptor blocker); Atypical: Positive and Negative Sx; (DA and Serotonin receptor blocker)

Q639. What drugs should be used first-line for antipsychosis?; (3)

A639. Risperidone;; Olanzapine;; Quetiapine; (these atypicals are DOC before Haloperidol and Clozapine)

Q640. where does the serotonin system arise from in the brain?

A640. Raphe Nuclei

Q641. What antidepressant is also prescribed for sleep disorders?

A641. Trazodone

Q642. What is the main side-effect of a SSRI (causing people to stop using it)?

A642. Sexual Dysfunction:; Anorgasmia, ED and Diminished Libido

Q643. what is the best Tx for Depression?; What are the contraindications?; AE? (3)

A643. Electroconvulsive Therapy; (usually done to patient that is severely suicidal and cant wait for drugs to set in); CI: No contraindications! Good for everyone; AE: Memory, Seizures and Increases ICP

Q644. What can Lithium cause in an unborn child?

A644. Ebstein's Anomaly; (cardiac malformation of the tricuspid valve)

Q645. DOC for an Acute Mania attack

A645. Haloperidol

Q646. what non-Rx Tx is used for Treatment-refractory major depression?

A646. Vagus Nerve Stimulation

Q647. Name the (5) main drugs used as Mood Stabilizers

A647. Lithium;; Valproic Acid;; Lamotrigine;; Carbamazepine;; Gabapentin

Q648. what drug can be used in acute episodes of bipolar disorder but has AE of blood dyscrasia, impaired liver function, thrombocytopenia and prolonged coagulation times?

A648. Valproic Acid

Q649. what is a second-line agent for Bipolar disorder if the patient does not respond to lithium?; (2 possible)

A649. Carbamazepine; (or Valproic Acid)

Q650. what drug used for Bipolar disorder renders birth control pills ineffective?

A650. Carbamazepine

Q651. what drug for bipolar disorder induces P450?

A651. Carbamazepine

Q652. what drug is used for the maintenance phase of bipolar I disorder (depressive phase) and can cause an allergic rash leading to Stevens-Johnson's syndrome?

A652. Lamotrigine

Q653. What is the main drug class that treats anti-anxiety (Anxiolytics)?

A653. Benzodiazepines

Q654. what do you treat a benzodiazepine overdose with?

A654. Flumazenil

Q655. Main treatment for Generalized Anxiety Disorder that does not cause dependence, sedation or anorgasmia.

A655. Buspirone

Q656. Which Benzos can be given to patients with liver failure?; (3)

A656. Outside The Liver:; Oxazapam,; Lorazapam,; Temazapam

Q657. (3) main AE of Benzos

A657. Sedation;; Dependence;; Memory impairments; (not good for elderly)

Q658. Benzo used for a Panic attack

A658. Alprazolam

Q659. what separates ADHD from other conduct disorders?

A659. Child must have Sx in at least two areas; (such as home and school)

Q660. (2) AE of Methphenidate to children

A660. 1. Growth Hormone Suppression; 2. Tremor; (recommended to take holiday from drugs during summer)

Q661. Tourette's is associated with what (2) comorbid psychiatric illnesses?; Tx? (3 possible)

A661. ADHD and OCD; Tx:; 1. Haloperidol; 2. Pimozide; 3. Clonidine

Q662. Tx of choice for patient with Anorexia that is not life- threatening?; (2 in order)

A662. Tx:; 1. Monitor calories, weight and serum electrolytes (counseling); 2. SSRI (Fluoxetine) (also for Bulimia)

Q663. What internal substance can commonly induce a panic attack in those that are predisposed to having them?; (2)

A663. Sodium Lactate; or; Carbon Dioxide

Q664. What can rapid refeeding after anorexic starvation precipitate?

A664. Hypermetabolic HypoPhosphatemia

Q665. What musculoskeletal complaint frequently is reported in bulemics?; Why?

A665. Muscle Spasms; (due to low serum Potassium and Sodium)

Q666. A high GGT and MCV indicates what type of substance abuse?

A666. Chronic Alcohol abuse

Q667. What is the best way to approach acute pharmacotherapy for GAD?

A667. Give a Benzo-Buspirone combo immediately along with having them start a SSRI. In about 3 weeks, when the SSRI begins to work, wean them off the Benzo-Buspirone combo

Q668. How is GAD different from Panic disorder?

A668. Panic Disorder: Discrete episodes of Anxiety; GAD: Consistent worry about all aspects of their life

Q669. What is the behavior therapy and medical Tx (2) for Panic Disorder?; Which med is for Acute Sx?; Chronic?

A669. Tx:; 1. Cognitive Behavior Therapy; 2. Benzo (Aprazolam) for Acute Sx; 3. SSRI (first-line) for Chronic Sx

Q670. what is the Behavioral therapy for Specific phobias?; (2)

A670. Systematic Desensitization (incorporates relaxation); or Flooding (no relaxation techniques)

Q671. What is the Tx for stage fright?

A671. Beta-Blocker

Q672. What type of behavior therapy is good for OCD?; What are the (2) medications and classes that Tx it?

A672. BT:; Exposure-Response Therapy (make them dirty and prevent them from washing hands); Meds:; 1. SSRI: Fluoxetine; 2. TCA: Clomipramine

Q673. MCC of Post-traumatic Stress Disorder in Men? Women?

A673. Men: Combat; Women: Rape

Q675. Marty is a 30-year-old male who lives with his mother. He works as a night-time cleaner in a large store since he dropped out of college many years ago. He complains of being "nervous all of the time" and would like to "get his life back". He stated that he would like to change jobs but prefers his current job because he does not have any contact with other employees. He did not have many friends in high school or in college, mostly due to his feeling "self-conscious". When among strangers, he would feel nervous and would "break out in a sweat". He had what he described as "nervous attacks", which came on suddenly and lasted for a few seconds to minutes. These attacks only came on when in the presence of strangers. Since these episodes increased in intensity and frequency, he dropped out of college. Dx?

A675. Social Phobia; (not a panic attack, which occurs "out of the blue" versus someone uneasy around strangers)

Q676. What is seen on a CT/MRI and PET-scan to indicate Schizophrenia?

A676. CT/MRI: Increase in size of Ventricles; PET-scan: Hypoactivity of Frontal Lobes

Q677. Schizophrenia type:; presence of delusions of grandeur or persecution; (example: think they are followed by FBI)

A677. Paranoid; (MC type)

"Q678. Schizophrenia type:; marked regression to primitive, disinherited, and disorganized behavior, worst prognosis, early onset; ""Facial Grimacing"" or ""silly affect""; most inappropriate of all types"

A678. Disorganized

Q679. Schizophrenia type:; Patient is running around and jumping on tables, then finally collapsing in exhaustion; may become rigid or have bizarre postering

A679. Catatonic

Q680. Schizophrenia type:; characteristics of more then one other type

A680. Undifferentiated

Q681. Schizophrenia type:; frequent auditory hallucinations

A681. Paranoid

Q682. Schizophrenia type:; patient meets criteria for schizophrenia in the past but now lacks delusions or hallucinations

A682. Residual

Q683. what is the difference in Type I or Type II schizophrenia?

A683. Type I: Positive and Negative Sx (Tx: Typical or Atypical Anti-psych); Type II: Negative Sx only (Tx: Atypical Anti-psych)

"Q684. What is this an example of:; ""I am the King of Budapest"""

A684. Delusion; (fixed false belief)

Q685. What is this an example of:; Patient describing the trees looking like scary monsters

A685. Illusion; (sensory misconception)

Q686. If an unstable patient in the ER mentions he is having visual hallucinations, what is you first thought of Dx?

A686. Drugs; (visual is more related to drugs and auditory is more related to schizophrenia)

Q687. Aside from time, what is the difference between a Brief Psychotic Disorder and other Schizophrenic disorders?

A687. BPD involves a Stressor that initiates the Sx; (stressor could include giving birth; time from 1 day to 1 month)

Q688. what is the difference b/t Delusional disorder and Schizophrenia?

A688. Delusional disorder:; Delusions are non-bizarre and could be possible;; Delusions occur of at least 1 month

Q689. Type of Delusional Disorder:; the individual is being harassed or malevolently treated

A689. Persecutory

Q690. Type of Delusional Disorder:; the individual posses exaggerated power, money or knowledge

A690. Grandiose

Q691. Type of Delusional Disorder:; thinks that another person, usually of higher status, is in love with the individual

A691. Erotomanic

Q692. Type of Delusional Disorder:; that the individuals partner is unfaithful

A692. Jealous

Q693. Type of Delusional Disorder:; that the individual has a physical defect or a medical condition

A693. Somatic

"Q694. what is a ""Clang Association""?"

A694. a Rhyming of words seen in schizophrenics

Q695. a patient has sudden loss of muscle tone and drops to the floor, only to be in REM within 10 minutes. Dx?; Tx?; (2 possible)

A695. Dx: Cataplexy; Tx:; 1. Imipramine + stimulant; 2. SSRI + stimulant

Q696. What is the definition of hallucinations when falling asleep?; Waking up?

A696. GOing to sleep: HypnaGOgnic; Waking up: Hypnopompic

Q697. (2) Drug Tx for Narcolepsy

A697. 1. Methphenidate; 2. Modafinil

Q698. How is Narcolepsy waking different from waking after passing out from alcohol?

A698. Narcolepsy patients feel refreshed after waking

Q699. A middle-aged overweight businessman complains of being tired all day. Dx?; Tx?

A699. Dx: Sleep Apnea; Tx: Continuous Positive Ariway Pressure; (C-PAP)

Q700. A patient has depressed Sx during winter months but feels fine during the summer. Dx?; Tx?

A700. Dx: Seasonal Affective Disorder; Tx: Phototherapy

Q701. A 22-yo female was arguing with her boyfriend and the next day she has a depressed mood. Dx?; Tx?

A701. Dx: Adjustment Disorder; (characterized by the development of symptoms in response to an identifiable stressor occurring within 3 months of the onset of the stressor; examples: car accident, divorce, etc; NOT berevement); Tx: Supportive Psychotherapy

Q702. What is the term for a condition similar to post-traumatic stress disorder, but Sx occur within 1 month of the traumatic event and last from 2 days to 1 month?

A702. Acute Stress Disorder

Q703. A 30-year-old female was fired from her job about 1 month ago. Since then, she has complained of depressed mood and sleep problems. She denies any appetite or weight problems. She denies any suicidal ideation or plan. Her concentration is good and her memory is intact. Dx?

A703. Adjustment Disorder

Q704. what (3) sleep changes are common in depressed patients?

A704. 1. Decreased Slow-Wave Sleep; 2. Decreased REM; 3. Early-morning Awakening

Q705. what is the difference b/t Substance Dependence and Abuse?; (3)

A705. Abuse leads to Dependence; Dependence also has:; Tolerance;; Withdrawal;; Inability to control ETOH use

Q706. A 15yo boy builds model airplanes. What is most likely drug of abuse?

A706. Alcohol; (Alcohol is always most abused)

Q707. Number one risk factor for Suicide

A707. Psychiatric illness; (then: Previous Attempt)

Q708. what is the highest rate of suicide for any age group?

A708. Elderly (>65) Men

Q709. What is the highest ethnicity for suicide?

A709. Native American Adolescents

Q710. Most common way to commit suicide?

A710. Gun

Q711. How can you tell the difference b/t a cocaine/amphetamine user and paranoid schizophrenia?

A711. Drug test; (Cocaine stays in system for 2 - 3 days)

Q712. Substance Abuse Buzz words:; Paranoia

A712. Cocaine or Amphetamines

Q713. Substance Abuse Buzz words:; Arrhythmia

A713. Cocaine or Amphetamines

Q714. Substance Abuse Buzz words:; Depression

A714. Cocaine withdrawal; (worry about suicide)

Q715. Substance Abuse Buzz words:; Severe Violence

A715. PCP; (also vertical nystagmus)

Q716. Substance Abuse Buzz words:; Pinpoint pupils

A716. Opiate overdose; (Heroin)

Q717. Substance Abuse Buzz words:; Flu-like Sx

A717. Opiate Withdrawal

Q718. Substance Abuse Buzz words:; Seizures; (2)

A718. 1. Benzodiazepine intoxication; 2. Opioid withdrawal (?)

Q719. Substance Abuse Buzz words:; Death

A719. Barbiturates

Q720. Substance Abuse Buzz words:; Tremors after hospital admit

A720. Alcohol

Q721. What are the steps of treating Alcohol withdrawal?; (4)

A721. 1. Rule-out Medical complications (hepatic dysfunction or Wernicke's encephalopathy) by Lab tests and exam; 2. Diazepam (Benzodiazepine); 3. Multi-vitamins with Thiamine and Folate; 4. Control electolytes and fluids (inc Glucose)

Q722. what is given to manage cocaine/amphetamine intoxication?; (2 possible meds)

A722. Haloperidol; or; Benzodiazepine

Q723. A patient enters the ER with confusion, ophthalmoplegia, ataxia with memory loss and a personality change and smells of alcohol. Dx?

A723. Wernicke-Korsakoff syndrome

Q724. A patient presents complaining about multiple problems in various organ systems. Dx?; Tx? (2 in order)

A724. Dx: Somatization Disorder; Tx:; 1. Continue to Treat with brief monthy visits (fearing that if you deny Tx, then they may go to someone else costing the patient time and money); 2. Slowly begin to tell patient that Sx are psychological (never refer to psychiatrist)

Q725. A 50yo woman was referred by her husband's psychiatrist because of "attacks of dizziness" that have been occurring for more than 10 years. Every day, at about 3pm, the attacks occur. They leave her helpless and, when her husband arrives, she is unable to attend to him. She remains in bed until 8pm when the attacks subsided then falls asleep. She describes her husband as someone who repeatedly abused her and their children, which resulted in their leaving home at an early age, and moving in with their grandmother. He would make comments about the house, dinner, etc. Many times, these verbal comments were followed by actual episodes of violence, several of which have resulted in her hospitalization. Dx?; Tx?

A725. Dx: Conversion Disorder (One or two neurological symptoms affecting voluntary or sensory function that cannot be explained by any known neurological disorder; as a result of stressor the person has sx like paralysis or blindness or deafness...usually from seeing, hearing or doing something wrong); Tx: Psychotherapy

"Q726. what is ""La Belle Indifference"" and what disorder is it seen in?"

A726. Seen in: Conversion Disorder; Lack of concern about being paralyzed, blind or deaf

Q727. A patient believes that she has a specific disease, giving the actual name of the disease, regardless of reassurance that the person is healthy. Dx?

A727. Hypochondriasis

Q728. A patient believes a body part is abnormal, defective, or misshapen. Dx?; Tx? (2 together)

A728. Dx: Body Dismorphic Disorder; Tx:; 1. Psychotherapy; 2. SSRI (or a TCA or MAOI)

Q729. A patient with conscious production of signs and symptoms of a medical or mental disorder (example: placing blood in urine test to alter labs) to assume a sick role. Dx?

A729. Factitious Disorder (Munchausen's syndrome); If doing it to a child it is Factitious by proxy (illness caused by a parent). Parent should be reported to child abuse.

Q730. A person who has conscious claims of a medical problem for a specific gain; Dx?

A730. Malingering; (Different from Factitious disorder b/c it is for a specific gain and not attention)

Q731. A patient cannot remember what his name is, but remembers what he had for lunch. He is otherwise healthy. Dx?

A731. Dissociative Amnesia; (This clinical picture is exactly the reverse of the one seen in dementia, in which patients may remember their names but forget general information, such as what they had for lunch. Except for their amnesia, patients with dissociative amnesia seem completely intact and function coherently. By contrast, in most amnesias due to a general medical condition (such as postictal and toxic amnesias), patients may be confused and behave in a disorganized manner. Other types of amnesias (e.g., transient global amnesia and postconcussion amnesia) are associated with an ongoing anterograde amnesia, which does not occur in patients with dissociative amnesia. This Amnesia deals with forgetting something of a stressful nature)

Q732. Definition:; The invention of false information to cover up a gap in memory

A732. Confabulation

Q733. Dx:; an acute and transient retrograde amnesia that affects recent memories such as date and location, but maintains personal information like name. Although patients are usually aware of the amnesia, they may still perform highly complex mental and physical acts during the 6 to 24 hours that the episodes usually last.

A733. Transient Global Amnesia; (can be due to a TIA, migraine, or seizure)

Q734. Dx:; A patient physically travel away from their customary homes or work situations and fail to remember important aspects of their previous identities (name, family, occupation).

A734. Dissociative Fugue; (Such patients often, but not always, take on an entirely new identity and occupation, although the new identity is usually less complete than the alternate personalities in dissociative identity disorder, and the old and new identities do not alternate, as they do in dissociative identity disorder)

Q735. Dx:; A patient has two or more distinct personalities, each of which determines behavior and attitudes during any period in which it is dominant. Its cause typically involves a traumatic event, usually childhood physical or sexual abuse; Tx? (2)

A735. Dissociative Identity disorder (multiple personality disorder); Tx:; Psychotherapy; Hypnotherapy

Q736. Dx:; A persistent or recurrent alteration in the perception of the self to the extent that a person's sense of his or her own reality is temporarily lost. Patients may feel that they are mechanical, in a dream, or detached from their bodies. Next step?

A736. Depersonalization Disorder; Next step: Neurologic testing; (The fact that depersonalization phenomena may result from gross disturbances in brain function underlies the necessity for a neurological evaluation, especially when the depersonalization is not accompanied by common and obvious psychiatric symptoms. In particular, the possibility of a brain tumor or epilepsy should be considered. The experience of depersonalization may be the earliest presenting symptom of a neurological disorder)

Q737. Define:; Anterograde Amnesia; Retrograde Amnesia

A737. Anterograde: Ability to learn new information; Retrograde: Ability to recall previously remembered knowledge

Q738. What type of amnesia is assoc with ECT?

A738. Retrograde (a few minutes before Tx); and; Anterograde (for up to 5 hours after Tx)

"Q739. A 50-year-old man presents to an ED with a one day History of bilateral tremor in his hands, diaphoresis, anxiety, headache, and the sensation that ""my skin is crawling"". He denies other symptoms. He takes hydrochlorothiazide for HTN. He states that he sees a psychiatrist for bipolar disorder and anxiety, and that he takes three psych meds, the names of which he can not remember. He ran out of his meds three days ago. His temperature is 37 C (98.6 F), blood pressure is 150/100 mm Hg, pulse is 115/min, and respirations are 20/min. Physical examination is notable for diaphoresis and tremulousness. What drug is the most appropriate initial step in this patient's care?"

A739. Lorazepam; (The patient takes an unknown anxiety medication, and is most likely experiencing benzodiazepine withdrawal symptoms. Commonly observed symptoms of benzodiazepine withdrawal include: anxiety, diaphoresis, irritability, insomnia, fatigue, headache, myalgias, nausea, perceptual disturbances, tremors, and seizures. The most appropriate management step would be parenteral administration of a short-acting benzodiazepine, such as lorazepam)

Q740. A 61-year-old woman, who has been treated with amitriptyline for depression, is brought to her psychiatrist by her family. The woman is confused, disoriented, and hallucinating, and her skin appears dry and warm. The family noticed that she took more pills than prescribed. Dx?

A740. Anticholinergic delirium; (caused by the use of anticholinergics or other drugs with anticholinergic properties, like tricyclic antidepressants. In elderly patients, the symptoms can be present even with usual doses. Overdosing results in clouding of consciousness, as well as constipation, urinary retention, dry mouth, elevated temperature, dry flushed skin, worsening of glaucoma, and tachycardia)

Q741. A 63-year-old white male who has recently retired from work as a plumber for over 30 years returns to his family physician saying that he has been feeling very down lately, and has been having decreased appetite and a loss of interest in activities that used to give him pleasure. He is a smoker, drinks no alcohol, and is being treated by his family physician for moderate essential hypertension. What is the most appropriate next step in management?

A741. Review the patient's medication history; (Many medications used to control hypertension, such as propranolol, and in the past, reserpine, are known to occasionally lead to depressive symptoms. By evaluation of the patient's medication record, the physician can evaluate which medications were started at what time and can make adjustments to dosage or switching to alternative medications to control hypertension)

"Q742. A woman who attends weekly psychotherapy sessions becomes furious at her psychiatrist, who is about to leave for vacation and is not willing to reveal where he is going. She angrily says that he is just like her father, who always had his own ""own life"" outside the family. What best describes this patient's reaction?"

A742. Transference; (Transference is defined by psychoanalysts as a patient's unconscious feelings and behavior toward the analyst that are based on infantile wishes the patient has toward parental figures)

Q743. A 44-year-old, HIV-positive patient has been treated for Pneumocystis carinii pneumonia in the hospital. He has a prior history of depression and was treated with paroxetine, which was continued in the hospital. While in the hospital, he became delirious and had visual hallucinations. The psychiatry consult team started him on olanzapine. The patient's delirium gradually resolved, but prior to discharge he complained that his urine stream became weak and his bladder felt full. On examination, the physician confirmed lower abdominal distention. What medicine is the most effective treatment?

A743. Bethanechol; (Bethanechol is direct-acting cholinergic stimulant effective in reducing the peripheral anticholinergic effects of some psychotropic medications. It can be administered intramuscularly, orally, or subcutaneously to efficiently relieve the symptoms of urinary retention)

"Q744. A 24-year-old man was recently hospitalized in a psychiatric unit, where he was started on olanzapine. Upon visiting his new primary care physician for a routine physical examination prior to participating in a vocational rehabilitation program, his physician notices that his thoughts are quite illogical. For example, when she asks the young man what sort of employment he hopes to work toward, he answers, ""if you subtract some yellow from the sky, it becomes greener."" After a brief silence, he then states, ""telephone bills should never exceed twenty dollars ... according to the Book of Numbers."" What mental status examination finding most accurately describes this patient's thought processes?"

