MTB

Question 1

Rett disorder Presentation

Answer 1

Progressive encephalopathy
Microcephalopathy
Hand wringing
Loss of speech
Ataxia
Psychomotor retardation

Question 2

Child Disintegrative disorder Presentation

Answer 2

Normal development first 2 yrs
Regression after 2
Repetitive/stereotyped movements

Question 3

Oppositional defiant disorder Presentation and management

Answer 3

Usually by 8 yoa
Argumentative, loss of temper, blame others
Authority figure issues
Teach parents coping skills

Question 4

Diff bt Antisocial v Conduct Disorder

Answer 4

Antisocial > 18 yoa

Conduct < 18 yoa

Question 5

Assn’s w Conduct Disorder

Answer 5

Parents w Antisocial

Parents w Alcohol dependence

Question 6

Diff bt oppositional defiant disorder v Conduct Disorder

Answer 6

ODD - do not break rules, commit crimes

Conduct disorder - do break rules/commit crimes

Question 7

How do tics present

Answer 7

Preceded by irresistible urges, followed by relief

Exacerbated by stress and fatigue

Question 8

Comorbidities w Tourette

Answer 8

OCD

ADHD

Question 9

Tourette presentation

Answer 9

Multiple tics
Last > 1 year
Before Age 18

Question 10

TX for Tourette

Answer 10

Dopamine Antagonists
APs = Risperidone (2nd G AP) 
FDA approved are 1st G AP, used less b/c of AEs
- Haloperidol
- Pimozide

Question 11

How long must major depression be present for Dx

Answer 11

2 weeks

Question 12

What is MDD

Answer 12

Anhedonia
+
4 others = SIGECAPS
weight, sleep, psychomotor, fatigue, concentration, worthlessness, death thoughts

Question 13

MC medical cause of depression

Answer 13

Hypothyroidism

Question 14

MC Neuro Assn w depression

Answer 14

PD

Question 15

Management of Pt on SSRI w improvement but not full response

Answer 15

Increase dose

Question 16

Management of Pt on SSRI w single episode of depresssion

Answer 16

Continue SSRI for 6 months and follow pt

Question 17

Management of pt w depression + neuropathic pain

Answer 17

Desvenlafaxine

SNRI

Question 18

Management of pt w depression + fearful of weight gain or sexual AEs

Answer 18

Bupropion

Question 19

Bipolar Disorder Presentation

Answer 19

Mood disorder - typically starts w depression

Pt has manic sx’s that last at least ONE WEEK + cause significant distress in level of functioning

Question 20

Manic sx’s in Bipolar

Answer 20

DIG FAST

Question 21

DX for Bipolar

Answer 21

R/O drugs - cocaine, amphetamine

Question 22

Difference bt mania and hypomania

Answer 22

Mania 
- last more than 1 week
-affect functioning
- severe enough for hospitalization 
- psychotic features
Hypomania
- less than 1 week
- do not severely affect functioning

Question 23

Is depression required for Bipolar I DX?

Answer 23

No. Mania alone is enough for Dx.

Question 24

What is required for Bipolar II DX?

Answer 24

Hypomania

Depression - at least 1 MDD Sx required

Question 25

TX for Bipolar - Acute mania

Answer 25

``` Lithium Valproic acid Atypical APs = OAR - Olanzapine - Aripripazole - Risperidone ```

Question 26

TX for Bipolar Depression

Answer 26

Lithium | Lamotrigine

Question 27

Steps in management of Acute Mania

Answer 27

1. Hospitalize 2. Mood stabilizers 3. APs. DOC = Risperidone 4. IM depot phenothiazine - noncompliant, severely manic 5. