Behavioral Health

Question 1

> 1 manic or mixed episode which often cycles with occasional depressive episodes (but major depressive episodes are not required for diagnosis)

Answer 1

Bipolar I Disorder

Question 2

Strongest risk factor for bipolar I disorder

Answer 2

Family history (1st degree relatives)

Question 3

Average age of onset for bipolar I disorder

Answer 3

20s-30s

Question 4

Abnormal and persistently elevated, expansive or irritable mood at least 1 week (or less if hospitalization is required) with marked impairment of social/occupational function

Answer 4

Mania

Question 5

Management of bipolar disorder

Answer 5

1. Lithium first line
2. Valproic acid, carbamazepine
3. Haloperidol or Benzos if psychosis or agitation develops
4. Therapy

Question 6

> 1 hypomanic episode + > 1 major depressive episode. mania or mixed episodes are absent

Answer 6

Bipolar II disorder

Question 7

Symptoms similar to manic symptoms - period of elevated, expansive, or irritable mood at least 4 days that is clearly different from the usual nondepressed mood but does not cause marked impairment, no psychotic features and does not require hospitalization

Answer 7

Hypomania

Question 8

Management of bipolar II disorder

Answer 8

Acute mania - lithium, valproate
Depression - lithium, valproate, carbamazepine
Mixed - atypical antipsychotics, valproate

Question 9

> 1 delusion lasting > 1 month without other psychotic symptoms. Apart from delusion, behavior is not obviously odd or bizarre and there is no significant impairment of function. Not explained by another disorder

Answer 9

Delusional Disorder

Question 10

> 1 psychotic symptom with onset and remission < 1 month

Answer 10

Brief psychotic disorder

Question 11

Meets criteria for schizophrenia but < 6 months duration

Answer 11

Schizophreniform disorder

Question 12

Schizophrenia + mood disturbance (major depressive or manic episode)

Answer 12

Schizoaffective disorder

Question 13

> 6 months duration of illness with 1 month of acute symptoms along with functional decline

Answer 13

Schizophrenia

Question 14

Risk factors for schizophrenia

Answer 14

Family history

Question 15

Management for schizophrenia

Answer 15

1. Hospitalization for acute psychotic episodes
2. 1st line: risperidone, olanzapine, quetiapine
3. Clozapine in refractory cases
4. Haloperidol, Chlorpromazine

Question 16

Risk factors for depressive disorders

Answer 16

Family history
Female (2:1)
Highest incidence 20s-40s

Question 17

Depressed mood or anhedonia or loss of interest in activities with > 5 associated symptoms almost every day for at least 2 weeks

Answer 17

Major depressive disorder

Question 18

The presence of depressive symptoms at the same time each year (most common in winter)

Answer 18

Seasonal Affective Disorder/Seasonal Pattern

Question 19

Management of seasonal affective disorder/seasonal pattern

Answer 19

SSRIs
Light therapy
Bupropion

Question 20

Shares many of the typical symptoms of MDD but patients experience mood reactivity (improved mood in response to positive events). Sx include significant weight gain/appetite increase, hypersomnia

Answer 20

Atypical depression

Question 21

Treatment of atypical depression

Answer 21

MAO inhibitors

Question 22

Characterized by anhedonia (inability to find pleasure in things), lack of mood reactivity, depression, severe weight loss/loss of appetite, excessive guilt, psychomotor agitation or retardation and sleep disturbance

Answer 22

Melancholia

Question 23

Motor immobility, stupor and extreme withdrawal

Answer 23

Catatonic Depression

Question 24

Screening for depression

Answer 24

PHQ-2 for initial screen

If positive, use PHQ-9

Question 25

Management of major depressive disorder

Answer 25

1. Principal therapy: psychotherapy - CBT, support groups 2. SSRIs, SNRIs 3. Bupropion and Mirtazapine 4. ECT

Question 26

Excessive anxiety or worry for a majority of days > 6 month period about various aspects of life

Answer 26

Generalized Anxiety Disorder

Question 27

Management of generalized anxiety disorder

Answer 27

1. SSRIs, SNRIs 2. Buspirone 3. Benzos, beta blockers, TCAs 4. Psychotherapy: CBT

Question 28

Persistent (> 6 mo) intense fear of social or performance situations in which the person is exposed to the scrutiny of others for fear of embarrassment (ex. public speaking, meeting new people, eating/drinking in front of people)

Answer 28

Social anxiety disorder

Question 29

Management of social anxiety disorder

Answer 29

1. SSRIs, SNRIs 2. Beta blockers 3. Benzos 4. Psychotherapy

Question 30

Recurrent, unexpected panic attacks (at least 2 attacks) may or may not be related to a trigger. Usually sudden in onset, peaks within 10 minutes and usually lasts < 60 minutes

Answer 30

Panic disorder

Question 31

Anxiety about being in places or situations from which escape may be difficult (open spaces, enclosed spaces, crowds, public transportation)

Answer 31

Agoraphobia

Question 32

Management of panic disorder

Answer 32

1. SSRIs, SNRIs 2. CBT Acute attack - benzo

Question 33

Management of PTSD

Answer 33

1. SSRIs 2. MAO inhibitors 3. Trazodone for insomnia 4. CBT

Question 34

Management of tobacco dependence

Answer 34

1. CBT 2. Nicotine gum, nasal sprays, transdermal patches, inhaler, lozenges 3. Bupropion 4. Varenicline (Chantix)

Question 35

Physical exam findings for opioid abuse

Answer 35

1. Pupillary restriction 2. Respiratory depression 3. Biot's breathing 4. Bradycardia 5. Hypotension

Question 36

Groups of quick, shallow inspirations followed by regular or irregular periods of apnea

Answer 36

Biot's Breathing | Seen with opioid abuse

Question 37

Symptoms of opioid withdrawal

Answer 37

Goosebumps (piloerections) Pupil dilation Flu-like symptoms N/V

Question 38

Management of acute intoxication of opioid

Answer 38

Naloxone (Narcan)

Question 39

Management of opioid withdrawal

Answer 39

Clonidine Methadone tapering Buphrenorphine + Naloxone Benzos may be helpful

Question 40

Signs/symptoms of alcohol withdrawal

Answer 40

1. Increased CNS activity - anxiety, tremors, diaphoresis, palpitations 2. Withdrawal seizures 3. Hallucinosis 4. Delirium tremens

Question 41

Management of alcohol withdrawal

Answer 41

1. Requires hospitalization - can be fatal 2. IV benzos 3. IV thiamine and magnesium (prior to glucose admin)

Question 42

Medication that can be used as a deterrent to alcohol abuse

Answer 42

Disulfiram

Question 43

Strongest single predictive factor of suicide

Answer 43

Previous attempt or threat