A744. Loose Associations; (His ideas are disconnected and seem to jump from one topic to an unconnected topic. Loose associations are one of the characteristic signs of a primary thought disorder, such as schizophrenia)

Q745. Dx:; poor ability to think in abstract terms, despite normal intelligence

A745. Concrete thinking

Q746. Dx;; when thoughts and speech halt, often in mid-sentence, as if forgotten. The idea may be picked up later, after a period of apparent confusion

A746. Thought Blocking

Q747. Define:; a person's biological sexual characteristics: chromosomes, external genitalia, internal genitalia, hormonal composition, gonads, and secondary sexual characteristics

A747. Sexual Identity

Q748. A 40-year-old man is admitted to the hospital for evaluation and treatment of depression associated with suicidal thoughts. He denies any past psychiatric history. His medical history is significant for hypertension, for which he currently takes hydrochlorothiazide. He also describes a history of once having a painful erection that lasted for eight hours and had to be treated with intracavernous injections in the emergency room. He states that this was thought to be related to an antihypertensive medication that he used to take. During the treatment of this man's psychiatric condition, what medication should be avoided?

A748. Trazodone; (Trazodone is an older antidepressant medication that is commonly used in lower doses for the treatment of insomnia associated with depression. Due to its significant alpha- adrenergic blocking properties, it has been associated with priapism)

Q749. A 28-year-old man presents to his primary care physician for his yearly physical examination. He currently smokes approximately one pack of cigarettes a day and is interested in quitting. He has no significant past medical history and has no allergies. He is interested in smoking cessation classes, but would like additional help. What medication would be the most appropriate agent for treating nicotine dependence in this patient? (spell it)

A749. Bupropion (Wellbutrin)

Q750. A 72-year-old man with a history of renal dysfunction, congestive heart failure, and previous myocardial infarction is currently undergoing dialysis. Over the past few weeks, he has been feeling increasingly depressed and has begun to act bizarrely, with persecutory delusions that the government is poisoning the chemicals used on him for dialysis. Also in the last few weeks, due to increased stomach pain, his medications have been adjusted and now include cimetidine for stomach ulcers, digoxin, and a baby aspirin daily. He also takes docusate sodium as needed for stool softening and ibuprofen as needed for mild arthritis pain. Which of the medications would be most likely to have induced the symptoms the patient is now experiencing?

A750. Cimetidine; (the only drug listed known to cause psychiatric effects of clinical significance, including delusions and psychosis. The exact mechanism is unknown, but is thought to be related to the effects of cimetidine on the H-2 histamine receptor in the brain. The treatment of cimetidine-induced psychosis is to reduce the dosage of the medication, and discontinue it if an alternative therapy is available)

Q751. A 34-year-old man is admitted to the psychiatric temporary observation unit complaining of depression and suicidal ideation following a cocaine binge. During his stay, he starts feeling as if insects are crawling under his skin. This is most typical of what phenomena?

A751. Formication; (a form of haptic hallucinations, associated with the sensation of touch. It is commonly seen in delirium tremens, amphetamine psychosis, and cocaine intoxication)

Q752. A 20-year-old white man is brought to the emergency clinic by two friends on a Sunday morning after a fraternity party the night before. His friends note that since the party, he has been very belligerent, agitated, and loud. They suspect that he may have used drugs with some friends at the party. His temperature is 37 C (98.6 F), blood pressure is 145/95 mm Hg, pulse is 105/min, and respirations are 20/min. Physical examination reveals slurred speech, unsteady gait, and nystagmus. The patient appears to be responding to auditory hallucinations. Dx?

A752. Phencyclidine (PCP) intoxication; (intoxication is characterized by maladaptive behavioral changes, and may be associated with vertical or horizontal nystagmus, hypertension, tachycardia, numbness or decreased response to pain, ataxia, dysarthria, muscle rigidity, and seizures; not alcohol withdrawal b/c of the nystagmus)

Q753. A 25-year-old woman presents to the emergency department complaining that she is having auditory hallucinations and tremors, along with associated nausea and vomiting. She feels very anxious. On mini-mental status examination, she scores 22 of 30, and she appears to be obtunded. From what substances is this patient most likely withdrawing?

A753. Benzodiazepines, such as alprazolam (Xanax); (Symptoms include insomnia, tremor, gastrointestinal distress, hallucinosis, and anxiety. Withdrawal from benzodiazepines can also be accompanied by generalized seizures)

"Q754. A 68-year-old woman with hypertension comes to the physician because of decreased appetite, fatigue, insomnia, inability to concentrate, and feelings of worthlessness over the past two months. She states that her grandchildren are coming to stay with her for three weeks and she ""wants to get to the bottom of this"" before they arrive. Her antihypertensive medication was changed three months ago. What antihypertensive medication is the most likely cause of the patient's new symptoms?"

A754. Propranolol; (The symptoms of change in appetite, fatigue, insomnia, lack of concentration, and worthlessness for greater than 2 weeks are consistent with depression. Propranolol is one of the most common pharmacological agents to cause depression. Other side effects of propranolol include dizziness, bronchospasm, nausea, vomiting, diarrhea, and constipation. It may also precipitate asthma, congestive heart failure, and hypoglycemia in susceptible patients)

Q755. A medicine consult is requested on a 32-year-old woman with paranoid schizophrenia who is a patient in a closed psychiatric unit. Several days after the patient's admission, she developed polyuria, vomiting, stupor, diarrhea, and restlessness. She is currently taking risperidone, 10 mg given at bedtime, but no other medications. What is the most likely diagnosis?

A755. Water Intoxication; (This patient is showing the symptoms of psychogenic polydipsia, which is the excessive intake of water as a result of a psychiatric disorder. The symptoms of excessive water intake include polyuria, vomiting, and diarrhea. As the patient is on a closed psychiatric unit, the chances of reactions to excessive medications are rare, given the careful monitoring of medication intake on most psychiatric units. Surreptitious water consumption would be easy to overlook in a patient without a previous history)

Q756. What Dx can occur to an infant if the mother uses Benzodiazepines in the first trimester?

A756. Cleft Palate; (During the first trimester of pregnancy, the use of benzodiazepines increases the risk of cleft palate 10-fold)

Q757. A 29-year-old, previously successful woman was climbing stairs in her new home about a month ago, when the whole house fell apart. She ended up in a hospital with a fractured left femur. The psychiatry team was consulted because the patient complained of nightmares and flashbacks and was afraid to go to sleep as a result. During the interview, she is tearful, and afraid that her fear of falling is preventing her from participating enough in her rehabilitation, and that the team will discharge her from hospital. Dx?; What is the most appropriate med for this patient?

A757. Dx: Posttraumatic Stress Disorder (PTSD), as well as depressive symptoms; Tx: Sertraline - SSRI; (an antidepressant approved for treatment of this disorder. Other antidepressants and anticonvulsants have also been shown to be effective in the treatment of PTSD)

Q758. A young woman who sustained minor injuries after a motor vehicle accident is admitted to the hospital. During the observation period, the intern notices that the patient's vital signs are all increased, and she seems confused, disoriented, and delirious. On admission, she states she has been using medication to help with anxiety for couple of months. However, she ran out of it 2 days prior to the accident. From what medication is this patient most likely experiencing withdrawal?

A758. Alprazolam is a short-acting Benzodiazepine; (It has a rapid onset of action and a relatively short half-life. It is indicated for treatment of panic attacks and anxiety disorders in general. Given its properties, however, it also has a highly addictive potential. The abrupt discontinuation of its use may result in withdrawal delirium, seizures, or death)

Q759. Abrupt discontinuation of what psychiatric drug class can lead to Flu-like symptoms?

A759. SSRI

Q760. A woman comes to the clinic with her 13-year-old grandson, stating he has had behavioral problems for the past 4 years. He is living with her now because his mother is in drug rehabilitation center. She describes that he has run from home twice and has been kicked off the school bus for threatening other kids and challenging the driver. He is about to be expelled from school, since he was caught extorting money from other children. What is the most likely diagnosis?

A760. Conduct disorder; (a childhood/adolescent disorder defined as a pattern of behavior in which the basic rights of others are violated with three or more of the following present in the past 12 months: destruction of property, cruelty to animals and people, deceitfulness or theft, and serious violations of rules. It causes clinically significant impairment in social functioning and it is reserved for patients younger than 18)

Q761. A parent comes to you to talk about their 16yo who, in the past 7 months, has had a loss of temper, arguments with adults, defying of rules, deliberately annoying other people, blaming others for own faults, presence of vindictive behavior, presence of anger, and resentment. Dx?

A761. Oppositional Defiant Disorder; (a pattern of negativistic and defiant behavior lasting at least 6 months with four or more of the following: loss of temper, arguments with adults, defying rules, deliberately annoying other people, blaming others for own faults, presence of vindictive behavior, presence of anger, and resentment)

Q762. A 27-year-old woman is 2 weeks' postpartum with her first child. During her first postpartum follow-up visit, she complains to her physician that she has had several crying spells and has been increasingly irritable; however, she has had some spells during which she has felt almost euphoric. She has had these symptoms over the past week. She has not had any previous psychiatric disorders. What is the most likely diagnosis?

A762. Maternity Blues; (a normal state of sadness, dysphoria, frequent tearfulness, and dependence that about 20% to 40% of women experience in the postpartum period. It is thought to be derived from rapid changes in women's hormonal levels and the stress of childbirth associated with maternity)

Q763. A 43-year-old woman presents to the emergency department complaining of dizziness, tremor, diaphoresis, and shortness of breath. She indicates to the physician that she has come into the hospital with similar complaints twice in the past several weeks. On those occasions, as well as currently, her physical examination, routine laboratory studies, ECG, and cardiac enzymes have all been unremarkable. The patient states that these episodes are starting to concern her greatly and she is worried about going out of her house alone now. What is the most likely diagnosis?

A763. Panic Disorder; (This patient's symptoms are all suggestive of panic attacks. Her symptoms do not appear to be related to substance use or a general medical condition. The frequency of her symptoms and her agoraphobia are also indicative of a diagnosis of panic disorder)

Q764. A 24-year-old graduate student and teaching assistant comes into the student health center after being instructed by his college dean to seek counseling. According to the collateral history obtained from the patient's roommates and instructors, the man exhibits annoyingly grandiose behavior, is frequently demanding of his peers' admiration, and has had to be reprimanded for treating his undergraduate students without empathy or understanding in demanding that their work be submitted in two different forms for each assignment. Given this history, what is the most likely diagnosis?

A764. Narcissistic personality disorder; (patients frequently demand constant attention and admiration, and they are often indifferent to criticism. They frequently exhibit grandiosity in behaviors or fantasies, show lack of empathy, often exhibit a sense of entitlement, and frequently exploit whatever interpersonal relationships they have developed)

Q765. A mother brings her 8-year-old son to a psychiatrist for new- onset enuresis. A prior workup to determine a medical cause was negative. In conversation, it seems that the enuresis started following parental arguments and separation. The boy wets himself at least twice a week and feels upset about it, refusing to go for a sleep-over at his friend's house. What is the most commonly used treatment for this condition?

A765. Behavioral therapy; (the most frequently used treatment in children with enuresis. Dry nights are recorded on a calendar and rewarded with a star as a gift)

Q766. A 35-year-old man is brought to the emergency clinic by his mother because of an episode of slurred speech associated with the uncomfortable sensation that his tongue is thick and curling up. The episode started suddenly 30 minutes ago. The patient is noted to be holding on to his tongue with his thumb and forefinger. When asked about this, the patient responds with dysarthria, saying that his medication has caused this once before and that he needs a shot to make it go away. His mother reports that the patient has had schizophrenia for 10 years and consistently takes two medications prescribed by his psychiatrist. Several days ago he ran out of one of his medications, but has continued to take the other one. What is the most appropriate initial step in the management of this patient?

A766. Quickly administer an Anticholinergic meds IM; (The patient is experiencing an acute dystonic reaction, which is a form of extrapyramidal side effect (EPS) associated with antipsychotic medications. These side effects are related to antagonism of dopamine receptors in the nigrostriatal pathway. The patient is likely taking a conventional antipsychotic agent plus a prophylactic anticholinergic agent (such as benztropine, diphenhydramine, or trihexyphenidyl). Upon stopping the anticholinergic, the dystonic reaction was more likely to occur. The appropriate initial management of this patient would include immediate IM administration of an anticholinergic agent, such as 2 mg of benztropine or 50 mg of diphenhydramine)

Q767. A 45yo woman presents to her physician because of blurred vision for 2 days. She has no medical Hx. She does state that several days ago she started Tx for depression with a psychiatrist, due to a two-month period during which she had several depressive symptoms. She has a dry mouth and dizziness when she stands up from lying or sitting. Her temperature is 98.6 F, BP lying down is 135/75 mm Hg, BP standing is 110/64 mm Hg, pulse lying down is 84, pulse standing is 95, and respiratory rate is 16/min. Examination is unremarkable except for mild mydriasis. What medication accounts for this patient's symptoms?

A767. TCA (Imipramine); (inhibits norepinephrine and serotonin reuptake. Like most TCAs, imipramine also has antagonistic effects at muscarinic, histaminic, and a-adrenergic receptors. This patient's complaint of blurred vision is most likely due to the antimuscarinic effects of the medication. The blockade of muscarinic acetylcholine receptors causes mydriasis (pupillary dilation) resulting in blurred vision. Dry mouth is also due to the anticholinergic effect of imipramine. Orthostatic hypotension is caused by the a1-adrenergic receptor blockade associated with TCAs)

Q768. A 19-year-old student is admitted to the psychiatry inpatient unit with the working diagnosis of first-break psychosis. Because of combativeness and threats to others, he is put in seclusion. At first, he refused to take medication by mouth; however, after attacking a nurse he is given haloperidol intramuscularly on two occasions. He has now developed acute torticollis and twitching of the mouth and face on that side. The family is furious, stating that the treatment caused the seizures. What reaction did this patient most likely have?; Tx?

A768. Acute Dystonia; (an involuntary spasm of a particular group of muscles that can involve the neck, jaw, tongue, eyes, or the entire body. It can be an early adverse effect of antipsychotics, and it is more common in younger men. It is more common with typical antipsychotics); TX: parenteral administration of anticholinergics; (Benztropine)

Q769. A 45-year-old woman returns to her psychiatrist two months after being hospitalized for an episode of major depressive disorder, recurrent, severe with psychotic features. At the hospital, she was started on two meds, an antidepressant and an atypical antipsychotic. At her appointment, she complains to her physician that she has missed her menstrual period for two months. She also complains of tenderness in her breasts, and an occasional small amount of milky discharge from her breasts onto her blouse. She also admits to low libido over the past month. What medication is most likely responsible for this constellation of symptoms?

A769. Risperidone; (Although it is an atypical antipsychotic, it is like conventional antipsychotics in its ability to cause significant elevations in plasma prolactin levels. In the tuberoinfundibular dopamine pathway, dopamine inhibits the release of prolactin from the anterior pituitary. Conventional antipsychotics and risperidone can cause hyperprolactinemia due to their dopamine antagonism in this pathway, releasing the tonic dopamine inhibition. Clinical manifestations of hyperprolactinemia may include galactorrhea, sexual dysfunction, menstrual irregularities including amenorrhea, infertility, and weight gain)

Q771. A 43yo woman with a long History of Schizophrenia complains of a loss of night vision. What medication is she taking?

A771. Thioridazine

Q772. A 28yo man with a History of psychiatric admission 6 months previously is seen in the ED with a painful erection, which has persisted for 18 hours. What is the next best step?; What drug is he using?

A772. Next step: Epinepherine injection into Penis; Drug: Trazodone

Q773. A 57yo woman complains of feeling dizzy when she gets up in the morning and when standing. She takes imipramine each evening for depression. What physiologically is the cause of her Sx?

A773. Alpha-Adrenergic Blockade

Q774. A 34yo man is seen in the ED with HA, dizziness and BP of 210/150. He has no medical problems, states he is feeling fine and says last night he had a nice meal with red wine and french cheese. What possible medications is he taking?; (2)

A774. Phenelzine; or Tranylcypromine

Q775. A 22yo college student who enjoys drinking beer attempted to take a SSRI for his depression but was upset with the side- effects. He switched to another class and several days later he was admitted to the ED with muscle spasms, confusion, fever, tachycardia and HTN. What was the cause?

A775. Serotonin Syndrome; (switched from SSRI to MAOI without giving enough time between the meds to flush the excess SSRI out of the system. Five weeks should elapse before switching from an SSRI to a MAOI)

Q776. A 17yo adolescent with Bulimia is very depressed. She is also suffering from insomnia and apathy. Why should she avoid Bupropion?

A776. It can lower Anorectic effects; (and seizure threshold in person with seizure disorder)

Q777. A 38yo woman is admitted to the hospital for an elective Hysterectomy. On post-op day 3 she experiences auditory and visual hallucinations, tremors and agitation. What is the best therapy?

A777. Benzodiazepine; (she is probably experiencing an alcohol or Benzo withdrawal; this is Tx)

Q778. A 25yo man with bipolar disorder took too many pills, had 2 seizures and is now in a coma. What is the best therapy?; What drug caused this?

A778. Drug: Lithium; Therapy: Dialysis (Dialysis is used to Tx lithium toxicity, when it is severe and life-threatening)

Q779. A 38yo Schizophrenic woman feels restless and cannot sit still; her physician thinks this is due to her medication. What can be given to calm her?; What is this Dx?

A779. Tx: Propranolol; Dx: Akathisia

Q780. A 32yo woman with panic disorder and anxiety took an overdose of Diazepam and is taken to the ED with somnolence and hypoventilation. What is the best Tx?

A780. Flumazenil

Q781. A 30yo man being Tx for schizophrenia complains of tremor and a slow gait. What is the best Tx?; (2)

A781. Amantidine or Levodopa; (for the Drug-induced Parkinsonism)

Q782. After taking a SSRI for weeks to months, what is a side effect a Woman may complain of?

A782. Anorgasmia

Q783. What is the Tx for a patient that develops Neuroleptic Malignant Syndrome?; (3)

A783. Mostly supportive therapy, but the following drugs are also used:; Bromocriptine;; Amantidine;; Dantrolene

Q784. What is the definitive Tx for Tardive Dyskinesia?

A784. Nothing--it is a permanent condition

Q785. what is the best Tx for EPS, such as Dystonic reactions?(2)

A785. Tx:; 1. Benztropine (an Anticholinergic med); 2. Reducing the dose of the Antipsychotic

"Q786. A 33yo man thinks he is ""going to have a heart attack like his father"". He explains his father died at 45 of a MI. He is experiencing angina attacks consisting of nervousness, sweating, palpitations, flushing and numbness in his hands lasting 5 minutes. He is anxious about having these Sx despite negative lab results and ECGs. Dx?"

A786. Panic Disorder (without Agoraphobia)

Q787. A 33yo female who is being treated for hypothyroidism is beginning to get panic attacks. Dx?

A787. Dx: Synthroid-induced panic attacks

Q788. What is a common defense mechanism seen in Dependent Personality Disorder?

A788. Idealization

Q789. (3) Possible drug Tx for Generalized Anxiety Disorder

A789. Buspirone (not good to give after Benzo; starts to work in 2- 3 weeks);; Benzodiazepines;; SSRIs

Q790. Dx:; A person with 4 or more episodes of mania in a year

A790. Rapid Cycling Bipolar Disorder

Q791. What is the drug Tx for someone experiencing acute Mania?; (2 together)

A791. Mood Stabilizer and Antipsychotic; (then take patient off the anti-psych as soon as Sx go away)

Q792. When is ECT used first in a Depressed patient?; (3)

A792. Suicidal;; Catatonic;; Not eating or drinking

Q793. What medication causes sickness to those trying to stop alcohol dependence?

A793. Disulfiram; (blocks Acetylaldehyde DH)

Q794. what medication decreases cravings of alcohol in patients who are alcoholics?

A794. Naltrexone

Q795. How do you know if Wernicke's progresses to Wernicke- Korsakoff?

A795. Anterograde Amnesia develops

Q796. A 32-year-old man is in twice-weekly insight-oriented psychotherapy with a psychiatrist. Recently, the patient has been exploring his thoughts and feelings around his wife's complaint that he is too restricted and inhibited in their sexual activity. The patient admits that he wishes to be more sexually available for his wife, but finds himself maintaining a restricted stance. What defense mechanisms would best describe this patient's tendency in his sexual relationship with his wife?

A796. Reaction formation; (often seen in obsessional characters, is the term for the defense mechanism in which an unacceptable impulse is transformed into its opposite. In this case, during insight- oriented psychotherapy, the patient realizes his wish to be freer in his sexual relationship with his wife, an impulse which he finds unacceptable on some level, but finds himself responding in the opposite way by maintaining a restricted stance)

Q797. What defense mechanism occurs when a socially acceptable means of expressing an impulse replaces one that would be socially unacceptable?

A797. Sublimination; (a Substitution that allows instincts to be channeled, rather than blocked or diverted)

Q798. A 26yo man is brought to the ED for schizophrenic symptoms. During examination, the patient appears to be awake, but firmly resists any attempts to be moved. He does not follow instructions, and the nurse was unable to move his arm to obtain a blood pressure measurement without assistance. What term would best describe this patient's resistance to being moved?

A798. Negativism; (a motiveless resistance to all attempts to be moved or to all instructions. Signs of catatonia include stupor, negativism, rigidity, posturing, mutism, stereotypes, mannerisms, waxy flexibility, and catatonic excitement. Catatonia may be associated with schizophrenia of the catatonic type, mood disorders with catatonic features, or general medical conditions)

Q799. Dx:; a pathological imitation of the movements of one person by another. It can be seen in catatonia, delirium, dementia, and other disorders.

A799. Echopraxia; (Practices your behavior; not to be confused with Echolalia - repeating words or phrases)

Q800. Dx:; a repetitive fixed pattern of physical action, movement, or speech. It may be seen in catatonia

A800. Stereotypy

"Q801. A 53-year-old woman is admitted for depression with psychotic features. During the examination, the psychiatrist asks her whether she has ever had problems with her heart. The patient responds, ""What are you saying? I don't have a heart any more; there is nothing left inside me."" What is the patient most likely exhibiting?"

A801. Nihilistic delusions; (False feelings that the self or others do not exist or are destroyed. It is typical for depression with psychotic features. At its extreme, it is called Cotard's syndrome. The patient complains that he or she has lost possessions, status, strength, heart, blood, and intestines, and that the world has been reduced to nothingness)

Q802. Hallucination type:; a false sensation of things occurring in or to the body, most frequently of visceral origin

A802. Cenesthetic hallucination

Q803. Dx:; a disorder of thought process in which a patient meaninglessly repeats certain phrases or words

A803. Verbigeration

"Q804. A 28-year-old woman with a history of paranoid schizophrenia is brought by a friend to the hospital. The woman had been an inpatient at a psychiatric hospital; for several months after being discharged, she had been maintained on haloperidol decanoate shots. For the past couple of days, after the last injection, she has appeared ""strange."" She is stiff, cannot swallow or talk, and appears tremulous. The friend is concerned that she has some kind of infection, since she has a fever. On examination, her temperature is 38.7 C (101.7 F), blood pressure is 157/104 mm Hg, pulse is 122/min, and respirations are 24/min. She has increased tone in her neck and extremities, and appears tremulous, diaphoretic, and confused. Her leukocyte count is 19,600/mm3 and the serum creatine phosphokinase is markedly elevated. A workup for infection is negative. What is the most likely diagnosis?"

A804. Neuroleptic malignant syndrome (NMS); (A rare complication of neuroleptic therapy that confers high mortality if not recognized and treated promptly. It is defined by the development of severe muscle rigidity and elevated temperature in association with at least two or more of the following: dysphagia, tremor, diaphoresis, tachycardia, change in level of consciousness, leucocytosis, elevated or labile blood pressure, and elevated creatine phosphokinase as an indicator of muscle injury. The predisposing factors include high neuroleptic doses, intramuscular injections, and lithium treatment)

Q805. A 49-year-old woman, who is being treated with chemotherapy after surgery for breast cancer, presents at the emergency department of the local hospital. She had just started taking prochlorperazine for nausea the day before. She is brought in by the her husband because she has been acting bizarrely over the past 24 hours, with waxy flexibility in her movements and mutism. She has no previous psychiatric history. Her physical examination, laboratory tests, and vital signs are all within normal limits. What is the most appropriate pharmacotherapy?

A805. Benztropine; (Prochlorperazine (Compazine) is frequently used to treat nausea and emesis in some patients. Side effects of this medication, including extrapyramidal reactions (e.g., catatonia), are treated best by anticholinergic / antiparkinsonian medications such as benztropine)

"Q806. A patient is seen on the psychiatry consultation liaison service by a medical student. To assess the patient's cognitive functions, the student asks the patient what the proverb ""Don't cry over spilled milk"" means. The patient answers that if you spill what you cook, you have to do it all over again. What type of thinking is this patient most likely exhibiting?"

A806. Concrete Thinking; (Literal thinking that shows a lack of understanding of the nuances of meaning. These individuals lack the ability to use metaphors)

Q807. What is it called when a patient has the ability to appreciate nuances of meaning and the ability to use metaphors and hypotheses appropriately?

A807. Abstract Thinking

Q808. A 30-year-old woman presents to her primary care physician with multiple symptoms of depression. She complains of about 2 months of feeling sad and anxious. She describes difficulty falling asleep at night, decreased appetite with a 15 lb weight loss, diminished interest in her hobbies, and poor concentration. The patient denies any other problems. Physical examination is within normal limits. The patient and her physician discuss initiating treatment with a selective serotonin reuptake inhibitor (SSRI). Aside from sexual consequences, what would be the most important additional information to gather before starting the SSRI?

A808. Past history of hypomanic or manic episodes; (This might significantly alter treatment planning. It is likely that all antidepressants, including SSRIs, have a potential to cause a switch into hypomania or mania, or to accelerate cycling in patients with bipolar disorder. If the patient has a history of hypomanic or manic episodes, her depression would be considered a bipolar depression rather than a unipolar depression. In this case, the patient would likely need to be started on a mood stabilizer before beginning treatment with an antidepressant medication)

Q809. A 40-year-old man is brought in for evaluation by the Coast Guard after the small plane he was piloting crashed into the ocean. The man's wife and two friends were also on the plane. The man has survived the crash with cuts and a broken arm, but he claims he has no memory of the crash or how he escaped the plane. He is also unable to explain how he got his life jacket on. His physical examination now is significant only for minor lacerations and a fractured right humerus, and he has no alteration in consciousness. A CT scan is normal. He is very upset that the fate of his wife is unknown, and he has nightmares for the next several nights while trying to sleep. What is the most likely diagnosis?

A809. Dissociative Amnesia; (an extremely stressful event has been followed by localized loss of memory or amnesia of circumstances surrounding the event, making the diagnosis of dissociative amnesia the most likely diagnosis. Dissociative amnesia is often accompanied by nightmares and anxiety concerning the event, both of which this patient also has)

Q810. A 26-year-old man presents to his primary care physician complaining that he has been more and more afraid to leave his house because he has been having frequent anxiety attacks that occur without warning. He is worried that he will have an attack at some time while he is in public. What is the most appropriate initial medication for this patient in an acute situation?

A810. a Benzodiazepine; (This patient's symptoms suggest that he has panic disorder, which is most appropriately treated acutely with a benzodiazepine with a medium length half-life and duration of action, such as clonazepam)

Q811. A 22-year-old African American male is admitted to a psychiatric unit for stabilization of an acute episode of psychosis. He has experienced several weeks of depressive and psychotic symptoms, and has had periods of anxiety and aggression associated with psychotic symptoms and anger about his involuntary civil commitment. He has been started on an antidepressant, an antipsychotic, and has required additional medications on several occasions for agitation. On the fifth day of his hospitalization, he develops a sustained muscular contraction involving his left neck muscles, with associated pain and distress. Dx?

A811. Acute Dystonia

Q812. Dx:; A condition in which the patient has signs and symptoms of pregnancy. It is related to conversion symptoms and can be viewed as a psychosomatic disorder.

A812. Pseudocyesis

Q813. A 40-year-old woman is brought to the hospital after overdosing on alcohol and pills. In talking to a psychiatrist, she denies any prior psychiatric problems but says that about a week ago her apartment burned down. She was trying to get a job before that happened, but when she realized that she had lost everything she had, and that moving in with her family would probably not be possible, she decided to take her own life. What is the most likely diagnosis?

A813. Adjustment Disorder; (A set of behavioral or emotional symptoms developing as a response to an identifiable stressor within 3 months after exposure to the stressor. The symptoms are excessive compared with what one would expect from the exposure, and they cause marked impairment in social functioning)

Q814. A 52-year-old man is recuperating in a hospital after having sustained a recent cerebrovascular accident that damaged part of his right temporal lobe. Once the patient has recuperated from the immediate effects of his stroke, to what psychiatric disorder will he be most predisposed?

A814. Major Depressive Disorder; (Any event that affects the vasculature, such as a myocardial infarction or a cerebrovascular accident (CVA), has been shown to increase the risk of major depressive disorder in the months following such an event. The pathophysiology of such a development is unclear, but is thought to be related to the effects of serotonin on vascular physiology)

"Q815. A 26-year-old man with schizophrenia comes to the emergency department with a 2-hour history of involuntary contractions of the muscles in his neck. He states that he was watching television and ""all of a sudden I turned my head and my neck locked"". He began taking a high-potency antipsychotic agent 3 days earlier. Examination shows no abnormalities except torticollis. What is the most appropriate pharmacotherapy?"

A815. Benztropine; (The treatment of acute dystonia is with anticholinergic medications, such as benztropine or diphenhydramine)

"Q816. A 22-year-old white woman comes to a psychiatrist's office after having been referred by her family physician. She reports no mental problems but tells the psychiatrist that she is concerned about hair loss. Her mother says that the patient has been grooming herself frequently and checking her image in the mirror. Her family physician has examined her several times; there is no evidence of hair loss. He has run multiple tests, but there is no evidence of any abnormality. The woman states that she is embarrassed and tries to avoid going out because everyone ""will notice"" and ask questions. She denies pulling her hair. Despite this problem, she is still doing well on her job. What is the most likely diagnosis?; Tx? (2 possible)"

A816. Body dysmorphic disorder; (The preoccupation with an imagined defect in appearance or excessive preoccupation with a slight anomaly present. Patient are often ashamed to present for treatment. They may frequently check their image and try to compensate for the imagined defect. The disorder leads to social isolation secondary to imagined mockery); Treatment:; 1. prevention of iatrogenesis; 2. SSRI

Q817. A 69-year-old patient is admitted to the neurology service following a stroke. During the next few days, the staff observes that the patient has developed the clinical picture of mania. What area of the brain has most likely been affected by the stroke?

A817. Right Frontal Lobe; (or other parts of right hemisphere)

Q818. A 69-year-old patient is admitted to the neurology service following a stroke. During the next few days, the staff observes that the patient has developed catastrophic reactions that include restlessness, hyperemotionality, irritability, and sudden outbursts of emotion. What area of the brain has most likely been affected by the stroke?

A818. Left hemispheric lesions including Broca's area

Q819. A 69-year-old patient is admitted to the neurology service following a stroke. During the next few days, the staff observes that the patient has developed the clinical picture of depression. What area of the brain has most likely been affected by the stroke?

A819. Left Prefrontal Cortex

Q820. A 69-year-old patient is admitted to the neurology service following a stroke. During the next few days, the staff observes that the patient has developed the clinical picture of Peduncular Hallucinosis (dreamlike hallucinations). What area of the brain has most likely been affected by the stroke?

A820. Midbrain lesions

Q821. A 10-year-old boy diagnosed with attention deficit/hyperactivity disorder (ADHD) comes to a new doctor for the first time. His mother reports that they moved recently to the city, but that he was started on a medication for his ADHD by his previous doctor. After learning which medication the patient has been taking, the doctor becomes concerned about the patient's liver function. What medication is the patient most likely taking?

A821. Pemoline; (A sympathomimetic agent approved for the treatment of attention deficit/hyperactivity disorder. Given the rate of reported cases of hepatic failure, which ranges from 4 to 17 times higher than expected in general population)

Q822. A 22-year-old woman with anorexia nervosa and a history of depression, for which she is currently taking bupropion, moves to a new city and presents to a local psychiatrist to establish care in her new location. She tells the doctor that she has been on the same dose of bupropion since she was 18 years old, and that her depression has been stable, but that she has lost 10 pounds over the last month and weighs only 90 pounds (41 kg) now with a height of 5 feet 5 inches (165 cm). What medicine complication should the physician be most concerned?

A822. Seizures; (Bupropion is an antidepressant that can lower the seizure threshold for some patients, and as a result should be discontinued or carefully monitored in a patient with anorexia nervosa. Patients with anorexia are at increased seizure risk related to large fluid shifts and electrolyte disturbances caused by bingeing and purging behavior)

Q823. Thought Process Disorder:; Using Made-up words

A823. Neologisms

Q824. Thought Process Disorder:; the point of conversation is reached after a long, circuitous path

A824. Circumstantiality

Q825. Affect type:; Laughing one second and crying the next

A825. Labile affect

"Q826. Delusion Type:; Belief that some event is uniquely related to the individual; (""Jesus is speaking to me through TV characters"")"

A826. Ideas of Reference

Q829. A 28yo woman taking care of her schizophrenic husband starts believing her husband's claim that he invented the telephone. When she went abroad a few months her belief disappeared. Dx?

A829. Shared Psychotic Disorder

Q830. Dx:; A type of depression characterized additionally by hypersomnia, hyperphagia, reactive mood, leaden paralysis and hypersensitivity to interpersonal rejection

A830. Dx: Atypical depression

Q831. First-line Tx for Adjustment Disorder

A831. Supportive Psychotherapy

Q832. What is a common defense mechanism of Histrionic Personality Disorder?

A832. Regression; (reverting to childlike behaviors)

Q833. how do you differentiate Dependent Personality Disorder from a dependence of a debilitated person?

