MTB 1

Question 1

Presentation of Brief Psychotic Disorder
Time
Sx’s
TX

Answer 1

1 day -> 1 month
Delusions, hallucinations, disorganized speech, catatonic
APs

Question 2

Presentation of Schizophreniform
Time
Sx’s
TX

Answer 2

1 month -> 6 months
Delusions, hallucinations, disorganized speech, catatonic, negative Sx’s
APs

Question 3

Presentation of Schizophrenia
Time
Sx’s
TX

Answer 3

More than 6 months
Delusions, hallucinations, disorganized speech, catatonic, negative Sx’s. Severe level of functioning affected
APs

Question 4

Receptors ass’d with positive sx’s of psychosis

Answer 4

Dopamine

Question 5

Receptors ass’d with negative sx’s of psychosis

Answer 5

Muscarinic

- Atypical APs tx better

Question 6

TX for Schizophrenia

Answer 6

1. Hospitalize if acutely psychotic
2. Atypical AP
3. Emergency -> IM OZ = Olanzapine or Ziprazidone, Haloperiodol = AE’s
4. Non-compliant => Long acting IM Risperidone. First assess tolerability w oral if 1st time
5. Last line - Clozapine if unresponsive to others, Tx-resistant

Question 7

What is TX-resistant Schizophrenia

Answer 7

Failed response to 2+ trials of AP’s

Question 8

Pt w command hallucinations, denies SI/HI - next step?

Answer 8

Hospitalize

Question 9

AE’s of olanzapine

Answer 9

Weight gain
DM
Sedation
Increase LFT’s

Question 10

AE’s of Risperidone

Answer 10

Movement disorders

Ammennorhea = Palliperidone

Question 11

AE’s of Quetiapine

Answer 11

Less likely for Movement disorders

Question 12

AE’s of Ziprasidone

Answer 12

QT Prolongation

Avoid in pts w conduction defects

Question 13

AE’s of Clozapine

Answer 13

Agranulocytosis

Question 14

Which Atypical AP’s are least likely to cause weight gain/metabolic syndrome/DM?

Answer 14

AZ
Arirpripazole
Ziprasidone

Question 15

Which Typical AP’s have a greater assn w/ Extrapyramidal Sx’s

Answer 15

Hi Potency
Fluphenazine
Haloperidol

Question 16

Which Typical AP’s have a greater assn w/anticholinergic effects

Answer 16

Low Potency
Thioridazine
Chlorpromazine

Question 17

AE’s of Thioridazine

Answer 17

QT Prolongation
Arrhythmias
Retinal pigmentation

Question 18

AP TX for Insomnia

Answer 18

Aripripazole
Olanzapine
Quetiapine
Ziprasidone

Question 19

Presentation of Acute Dystonia
Time
Sxs
TX

Answer 19

Hours to days, during 1st week
Muscle spasm, torticollis, oculogyric crisis
Younger men at higher risk
Reduce dose
Benztropine, trihexyphenidyl, diphenhydramine

Question 20

Presentation of Akithesia
Time
Sxs
TX

Answer 20

Within weeks
Restlessness, Pacing, rocking, inability to sit still
Reduce dose, beta blockers or benzos, Switch to newer Atypical AP

Question 21

Presentation of Bradykinesia/Parkinsonism
Time
Sxs
TX

Answer 21

Within weeks
Bradykinesia, tremors, rigidity - elderly at risk
Reduce dose
Benztropine, trihexyphenidyl, diphenhydramine

Question 22

Presentation of Tardive Dyskinesia
Time
Sxs
TX

Answer 22

Months to Years
Abnormal involuntary movements of head, limbs, trunk, Perioral movements, often irreversible
Switch to Atypical AP, Clozapine - least risk

Question 23

Presentation of NMS
Time
Sxs
TX

Answer 23

Anytime
Muscle rigidity, hyperthermia, volatile vital signs, altered LOC, increased WBC and CK
Dantrolene or bromocriptine

Question 24

Presentation of Schizoaffective

Answer 24

Uninterrupted period of Sx’s for MDD, manic or mixed
Sx’s or schizophrenia, delusions, hallucinations for at least 2 wks WITHOUT mood sx’s
TX: assess for hospitalization, AD’s, AP’s, anticonvulsants

Question 25

Presentation of Delusional Disorder

Answer 25

Non-bizarre delusions More than 1 month No impairment in level of functioning

Question 26

TX of Delusional Disorder

Answer 26

Atypical APs | Psychotherapy

Question 27

TX for panic disorder

Answer 27

1. SSRIs 2. Benzos - alprazolam 3. CBT

Question 28

TX for panic Attack

Answer 28

Alprazolam

Question 29

OCD

Answer 29

Obsessions and compulsions that affect level of functioning | Distressed about their Sx's

Question 30

OCD v OC Personality

Answer 30

``` OCD = distressed about sx's Personality = unaware of problem ```

Question 31

What are PANDAS

Answer 31

Pediatric AI Neuropsych Disorders Ass'd with Strep Infxn | - Ass'd with GAS

Question 32

PTSD Presentation

Answer 32

``` Sx's affect functioning Increase startle response Hypervigilance Sleep disturbances Anger Outbursts Concentration difficulties ```

Question 33

What are Sexual Assault victims at increased risk of

Answer 33

``` PTSD MDD SI STDS Pelvic Pain Fibromyalgia Functional GI disorders ```

Question 34

Diff bt PTSD and Acute stress disorder

Answer 34

PTSD = More than 1 month | Acute stress disorder = 2 days -> 1 month

Question 35

TX for PTSD

Answer 35

Paroxetine Sertraline Relaxation techniques

Question 36

Time Requirement for GAD

Answer 36

6 months

Question 37

Sx's for GAD

Answer 37

``` Fatigue concentration Sleep muscle tension restlessness ```

Question 38

TX for GAD

Answer 38

SSRIs Venlafaxine Buspirone = benzo abuse risk

Question 39

Lorazepam Indications

Answer 39

Emergency b/c IM

Question 40

Clonazepam Indication

Answer 40

Longer half life = addiction concerns

Question 41

Chlordiazepoxide, oxazepam indications

Answer 41

Alcohol Withdrawl

Question 42

Flumazenil IS a benzo antagonist when

Answer 42

Overdose is Acute AND NO chronic dependence

Question 43

Alcohol Abuse v Dependence

Answer 43

Abuse - continued use despite adverse consequences | Dependence - withdrawl when trying to cut down

Question 44

TX for Alcohol Intoxication? | Withdrawl?

Answer 44

Mechanical Vent | Benzos, Thiamine, Multivitamins, Folic Acid