Exam Practice Questions Flashcards

Question

Which antidepressant is best used in setting of QTC prolongation?

Answer 1

Wellbutrin - does not prolong QT at all

Answer 2

Nonsteroidal Anti-Inflammatory Agents: May increase the serum concentration of Lithium. Management: Consider reducing the lithium dose when initiating a NSAID

Answer 3

OCD first line = SSRI (minus citalopram)

Answer 4

Yes, Typicals and Lurasidone and RIsperidone block D2 receptors in pituitary, increasing PL

Answer 5

* tendency to self-reference external events without basis

Answer 6

Ventricular enlargement Reduced voume of corpus callosum Increased periventricular white matter changes

Answer 7

Recreation of feelings with interaction with therapist in psychoanalysis a whole series of psychological experiences are revived not as belonging to the past, but as applying to the person of the analyst at the present moment

Answer 8

Amygdala Hyperactivity

Answer 9

Venlafaxine Wellbutron, Paxil, Duloxetine, Setraline all inhibitors of 2D6; Abilify is a 2d6 substrate

Answer 10

Head imaging - CT or MRI - first Then Will likely need LP later Blood culture

Answer 11

* Maintenance is whatever worked to get them out of acute symptoms

Answer 12

Children need a higher dose per weight than adults

Answer 13

Reduced total sleep time Reduced Sleep efficiency Decreased SWS Increased sleep fragmentation Increased sleep latency REM declines after age 65 Phase advance (to bed earlier and wake earlier)

Answer 14

Abilify * Typicals and Lurasidone block D2 receptors in pituitary, increasing PL * Lurasidone causes ++ weight gain

Answer 15

1. Negative reinforcement

Answer 16

Exposure to looking after baby and not seeking reassurance

Answer 17

Nasuea/Vomiting Bradycardia Sedation Hypotension

Answer 18

1. Consider cholinesterase inhibitor & Consider lowering dose of antiparkinson med 2. If necessary, can use AP, but only atypical. RIsk: Limited efficact in LBD, increased risk of death

Answer 19

Maintain positive transference relationship

Answer 20

Confirm compliance Rule out substance use Start clozapine (best if olanzapine was one of meds tried)

Answer 21

In pyromania, fire setting is for pleasure. In ASPD, there woukd have to be a component of vengeance or anger

Answer 22

Harm Avoidance * a personality trait characterized by excessive worrying; pessimism; shyness; and being fearful, doubtful, and easily fatigued

Answer 23

Assess and reduce or discontinue and anticonvulsant medications Caffeine hyperventilation

Answer 24

* Psychostimulants should be used with precautions in patients with tics. Psychostimulant medications are used cautiously in tic spectrum disorders but the Committee agrees that use can be indicated if there is sufficient impairment of the concurrent ADHD. In these cases, the medications for ADHD are often combined with other drugs for tics (e.g., atypical neuroleptics or alpha-2 agonists).

Answer 25

Experimental

Answer 26

**CBT may benefit those with milder forms of the disorder** (eg, not physically dangerous) and who possess some insight and reason to improve. Clinical trials have been negative

Answer 27

Anxiety Disorders

Answer 28

Antidepressants CBT + other first line psychotherapy

Answer 29

Unstable Vitals: HR\<40, BP 80/60 or symptomatic Weight \<70% IBW or \<15 BMI * Cardiac dysrhythmia * Heart, renal liver compromise * Dehydration * Complications of malnutrition * Refeeding syndrome * Poor response to outpatient tx

Answer 30

Voltage Gated Calcium Channels

Answer 31

Pregnant Using Opioids LFTs 3x upper limit normal or cirrhosis (needs FU liver enzymes after 3 weeks)

Answer 32

Family Intervention - reinforce more prosocial behaviors and to diminish undesired behaviors at the same time (form of CBT) Individual Play therapy - sometimes benefit

Answer 33

Pragmatic language

Answer 34

Psychosocial Stressors

Answer 35

* overvaluing significance of a particular event

Answer 36

1. Orbitofrontal cortex

Answer 37

TCAs (but clomipramine less so)

Answer 38

Absent alpha waves Generalized delta and theta waves

Answer 39

Selective abstraction * KS Selective Abstraction: The only events that matter are failures, deprivation, etc. Should measure self by errors, weaknesses, etc.

Answer 40

Stimulant use Ddx - delusional infestation * Substance abuse should be sought especially when delusional infestation presents in younger age groups * Chronic alcohol use and withdrawal and long-term cocaine and amphetamine abuse are common precipitants * "cocaine bugs" have been described with acute use as well

Answer 41

It refers to carrying out exercises that bring about the physical sensations of a panic attack, such as hyperventilation and high muscle tension, and in the process removing the patient's conditioned response that the physical sensations will cause an attack to happen.

Answer 42

* Drawing a specific conclusion without sufficient evidence

Answer 43

Maintenance - psychoeducation\*\*\*\* reccommend to all pts and fam at disaease onset cognitive behavioural therapy (CBT) family-focused therapy (FFT), IPSRT Peer Support Mania - no evidence, no reccommendations

Answer 44

Mental state at the time of the alleged crime

Answer 45

Acute confusion (rapidly after initiation) Depression (develops more slowly over weeks to months of treatment) Manic conditions most often characterised by extreme irritability and agitation, but also occasionally by euphoria

Answer 46

* Neologism. The invention of new words or phrases or the use of conventionalwords in idiosyncratic ways.

Answer 47

Point prevalence

Answer 48

Clozapine Quetiapine

Answer 49

- SAD ATRC manual “a safety behaviour is an action that is carried out in order to reduce distress or prevent a feared consequence from occurring.”

Answer 50

3 item recall

Answer 51

* Age \< 60 years *  Rapid (e.g., over 1–2 months) unexplained decline in cognition or function *  Short duration of dementia (\< 2 years) *  Recent and significant head trauma *  Unexplained neurologic symptoms (e.g., new onset of severe headache or seizures) *  History of cancer (especially types that metastasize to the brain) *  Use of anticoagulants or history of bleeding disorder *  History of urinary incontinence and gait disorder early in the course of dementia (as may be found in normal pressure hydrocephalus) *  Any new localizing sign (e.g., hemiparesis or a Babinski reflex)  –Unusual or atypical cognitive symptoms or presentation (e.g., progressive aphasia

Answer 52

The sensitivity of that test is calculated as the number of diseased that are correctly classified, divided by all diseased individuals. Sn = True Positives/Total Diseased

Answer 53

Nausea, vomiting, insomnia

Answer 54

Diffuse atrophy with sparing of medial temporal lobe Swallow Tail Sign in Midbrain

Answer 55

OR = odds of disease in exposed / odds of disease in the non-exposed

Answer 56

Reduction in cortical grey matter Reduced hippocampal volume Enlarged ventricle size (lat and 3rd) decreased amygdala and thalamus ↓symmetry, ↓limbic size (e.g. amygdala), ↓thalamus (ind. of tx) basal ganglia inc volume (englarged caudate)

Answer 57

Treat MDD by relevant MDD guidelines

Answer 58

Metformin * dose of 500 or 1000 mg/d for 12 weeks slightly reduced the body **weight** and body mass index (BMI) of patients with schizophrenia who were being treated with **clozapine** and who had preexisting metabolic abnormalities

Answer 59

Clonazepam Alprazolam Olanzapine

Answer 60

Agoraphobia

Answer 61

Risperidone

Answer 62

Bell and Pad

Answer 63

Validate her distress

Answer 64

Older than 50 RIsk fx for Cardiovascular disease Sometimes assoc with epilepsy and migraine

Answer 65

Seizures Ileus Agranulocytosis Myocarditis Siallorhea Metabolic

Answer 66

Rostral Midbrain Hummingbird Sign

Answer 67

First containment, then duty to warn

Answer 68

SI (7x) Depression mania delirium confusion disorientation

Answer 69

Sleep Disturbance (55-80%)

Answer 70

Prove that they are feigining symptoms

Answer 71

Temazepam Do not administer Linezolid with: TCAS SSRIs High tyramine containg foods - bc of risk of serotonin syndrome

Answer 72

100mg IM Thiamine Diazepam 5mg TID OR Chlordiazepoxide 50mg BID or Lorazepam 1mg QID or Oxazepam 15mg BID NOT prn because pt has hx of withdrawalseizures

Answer 73

Future Anxiety Disorders

Answer 74

* **ECT** + **lithium** is associated with 12-fold higher odds of **delirium** compared to **ECT** alone * The odd for cognitive impairment is 542% higher for **ECT** + **lithium** compared to **ECT** only.

Answer 75

Transient Global Amenia

Answer 76

Quetiapine - All antipsychotics are pregnancy Category C (except for clozapine, which is B) - Li, VPA = D - Lamotrigine C

Answer 77

Hypophosphatemia (most concerning aspect of refeeding syndrome) Also: * Hypokalemia * Congestive heart failure * Peripheral edema * Rhabdomyolysis * Seizures * Hemolysis

Answer 78

Reassure they will improve with time - indications for nocturnal polysomnography (PSG) include - •Habitual snoring, observed apneas, nocturnal enuresis, or other symptoms suggesting OSA. - •Significant safety concerns, excessive disruption of the family members' sleep, or contemplation of pharmacotherapy. - •Atypical features that raise concern for nocturnal seizures, such as daytime neurologic symptoms, older age group, family history of seizures, and multiple occurrences on a single night

Answer 79

Regular appointments, not contingent on symptoms

Answer 80

marijuana use is associated with worse treatment outcomes “known risks of marijuana thus currently outweigh unknown benefits for PTSD” Some evidence for nabilone in treating PTSD nightmares

Answer 81

Mood Disorders | (Depression and bipolar)

Answer 82

Sleep restriction

Answer 83

Buproprion

Answer 84

Sedative, Hypnotic, or Anxiolytic Withdrawal causes two or more of the following: autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm), hand tremor, insomnia, nausea/vomiting, transient visual/tactile/auditory hallucinations or illusions, psychomotor agitation, anxiety, seizures

Answer 85

GnRH agonist

Answer 86

Doapmine Agonist * DAs as a class are associated with the development of ICDs such as pathologic gambling, compulsive sexual behavior, or compulsive buying, in up to 50 percent of patients with long-term use.

Answer 87

Rebound insomnia

Answer 88

Huntington's

Answer 89

* Insomnia – sleep hygiene * Melatonin * Doxepin/trazodone * Clonazepam = rem sleep disorder

Answer 90

Non-Judgment

Answer 91

Orbitofrontal cortex

Answer 92

**1**00 mg thiamine IM, Chlordiazepoxide 50 mg BID

Answer 93

Point prevalence

Answer 94

Agoraphobia

Answer 95

Harm Avoidance

Answer 96

Preoccupied

Answer 97

Neurocognitive deficits of schizophrenia

Answer 98

Selective Abstraction

Answer 99

Dopamine Agonist

Answer 100

Negative Reinforcement

Answer 101

MCA Dominant Stroke

Answer 102

* Right hemiparesis * R sided sensory loss * Dysarthria * **Ahpasia\*\*\*** * Alexia, agraphia, acalculia, apraxia * Right homonymous hemianopia

Answer 103

* Left hemparesis * L sided sensory loss * Dysarthia * Left sided neglect * Anosognosia * Asomatognosia * Loss of prosody of speech * Flat affect * homonymous hemianopia \*\*\* NO aphasia

Answer 104

Methylphendiate \*principle in treating ODD and ADHD is to optimize treatment for ADHD

Answer 105

* Ensure safety of patient and bed partner * CLonaz 0.5-2mg QHS (most widely used) * Mounting evidence for melatonin, case reports dopa-agonist

Answer 106

* CBT, IPT, DBT * Imipramine, sertraline, citalopram, topiramate (Grade a evidence) * Vyvanse approved for moderate to severe BED

Answer 107

Medication Non-adherence

Answer 108

Naltrexone Recall that Normal ALT for men is about 30, Naltrexone contraindicated with \>3x upper limit normal ALT

Answer 109

Valproic acid and propranolol

Answer 110

Quetiapine

Answer 111

Family Therapy

Answer 112

Travel with change in time zones

Answer 113

Pramipexole \*Because low muscle tone during REM = periodic limb movement disorder, and tx is Pramipexole

Answer 114

Melatonin \*because this is a REM movement sleep disorder

Answer 115

NREM – low resting muscle tone REM- near paralysis of skeletal muscle (loss of REM atonia)

Answer 116

Isolation of Affect

Answer 117

Discontinue Diazepam and give risperidone (Because not DT, so question is asking you how to treat delirium)

Answer 118

Add Ketamine to propofol \*As propofol is an anticonvulsant \*Additional procedures to lower the seizure threshold include * hyperventilation * administration of 500 to 2,000 mg IV of caffeine sodium benzoate 5 to 10 minutes before the stimulus.