A833. DPD features must manifest before early adulthood

"Q834. Dx:; An overweight woman starts a diet, loses 5 pounds, and then says she's taking a break from the diet because she ""hasn't been feeling well."""

A834. Passive-Aggressive Personality Disorder; (stubborn, inefficient procrastinators that manipulate others to do their chores or errands while complaining about their own misfortune)

Q835. What is the Tx of choice for all Personality Disorders?

A835. Psychotherapy

Q836. what controlled substance is commonly seen in cough syrup?

A836. Dextromethophan; (Opiate)

Q837. A patient presents to the ED with dysphoria, Rhinorrhea, Piloerection, insomnia, increased lacrimation, N/V, dilated pupils and sweating; Dx?; Tx?

A837. Opiate Withdrawal (piloerection and rhinorrhea are key Sx); Tx:; if moderate - Clonidine; if severe - Methadone detox

Q838. withdrawal from what class of drugs in abuse can be life threatening?

A838. Sedatives; (Benzos / Barbs)

Q839. Dx:; a patient has dementia, diminished position and vibration sensation and a pupillary accommodation response without a light response. Diagnostic test?

A839. Dx: Neurosyphilis; Dx test:; CSF Fluorescent Treponemal Ab Absorption test; (CSF FTA-ABS or CSF VDRL)

Q840. Define:; Inability to perform purposeful movements; (copying a picture)

A840. Apraxia

Q841. Define:; Inability to interpret sensations correctly; (if visual: inability to recognize a previously known object)

A841. Agnosia

Q842. Dx:; progressive dementia, muscular hypertonicity, choreform movements; Genetics?

A842. Huntington's Disease; genetics: Autosomal Dominant; (HD is Hereditary Dominant)

Q843. Dx:; rapidly progressive dementia 6 - 12 months after onset of Sx and myoclonus (muscle spasms), generalized hypertonicity, and profound speech disturbances; what does brain tissue look like?

A843. Creutzfield-Jakob Disease (CJD); brain: Spongiform changes (and Prions)

Q844. what are the TORCH toxins that can lead to mental retardation?

A844. Toxoplasmosis;; Other (Syphilis, AIDS);; Rubella;; CMV;; Herpes

Q845. when suspecting a learning disorder, what is the first step?

A845. rule-out a Hearing or Visual deficit

Q846. Another name for Dissociative Identity Disorder

A846. Multiple personality Disorder

Q847. A 33yo nun is astounded when a man claims that he saw her at a strip club the night before. She denies his accusations and has no memory of the event. Dx?

A847. Dissociative Identity Disorder; (multiple personalities)

Q848. A 68-year-old man is admitted to the hospital for delirium associated with a urinary tract infection. Upon adequate treatment of the infection, the patient's mental status improves significantly, though he is noted to remain partly disoriented. He also has an impairment in short-term memory, difficulties in naming simple objects, and impaired concentration. His family members confirm an 8-month history of gradual progressive decline in cognitive abilities, which they attribute to old-age.Prior to discharge from the hospital, the nursing staff reports that the patient continues to have urinary incontinence, though his infection has resolved. He is also noted to have a very unsteady gait, requiring assistance when walking. Dx?

A848. Normal Pressure Hydrocephalus; (A potentially reversible cause of dementia that causes gait disturbances (unsteady or shuffling gait), urinary incontinence, and dementia. Enlargement of the ventricles with increased cerebrospinal fluid (CSF) pressure is found, and therapeutic lumbar punctures may significantly improve symptoms)

Q849. Dx:; the excessive and compulsive need for coitus in a man. Its corollary in a female is termed nymphomania.

A849. Satyriasis

Q850. A 29-year-old woman presents to her new primary care physician requesting medication to help with her recent spells of anxiety and depression. She wishes to be started on a medication that will not cause too much sedation. Examination of the patient's old records reveals two previous suicide attempts by overdose, once with acetaminophen at age 16 and another, with aspirin, during college. Given this history, what antidepressant medication would most likely be contraindicated for this patient?

A850. Tricyclic Antidepressant; (It is lethal in overdose and is the leading cause of overdose-related deaths in the psychiatric population. Overdose is associated with prolongation of the QT interval, leading to cardiac arrhythmia and death. Given this patient's history of previous overdoses, a TCA would be contraindicated)

Q851. Dx:; delusion in which a person believes that he or she is being controlled by another person or external force

A851. Ideas of Influence

Q852. Dx:; delusions in which a person has a false belief that others (including people on TV or radio) are talking about him or her. In a broader sense, the behavior of others refers to oneself, other persons, or objects that have special significance and meaning

A852. Ideas of Reference

Q853. Dx:; the feeling of revelation in which a person experiences illumination associated with a sense of being chosen as a leader

A853. Noesis

Q854. A 64-year-old man is undergoing chemotherapy and has occasional nausea and vomiting, which are treated with IV prochlorperazine. After several days of therapy, the patient complains that he feels very restless and agitated and he cannot stop moving his legs. What medication, if given during his initial regimen, might have best prevented this reaction?

A854. Lorazepam; (This patient has evidence of akathisia, the feeling of restlessness that sometimes occurs as a reaction to use of neuroleptic medications, such as prochlorperazine and haloperidol. Prevention of akathisia is most reliably maintained by use of a benzodiazepine medication, such as lorazepam given IV during administration of the neuroleptic drug. This is particularly important in a patient whose immune system and metabolic capacity may show signs of compromise)

Q855. Dx:; mental retardation, short stature, continuous eyebrows, thin downturning lip, microcephaly, small and malformed hands, and hirsutism

A855. Cornelia de Lange syndrome

Q856. A 41-year-old man with a long history of schizophrenia, paranoid type, has been on the inpatient unit for almost 2 weeks. This is his third admission in the past 6 months, and each time he seems to be less responsive to treatment. In the past, he has been on typical antipsychotics and then tried on different combinations, including some atypical ones, with limited success. His family is supportive and makes sure he takes his medication. Given his most recent poor response, what is the most appropriate next step in treatment?

A856. Clozapine; (An atypical agent that has been proven to be more effective than conventional antipsychotics in the treatment of patients with resistant schizophrenia. It exerts an antagonistic effect on D1 and D4 receptors, as well as on the alpha-adrenergic, histaminergic, serotonergic, and cholinergic systems. It is 30% effective in the treatment of patients with resistant schizophrenia in the first 6 weeks)

Q857. A patient is talking to his psychiatrist about a conflict he has with his partner. They argue because the partner complains that the patient is inefficient and procrastinates doing things that are his responsibility. He never completes a task the way in which he was asked to do it, but in his own way and usually much later. What type of defense mechanism is this patient exhibiting?

A857. Passive-Aggressiveness; (Aggression toward others is expressed indirectly, usually through procrastination, stubbornness, passivity, and forgetfulness. The manifestations usually affect others more than the person who is doing it)

Q858. A 12-year-old boy is brought to his pediatrician due to failing grades in school. The boy failed last year and is repeating the sixth grade. His parents have suspected for several years that the boy may have low intelligence due to repeated difficulties in school. The family is referred to a psychologist for psychological testing, including an assessment of intelligence. What test would be most appropriate for evaluating the boy's intelligence and to assist with possible placement in special classes in his school?

A858. Stanford-Binet Test; (A comprehensive intelligence test that is used in psychiatry and education. Another widely used intelligence test is the Wechsler Adult Intelligence Scale. Such tests are routine intelligence tests in the assessment of borderline intellectual functioning, mental retardation, and specific learning disorders)

Q859. A 54-year-old woman presents to her primary care physician for her routine yearly health maintenance examination. She denies any new problems. Her only significant medical history includes a 25-year history of schizophrenia, which has been well-controlled with antipsychotic agents, and a 5- year history of hypertension for which she takes a diuretic. Vital signs and physical examination are within normal limits. However, the patient is noted to have occasional irregular puckering and lip-smacking movements. She denies having noticed the abnormal movements, and her speech is normal. Dx?

A859. Tardive dyskinesia; (The abnormal involuntary movements usually involve orofacial muscles but may include the trunk and extremities)

Q860. Dx:; the patient often tends to emphasize disability related to memory loss, communicates a strong sense of distress, significant memory loss for both recent and remote events and there is little effort to perform even simple tasks

A860. Pseudodementia of Depression

"Q861. A 48-year-old obese woman with a history of psychotic depression is brought to the psychiatric emergency department following a suicide threat. She is difficult to interview because she feels tired and sleepy and states she is on a continuous positive airway pressure (CPAP) machine at home secondary to having obstructive sleep apnea. She reports that she has been on Prozac and other medications, which she got for ""the voices."" During the interview, the psychiatrist learns she has gained 20 pounds in the past several months. What medication most likely caused this significant weight gain?"

A861. Olanzapine; (An atypical antipsychotic indicated for the management of psychotic disorders. In placebo-controlled, 6-week studies, 29% of olanzapine-treated patients gained greater than 7% of their baseline weight compared with 3% of placebo-treated patients. Among patients on long-term treatment with olanzapine 56% gained more than 7% of baseline weight)

"Q862. Throughout the session, the patient has a sense of depression and views herself as inadequate and disappointing to the therapist. The therapist makes the following comment, ""I notice that on a day without your make-up, you fear that I will find you inadequate, probably much like you perceived your father's disappointment if you didn't win the beauty contest. It seems difficult for you to feel accepted if you do not feel attractive. "" What psychotherapeutic technique best describes the therapist's comment?"

A862. Transference Interpretation; (An interpretation involves making something conscious that was previously unconscious, such as the connection between the patient's sense of depression and her lack of make-up as well as the correlation between her relationship styles with her father and with her therapist. An interpretation is an explanatory statement that links a feeling, thought, behavior, or symptom to its unconscious meaning. In this case, the interpretation directly deals with the transference...the patient's feelings and behavior toward the therapist that are based on earlier wishes with important figures)

Q863. Dx:; a persisting response to a prior stimulus even though a new stimulus has been presented. It can be verbal or motor, and is seen in cognitive disorders

A863. Preservation

Q864. A 36-year-old woman comes to her gynecologist because of a three-month history of amenorrhea. Until this time, her menstrual periods had been regular. She also complains of decreased sex drive, worsening over the past couple of months. The patient denies any other symptoms. She has no significant medical history, although she started seeing a psychiatrist five months ago after a brief hospitalization during which she was diagnosed with major depressive disorder, severe, with psychotic features. Her depressive symptoms are resolving. What Atypical antipsychotic is most likely responsible for the patient's presenting complaints during her visit to her gynecologist?

A864. Risperidone; (The newer atypical antipsychotics have minimal, if any effect on plasma prolactin concentrations, except for risperidone, which is associated with elevated prolactin. Antipsychotic-induced hyperprolactinemia may cause side effects including amenorrhea and infertility, sexual dysfunction, galactorrhea, and weight gain)

Q865. What common childhood disorder is seen in 10-20% of kids with mental retardation?

A865. ADHD

Q866. Dx:; A child with increased head circumference, facial coarsening, joint hyperextensibility, mental retardation and macro-orchidism; What is the most commonly assoc childhood psych illness?

A866. Dx: Fragile X syndrome; assoc with :; ADHD (75%)

Q867. Dx:; X-linked metabolism disorder assoc with mental retardation, microcephaly, gout, seizures and self-mutilation

A867. Lesch-Nyhan syndrome; (Purine metabolism causing excess Uric Acid due to deficiency in Hypoxanthine-GPT)

Q868. Dx:; disorder in amino acid metabolism with mental retardation, seizures, hyperactivity, decreased pigmentation and a mousy body odor

A868. Phenylketonuria (PKU); (deficiency in phenylalanine hydroxylase; low levels of Tyrosine)

Q869. Dx:; child who is a compulsive over-eater, has hyperphagia, obesity and predisposed to Oppositional Defiant Disorder

A869. Prader-Willi; (chromosome 15)

Q870. Which autosomal dominant disorder is characterized by adenoma sebaceum, brain lesions, seizures and mental retardation?

A870. Tuberous Sclerosis

Q871. Dx:; cafe au lait spots, pigmented iris hamartoma, skeletal disorder, schwann cell tumor; 1/3 of these patients have MR

A871. Neurofibromatosis; (Von Recklinghausen Disease)

Q872. Dx:; a 3-9yo child with a seizure disorder and language problem

A872. Landau-Keffler Syndrome; (Acquired Epileptic Aphasia)

Q875. what is the Tx for a mentally retarded girl with worsening behavior?

A875. Review Behavior Management Plan

Q876. when do you start treating a child with Enuresis?

A876. Age 5

Q877. What is most likely to happen to the child who is a hyperactive kid (untreated)?

A877. Substance Abuse in future

Q878. First Tx for a stroke-induced dementia?

A878. Tx the Vascular problems first

Q879. Aside from finding the underlying cause of Delirium, what medication is the first-line of Tx?

A879. Haloperidol

Q880. if patient has alcohol withdrawal with hallucinations, what is the additional Tx (specific Rx)?

A880. Haloperidol

Q881. A 5yo child with cold-like Sx and hallucinations is being treated by mother with OTC medications. What is the cause of the Sx?

A881. Benadryl

Q882. A homeless alcoholic has oxalate crystals in his urine. What is cause?

A882. Ethylene Glycol

Q883. a woman is on corticosteroids for one month for her arthritis. What psych disorder can it lead to?

A883. Depression

Q884. Tx for Premenstrual Dysphoric Disorder

A884. SSRI

Q885. a patient with asthma and a substance abuse problem in his family is anxious about giving a speech. What is the best med?

A885. Benzodiazepine; (normally propranolol, but not in an asthmatic)

Q886. Hyperthyroidism is associated with what psychiatric disorder?

A886. Panic Disorder

Q887. What type of cancer is assoc with Depression?

A887. Pancreatic CA

Q888. Dx:; Dementia, visual hallucinations, delusions and parkinson- like features; cause is brain-related; Tx for the delusions/hallucinations?

A888. Dx: Lewy Body Disease; Tx for delusions: Benzodiazepine (not an antipsychotic b/c it will increase EPS)

Q889. DOC for Nightmares

A889. Tranylcypromine; (MOAI b/c it works in REM)

Q890. DOC for Night Terrors

A890. Benzodiazepine; (works in stage 4)

Q891. What genetic disorder is assoc with Schizotypal Personality disorder?

A891. Fragile X (females)

Q892. After a cocaine binge and detoxification in a hospital thereby resolving his euphoria and paranoia, a patient begins to describe his history of cocaine use for the past 5 years. There were times of sobriety where he felt depressed, but they were infrequent in the constant use the past 5 years. What is the best Tx?

A892. Narcotics Anonymous

Q893. What is the most sensitive test in diagnosing delirium?

A893. Electroencephalogram; (shows generalized slowing; if alcohol or sedative-induced it will show fast low-voltage activity; in hepatic encephalopathy it will show triphasic delta waves)

Q894. What NT is most likely involved in Delirium?

A894. Acetylcholine; (why anticholinergics are most commonly a cause)

"Q895. A 16yo woman experienced a depressed mood with anergia, insomnia, and a decreased appetite with weight loss since her boyfriend left her 6 weeks ago. She also has decreased energy, suicidal ideation and hears voices that tell her she is ""no good."" She is well dressed and has good hygiene. She admits to having frequent thoughts of suicide in the past few days but would not act on them because it would be a ""sin.""; Dx?; Tx? (3 together)"

A895. Dx: Major Depression with Psychotic features; Tx:; 1. She should be Hospitalized; 2. begin SSRI; 3. begin Antipsychotic

Q896. Psychotic depression is diagnosed in a 14yo boy and he is treated with risperidone and an SSRI. Three months later his Sx have resolved and he is no longer psychotic. What is the next step?

A896. The Antipsychotic should be discontinued via a Tapering dose; (children with major depression and psychotic features respond to a combo antidepressant and atypical antipsychotic. The atypical antipsychotic should be continued for 3 months and then tapered off. The antidepressant should be continued for 6-9 months and then tapered off over 2-3 months at 33% per month)

Q897. what action is most appropriate in treating a patient with Conduct Disorder?

A897. Patients should receive jail time in keeping in line with their behavior; (natural consequences is one of the most effective Tx)

Q898. A 23yo medical student makes lists of all the tasks he must accomplish in a day, spends hours studying instead of time with classmates, attends every lecture and takes meticulous notes, not trusting others to do so. He and his girlfriend are both doing very well in medical school. Dx?

A898. Obsessive-Compulsive Traits; (his social and occupational functioning are both good, which rules out OCPD)

Q899. Defense mechanism:; A man comes home to find his wife in bed with another man. When relating the information to his friend, the man can tell of certain details of the scene but appears emotionally unmoved by the event.

A899. Isolation of Effect

"Q900. Defense mechanism:; A woman steals a coat and states ""it's okay--the store has plenty of money and they wont miss one coat."""

A900. Rationalization

"Q901. Defense mechanism:; a child avoids stepping on a crack in the sidewalk to avoid ""breaking your mother's back."""

A901. Undoing

"Q902. A 36yo man who survived a serious car accident 4 months ago complains of ""jitteriness"" when driving to work and is currently using public transportation due to anxiety. He ""spaces out"" at work and has difficulty concentrating at his job, which has caused his performance to slip. He has trouble sleeping at night and has lost 4 pounds because of a decreased appetite. Dx?"

A902. Major Depression; (commonly occurs with PTSD as a comorbid condition)

Q903. Tx for Post-Traumatic Stress Disorder; (3 together)

A903. 1. SSRI; 2. Psychotherapy; 3. Social Interventions

Q904. Tx for Alzheimer's Dementia

A904. Acetylcholinesterase Inhibitor; (increasing ACh)

Q905. what type of behavioral therapy is useful in a patient with Dysthymia?

A905. Cognitive-Behavioral Therapy; (shown to have better outcome then psychotherapy or supportive therapy)

Q906. If a patient with dementia progresses to become agitated and aggressive, what class of med would help manage his behavior?

A906. Antipsychotic (high-potency)

Q907. What are the steps to medical management in a patient with Depression?; (4 steps)

A907. 1. start low dose SSRI; 2. Increase SSRI dose (up to max dose for body size); 3. if still not working - try alternate SSRI; 4. Change class (TCA or MOAI)

Q908. What type of amnesia is assoc with loss of memory for a few hours to a few days?

A908. Localized Amnesia

Q909. What type of amnesia covers a whole lifetime?

A909. Generalized Amnesia

Q910. What type of amnesia involves forgetting successive events as they occur despite being alert?

A910. Continuous Amnesia

Q911. Describe the DEA Control Levels I - V of drugs

A911. I: Not for Rx (LSD); II: No refills without examination; III: Moderate physical dependence but high Psych dependence; IV: Rx must be written after 5 refills (lower abuse potential); V: Lowest abuse potential

Q912. Describe the Classes A-X for psychtropic meds during pregnancy

A912. A: no risk; B: adverse findings in animals, not humans; C: Risk not ruled out; benefits outweigh risk; D: Positive risk; X: Contraindicated in Pregnancy

Q913. A 26yo single mother of three is admitted to the neurology service with complaints of diminished sensation in both legs. What psychological defense mechanism could this person be suffering from that is assoc with a breakdown of consciousness, memory, sensory or motor behavior?

A913. Dissociation

Q914. Definition:; Fear that one's penis is shrinking

A914. Koro

Q915. Definition:; Another name for Voyerism

A915. Scopophilia

Q916. Dx:; Overt compliance by subbordinates masking covert resistance or hostility

A916. Passive-Aggressive

Q917. What meds are useful in reducing aggressive behavior in Antisocial Personality Disorder?; (3)

A917. 1. SSRI; 2. Mood Stabilizers; 3. Propranolol

Q918. what is the best behavior therapy for Antisocial Personality Disorder?

A918. Socially-based Interventions; (group therapy)

Q919. What are the (2) Antisocial Personality Disorder defense mechanisms?

A919. 1. Acting Out; 2. Projective Identification

Q920. What diagnostic test can be used to confirm a clinical impression of Antisocial Personality Disorder?

A920. Electroencephalogram (EEG); (shows soft neurological signs suggestive of minimal brain damage that occurred in childhood)

Q921. A 39yo man with antisocial personality disorder, incarcerated for murdering a man, has a multitude of medical complaints over the course of several years. Yearly physicals never show anything wrong with him, yet he complains of a variety of aches and pains, neurological symptoms and GI distress. He does not enjoy the time he spends in the jail infirmary. Dx?

A921. Somatization Disorder; (development becomes more common in patients with APD as they grow older)

Q922. A 15yo girl who has a diagnosis of major depression with suicide attempt is treated for this and seems to respond well. Her parents report that for years now she is constantly worried that the cameras in the doctor's office are recording her and she believes that she is being stalked by several boys at her school. Dx?; Tx?

A922. Dx: Schizoaffective Disorder (Schizophrenia Sx are predominant, with depression during the schizophrenic episodes); Tx: Antipsychotic (if ineffective, add a SSRI)

Q923. A 40yo with Schizoaffective disorder has been hospitalized for the third time in 5 years. During each episode he becomes non-compliant in taking his meds, develops acute manic Sx and hallucinations and then becomes violent. The patient is prescribed a mood stabilizer and an antipsychotic. What other medication may be helpful for his acute mania?

A923. Lorazepam (or Clonazepam); (both have been shown to be effective adjunctive Tx for acute mania both in patients with schizoaffective disorder and bipolar disorder)

Q924. what is the key to diagnosing Schizoaffective disorder?

A924. the psychotic episodes occur during the mood episodes; (but the mood symptoms do not always occur during the psychotic episodes)

Q926. (3) main drug treatments for ADHD; (and AE of each)

A926. 1. Methylphenidate (tics); 2. Atomoxetine (sedation); 3. Pemoline (hepatotoxicity)

Q927. What drug treats the autonomic symptoms of opioid withdrawal such as HTN, tachycardia, sweating, lacrimation and rhinorrhea?

A927. Clonidine

Q928. Tx in Pain Disorder; (3 together)

A928. 1. Validate pain and explain psychological factors; 2. consider SSRI; 3. referral to pain clinic

Q929. Acute Stress disorder is diagnosed in a 32yo woman who witnessed her fiancée being shot to death in a robbery attempt. She has difficulty sleeping and feels she is not emotionally attached to anything around her. She also has repetitive flashbacks of the event. What med might help her over the short term?

