Management

Question 1

Indications for ECT for depression?

Answer 1

1) Treatment resistance
2) Psychotic features
3) Emergency situations: pregnancy, refusal to eat/drink, imminent suicide risk

Question 2

First-line treatment of MDD with psychotic features?

Answer 2

Antidepressant + atypical antipsychotic (eg sertraline + olanzapine) OR ECT if indicated

Question 3

Treatment of acute mania

Answer 3

• Mood stabilizers: lithium, and anticonsulvants (valproic, lamotrigine, carbamazpine)
• Atypical antipsychotics (esp with pyschotic features): quetiapine, olanzapine, aripiprazole, risperidone, asenapine, and ziprasidone have FDA approval. IM injection = rapid onset of action

Question 4

Pharmacologic goal for anxiety disorders?

Answer 4

Achieve symptomatic relief and continue treatment for 6 months before attempting to titrate off medication.

Meds can reduce symptoms enough to enable participation in therapy, which can prevent relapse if medications are no longer prescribed.

Question 5

OCD treatment

Answer 5

First line pharmacotherapy = SSRI + CBT (exposure and response prevention)

Question 6

Treatment for PMDD

Answer 6

SSRIs first line–daily therapy or luteal phase only treatment

Question 7

Treatment for panic disorder?

Answer 7

First line/maintenance: SSRI/SNRI + CBT
Acute distress: benzos!

BETA-BLOCKERS HAVE NOT SHOWN TO BE EFFECTIVE FOR PANIC DISORDER! Good for things like phobias.

Question 8

Treatment for adjustment disorder?

Answer 8

PSYCHOTHERAPY IS PREFERRED: supportive (most effective) and group therapy

Pharmacotherapy might be used to treat associated symptoms like insomnia, anxiety or depression in TIME-limited fashion

Question 9

First line maintenance treatment for bipolar disorder?

Answer 9

Lithium, valproate, quetiapine, lamotrigine

Question 10

Atypical antipsychotics with lower risk of metabolic syndrome?

Answer 10

Aripiprazole, ziprasidone, lurasidone

Question 11

Barbituate intoxication? Benzo intoxication?

Answer 11

Barbituate intoxication –> alkalinize urine with sodium bicarbonate

Benzo intoxication –> flumazenil

Question 12

Preferred medications for treatment of psychotic symptoms in PD not responsive to dose reduction of carbidopa-levodopa?

Answer 12

Quetiapine and clozapine–both less likely to exacerbate motor symptoms.

Question 13

In pseudodementia in the elderly, what medication can be used adjunctively to antidepressants for those with severe depression and/or psychomotor retardation?

Answer 13

Methylphenidate–be careful of cardiac arrhythmia!

Question 14

First line treatment for social anxiety d/o?

Answer 14

First line is psychotherapy. SSRIs and SNRIs are first line medications.