Answer 119

Acute Stress Disorder

Answer 120

Venlafaxine

Answer 121

Quetiapine * Quetiapine recommended for GAD in bipolar CANMAT * But pregabalin first line in Katzman, and quetiapine second line

Answer 122

Sclerosing panencephalitis

Answer 123

1. Aripiprazole \*\*As Lurasidone – must be given with food, can be decreased up to 50% on empty stomach Ziprasidone – divided doses Asenapine – must be given SL, cant eat or drink for 10 mins after, in 2 divided doses

Answer 124

generalized tonic-clonic seizure \*about the same risk as antidepressants; less than 0.1 to 0.5 percent of patients when safety guidelines regarding patient selection and stimulation parameters are followed

Answer 125

ALS \*pseudobulbar affect, most commonly seen in ALS

Answer 126

Adjustment disorder \*because of timeline

Answer 127

Preoperational \*ages 2-7 \*During this stage, children begin to engage in symbolic play and learn to manipulate symbols. That they do not yet understand concrete logic.

Answer 128

Aripriprazole

Answer 129

Stable Housing

Answer 130

Does not know his mortgage situation

Answer 131

Applied behavior analysis

Answer 132

Adaptive Functioning

Answer 133

Cover the exits with disguise

Answer 134

Supportive

Answer 135

Overlap of child and adult services

Answer 136

Review all outstanding investigations.

Answer 137

Adults * depression * anxiety disorders * suicidality and self-harming behaviors * substance abuse. Children * depressive disorders * anxiety disorders * impulse-control disorders.

Answer 138

Can’t ride a tricycle

Answer 139

Three word recall

Answer 140

Citalopram \*In FTD, Citalopram or Trazodone as initial pharmacotherapy for patients with troubling behavioral symptoms

Answer 141

Rivastigimine \*Rivastigmine appears to moderately improve cognition and to a lesser extent activities of daily living in patients with PDD

Answer 142

Lorazepam IF goal is just getting them to CT Abilify IF goal is treating delirium If it says prolonged QTC, stay away from Haldol\* \*Note:Aripiprazole may cause a decrease in the QTc interval. This makes it an attractive option in ICU patients that often have multiple risk factors for QTc interval prolongation

Answer 143

Agoraphobia

Answer 144

Agoraphobia

Answer 145

Intact social skills in early years

Answer 146

harm avoidance

Answer 147

Correct: early corrective emotional experience by early transference interpretation Recall that systematic analysis = psychoanalysis

Answer 148

Having a diagnosis of schizophrenia Note that: * stigma may be lesss sevre in Asian and African countries/ islamic * Women and people living in rural areas more stigmatized * men more discrimination in job, women moreso in family/spcial areas

Answer 149

Aripiprazole OCD Adjunctive Agents 1st abilify, risperidone 2^nd: quetiapine, topiramate, memantine 3^rd: amisulpride, celecoxib, citalopram, Haldol, IV ketamine, granisetron, ketamine, mirtaz, NAC, olanzapine, odansetron, pindolol, pregabalin, riluzole, zipras NOT: buspirone, clonza

Answer 150

Abilify RIsperidone

Answer 151

Halve starting dose of lamictal (as epival increases lamotrigine levels)

Answer 152

Amlodipine (doesnt act on kidney) \*note that thiazides are the worst

Answer 153

Age of onset, as per "the age of onset of anxiety disorders: a meta-analysis" 2017, Canadian Journal of Psychiatry ([https://doi.org/10.1177/0706743716640757](https://doi.org/10.1177/0706743716640757)) youngest =\> oldest age of onset: 1. Separation anxiety 2. Specific phobia 3. SAD 4. OCD 5. Panic disorder 6. GAD

Answer 154

Nightmares

Answer 155

Stereotypic movement disorder \*Note * Stereotypic movement disorder - Repetitive, seemingly driven, and apparently purposeless motor behavior (e.g., hand shaking or waving, body rocking, head banging, self-biting, hitting own body).Interferes, occurs in early developmental period * DCD - motor skills far below what is expected for developmental age

Answer 156

Pramipexole

Answer 157

Developing discrepancy between current behaviour and ideal

Answer 158

Escitalopram

Answer 159

Malingering

Answer 160

Triangulation of conflict through the child * In a **structural** model, families are viewed as single, interrelated systems assessed in terms of significant alliances and splits among **family** members, hierarchy of power (parents in charge of children), clarity and firmness of boundaries between the generations, and **family** tolerance for one another. The **structural** model uses concurrent individual and **family** **therapy**.

Answer 161

Mesocortical = negative symptoms * Decreased dopamine in the **mesocortical** projection to the dorsolateral prefrontal cortex is postulated to be responsible for **negative** and depressive **symptoms** of **schizophrenia** * ++ dopamine in ML  = psychotic symptoms * Blockade of dopamine in NS – dystonia, parkinsonian symptoms, akathisa * ++ dopamine in NS – hyperkinetic movements chorea * Blockade of D2 in TI - hyperprolactinemia

Answer 162

Ceruplasmin * If you have **Wilson disease**, your **ceruloplasmin** level will probably be below 10 mg/dL.

Answer 163

Lisdexamphetamine

Answer 164

Increase lithium

Answer 165

Habit reversal

Answer 166

Driving with passengers in the taxi.

Answer 167

Alzheimer's

Answer 168

Complete psychiatric review of systems to screen for comorbid disorders.

Answer 169

Feelings of Emptiness. \*DBT has no evidence for core features of BPD

Answer 170

Tricky question. If you are the forensic psychiatrist, you would manage the pt for up to a week and if it's longer than a week you contact RB. If you are a general psych, you need to contact the fprensic program caring for the patient.

Answer 171

Nicotine is a selective agonist of the nicotinic cholinergic receptor

Answer 172

40-50% if not treated

Answer 173

a) Valproate or atypical antipsychotics (ziprasidone and quetiapine less preferable according to ACOG) b) Lithium - not recommended, but some studies recently showing overall risk to baby is low. If it is used in breastfeeding, must monitor Li levels of fetus as well as mother

Answer 174

Grief Role Dispute Role Transition Interpersonal Defiicts

Answer 175

Signfiicant Suffeirng Strong motivation to understand, persevere and change Psychological mindedness Ego Strength Ability to form relationship

Answer 176

* Depression (acute, recurrent, maintenance, subsyndromal, geriatric, adolescent, HIV+, postpartum, antepartum) * Adjunctive Tx in BAD * Bulimia * Initial/limited evidence in * Dysthymic disorder * Social phobia * PTSD

Answer 177

* Stop offending agent * Admit to ICU * Provide supportive care - airway, fever, fluids * Involve CL psych early * Possibly use cyproheptadine (5HT2a-blocker) or benzos

Answer 178

Add Abilify * Abilify is a partial D2 receptor agonist, has been reported to improve AP-related HPL * Seroquel is not long acting * Zuclopenthixol good because long acting, but also can cause HPL * No need to repeat PRL, as of little clinical benefit, and he is symptomatic

Answer 179

Resuming alcohol treated mild withdrawal symptoms.

Answer 180

## Footnote 1. Sensitivity: A/(A+C) × 100. 2. Specificity: D/(D+B) × 100. 3. Positive Predictive Value: A/(A+B) × 100. 4. Negative Predictive Value: D/(D+C) × 100.

Answer 181

## Footnote 1. Sensitivity: A/(A+C) × 100. 2. Specificity: D/(D+B) × 100. 3. Positive Predictive Value: A/(A+B) × 100. 4. Negative Predictive Value: D/(D+C) × 100.

Answer 182

## Footnote 1. Sensitivity: A/(A+C) × 100. 2. Specificity: D/(D+B) × 100. 3. Positive Predictive Value: A/(A+B) × 100. 4. Negative Predictive Value: D/(D+C) × 100.

Answer 183

## Footnote 1. Sensitivity: A/(A+C) × 100. 2. Specificity: D/(D+B) × 100. 3. Positive Predictive Value: A/(A+B) × 100. 4. Negative Predictive Value: D/(D+C) × 100.

Answer 184

Specificity measures the proportion of negatives that are correctly identified (i.e. the proportion of those who do not have the condition (unaffected) who are correctly identified as not having the condition). It is a measure of validity.

Answer 185

One measure of test validity is sensitivity, i.e., how accurate the screening test is in identifying disease in people who truly have the disease. When thinking about sensitivity, focus on the individuals who, in fact, really were diseased. It is a measure of validity.

Answer 186

Positive predictive value is the probability that subjects with a positive screening test truly have the disease.

Answer 187

Negative predictive value is the probability that subjects with a negative screening test truly don't have the disease.

Answer 188

Test validity is the ability of a screening test to accurately identify diseased and non-disease individuals. An ideal screening test is exquisitely sensitive (high probability of detecting disease) and extremely specific (high probability that those without the disease will screen negative). The validity of a screening test is based on its accuracy in identifying diseased and non-diseased persons, and this can only be determined if the accuracy of the screening test can be compared to some "gold standard" that establishes the true disease status. The gold standard might be a very accurate, but more expensive diagnostic test.

Answer 189

Social anxiety disorder with panic attacks.

Answer 190

1. low voltage high frequency waves.

Answer 191

* being female * rapid onset of symptoms * older age at first episode * predominantly positive \> neg symptoms * presence of mood symptoms * good pre-illness functioning

Answer 192

somatic complaints

Answer 193

Interoceptive

Answer 194

Exposure response prevention (But best option would be graded exposure if that were an option)

Answer 195

Neonatal adaptation syndrome

Answer 196

ODD if over 6 months Could be adjustment d/o, but based on stem

Answer 197

Physostigmine

Answer 198

Build defensive structures

Answer 199

You're worried about your daughter because you care for her

Answer 200

Visual Evoked Potentials

Answer 201

Delusional DIsorder

Answer 202

Triptans **St John's wort** (SJW) interacts with **triptans** (**sumatriptan**, naratriptan, rizatriptan, zolmitriptan) and may lead to increased serotonergic effects with an increased incidence of adverse reactions. If a patient is taking SJW and **triptans** it is advised that the patient stops taking SJW.

Answer 203

Decrease Abilify Because Abilify is metabolized by CYP2D6, and Bupropion inhibits 2D6, leading to increased level of Abilify.

Answer 204

Cyclothymia

Answer 205

Being late to sessions

Answer 206

There is little evidence for cannabis in treating PTSD.

Answer 207

No active control group

Answer 208

Communication Analysis

Answer 209

Help mother set firm boundaries and consequences

Answer 210

Risperidone or Abilify

Answer 211

**Bleeding** * ROCKET AF trial - no significant increase in bleeding risk when SSRIs were combined with anticoagulant therapy, although there was a suggestion of increased bleeding risk with SSRIs added to warfarin. * SSRIs have been shown to be associated with an increase in INR when combined with warfarin treatment: [https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/bc-guidelines/warfarinmgmt\_2015\_full.pdf](https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/bc-guidelines/warfarinmgmt_2015_full.pdf)

Answer 212

Psychoeducation In maintenance, psychoed is first line In depression, no first line, but CBT and FFT are second line

Answer 213

Have her care for baby and prevent reassurance

Answer 214

Hyperthyroid Symptoms of hyperparathyroidism woul include joint pain, muscle weakness, fatigue, brain fog, memory loss, anxiety, depression, heartburn, constipation

Answer 215

Hemorrhagic stroke Normal Pressure Hydrocephalus

Answer 216

Ugh, bad question. We would admit to hospital, and then inform the forensic dept looking after patient.

Answer 217

Long acting stimulant still first line

Answer 218

Hierarchy construction

Answer 219

Paroxetine withdrawal

Answer 220

B12, however is MAOI was involved then it would be B6

Answer 221

Develop a school/home/police resource officer safety plan

Answer 222

Add lorazepam

Answer 223

Discuss with the patient and see if he wants treatment

Answer 224

Lorazepam | (or any other in LOT)

Answer 225

Good behaviour at home when young \*could also be "language skills are weakness", "greater degree of behavioural issues after age 10"

Answer 226

Transference neurosis

Answer 227

Acetylcholinesterase inhibitor (Note that cholinesterase inhibitors are efficacious in DLB, with reported benefit not only in cognition, but also for fluctuations, psychotic symptoms, and parkinsonian symptoms.)

Answer 228

Add lorazepam

Answer 229

DC VPA If serum ammonia is increased, epival should be discontinued (straight from monograph)

Answer 230

Not Canadian citizen (You must be eligible for health services in Canada for MAID) BUT if Canadian resident, "death not imminent" would be acceptable, because CMPA says death should be imminent in 6-12 months

Answer 231

Decreased hippocampus

Answer 232

Clozapine Recall Strategies for TD 1. DC agent if possible 2. Clozapine or quetiapine 3. Clonazepam 4. Botox 5. Valbenazine/tetrabenazine 6. Trihexanphenaydl/Cogentin – not usually reccommende

Answer 233

Citalopram

Answer 234

Burning in the brain

Answer 235

Sleep hygiene

Answer 236

Reassess before giving passes

Answer 237

Olanzapine

Answer 238

Lithium – IF lamotrigine not option If lamotrigine is option, try that. eGFR) for these patients should be measured at least every 3-6 months.652 Since 37% of patients aged \>70 years have an eGFR \<60 mL/min per 1.73 m2,823 a strict eGFR cut-off for lithium discontinuation is difficult. The UK National Institute for Healthcare and Excellence (NICE) guidelines for chronic kidney disease (CKD) recommend nephrologist consul- tation if there is rapidly declining eGFR (\>5 mL/min per 1.73 m2 in 1 year, or \>10 mL/min per 1.73 m2 within 5 years), if the eGFR falls below 45 in two consecutive readings, or if the clinician is concerned

Answer 239

Projection

Answer 240

the therapeutic process of bringing forgotten or inhibited material (i.e., experiences, memories) from the unconscious into consciousness, with concurrent emotional release and discharge of tension and anxiety.

Answer 241

Lisdexamphetamine Recall, In most cases, ADHD and SUD need to be treated concurrently and independently when comorbid. But if it's cocaine use, then no stimulant.

Answer 242

Decreased alpha and generalized delta theta.

Answer 243

GNRH agoinist - Hormonal intervention to suppress puberty - Youth with feelings of intense gender dysphoria are at risk for adverse psychosocial outcomes.

Answer 244

Selegeline - Desipramine \>2% - Selegeline \<2% - Fluox 30% - Duloxetine \>30% - Mirtazapine \>2% - Buproprion \<2%

Answer 245

Moclobemide - Venlafaxine and Fluox risk of HTN - Irreversible MAOIS always risk HTN crisis when ingested with tyrosine - Venlafax and Flux small risk of GI bleed 1 in 300 pt years - Atypical depression – MAOs may have superiority - Still very small risk of htn crisis with Moclobemide even thnogh reversible

Answer 246

Decreased amplitude, high frequency waves

Answer 247

Melatonin PM - Before modafinil

Answer 248

Nortriptyline

Answer 249

Long acting amphetamine (Vyvanse)

Answer 250

PCOS if adolescent girl Off-label could also be a reasonable answer

Answer 251

Continue lithium at therapeutic dose

Answer 252

* Risk of Ebstein Abnormality 1st trimester * Recently, found that this defect only occurs in less than 1% of exposed children. * Also been associated with perinatal toxicity, including case reports of hypotonia, cyanosis, neonatal goiter, and diabetes insipidus. * In severe BD, risk of recurrence may overshadow risk of Ebstein * For women with significant periods of euthymia and few past mood episodes, slowly tapering off lithium and reintroducing lithium after the first trimester may help reduce the risk of relapse.

Answer 253

She will likely respond and has no contraindications to ECT * ECT use in adolescents is considered a highly efficient option for treating several psychiatric disorders, achieving high remission rates, and presenting few and relatively benign adverse effects. * Increase risk of prolonged seizures, lower seizure threshold – you would not increase stimulus

Answer 254

consult with colleague

Answer 255

Nortriptyline OR citalopram Treatment of PBA TCAs (nortrip, amitrip) SSRIs fluox, citalopram, setraline Dextromethorphan-quinidine

Answer 256

Risperidone

Answer 257

Risperidone (even better than citalopram)

Answer 258

Chain Analysis

Answer 259

identify role transition

Answer 260

Ego Deficits - Supportive psychotherapy is generally indicated for those patients for whom classic psychoanalysis or insight-oriented psychoanalytic psychotherapy is typically contraindicated—those who have poor ego strength and whose potential for decompensation is high

Answer 261

systematic hierarchy

Answer 262

systemic desensitization

Answer 263

Quetiapine First line monotherapy maintenance, acute, prevention, mania

Answer 264

5 - NNT = 1/ARR - ARR = CER (Control Event Rate) – EER (Experimental Event Rate).

Answer 265

Amygdala (but also hippocampus)

Answer 266

ALS Note that PBA is seen in many neurologic disorders

Answer 267

Huntington's Depression and irirtability often predate motor symptoms

Answer 268

Visual Evoked Potential

Answer 269

Prader WIlli

Answer 270

Habit Reversal

Answer 271

Tics, because suppressible Dyskinesia is more common than tics overall in cocaine use, but not usually supressible "Possibly one of the most visually dramatic movement disorders induced by cocaine is transient chorea and buccolingual dyskinesias, known in street slang as “crack dancing”"

Answer 272

CBT (treat disorder, even if you suspect PANDAS) AACAP treatment guidelines consider CBT or CBT + SSRI medication the first-line treatment of pediatric OCD.

Answer 273

Sildenafil

Answer 274

haloperidol

Answer 275

Alprazolam - The GABA positive allosteric modulators used in clinical practice fall under four categories: benzodiazepines, barbiturates, ethanol, and induction anesthetics. There are also drugs used to treat insomnia, e.g., zolpidem. - Baclofen is GABA B

Answer 276

a) M\>F * Slight more F\>M, but very similar * F more likely to have erotomania * M more likely paranoid * Pts married and employed * Some assoc with recent immigration and low SES * May appear to be delusional disorder, but can be an ealry sign of dementing illness * Other Risk Factors * Advanced age * sensory impairment * isolation * fam hx * Personality featues (interpersonal sensitivity)

Answer 277

Bleuler First coined the term shcizophrenia Defined with the 4 As

Answer 278

Echo * Any cardioresp symptoms --\> ED * Myocarditis fatal 1/3 of time

Answer 279

Give Lorazepam * Side effects not generally warranting discontinuation * Neutropenia * Sialorrhea * Orthostatic Hypotension * Sedation * Constipation * Myoclonus * Seizures * Metabolic Abnormalities * Nocturnal Enuresis * Clozapine-induced Transaminitis

Answer 280

Melatonin * This is REM behaviour disorder * Tx = clonazepam or melatonin * Clonaz not good for OSA

Answer 281

Fluoxetine

Answer 282

Dysarthria When Naproxen and Li combined can increase Li levels --\> confusion, tremor, slurred speech, and vomiting

Answer 283

stimulant induced psychotic disorder

Answer 284

Dopamine agonists

Answer 285

Bipolar Disorder BAD 60-85% heritability OCD 48% heritability

Answer 286

parental anxiety Regardless of the mechanism, children of parents with an anxiety disorder are up to five times more likely to be diagnosed with an anxiety disorder. More specifically, parental panic disorder and major depression are associated with an increased risk for separation anxiety disorder in children

Answer 287

GAD Kids with separation anxiety disorder are at an increased risk of developing panic disorder with agoraphobia, specific phobia, generalized anxiety disorder, OCD, pain disorder, and alcohol dependence

Answer 288

Decrease abilify

Answer 289

VPA Level Approach to VPA Tremor - Get level - Reduce VPA dose - Consider DC Epival - Propranolol can be helpful (same with Li induced tremor)

Answer 290

Repeated measures design

Answer 291

personalization

Answer 292

Sertraline

Answer 293

CBT Atypical features, no superiority

Answer 294

APS or Negative Symptoms

Answer 295

Use is perceived to be low risk increasingly more

Answer 296

No issues in language

Answer 297

transference neurosis

Answer 298

Learn skills to manage symptoms

Answer 299

Universality

Answer 300

transient global amnesia

Answer 301

CBT But depending on how high LFTs are, can give naltrexone (contraindicated in \>2x normal)

Answer 302

Phyostigmine

Answer 303

diaphoresis

Answer 304

Alzheimer’s

Answer 305

Continue dose and monitor side effects

Answer 306

Narcissistic

Answer 307

projective identification

Answer 308

d/c abilify

Answer 309

neurocog sx of schizophrenia

Answer 310

inform team and hold debrief

Answer 311

executive dysfunction Recall: Anosognosia is when numbers are eg. only on right side becuse of a non-dominant parietal lesion

Answer 312

subcallosal cingulate

Answer 313

not meet criteria for MAiD \*tricky, might also be ask for capacity assessment

Answer 314

autonomy and loss of control

Answer 315

Do what is in patient’s best interest

Answer 316

family history affective disorder

Answer 317

inpatient admission

Answer 318

* \<40BPM * BP \<80/60 or presyncope * QTc \>499 or any rhythm other than normal sinus rhythm or sinus bradycardia. * Wt \<70% IBW * BMI 14-15 * Cardiovascular, hepatic, or renal compromise requiring medical stabilization. * dehydration. * Serious medical complication of malnutrition (eg, syncope, seizures, cardiac failure, liver failure, pancreatitis, hypoglycemia, or marked electrolyte disturbance). * Moderate to severe refeeding syndrome: * Marked edema * Serum phosphorous \<2 mg/dL ●Poor response to outpatient treatment

Answer 319

increase interpersonal function

Answer 320

ECG Max dose in elderly 20mg

Answer 321

MRI R/O NPH

Answer 322

Child and adolescent

Answer 323

detouring conflict through the child

Answer 324

Externalize ED

Answer 325

Family Psychoeducation

Answer 326

Med Adherence

Answer 327

Language Disorder

Answer 328

ensure child safety \* Most important priority is comprehensive safety assessment

Answer 329

disorganized

Answer 330

grey matter decreased volume

Answer 331

Secondary reinforcement

Answer 332

VPA increasing lamotrigine levels

Answer 333

Complex Partial

Answer 334

Half the dose Because they are on it for epilepsy. But if on anticonvulsant for bipolar, you stop it.

Answer 335

block Dopamine transport mechanism

Answer 336

bell pad treatment

Answer 337

Hold lithium

Answer 338

not understand consequences

Answer 339

Patient must be able to understand 1. Understand harges & potential consequences 2. Understand and enage in Trial process 3. Capacity to participate with an attorney in a defense 4. Potential for courtroom participation

Answer 340

rebound insomnia

Answer 341

Children require higher by weight doses than adults

Answer 342

accepts but has delusional beliefs around dialysis

Answer 343

hyperthyroid

Answer 344

overvalued ideas of guilt

Answer 345

Assessing before giving pass

Answer 346

24 hour crisis

Answer 347

SSRI Unless contraception is a high priority

Answer 348

Disintegration Loss of Love Object Castration Superego

Answer 349

Lamotrigine

Answer 350

Social Phobia with panic

Answer 351

4-6 weeks * CANMAT - The standard protocol is 10,000 lux (light intensity) for 30 minutes per day during the early morning for up to 6 weeks, with response usually seen within 1 to 3 weeks.