A929. Zolpidem; (a hypnotic for the insomnia)

Q930. A 42yo woman is determined to kick her heroin habit at home without use of methadone or any prescription drugs. What over-the-counter medication is most likely to be of benefit to the patient as she goes through opioid withdrawal?

A930. Acetaminophen; (to relieve the muscle cramps assoc with withdrawal)

Q931. (5)* signs of opioid withdrawal

A931. SLUMP:; Salivation / Sweating;; Lacrimation;; Urination / Defecation;; Muscle cramps;; Piloerection

"Q932. In a patient with Pain Disorder who suffers from headaches that are ""unbearable"", what is the suggested treatment?"

A932. Biofeedback and Relaxation techniques; (analgesics are not helpful in these patients and addicting meds should be avoided)

Q933. What type mood disorder specifier is Anhedonia, diurnal variation and early morning wakening?

A933. Melancholic features

Q934. what is a neurophysical effect of Autism?

A934. Rapid brain growth

Q935. What gene and allele is a risk for Alzheimer's Disease?; What does it do?

A935. APOE gene 4 allele; Decreases the clearance of A-beta 42 amyloid; (not increases production)

Q936. What medication increases the levels of Lithium?; (2); What decreases the levels?; What hormone does it affect?

A936. Increases:; 1. Thiazide Diuretics; 2. NSAIDs; Decreases: other Diuretics; affects: Thyroid Hormone (decreases)

Q937. Adverse effects of this atypical antipsychotic include:; sedation, increased appetite, tachycardia and hyperlipidemia.

A937. Clozapine; (also Agranulocytosis)

Q938. Adverse effects of this antipsychotic include:; sedation, increased appetite, possible hyperlipidemia and arrhythmias

A938. Haloperidol

Q939. Portion of the brain:; processes info to establish and maintain new and longer lasting memories

A939. Medial Temporal region

Q940. Portion of the brain:; involved in ambiguous learning situations such as gambling

A940. Orbitofrontal Cortex

Q941. Portion of the brain:; involved in Working memory, which allows one to keep several ideas in the mind at once

A941. Prefrontal Cortex

Q942. Drug class with following action on 5-HT receptors:; downregulation of terminal 5-HT 1b autoreceptors after long administration

A942. SSRI

Q943. Drug class with following action on 5-HT receptors:; increases responsiveness of postsynaptic 5-HT 1a receptors

A943. TCAs

Q944. Drug class with following action on 5-HT receptors:; decreased responsiveness of 5-HT 1a receptors

A944. MAOIs

Q945. what occurs physiologically to the hematological system with stress?

A945. Platelet aggregation increases

Q946. What is the adverse effect if mixing a SSRI and an Antispasmotic for IBS?

A946. Sedation

Q947. what atypical antipsychotic is most commonly associated with elevated lipids and diabetes?

A947. Olanzapine; (also weight gain)

Q948. what additional diagnosis is a risk factor of developing Tardive Dyskinesia in those treated for schizophrenia?

A948. Mood disorders

Q949. MOA of Disulfiram

A949. Acetalydehyde metabolism inhibitor

Q950. What antipsychotic has the highest risk for QTc cardiac conduction prolongation?

A950. Ziprasidone

Q951. MOA of Amantidine

A951. Releases Dopamine; (in substantia nigra, causing antiparkinson effects)

Q952. MOA of Donepezil; Use?

A952. Anticholinesterase inhibitor; Use: Mild Dementia

Q953. MOA of Haloperidol

A953. Block Post-synaptic Dopamine receptors

Q954. Anticholinergic agent used to treat primary and medication- induced Parkinsonism

A954. Trihexyphenidyl

Q955. First line of Tx for Post traumatic Stress Disorder

A955. SSRI

Q956. low levels of what NT are shown to be assoc with impulsiveness and aggression?

A956. Serotonin

Q957. what is a common comorbid disorder with Bulimia?

A957. Kleptomania

Q958. a 40yo businessman states that over the past 2 years he has had trouble staying awake for more then 2 hours before falling asleep. He has a hard time sleeping through the night. Meanwhile his work is suffering. Dx?; Tx? (3 possible drugs)

A958. Dx: Primary Insomnia; Tx:; 1. Zolpidem (Ambien); 2. Zaleplon (Sonata); 2. Trazodone (Desyrel)

Q959. another name for Sleepwalking disorder

A959. Somnambulism

Q960. what NT enhances libido?; what NT inhibits libido?

A960. Enhances: Dopamine; Inhibits: Serotonin

Q961. Dx:; genital pain before, during or after sexual intercourse

A961. Dyspareunia

Q962. Dx:; involuntary muscle contraction of the outer third of the vagina during insertion of the penis or object

A962. Vaginismus

Q963. Conditioning type:; Drugs serve as reinforcers to increase frequency

A963. Operant conditioning; (behaviors can be learned when followed by positive or negative reinforcement)

Q964. Conditioning type:; Drugs play a major role in relapse

A964. Classical conditioning; (a stimuli evokes a conditioned response)

Q965. Behavioral therapy technique:; a patient who is afraid of flying is made to fly on a plane

A965. Flooding

Q966. Behavioral therapy technique:; a patient who is afraid of flying is made to imagine flying

A966. Implosion

Q967. Behavioral therapy technique:; an alcoholic is given Antabuse which makes him ill every time he drinks alcohol; aside from addictions, what else is this therapy used to treat?

A967. Aversion therapy; also Tx: Paraphilias (necrophilia, S&M, etc)

Q968. Aside from Depression, what other disorders use SSRIs as the first drug treatment?; (10)*

A968. A Bad PMS In A PP Organ:; Anorexia,; Body Dysmorphic Disorder,; Panic Disorder,; Migraines,; Social Phobia,; IBS,; Autism,; PTSD,; Premenstrual Dysphoric disorder,; OCD

Q969. Aside from Depression, what other disorders use TCAs as a main treatment?; (3)

A969. Enuresis,; Neuropathic Pain,; Insomnia

Q970. Most life-threatening adverse effect of TCA

A970. Orthostatic Hypotension

Q971. What is the first step when suspecting serotonin syndrome?

A971. Discontinue Medication

Q972. MOA of Mirtazepine; common AE?

A972. NASA: NE and Serotonin Antagonist; common AE: Weight Gain

Q973. What drugs cause Anti-HAM effects?; (2)

A973. Antipsychotics,; TCAs; (anti-HAM = antiHistamine - sedation; antiAdrenergic - Hypotension; antiMuscarinic - dry mouth, blurred vision, urinary retention)

Q974. What can be used in a patient with Generalized Anxiety Disorder if he is an alcoholic with HTN?

A974. Buspirone; (Benzos are contraindicated in alcoholics and Venlafaxine is contraindicated in HTN patients)

Q975. what are the (3) main uses of Benzodiazepines?

A975. PIA:; Panic Attacks / Anxiety,; Insomnia,; Alcohol withdrawal/detox

Q976. difference between Dystonia and Tardive Dyskinesia symptoms around the head?

A976. Dystonia:; sustained Contraction of muscles of neck and tongue; TD:; Choreoathetoid (writhing) movements of mouth and tongue

Q977. what (2) atypical antipsychotics also have FDA approval for Tx of Mania?

A977. Quetiapine,; Ziprasidone

Q978. a 20yo woman comes to see you because her mother says she isnt herself. The patient is dressed in brightly colored clothing and has worn a large amount of makeup for the past 3 weeks. She acts overtly seductive toward her colleagues at work, is more distractible and is easily irritated. She also sleeps less, claiming she no longer needs the sleep. Dx?

A978. Bipolar Disorder, Mania

Q979. What is a good behavioral treatment for insomnia?

A979. De-conditioning; (using the bed only for sleep; get up if not able to sleep in a short period of time)

Q980. (3) meds used to reduce Sx of flashbacks

A980. CVC:; 1. Clonazepam; 2. Valproic Acid; 3. Carbamazepine

Q981. What pathology would be most important to rule out before starting treatment of Tourette's disorder?

A981. Environmental Allergies; (they have a presentation most resembling Tourette's disorder)

Q982. What lab test is most helpful in assessing the severity of starvation in anorexia?

A982. Albumin levels

Q983. what psychiatric disorder is seen in people with Graves Disease?

A983. Generalized Anxiety Disorder; (criteria for GAD are met in up to 60% of those with Graves)

Q984. What are the (2) common defense mechanisms of Avoidant Personality disorder?

A984. 1. Displacement; 2. Projection

Q986. A 24yo man gets excited about sex but has a problem performing sexually. He can have an erection, but it is not maintained when the time for intercourse occurs. There is nothing physically wrong. He seems to be struggling with abandonment issues with his father. Tx?

A986. Tx: Psychodynamic Psychotherapy; (CBT is not likely to elicit the unconscious conflict troubling him)

Q987. What BT type is best suited for someone with Borderline Personality Disorder?

A987. Dialectical BT; (patients learn skills to confront and manage the volatile emotions and impulses they are feeling)

Q988. In what (2) types of psychiatric disorders will you see cognitive thinking?

A988. 1. Schizophrenia; 2. Cognitive disorder (dementia; MR)

Q989. Hyperarousal symptoms seen in PTSD are thought to be due to a stress-induced, chronic hyperactivity of what area of the brain?

A989. Locus Ceruleus; (main noradrenergic nucleus of the brain)

Q990. what nucleus of the brain degenerates in Alzheimers dementia?

A990. nucleus basalis of Meynert

Q991. A young woman with a history of cutting states that the act calms her and she feels no pain. Self-injury can have this effect b/c it triggers the release of what?

A991. Endorphins; (body's defense mechanism to deal with pain)

Q992. After being struck in the head with a bat, a patient's personality changes. What part of the brain was affected?

A992. Frontal lobes

Q993. A little girl who was underweight and hypotonic at infancy is obsessed with food, eats compulsively and at age 4 is already grossly overweight. She is also argumentative, oppositional and rigid. She has a narrow face, almond- shaped eyes and a small mouth. Dx?

A993. Prader-Willi syndrome

Q994. what NT regulates mood, sleep, pain and aggression?; what nuclei?

A994. Serotonin; Raphe Nuclei

"Q995. An elderly man awakes in a state of aggitation. Although he appears that he wants to communicate, he can only state ""See you later"" over and over. The right side of his face droops and he seems to have difficulty moving his right arm. A CAT scan shows a recent brain infarct. Where is the lesion (specifically)?; What vessel?"

A995. Left Frontal Lobe; (at Broca's area, which presents with nonfluent aphasia and can cause one to repeat); Middle Cerebral Artery

Q996. Aggressive behavior is assoc with an increase or decrease in what NT?

A996. Decrease in Serotonin

Q997. Where is the brain lesion:; a 22yo woman with an inoperable craniopharyngioma has become grossly obese and experiences rapid fluctuation of body temperature.

A997. Hypothalamus; (expansion of the tumor)

Q998. Where is the brain lesion:; an 82yo woman at the late stages of a dementing disorder roams her nursing home touching and licking everything she passes. She is placcid and nothing frightens her.

A998. Amygdala; (behavior and personality changes including hypersexuality, placcidity and lack of fear = Kluver-Bucy syndrome)

Q999. Where is the brain lesion:; a 34yo homeless man with a chronic psychiatric disorder hears the voices of angels and believes he is the new savior

A999. Mesolimbic circuit; (pathway of positive and negative Sx of schizophrenia)