dif

Question 1

Depression - sleep

Answer 1

Sleep disturbances in sleep stages: 1. decreased slow wave sleep
2. decreased REM latency 3. increased REM early in sleep cycle 4. increased total REM sleep 5. Repeated nightime awakening 6. Early-morning wakening (terminal insomnia)

Question 2

Narcolepsy is caused by

Answer 2

decreased hypocretin (orexin) production in LATERAL hypothalamus
strong genetic component

Question 3

intermittent explosive disorder?

Answer 3

like antisocial but without history of conduct disorder or other fearures of antisocial

Question 4

disulfiram vs naltrexone vs acamprosate as treatment of alcoholism

Answer 4

naltrexone –> to reduce craving (in active drinkers)
disulfiram –> in abstinent patients (2nd line)
acamprosate –> abstinent patients

Question 5

Metabolic effects of the 2nd generation antiphsycotics - highest risk drugs / how to monitor

Answer 5

1. Clozapine 2. Olanzapine
   Baseline + regular follow-up: BMI, fastign glucose + lipids, BP, waist circumference (at 3 months and then annually)
   - more frequent if DM or gained more than 5% of initial weight

Question 6

hoarding disaster?

Answer 6

distinct from OCD
- accumulation of a large number of possessions that may clutter living areas to the point that they are usuable –> distress when attempting to discard possessions

Question 7

interpersonal psychotherapy - indications / features

Answer 7

depression

- links symptoms to current relationship conflicts + interpersonal skill deficits

Question 8

supportive psychotherapy - indications / features

Answer 8

• lower functioning, psychotic disorders
• patients in crisis
• maintains hope, provide encouragement
  reinforces coping skills, adaptive defenses

Question 9

psychodynamic psychotherapy - indications / features

Answer 9

- higher functioning
personality disorders 
- builds insight into unconscious conflicts + past relationships
uses transference 
breaks down maladaptive defenses

Question 10

motivational interviewing - indications / features

Answer 10

substance use disorders
- nonjudgmental, acknowledges ambivalence + resistance
enhances intrinsic motivation to change

Question 11

dialectical behavioral therapy - indications / features

Answer 11

borderline personality disorder
- improves emotion regulation, distress tolerance mindfulness
decreases self harm, build skills

Question 12

biofeedback - indications / features

Answer 12

• prominent physical symptoms
  pain disorders
• improves control over physiological reactions to emotional stressors

Question 13

start SSRI for Major depression - when to stop them

Answer 13

if single episode of major depression –> continue for additional 6 months following acute response to reduce the risk of relapse
with chronic, recurrent or severe episodes –> 1-3 years

Question 14

medications that decreases lithium levels

Answer 14

theophylline

K+ sparing diuretics

Question 15

Marchiafava-Bgnami disease

Answer 15

dementia, motor dysfunction, dyrsarthria

- severe damage to the corpus callosum and surrounding white matter due to chronic alcohol use disorder and malnutrition

Question 16

Hoover sign

Answer 16

impaired flexion/extension strength of the hip with intact extension on contralateral hip flexion –> incompatible with known nerve pathways -> maybe conversion

Question 17

contraidication of haloperodol

Answer 17

seizure disorder

Question 18

severe or refractory anorexia nervosa

Answer 18

olanzapine

Question 19

catatonia?

Answer 19

syndrome seen in severe psychiatric and medical illness and is characterized by immobility, mutism, posturing
Lorazepam and electroconvulsive therapy are the treatments of choice

Question 20

antipsychotics - long QT?

Answer 20

only ziprasidone in very high doses

Question 21

type of amnesia as a SE of electroconvulsive therapy

Answer 21

anterograde and retrodrage

retrograde persists longer

Question 22

Narcolepsy - diagnostic criteria

Answer 22

recurrent lapses into sleep or naps (at least 3 times per week for 3 months)
PLUS
1 of the following:
- cataplexy
- low hypocretin-1 in CSF
- shortened REM sellp latency

Question 23

Antipsychotic extrapyramidal effects - definition

Answer 23

1. acute dystonia: sudden sustained contraction of the next, mouth, tongue and eye muscles
   2 .Akathisia: subjective restlessness, inability to stil still
2. Parkinsonism: Gradual onset tremor, rigidity, bradykenesia
3. Tardive dyskinesia: Gradual onset tremor after prolonged therapy (more than 6 months): dyskenesia of the mouth, face, trunk and extremeties

Question 24

Lipod profile how often

Answer 24

After 35, every 5 years

IN MEN

Question 25

Bath salts properties

Answer 25

Amphetamines with long duration effect and not detected in routine test Orally, inhale or injected

Question 26

Dantrolene mech of action

Answer 26

Rhyanodine receptor antag | - decreases intracellular Ca2+

Question 27

GERD, endoscopy shows barret without dysplasia - next step

Answer 27

Again in 1 year, if again no dysplasia, then endoscopy every 3 years If low grade dysplasia the same If high grade: surgery or high intensity surveillance

Question 28

switch to clozapine if extrapyramidal symptoms under antipsychotics

Answer 28

only if tardive dyskinesia

Question 29

REM sleep behavior disorder

Answer 29

complex motor behaviours that occur during REM - dream enactment can occur if the muscle atonia that usually accompanies REM sleep is absent or incomplete - latter of the night (higher % of REM) - very transient confusion after awake - recall heir dreams but not movements - older adult men - may be prodromal for Parkinson or Lewy

Question 30

schizophreniform vs schizophrenia beside duration

Answer 30

only schizophrenia requires functional decline

Question 31

medications that decreases lithium levels

Answer 31

theophylline | K+ sparing diuretics

Question 32

catatonia - treatment of choice

Answer 32

Lorazepam and electroconvulsive

Question 33

transient global amnesia

Answer 33

anterograde amnesia fro time and place that resolve in 24 h

Question 34

Dissociative identity disorder - association

Answer 34

with childhood trauma --> chronic auditory hallucinations that have venn present since childhood and are perceived as inside the patien;s head (vs psychotice, in which voices seem to come from outside)

Question 35

somatic symptoms disorder - management

Answer 35

regularly sceduled vistis with the same provider, avoiding unnecessary diagnostic testing and specialists referrals, exploring the role of psycholosocial stresors, promote stress deuction and healthy behaviors - refractory: CBT, SSRI

Question 36

initial apporach to patients presenting with symptoms after a trumatic incident

Answer 36

educate them on the range that will normalize their experience trama focused CBT is indicated if prersistent symptoms

Question 37

scizophrenia - diagnosis

Answer 37

2 of the following (1 frim the first 3) 1. delusions 2. hallucinations 3. disorganied speech 4. catatonic 5. negative

Question 38

general anx disorder - when to give benzo

Answer 38

nondepressed without history of substance abuse who fail to respond to or cannot toleratre antidepressants

Question 39

conversion disorder management

Answer 39

education --> if no response --> CBT

Question 40

hoarding disorder - treatment

Answer 40

CBT | SSRI can be used in parallel, but with limited effect