Answer 352

Other specified bipolar disorder - Short-duration hypomanic episodes (2–3 days) and major depressive episodes - Hypomanic episodes with insufficient symptoms and major depressive episodes - Hypomanic episode without prior major depressive episode - Short-duration cyclothymia (less than 24 months)

Answer 353

Scz less likely get regular monitoring

Answer 354

Nausea, headache, anxiety irritability, nausea, feeling dizzy, vomiting, nightmares, headache, and/or paresthesias (prickling, tingling sensation on the skin).

Answer 355

disclose diagnosis

Answer 356

interview bed partner

Answer 357

Resolution * Fusion/Intergration of states is psychological merging of two or more entities at a point in time, with a subjective experience of loss of all separateness * Many patients never attain a complete fusion of their personalities but achieve a therapeutic resolution: improved communication, collaboration, and cooperation among self-states leading to relative stability and adequate function

Answer 358

have hyperprolactinemia

Answer 359

having passenger in car

Answer 360

sleep restriction

Answer 361

Defense against dysparenunia

Answer 362

Cingulate gyrus

Answer 363

Olfactory hallucinations can be present (From DSM for DD: Hallucinations, if present, are not prominent and are related to the delusional theme (e.g., the sensation of being infested with insects associated with delusions of infestation).

Answer 364

Naltrexone (recall that Bup = substitution, clonidine just for withdrawal. Naltrexone is antagonist to prevent relapse)

Answer 365

Lamotrigine

Answer 366

Lurasidone is Preg Category B Lamotrigine and Quetiapine are Preg Category C Li and VPA are Preg Category D

Answer 367

Chart review

Answer 368

Advance parental age Prenatal Factors * advanced maternal and paternal age at birth * maternal gestational bleeding * gestational diabetes * first-born baby Perinatal Risk Factors * umbilical cord cx * birth trauma * fetal distress * SGA * low birth weight * low 5 min apgar score * congenital malformation * ABO/Rh blood factor incompatibility * hyperbilirubinemia

Answer 369

Rural Upbringing

Answer 370

Patients on atypicals do better than typicals in regard to smoking cessation

Answer 371

Varenicline Recall First Line * Varenicline * Combo NRT

Answer 372

Buprenorphine

Answer 373

Opioid withdrawal

Answer 374

**Volatile Solvent**

Answer 375

Diaphoresis

Answer 376

Risperidone

Answer 377

Risperidone

Answer 378

Lisdexamphetamine

Answer 379

Treat ADHD first, then reassess for depression (As long as ADHD is worse, and only remote hx of mood disorder**)**

Answer 380

Collaborative care alone is not enough to increase knowledge in family physician

Answer 381

1% ARR = CER - EER

Answer 382

Start Quetiapine

Answer 383

ECT (but quetiapine even better)

Answer 384

Family history of post-partum psychosis predicts OCCURRENCE Has a better prognosis than non-puerperal psychosis is also true The risk factors for postpartum psychosis: ●History of postpartum psychosis ●Family history of postpartum psychosis ●History of bipolar disorder, schizophrenia, or schizoaffective disorder ●Family history of bipolar disorder ●First pregnancy ●Discontinuation of psychiatric medications for pregnancy

Answer 385

FHx of bipolar d/o

Answer 386

Stop Mirtazapine, Start Valproate

Answer 387

Aripiprazole

Answer 388

Add risperidone

Answer 389

Acute Stress Disorder

Answer 390

Psyched re: trauma and encourage her to drive.

Answer 391

Cannabis interference with cognition and learning

Answer 392

Child abuse is one of many risk factors for developing BPD.

Answer 393

Examine thoughts, feeling and behaviours linking phone call to cutting incident.

Answer 394

Validation

Answer 395

Universality

Answer 396

Selective abstraction

Answer 397

Ziprasidone

Answer 398

Bad reaction to olanzapine (neuroleptics in general)

Answer 399

Exposure and response prevention

Answer 400

Anorexia, restricting type

Answer 401

Aripiprazole

Answer 402

Conduct Disorder

Answer 403

Fluoxetine (Cipralex also first line)

Answer 404

Interpersonal inventory

Answer 405

Interpreting the transference is key

Answer 406

Focus on corrective emotional experience in the transference interpretation early on

Answer 407

Spontaneous free association

Answer 408

Will likely need long term meds maintenance

Answer 409

CBT good if can engage | (PODS study)

Answer 410

Switch to Clozapine

Answer 411

Motivational interviewing with pros and cons

Answer 412

Naltrexone

Answer 413

Industry vs. Inferiority

Answer 414

Insecure attachment, ambivalent type Children classified as Anxious-Ambivalent/Resistant (C) showed distress even before separation, and were clingy and difficult to comfort on the caregiver's return. They showed either signs of resentment in response to the absence (C1 subtype), or signs of helpless passivity (C2 subtype).

Answer 415

MIrtazapine

Answer 416

Agonism at M4

Answer 417

Blocking Na Channels (If GABA receptors are an option, that may be a preferred answer)

Answer 418

1. Toxicity is closely related to high plasma level (Note that Nortriptyline has a curvilinear dose response curve)

Answer 419

Supportive

Answer 420

Causes clinically significant distress in school performance

Answer 421

Girls\>boys

Answer 422

Role transition

Answer 423

Tics improve by early adulthood

Answer 424

Risk of future violence

Answer 425

Schizophreniform

Answer 426

Hopelessness

Answer 427

Hypoactivity of DA in mesocortical cortex

Answer 428

Family psychoeducation

Answer 429

Family psycho-ed involving problem solving

Answer 430

Social Anxiety with panic attacks

Answer 431

Lesch Nyhan

Answer 432

* smooth philtrum * thin upper lip * upturned **nose** * flat nasal bridge and midface * epicanthal folds * small palpebral fissures * small head circumference.

Answer 433

Negative reinforcement

Answer 434

Vertical eye movement palsy

Answer 435

Panic disorder

Answer 436

Unspecified PD is one of the most common in the elderly

Answer 437

Medical history

Answer 438

Narcissistic PD

Answer 439

Not responding to name

Answer 440

Ca and Glucose

Answer 441

Middle Cerebral artery, dominant

Answer 442

Decreased total sleep time

Answer 443

Can only disclose if patient gives you consent

Answer 444

More severe atrophy is related to poorer outcome

Answer 445

Graded Exposure

Answer 446

Paranoid delusions (somatic delusions also very common)

Answer 447

Acamprosate (Because Naltrexone + suboxone not inidicated first line)

Answer 448

Indicate who will be receiving the report

Answer 449

Captopril (Thiazide or NSAID would also be correct)

Answer 450

Second generation gives metabolic side effects

Answer 451

Complex Partial (Recall, in simple partial, no alteration in awareness)

Answer 452

psychomotor retardation

Answer 453

Frontal Temporal Dementia

Answer 454

Current depression

Answer 455

5-10% (25% revert to normal)

Answer 456

* b-amyloid and tau protein levels * CSFP * APOE * homocysteine levels * high LDL * serum IL-6 * olfactory dysfunction * changes hippocampal volume on PET * amyloid plaque on PET * delayed verbal recall and executive function in neuropsych

Answer 457

systolic HTN \>160mm/Hx (evidence to treat) - serum cholesterol \>6.5mmol/L - Smoking, current - hyperlipidemia ( no evidence for statins dec risk though) - head injury with loss of consciousness - low education \<12 yrs - Diabetes (vascular dem RF) - estrogen alone or in combo with progesterone - occup exposure environmental toxins- pesticides, fertilizers, fumigants and defoliants

Answer 458

Wilson’s disease

Answer 459

Hypnopompic hallucinations (or hypnogogic) Note: Decreased REM latency Overall increased REM sleep

Answer 460

Female gender Poor Prognostic Factors in BAD * older age * male * psychosis * mixed episodes * substance use * younger onset * rapid cycling

Answer 461

Anyone who is in your situation would be angry

Answer 462

Childhood history of hyperactivity and some other ADHD-like symptom

Answer 463

psychosocial stressors are equally important at all stages of the illness

Answer 464

The biological relative of an adopted proband are not at increased risk of schizophrenia

Answer 465

Serotonin depletion

Answer 466

Abstinent for less than 6 months prior to transplant Predictors of Relapse: dx SUD vs. abuse fam hx add failed rehab multiple substances poor soc support short pretransplant length abstinence.

Answer 467

Buporopion SSRIs and SNRIs both show increased risk of bleeding in some studies

Answer 468

Suicidal behaviour

Answer 469

Derouting conflict through a child

Answer 470

Attenuated positive symptoms these are MOST related

Answer 471

Executive Dysfunction

Answer 472

Change in Sensitivity of adrenergic receptors

Answer 473

Risk of death is lower than other antidepressant treatment (risk of death is lower than with TCAs)

Answer 474

higher (Seizure threshold goes up as you age)

Answer 475

Transport Canada

Answer 476

Calcified Tumour

Answer 477

Normal clock drawing test

Answer 478

Conduct Disorder

Answer 479

Prader Willi

Answer 480

Start SSRI

Answer 481

Reassurance

Answer 482

Arrange for an inpatient admission

Answer 483

low thyroid hormones

Answer 484

* food restriction * excessive exercises * preoccupied with food, eating, calories * social isolation * mood irritability, depression, obsessive compulsive behaviour * cold intolerance * lanugo hair * hair loss * poor sleep (early am waking) * dizziness, fainting * GI symtpoms

Answer 485

* CBC (possible reductions in all cell lines) * Lytes * BUN, Cr * Hypercholesterolemia common * LFTs may be elevated * Decreased Mg, Zn, Phosphorous * Metabolic alkalosis if vomiting (hypochloremic, hypokalemic) * Metabolic acidosis with laxatives * Thyroid - T4 low-normal, T3 decreased, reverse T3 elevated * Low E for females, Low T for males * ECG - bradycardia, prolonged QTC * BMD, if 6 months amenorrhea

Answer 486

intellectual disabilities

Answer 487

Hold Li (TREAT SYMPTOMS, NOT LEVEL)

Answer 488

* Nausea * vomiting * diarrhea * sluggishness * ataxia * confusion * agitation * neuromuscular exictability (coarse tremor, fasciculation, myoclonic jerks) * Severe - seizures, encephalopathy

Answer 489

Address sleep hygiene

Answer 490

Consider first the well being of the patient

Answer 491

dyskinesia

Answer 492

*DSM 5 criteria for Stimulant Intoxication:* Two (or more) of the following signs or symptoms, developing during, or shortly after, stimulant use: 1. Tachycardia or bradycardia. 2. Pupillary dilation. 3. Elevated or lowered blood pressure. 4. Perspiration or chills. 5. Nausea or vomiting. 6. Evidence of weight loss. 7. Psychomotor agitation or retardation. 8. Muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias. 9. Confusion, seizures, **dyskinesias**, dystonias, or coma.

Answer 493

Past history of hypomanic episode

Answer 494

Opioid partial agonist at MU receptor

Answer 495

Acetylcholine

Answer 496

Fluoxetine

Answer 497

22 DiGeorge/22z11.2 [congenital heart problems](https://en.wikipedia.org/wiki/Congenital_heart_problems), specific facial features, frequent infections, [developmental delay](https://en.wikipedia.org/wiki/Developmental_delay), [learning problems](https://en.wikipedia.org/wiki/Learning_problems) and [cleft palate](https://en.wikipedia.org/wiki/Cleft_palate). 20-30x higher risk of schizophrenia

Answer 498

Stop citalopram (Clonus almost always = Serotonin Syndrome)

Answer 499

Score of 7 or less

Answer 500

Modafinil is indicated for daytime sleepiness

Answer 501

Visual hallucinations and illusions

Answer 502

Role transition due to changing relationship with daughter

Answer 503

Mindfulness

Answer 504

DBT to reduce self-harm

Answer 505

Onset is typically in late adolescence

Answer 506

Elevated Serum Creatinine

Answer 507

Erection during REM sleep

Answer 508

Diabetes Risk Factors for TD * Older * female * First \> SGA * Duration * dose * early occurrence of drug induced movement disorders * Shchiz * ID * ETOH or SUD * Dementia * Diabetes * Prior ECT

Answer 509

male gender Rapid Cycling RF * Younger, onset \<17 * Women \> men (70%) * Hypothyroidism \*\*\* NOT hyperthyroid * SSRIs

Answer 510

reduced alpha waves with generalized theta and delta waves OR diffuse slowing of the background rhythm

Answer 511

serum glucose and calcium

Answer 512

Reassurance

Answer 513

CBT is effective if the patient is willing to engage

Answer 514

Clozapine-induced tachycardia

Answer 515

Lorazepam 1 mg

Answer 516

Caffeine Cloz & caffeine metabolixed by CYP1A2, caffeine inhibits cloz metabolism and increases cloz levels SJW and Smoking are P450 inducers therefore decrease levels of clozapine Caffeine decreases Li levels

Answer 517

It can be added to stimulants

Answer 518

language problems/impaired namind

Answer 519

Impairments in naming objects and sentence comprehension

Answer 520

Abulia Recall: **W**i**N M**a**C -SP GAME₂S** 1. Waxy flexibility – slight, even, resistance to positioning by examiner 2. Negativism – do the opposite of what is asked/ no response to instructions or external stimuli 3. Mutism – no/very little verbal response 4. Catalepsy –passive induction of a posture held against gravity 5. Stupor – no psychomotor activity; not actively relating to environment 6. Posturing – spontaneous & active maintenance of a posture against gravity /adoption of unusual bodily postures continuously for a long time 7. Grimacing 8. Agitation – not influenced by external stimuli 9. Mannerism – repeated movements that appear to have some functional significance e.g. saluting 10. Echolalia – mimicking another’s speech 11. Echopraxia – mimicking another’s movements 12. Stereotypy – repetitive, abnormally frequent non-goal directed movements e.g. rocking to and fro

Answer 521

Tempoparietal

Answer 522

Can cause school difficulties

Answer 523

Continue treatment indefinitely

Answer 524

Family Tx focused on high expressed emotion

Answer 525

80%-90% of patients with schizophrenia had prodromal symptoms "Antipsychotics have been shown to be effective in this stage" could also be true

Answer 526

High sensitivity means if negative test, unlikely they have disease

Answer 527

Not enough information to comment on it’s clinical effect

Answer 528

hypercalcemia \*Remember that lithium can cause hyperparathyroidism and hypercalcemia

Answer 529

Preforontal leucotomy/lobotomy

Answer 530

A pediatric sleep scale - Getting at ruling out childhood OSA, which can mimic ADHD, and causes obesity, nocturnal enuresis, and recurrent tonsillitis

Answer 531

Buspirone monotherapy is not recommended

Answer 532

Add bupropion to lithium = 2^nd line

Answer 533

Be able to tolerate and contain group affect etc

Answer 534

When individuals can see how others see them therapy is complete

Answer 535

Valproic Acid

Answer 536

Paliperidone Paliperidone is the only option that is exclusively renally excreted and doesn’t interact with the liver.

Answer 537

Aripiprazole

Answer 538

Clonazepam Recall in BPD a) Antipsychotic (Aripiprazole) b) mood stabilizer (Topiramate?) c) SSRI (Fluoxetine?)

Answer 539

Communication analysis

Answer 540

Motivational interviewing and relapse prevention strategies

Answer 541

Dopamine Transporter (DAT1) polymorphism increases risk of psychosis with cannabis abuse

Answer 542

Switch to clozapine

Answer 543

Narcissistic PD

Answer 544

Generativity vs. stagnation

Answer 545

Hypertension

Answer 546

Desipramine

Answer 547

Guy who does a lot of coke, lots of relapses, lives with other people who do lots of coke

Answer 548

29 year old woman, 6 months pregnant, 8 month history of IV heroin use – about equivalent for buprenorphine not combined with naloxone (as per ASAM)

Answer 549

substance cues to use lead to glutamate mediated activation

Answer 550

Females have less gastric metabolism than men, resulting in increased physiologic effect for same amount of consumption compared to males (the other 2 answers describe short term effects)

Answer 551

Influx of Na

Answer 552

Risk of bleed is not clinically significant and paroxetine can be maintained

Answer 553

maintain current effective dose (recall that SSRI& SNRI are preg categegory C, except for Paxil, which is D)

Answer 554

Absolute risk of PPH is low

Answer 555

it is represented in language

Answer 556

Not triggered by a stressor

Answer 557

* there is little sleep change (correct answer; many patients with CFS report non-refreshing sleep) * there tends to be a family history of depression

Answer 558

factitious disorder

Answer 559

Alcohol use Hx

Answer 560

Regression

Answer 561

Hyperventilation/oxygenation

Answer 562

Social introversion Component of MMPI: 1) [Hypochondriasis](http://en.wikipedia.org/wiki/hypochondriasis) 2) [Depression](http://en.wikipedia.org/wiki/depression_(mood)) 3) [Hysteria](http://en.wikipedia.org/wiki/hysteria) 4) [Psychopathic Deviate](http://en.wikipedia.org/wiki/psychopathy) 5) [Masculinity](http://en.wikipedia.org/wiki/masculinity)/[Femininity](http://en.wikipedia.org/wiki/femininity) 6) [Paranoia](http://en.wikipedia.org/wiki/paranoia) 7) [Psychasthenia](http://en.wikipedia.org/wiki/psychasthenia) 8) [Schizophrenia](http://en.wikipedia.org/wiki/schizophrenia) 9) Hypomania 10) [Social Introversion](http://en.wikipedia.org/wiki/introversion_and_extroversion)

Answer 563

Speaks in 3 word sentences

Answer 564

Propranolol (or Risperidone)

Answer 565

Raised ICP

Answer 566

Combination of CBT and meds are more effective

Answer 567

50% with first episode will have relapse in next 2 years – this is TRUE only for inpts d/c’ed

Answer 568

Homosexual orientation have a higher completed suicide rate

Answer 569

decreased REM latency (also increased REM density)

Answer 570

Man has had depressive episode for past 3 years with onset in winter and resolution in spring, and one previous manic episode 5 years ago

Answer 571

Creutzfeld Jakob Disease

Answer 572

nucleus accumbens (also hypothalamus if that is an option)

Answer 573

positive connotation

Answer 574

propanolol

Answer 575

Structured clinical judgment assessment tools provide individualized measure of risk

Answer 576

Luria (Fist edge palm)

Answer 577

Nicotine is a selective agonist of the nicotinic cholinergic receptor

Answer 578

Personality Disorders are less common in the elderly

Answer 579

Abrupt Onset

Answer 580

Acute Stress Disorder

Answer 581

Is important in the process of group cohesiveness

Answer 582

The patient’s insomnia has returned, as the benzodiazepine was only providing symptomatic relief

Answer 583

virtual reality exposure is an effective treatment

Answer 584

Acamprosate

Answer 585

Higher prevalence in low SES

Answer 586

Personal history of bipolar disorder

Answer 587

Play Therapy

Answer 588

MDD with psychotic features

Answer 589

Myasthenia Gravis

Answer 590

Avoidance causing lack of positive reinforcement

Answer 591

conduct disorder Child BD is most comborbid with ADHD (62%), ODD (53%), anxiety disorders (27%), conduct (19%) and SUD (12%) Early onset BD predicts earlier onset ADHD (KS)

Answer 592

Best evidence exists for integration of mental health and vocational services in the same program.

Answer 593

Better related to prognosis than positive sx

Answer 594

Repeated hospitalization

Answer 595

HIV (susceptibility to RA or Schizophrenia could place individuals at lower risk for the other)

Answer 596

Onset in Early Adulthood

Answer 597

must be done without coercion

Answer 598

peer support group

Answer 599

chi-squared (binary predicter and binary outcome) – becayse YES or NO Recall: t-test (binary predicter and multi outcome) ANOVA (multi predicter and multi outcome)

Answer 600

cardiovascular disease

Answer 601

Listen to her illness experience

Answer 602

Neither desires nor enjoys close relationships, including being part of a family

Answer 603

Social Anxiety disorder/social phobia

Answer 604

Hypothyroid

Answer 605

glutamate induces transmission

Answer 606

Conduct Disorder

Answer 607

* Disintegration * loss of love object * castrartion * superego

Answer 608

Can be used in psychiatric and forensic populations (not used to assess current risk, and not used to assess risk to self)

Answer 609

Disguise exits and put barriers in place to others rooms

Answer 610

Antisocial PD

Answer 611

Projective identification

Answer 612

Methylphenidate

Answer 613

Sedation (Recall, it is an a-2 agonist)

Answer 614

Socratic questioning looking at why she feels the need to be perfect

Answer 615

Confirm compliance

Answer 616

Refer to community outreach team

Answer 617

Cyclothymia

Answer 618

IV thiamine

Answer 619

Explore goodness of fit in her job and her contribution to conflict

Answer 620

Stimulant * Cocaine too short * PCP wouldn’t last that long * PCP – vertical nystagmus in stem

Answer 621

Patient education about effects of victimization

Answer 622

Effexor - Treat suicide risk/MDD by relevant guidelines

Answer 623

Adjunctive risperidone (Recall, RIsperidone and Abilify are first line adjunctive agents for treating OCD)

Answer 624

Psychoed (Superior to IPSRT)

Answer 625

Mirtazapine Recall, regarding QTC prolongation: * TCAs highest (clomipramine best of them) * Then Citalopram, escitalopram, venlafaxine * Wellbutrin does not prolong QTC at all, Mirtazapine very low risk

Answer 626

Naltrexone

Answer 627

Nausea, vomiting, insomnia

Answer 628

Inability to name common objects

Answer 629

HRT ?? Recall, when treating Depression in Menopause * First line: Proven therapeutic option for depression (ie, antidepressants, CBT and other psychotherapies) during perimenopause * Likely good efficacy for all SSRI/SNRI, in treating depression and VMS * Desvenlafaxine is most studied * Some evidence that ET has antidepressant effects of similar magnitude to that observed with classic antidepressant agents when administered to depressed perimenopausal women with or without concomitant VMS. * ET ineffective in POSTmenopausal women * ET may augment clinical response to antidepressants in midlife and older women but their use should be considered with caution – ie, preferably when also indicated for other concurrent conditions such as VMS. * ET not FDA approved to treat mood disturbance

Answer 630

Derealization/Depersonalization disorder

Answer 631

Treat him because it is your duty as a doctor to treat in an emergency

Answer 632

Transference

Answer 633

Alprazolam

Answer 634

Propranolol * In treating **akathisia**, propranolol now first line * Benztropine second line * Benzos for non-responders

Answer 635

Generalized anxiety

Answer 636

You do not recommend cannabis because there is no evidence in PTSD

Answer 637

Leave the same for relapse prevention Recall * Maintenance is whatever worked to get them out of acute symptoms * Quetiapine maxes out on sedation and weight gain at 150

Answer 638

MDD * catatonia, more common in mood disorders * Majority of catatonia = depressive or bipolar

Answer 639

Interoceptive

Answer 640

Ach inhibitor * Recall, in LBD * If a patient experiences severe, disabling psychosis, a trial of a cholinesterase inhibitor and/or lowering the dose of antiparkinson medication should be considered first. * When antipsychotic therapy is required, drugs are associated with an increased risk of death when used in older adult patients with dementia. * If antipsychotic therapy is required in patients with DLB, only atypical antipsychotic drugs, such as olanzapine, quetiapine, pimavanserin, ziprasidone, aripiprazole, paliperidone, or clozapine, should be used in very small doses in order to reduce the risk of severe reaction * The older, conventional antipsychotics should be avoided entirely

Answer 641

Clonazepam

Answer 642

CBT * Recall * KS - primary treatment of ODD is family intervention using both direct training of the parents in child management skills and careful assessment of family interactions. * The goals of this intervention are to reinforce more prosocial behaviors and to diminish undesired behaviors at the same time * CBT - teach parents how to alter their behavior to discourage the child's oppositional behavior by diminishing attention to it, and encourage appropriate therapy focuses on selectively reinforcing and praising appropriate behavior and ignoring or not reinforcing undesired behavior

Answer 643

Predictive of BAD in later life

Answer 644

* 250-300ng/L normal target OR 1000-2500nmol/L * 50 – 150 =low * 200 – 300 good initial target * 350 – 400 could be tried if response insufficient

Answer 645

Executive dysfunction

Answer 646

Increased fragmentation

Answer 647

Generativity vs. Stagnation

Answer 648

Pramipexole (because freezing symptoms at night)

Answer 649

You cannot because of the physician-patient relationship

Answer 650

Suicide assessment

Answer 651

Wellbutrin

Answer 652

Assess and reduce or discontinue and anticonvulsant medications * Next steps * Caffeine * Hyperventilation * Consider adding ketamine to propofol

Answer 653

Rate of cognitive decline Recall * CT recommended if one or more of the following are present *  – Age \< 60 years *  – Rapid (e.g., over 1–2 months) unexplained decline in cognition or function *  – Short duration of dementia (\< 2 years) *  – Recent and significant head trauma *  – Unexplained neurologic symptoms (e.g., new onset of severe headache or seizures) *  – History of cancer (especially types that metastasize to the brain) *  – Use of anticoagulants or history of bleeding disorder *  – History of urinary incontinence and gait disorder early in the course of dementia (as may be found in normal pressure hydrocephalus) *  – Any new localizing sign (e.g., hemiparesis or a Babinski reflex) *  – Unusual or atypical cognitive symptoms or presentation (e.g., progressive aphasia) 

Answer 654

Prednisone (7x SI HR)

Answer 655

Consult with family MD to start on buprenorphine

Answer 656

Reduction in cortical grey matter

Answer 657

Paliperidone

Answer 658

Negative symptoms

Answer 659

1. Inappropriate behaviour/relations

Answer 660

Fluoxetine Paroxetine Sertraline Venlafaxine

Answer 661

CBT is an effective first line option (TF-CBT, EMDR, PE, and stress management therapy)

Answer 662

Hanging is most common method of completed suicide

Answer 663

50% have family history of affective disorders b) Occurs in about 1-2% of pregnancies – ***wrong,* *1 to 2 per 1000 births,*** c) Usually happens 6 weeks after delivery – ***wrong, within 2 weeks***

Answer 664

Lithium needs to be tapered before delivery because the drop in volume can lead to toxicity

Answer 665

Sub-callosal cingulum Recall, Dorsolateral PFC = for TMS

Answer 666

Atomoxetine

Answer 667

Paliperidone Recall, Paliperidone doesn't undergo CYP 450 metabolism (also LOT and desvenlafaxine)

Answer 668

Acamprosate \* recall, topiramate has risk of renal stones

Answer 669

Significant Weight gain is an uncommon side effect (recall that Abilify is a 2D6 substrate)

Answer 670

Fluvoxamine Recall Clozapine metabolized by 1A2 Fluvoxamine is strong 1A2 inhibitor

Answer 671

Olanzapine Smoking is a 1A2 inducer OLZ is a 1A2 substrate

Answer 672

Aripiprazole

Answer 673

5HT2a antagonists\> DA antagonists

Answer 674

Lamotrigine

Answer 675

Schizophrenia fertility rates are similar to the general population

Answer 676

Delusional disorder (Also no evidence for IPT in schizophrenia)

Answer 677

Paroxetine

Answer 678

Atomoxetine

Answer 679

Stimulants may be used in patients with tic

Answer 680

According to guidelines, Modafinil is first-line for narcolepsy Why other options are wrong: b) TCAs and SSRIs have been shown to be helpful for sleep paralysis and hypnogogic hallucinations – cataplexy c) Hypnopompic and hypnogogic hallucinations are more auditory in nature. – not true, can be auditory, visual or tactile d) Polysomnography is essential for the diagnosis – not entirely true. Fro Narcolepsy Type 1 either PSG or orexin, and in NT2 then you need PSG

Answer 681

Toxicity with tacrolimus Fluvoxamine is a 3A4 inhibitor, Tacrolimus is a 3A4 substrate

Answer 682

Police have a search warrant

Answer 683

80% (Sp = TN / TN + FP) TN + FP = all people without disease

Answer 684

Heritability Recall: LOD score - how close they are on the chromosome c)Gene linkage – genes likely to be expressed together

Answer 685

New cases in a defined population in a given period of time

Answer 686

Partial agonist of A4B2 nicotinic receptor

Answer 687

Sertraline 50 mg po daily

Answer 688

Narcissistic

Answer 689

Clonazepam (Because this is REM sleep disorder)

Answer 690

Risperidone

Answer 691

Stop the dialysis

Answer 692

Depression Recall five stages in order are denial, anger, bargaining, depression, and acceptance.

Answer 693

Mindful communication training

Answer 694

Peer group support

Answer 695

Switch to diazepam 100-120 mg po daily in divided doses and then gradually taper Though increase paroxetine is also correct, but not the \*next step\*

Answer 696

1. use the same medication for tapering 2. switch to a longer-acting equivalent 3. use adjunctive medications to help mitigate potential withdrawal symptoms.

Answer 697

History of alcohol use

Answer 698

Medical history

Answer 699

Specific Phobia or GAD

Answer 700

Alcoholic hallucinosis

Answer 701

Lesch Nyhan (all others are autosomal recessive)

Answer 702

25 mg (Starting dose = 0.5mg/kg)

Answer 703

Hard to differentiate pseudoseizures from complex partial seizures by EEG alone

Answer 704

MR – moderate range

Answer 705

If poor appetite, give with food

Answer 706

Cardiac arrthymias in a small proportion of patients In terms of F:M: estimated lifetime prevalence 3:1 F:M. In clinical settings, the ratio of females to males ranges from 10:1 to 20:1

Answer 707

**Eating disorder NOS** (OSFED + unspecified) - we don't know if she is pairing binging and purging - we don't know if she is restricting - we suspect that she is not severely underweight based on her mass (unless she is very very tall)

Answer 708

Illness Anxiety Disorder – will admit that their fears may be groundless or excessive

Answer 709

Blood flow in the brain

Answer 710

CBT is equally effective as medication and CBT combination

Answer 711

Most elderly gave up driving on their own

Answer 712

Consensual validation between group members decreases interpersonal distortions OR Consensual validation between group members decreases interpersonal distortions (they both are true)

Answer 713

Impaired naming and sentence comprehension

Answer 714

Knowledge of debts “Testamentary capacity” is a term with a particular legal meaning: whether an individual has the necessary cognitive abilities to be capable of making a valid will.

Answer 715

Considered complete When they can see how others see them

Answer 716

Acceptance

Answer 717

It typically doesn’t cause delirium

Answer 718

Most children of divorced parents are well adjusted

Answer 719

Social Phobia

Answer 720

start risperidone 0.5 mg QD

Answer 721

Hyperthyroidism

Answer 722

Avoidance of positive reinforcing activities takes away from experiencing joyful activities

Answer 723

CBT if he can engage in therapy

Answer 724

There is no change in risk of suicide in dementia

Answer 725

amygdala hyperactivity

Answer 726

Focal left frontal atrophy – you would find this in FTP

Answer 727

large hippocampus

Answer 728

Concrete operational

Answer 729

on an antidepressant

Answer 730

anxiolytic via noradrenergic inhibition

Answer 731

Serotonin syndrome

Answer 732

different outcomes re: psychotic predominant versus affective predominant * Recall, women with schizoaffective disorder are more likely to be married than women with schizophrenia * Schizoaffective bipolar type is more common in older women * Prognosis is worse for psychotic vs affective symtpoms

Answer 733

elderly have lower mortality with ECT versus other therapeutic options Why other options are wrong: a) no difference in complication rate between adults and elderly – higher complications in elderly b) response rate is lower in elderly – false – response rate is actually higher c) elderly have lower seizure threshold – they have a higher sz threshold

Answer 734

24 months or longer

Answer 735

Family interventions, focusing on reducing levels of expressed emotion

Answer 736

Risperidone

Answer 737

non response to ECT – because non responding would cause them to increase stimulus

Answer 738

melancholic features

Answer 739

psychotic features

Answer 740

circumlocutions and substitutions common Why others are wrong: "rarely before the age of 4" – false, onset age 2-7 "symptom of anxiety" – not true, associated with anxiety

Answer 741

early onset is considered before the age of 21

Answer 742

Lack of Affective disorder Recall, Risk Factors for TD: * older * female * white and african descent * longer illness duration * ID and bran damaga * Neg symptoms in schz * Mood DIsorders * Cog sx in mood disorders * DM * Smoking * ETOH and substance abuse * FGA vs SGA tx * higher cumulative and current AP dose or plasma levels * early PD side efects * anticholinergic co tx * akathisa * emergent dyskinesia

Answer 743

Decrease muscle relaxant

Answer 744

Worthlessness

Answer 745

Quetiapine

Answer 746

Stop Remeron and add Epival

Answer 747

acceleration of thought formation

Answer 748

Sublimation

Answer 749

Rivastigmine

Answer 750

Separation anxiety disorder

Answer 751

Usually only mild impairment Prevalence 10% - false 2-4% More common in females - false

Answer 752

Aggression

Answer 753

Interneuron space (synaptic cleft)

Answer 754

Increased cholesterol

Answer 755

Start in Mid 50s Symptoms of Huntington's disease usually develop between ages 30 and 50, but they can appear as early as age 2 or as late as 80

Answer 756

Significant improvements seen in 16 weeks

Answer 757

LBD Binswanger's disease, also known as subcortical [leukoencephalopathy](https://en.wikipedia.org/wiki/Leukoencephalopathy) and subcortical arteriosclerotic encephalopathy (SAE),[^[1]](https://en.wikipedia.org/wiki/Binswanger%27s_disease#cite_note-1) is a form of small vessel [vascular dementia](https://en.wikipedia.org/wiki/Vascular_dementia) caused by damage to the [white brain matter](https://en.wikipedia.org/wiki/White_matter).

Answer 758

Premorbid personality disorders are usually absent

Answer 759

Visual hallucinations ## Footnote \* BUT there is a specifier for "with perceptual disturbances which is hallucinatiosn with intact relaity testing or aud, vis, tactile illusions in the absence of a delirium" Recall, in Amphetamine Intoxication, 2 or more of 1. Tachycardia or bradycardia. 2. Pupillary dilation. 3. Elevated or lowered blood pressure. 4. Perspiration or chills. 5. Nausea or vomiting. 6. Evidence of weight loss. 7. Psychomotor agitation or retardation. 8. Muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias. 9. Confusion, seizures, dyskinesias, dystonias, or coma.

Answer 760

20% have no active symptoms after 65

Answer 761

Carbamazepine or Sertaline - both are true

Answer 762

Gets others to make decisions for them

Answer 763

Naltrexone 50 mg + relapse prevention techniques

Answer 764

Larger studies might find statistical significance not necessarily clinical significance

Answer 765

significantly increased rates of schizophrenia

Answer 766

Is involved in repetitive obsessions/rituals

Answer 767

CBT is superior to meds – in Katzman, CBT favoured over meds

Answer 768

Most likely to be associated with ASPD Depressive disorders, anxiety disorders, and substance use disorders are most commonly comorbid with intermittent explosive disorder Individuals with ASPD, BPD, disriptive behaviours, they have an elevated risk of have IED

Answer 769

Having lots of administrative responsibilities Others: * Female * Earlier in Career * Dissatisfaction with Work

Answer 770

Somatic symptom disorder – inherited from ASPD – both males and females are at risk of developing SSD when ASPD runs in family

Answer 771

Eyes closed during the seizure

Answer 772

Signposting

Answer 773

Limit the use of sedating medications

Answer 774

Offer Oral and LAI and decide based on patient preference

Answer 775

Thoroughness of suicide risk assessment

Answer 776

Intellectual Disability

Answer 777

Fluvoxamine * Fluovoxamine is metabolized by CYP3A4 * Increases levels of alprazolam, diazepam, theophylline, warfarin, clozapine, carbamazepine, mathadone, propranolol, diltiazem * It is the SSRI MOST at risk of drug drug interactions

Answer 778

Desvenlafaxine * Abilify is 2D6 substrate * Bupropion, Duloxetine and venlafaxine are 2D6 inhibitors * Desvenlafaxine

Answer 779

Stop VPA | (high ammonia, ALWAYS STOP)

Answer 780

Both improve

Answer 781

Prader Willi

Answer 782

Hyperventilation

Answer 783

Duloxetine

Answer 784

Slow Waves

Answer 785

Family therapy

Answer 786

Peaks in late childhood, improves through adolescence

Answer 787

Methylphenidate

Answer 788

History of suicide attempts

Answer 789

Risperidone

Answer 790

You need to be 9mo old to get Dx of RAD

Answer 791

Grandiosity

Answer 792

Klinefelter’s

Answer 793

Observation * Observe and reassure, children for whom not disruptive * CPS guideline

Answer 794

Volatile Solvents

Answer 795

May require high dose benzo (up to 16mg/d ativan)

Answer 796

Kohut * *Narcissistic Transferences* * The therapist comes to represent, in Kohut's terms, either the grandiose self in *mirror transferences* or the idealized parental imago in *idealizing transferences.* In idealizing transferences, all power and strength are attributed to the idealized object, leaving the subject feeling empty and powerless when separated from that object.

Answer 797

Initiative vs. guilt * Preoperational 2 – 7 * Phallic 3 – 5 * Erikson Initiative versus Guilt (about 3 Years to about 5 Years).

Answer 798

Modify instructions and homework

Answer 799

Helps to establish goals of therapy

Answer 800

Automatic thought

Answer 801

Others are interfering with my life

Answer 802

IPT Recall Davanloo – v. confrontational

Answer 803

Identification

Answer 804

CSF analysis (NMDA)

Answer 805

Exposure therapy

Answer 806

Transference

Answer 807

Exposure and response prevention (If "DIRT" specifically was an option, would go with that)

Answer 808

Refeeding Syndrome

Answer 809

Habit reversal

Answer 810

Universalization

Answer 811

Contain and tolerate intense affect

Answer 812

2 Risk Ratio or Relative Risk = Incidence in Exposed Group /Incidence in Non-exposed Group

Answer 813

Create a well defined aim statement

Answer 814

Limit sleep disruption

Answer 815

Fluoxetine

Answer 816

Continue clozapine in pregnancy stop postpartum (Typically you would continue an agent in breastfeeding if they were exposed in utero, but exceptions are when there are severe side effects with conitnued exposre such as clozapine,infant appears to be having side effects) CLozapine has been associated iwth floppy baby syndrome, infants exposed in utero should be monitored for agranulocytosis first weeks of life

Answer 817

Sleep Hygiene

Answer 818

Wants the sick role

Answer 819

Schedule regular appointments not contingent on symptoms complains

Answer 820

Brain is on fire

Answer 821

Non-judgement

Answer 822

Not being able to operate his lawnmower

Answer 823

ASPD (as this is individual dynamic therapy)

Answer 824

Switch to clozapine

Answer 825

Rivastigmine Recall in PD dementia, tx is symptomatic. Usually start with ACHei or memantine in stepwise fashion

Answer 826

1. Add abilify

Answer 827

Aripiprazole

Answer 828

PTSD Recall * 1/2 of people who present with PTSD had initially presented with acute stress disorder * ASD vs Adjustment Do * Dx Adj DO when resposne to criterion A event doesnt meet criteria for ASD or when symptom pattern doesnt meet criterion A for exposure to actual or threatened death, serious injury, sexual violence

Answer 829

Language disorder

Answer 830

Wechsler Individual Achievement Test (WIAT)

Answer 831

Nausea * As per Stahl, nausea, diarrhea, appetite loss, weight loss * Insomnia, dizziness * Muscle cramps, fatigue, depression, strange dreams

Answer 832

Ideomotor dyspraxia * **Ideomotor Apraxia**, often IMA, is a neurological disorder characterized by the inability to correctly imitate hand gestures and voluntarily mime tool use, e.g. pretend to brush one's hair. * Visuospatial **dysgnosia** is a loss of the sense of "whereness" in the relation of oneself to one's environment and in the relation of objects to each other. * **Dysmetria** is a lack of coordination of movement typified by the undershoot or overshoot of intended position with the hand, arm, leg, or eye. It is a type of ataxia. It can also include an inability to judge distance or scale

Answer 833

Terminal Heart failure and is moderately depressed * In order to be eligible for MAID, individuals must meet all of the following criteria: * be eligible for publicly-funded health services in Canada; * be at least 18 years of age and capable of making his or her own health care decisions; * have a grievous and irremediable medical condition; * make a voluntary request for MAID, i.e. a request that is not the result of outside pressure or influence; and * give consent to receive MAID after being provided with all of the information necessary to make the decision, including information about his or her medical diagnosis, available forms of treatment and options to relieve suffering. * have a serious and incurable illness, disease or disability; * be in an advanced state of decline in capability that cannot be reversed; * be enduring physical or psychological suffering from the illness, disease or disability that is intolerable to him or her and that cannot be relieved under conditions that he or she considers acceptable; and * be at a point where his or her natural death has become reasonably foreseeable, taking into account all of his or her medical circumstances.

Answer 834

Hemorrhagic stroke Note in Syphiliis – gait apraxia, incontinence – tabies dorsalis

Answer 835

Parkinson’s * There are three main types of synucleinopathy: [Parkinson's disease](https://en.wikipedia.org/wiki/Parkinson%27s_disease) (PD), [dementia with Lewy bodies](https://en.wikipedia.org/wiki/Dementia_with_Lewy_bodies) (DLB), and [multiple system atrophy](https://en.wikipedia.org/wiki/Multiple_system_atrophy) (MSA).

Answer 836

Citalopram * Serotonergic medications have been the most studied in bvFTD. The selective serotonin reuptake inhibitors (SSRIs) fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram have all been tested to treat the behavioral symptoms of FTD. There is evidence that these drugs can have some efficacy in reducing disinhibition, repetitive behaviors, sexually inappropriate behaviors, and hyperorality.

Answer 837

Clonazepam

Answer 838

Citalopram

Answer 839

Cyclothymic disorder

Answer 840

Small hippocampus

Answer 841

Shut the blinds and put towels over mirrors

Answer 842

Start SSRI

Answer 843

Lack of vertical eye movement

Answer 844

Dental carries and gingivitis (Long term TCA use, dry mouth, gingivitis)

Answer 845

Bupropion * Based on current literature, **fluoxetine**, **fluvoxamine**, and **sertraline** appear to have similar, low risk for QT prolongation, and **paroxetine** appears to have the lowest risk. Available data indicate that TCAs and citalopram pose the greatest risk for QT prolongation in older adults whereas the other SSRIs and SNRIs do not appear to pose any significant risk on their own. Data are lacking in other antidepressants, including bupropion, vilazodone, and levomilnacipran; however, it does not appear that bupropion prolongs the QT interval

Answer 846

Needs to treat his psychosis

Answer 847

Check calcium

Answer 848

Start Synthroid When hypothyroidism develops in Li use, treat per appropriate guidelines. Li-induced hypothyroidism is reversible with discontinuation of [lithium](https://www.uptodate.com/contents/lithium-drug-information?search=hypothyroidism+lithium&topicRef=7843&source=see_link), there is no need to discontinue it, and it should not be discontinued without consultation with the patient's psychiatrist. If lithium is subsequently discontinued, it is reasonable to reassess the need for continued thyroid hormone replacement. There are no standard protocols for reassessment. We measure TSH approximately two months after discontinuation of lithium.

Answer 849

Mirtazapine * The mechanism of action of mirtazapine is antagonism of central presynaptic α₂-adrenergic receptors and blockade of postsynaptic serotonin 5-HT₂ and 5-HT₃ receptors. The α₂-adrenergic receptor antagonism causes increased firing of norepinephrine and serotonin neurons. The potent antagonist of serotonin 5-HT₂ and 5-HT₃ receptors serves to decrease anxiety, relieve insomnia, and stimulate appetite. Mirtazapine is a potent antagonist of histamine H₁ receptors and is a moderately potent antagonist at α₁-adrenergic and muscarinic-cholinergic receptors.

Answer 850

CBT \*\*\* consensus with full group

Answer 851

Venlafaxine

Answer 852

Family history of bipolar

Answer 853

Female gender

Answer 854

Persistent pulmonary hypertension of the newborn (PPHN)

Answer 855

If they live in a rural or urban area

Answer 856

Mirtazapine * CANMAT review comorbidities * SSRIs and NASSA preferred agent cardiac * Avoid venlafaxine and TCAs for high blood pressure

Answer 857

Local resources to support if necessary

Answer 858

Normal clock drawing

Answer 859

Public safety

Answer 860

IV Thiamine

Answer 861

Starts in adulthood

Answer 862

Transient Global Amnesia

Answer 863

it’s a risk factor amongst many risk factors

Answer 864

Schizophreniform

Answer 865

Behavioural analysis

Answer 866

Self-doubt

Answer 867

Accept patient for where they are at, believe they can change

Answer 868

Venlafaxine Renal impairment: reduce the total daily dose by 25% to 50% in patients with renal impairment. Reduce the total daily dose by 50% or more in patients undergoing dialysis or with severe renal impairment

Answer 869

Carbamazepine Benzos AND estrogens are 3A4 substrates CBZ is inducer of 3A4 Erythromycin is 3A4 inhibitor

Answer 870

prior education expectation * High premorbid expectations * Paranoia * high risk patient as a young male, with a history of good adolescent functioning and high aspirations, late age of first hospitalization, higher IQ, with a paranoid or non-deficit form of schizophrenia, who retains the capacity for abstract thinking and who may be painfully aware of the impact of a deteriorating illness on his aspirations and life trajectory.

Answer 871

Negative symptoms

Answer 872

2/3 will have 2 comorbidities

Answer 873

It is main factor in outcome

Answer 874

cardiovascular (JAMA 2020 paper: Most likely cause of premature death = suicide)

Answer 875

Risperidone

Answer 876

Echo * Cardiac affection is a common issue in the **Down syndrome** (DS) population, in the form of both congenital and acquired heart disorders. **Echocardiography** plays an important role in the detection of such disorders. Fetal **echocardiography** can detect cardiac disorders as early as 10-12 wk of gestation.

Answer 877

* CBC, lytes, CAMP, albumin, LFTS, Cr, Urea * ECG

Answer 878

Psychological strategies preferred over medications in first trimester When meds are necessary, preference should be given to monotherapy and lowest effective dose

Answer 879

* Should be avoided due to risks of NTD (5%) * higher incidences of congenital abnormalities * striking degrees of neurodevelopmental delay in children at 3y, loss of 9 IQ pts

Answer 880

Pts may require higher doses of meds towards end of pregnancy because: Changes in physiology in 2nd and early 3rd trim Increased plasma volume Increased hepatice activity Increased renal clearance

Answer 881

Adults 1. CBT Modified for BN (most evidence) 2. IPT (as effective as CBT, but slower) 3. DBT (case reports) Adolescents 1. Family Based Therapy (superior to supportive and CBT) 2. CBT for BN (not as effective as FBT)

Answer 882

Prove feigning symptoms

Answer 883

ANK3 - Voltage gated sodium channels CACNA1C on 12p13 - L type Ca Channels

Answer 884

1. Start opioid agonist treatment (OAT) with buprenorphine/naloxone whenver feasible 2. For poor responders to above, consdier transition to methadone 3. If good response to methadone, consider transitioning to buprenorphine naloxone

Answer 885

* Pt needs to be in at least moderate withdrawal to start (COWS \>12) * 12-24 hours of abstinence since last opiod dose * Begin at 2-4mg, increase by up to 8mg/day * Max 24mg/day

Answer 886

Precipitated withdrawal Resp depression/sedation Headache, fatiguw, occasional sexual SE

Answer 887

* Suboxone * Buprenorphone is a partial opiod antagonist at mu receptor * Has a higher affinity for opioid receptor so displaces otehr opioids * But its maximal opioid agonist effect is lower than FULL op-ags (methadone, morphine, heroin) * "Ceiling effect" lowers risk of resp depression, side effects, non-med use * Naloxone os mu opioid receptor antagonist, can block the effect of buprenorphine * Methadone * FULL opiod agonist at mu receptor * increased risk for AEs and OD and death * When used as directed, safe and effective for OUD tx

Answer 888

* QTC Prolongation * Black Box Warning * Addiction, abuse, misuse * Resp depression * 3A4, 2C19,2C9,2D6 inhibitors could icnrease methadone levels --\> resp depression * Serotonin syndrome if with other S-agents

Answer 889

WIthdrawal management alone should be avoided, and detox should always be followed by immediate transition to long term addiction tx

Answer 890

* Cocaine * DOPAMINE * Ecstacy * Serotonin * Methamphetamine * Dopamine

Answer 891

* Longer use- decreased seizure threshold * Psychosis - paranoia, visual, auditory and tactile hallucinations * Stereotypical behaviours

Answer 892

* Euphoria * ↓ appetite * ↑vigilance * ↑ autonomic activity (or possibly ↓) * ↑seizures * ↑psychosis - paranoid delusions * ↑ nausea vomiting * ↑ arrhythmias * ↑ psychomotor behaviour - agitation, stereotyped behaviour eg dyskinesias

Answer 893

* DYSphoria * ↑ appetite * ↓ energy * ↓ psychomotor activity (retardation) * ↓ or ↑ sleep * vivid unpleasant dreams

Answer 894

* Acute - ↑ serotonin (blocks reuptake, directly releases S) * Chronic - ↓ serotonin levels by depleting stores and inhibiting synthesis of new S

Answer 895

* Acute * serotonin levels by blocking reuptake, directly releasing S * Chronic * ↓ serotonin levels by depleting stores, inhibiting synthesis of new S

Answer 896

* Bruxism/trismus (lock jaw) * Stimulant effects * ↑ wakefulness * ↑energy * ↑endurance * ↑ sweating * ↑ hot flashes * ↓ appetite * Risk of SS

Answer 897

* ↓ mood * ↓ energy * suicidality in absence of MDD

Answer 898

* panic disorder (highest assoc) * depression * anxiety * impulsiivty * sleep problems * cognitive dysfunction

Answer 899

* Cocaine * Metabolizes **rapidly** * Effects last 1-2 hours * Withdrawal 1-2 days * Methamphetamine * Metabolizes **Slowly** * Effects can last 10-20 hours * Withdrawal can last several days * Recall meth --\> 1000% ↑ of DA in NA (vs food 150%, sex 200%)

Answer 900

* Euphoria * ↓inhibition * dizzines * slurred speech * ataxia * ↓ alterness/ drowsy * accidents and injuries

Answer 901

* ↓ resp depression * nystagmus * dizzy * incoordination * slurred speech * unsteady gait * ↓ reflexes * tremor * blurred vision * arrhythmias * chest pain * muscle and joint pains * asphyxia * cardiac arrest * Sudden Sniffing Death * if myocardium sensitive to NE, sudden surge of NE can have sudden death with chronic use - permanent white matter changes, prolonged effects bc stored in fatty tissue

Answer 902

1. NRT 2. Varenicline 3. Bupropion

Answer 903

* LSD onset within 1 hr, peaks 2-4, lasts 8-12 * Sympathomimetic effects * ↑HR * ↑ temp * ↑sweating * ↑tremor * ↑ pupil size (mydriasis) * ↑BP Treat with reassurance, diazepam PO possibly

Answer 904

* Discontinuation + 2 of * ↑ANS, ↑tremor, insomnia, NV, ↑anxiety, vis/aud/tactile, GTC sz, agitation * 6-8 - hr shakes * 8-12 - psychotic/perceptual probs * 12-24 - h seizures * 72h - DTs (1-3%) * monitor with CIWA \<15 mild, \>20 severe * Tx with Diazepam 1mg/drink QID, or Chlordiazepoxide 2.5mg/drink QID

Answer 905

methamphetamine methylphenidate dextroamphetamine dextroamphetamine/amphetamine salt /adderall MDMA/MMDA/MDEA

Answer 906

* Recent use + 2 of * tachy or brady, ↑mydriasis, ↑↓bp, sweats, chills, NV, ↓wt/appetite, ↑agitation, resp depression, arrhythmias * confusion/seizures, dyskinesia coma * Symptoms gone at 24h, reolved after 48h * Tx Low dose Haldol 5mg for amphetamine induced psychocis

Answer 907

Express Empathy Develop Discrepancy Roll with Resistance Support Self-efficacy

Answer 908

NREM - 75% REM - 25%

Answer 909

REM - hyperarousal state - increased blood pressure, resp rate, brain temp, glucose metabolism, cerebral blood flow NREM - Hypoarousal state - lower blood pressure, low resting muscle tone

Answer 910

* N1 = theta, 5% * N2 = sleep spindles and k-complexes, 45% * N3 = delta waves, "Slow wave" or "deep sleep", 25% - furthest from wakefulness Note - when awake, eyes opened - beta waves - when drowsy, eyes are clsoed, alpha waves

Answer 911

Detailed dreams and nightamres Near total skeletal muscle paralysis ("atonia") Cyclical, every 90-100mins

Answer 912

Suprachiasmatic nucleus Anterior hypothalamus

Answer 913

NREM - hypothalamus (also thalamus, forebrain, medulla) REM - Pons (pontine reticualr formation)

Answer 914

First part of sleep cycle

Answer 915

Towards the end of sleep cycle

Answer 916

90mins Decreased in depression and narcolepsy

Answer 917

Association of bed with state of arousal

Answer 918

CBT for Insomnia 3 stages 1. Sleep hygiene and education, stimulus control, sleep restructuring 2. Cognitive therapy, relaxation training 3. Medication taper

Answer 919

Use for short-term, trasnient insonia eg when in hospital Use lwoest effective dose, intermittent dosing, gradually taper off Not indicated for chronic insomnia EG. Temazepam, zopiclone, zolpidem, doxepin, orexin and melatonin antagonists

Answer 920

* Sleep 8-12h, very difficult to wake in am * naps and sleeps in day * sleep not restful * fall asleep fast, good sleep efficacy * Polysomnography, Multiple sleep latency test (multipel naps in a day) * 1. Modafinil, 2. Dexedrine, methlyphenidate

Answer 921

1. Cataplexy a few x/ month (sudden bilat loss of muscle tone precip by laughing or in children or early disease, tongue thrusting, global hypotonia) 2. Hypocretin deficiency (\<1/3 normal, \<110pg/ml) 1. PSG - REM sleep latency _\<_ 15 min ; MSLT _\<_8min + REM seen on 2 naps

Answer 922

1. Sleep attacks 2. Cataplexy 3. Hypnopompic/hypnogogic hallucinations 4. Sleep paralysis

Answer 923

1. Scheduled napping, sleep hygiene, lifestyle adjusments 2. Daytime sleepiness - 1) modafinil, 2) dexedrine and methylphenidate 3. Sleep paralysis and H/HH - REM suppressants TCAs, SSRIs, SNRIs (off label) - theory is that these suppress REM, because REM is intruding on to wakefulness

Answer 924

CPAP Nasal surgery Oral devices Don't sleep supine DO NOT use narcotics, benzos, opioids

Answer 925

Chronotherapy (phase delay) Melatonin early PM Bright light early AM

Answer 926

* recurrent episodes of incomplete waking from sleep (first 1/3 of sleep) * sleepwalking * night terrors * none or littel of draems recalled * amnesia of episode

Answer 927

* SAFETY * Reassurance, education * Avoid precipitants (fll bladder, ETOH, noise, meds) * V little data on meds - ?SSRIs, TCAs, Benzos were used historically but coudl worsen because they suppress N3 sleep

Answer 928

* repeated episodes of arousal during sleep associated with **vocalizations**/**complex motor behaviour** * During REM, \>90min after sleep onset * 1 of the following * REM sleep without atonia on PSG/EMG (loss of skeletal muscle paralysis) * Hx suggestive of a-synucleinopathy

Answer 929

Ensure safety of patient and bed partner Clonazepam 0.5-2mg Melatonin 3-12 mg (always first line if OSA) ?Dopa agonists

Answer 930

\>450 men \>470 women

Answer 931

Topiramate

Answer 932

Lithium Topiramate Gabapentin Pregabalin \*Paliperidone \*Acamprosate

Answer 933

\>2 years (\>1yr in children) - * numerous periods with hypomanic symptoms **that do not meet** criteria for a hypomanic episode AND * numerous periods with depressive symptoms **that do not meet** criteria for a major depressive episode. * Symptomatic at least half the time * Criteria for a major depressive, manic, or hypomanic episode **have never been met**

Answer 934

* Flu-like symptoms (lethargy, fatigue, headache, achiness, sweating) * Insomnia (with vivid dreams or nightmares) * Nausea (sometimes vomiting) * Imbalance (dizziness, vertigo, light-headedness) * Sensory disturbances (“burning,” “tingling,” “electric-like” or “shock-like” sensations) * Hyperarousal (anxiety, irritability, agitation, aggression, mania, jerkiness)

Answer 935

After cessation of drinking: 6-8 hours - tremulousness 8-12 hours - psychotic an perceptual disturbances 12-14 hours - seizure up to 72h to a week - DTs The syndrome of withdrawal sometimes skips the usual progression and, for example, goes directly to DTs.

Answer 936

Delirium occurring within 1 week after a person stops drinking Autonomic hyperacticity (tachycardia, Diaphoresis, fever, HTN) Anxiety Insomnia Perceptual distortions, most frequently visual or tactile hallucinations; Fluctuating levels of psychomotor activity, ranging from hyperexcitability to lethargy

Answer 937

Hypomanic episode only needs to be 4 days, manic at least a week (or hosp) Hypomanic = marked change in functioning, but NOT functioanl impairment Both need 3/7 DIGFAST criteria

Answer 938

Other specified bipolar disorder - Short-duration hypomanic episodes (2–3 days) and major depressive episodes - Hypomanic episodes with insufficient symptoms and major depressive episodes - Hypomanic episode without prior major depressive episode - Short-duration cyclothymia (less than 24 months)

Answer 939

* Symptoms * Mood reactivity brightening in response to circumstances * Overeating * Oversleeping * Leaden Paralysis * A long-standing pattern of interpersonal rejection sensitivity * Assoc with * Younger age of onset * more severe psychomotor slowing * COMO panic disorder, SUD, and somatization

Answer 940

In the DSM: One of the following: 1. Loss of pleasure in all, or almost all, activities. 2. Lack of reactivity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens). Three (or more) of the following: 1. A distinct quality of depressed mood characterized by profound despondency, despair, and/or moroseness or by so-called empty mood. 2. Depression that is regularly worse in the morning. 3. Early-morning awakening (i.e., at least 2 hours before usual awakening). 4. **Marked psychomotor agitation or retardation.** *most specific to melancholic depression* 5. Significant anorexia or weight loss. 6. Excessive or inappropriate guilt.

Answer 941

Confusion Agitation Lethargy Headaches Nausea Imbalance

Answer 942

Mirtazapine is a Noradrenergic/Specific Serotonergic Antidepressant (NaSSA) * Presynaptic a2-adrenergic antagonist effects--\> increased release of norepinephrine and serotonin * Potent antagonist of 5-HT2A, 5-HT2C, 5-HT3, and H1 receptors * Moderate peripheral a1-adrenergic and muscarinic antagonist;

Answer 943

1. Non-pharmacology appraoch 2. AcheI 3. Memantine 4. Antipsychotic

Answer 944

1. Behavioural/non-pharm 2. SSRI (Citalopram \>Trazodone, others) 3. Antipsychotic ONLY after 1 and 2 have failed 4. Memantine

Answer 945

1. Treat underlying cause (eg. iron deficiency anemia) or DC causative agent 2. Non pharm - decrease ETOH, nicotine and caffeine; hot baths, hot or cold compresses, massage, sleep hygiene 3. Dopamine-agonists (Pramipexole, Ropinarole, then Levodopa) 4. Anticonvuslants (Gabapentin and pregabalin) 5. Benzodiazepenes 6. Low dose oxycodone

Answer 946

Condensation Displacement Visualization Symbolism

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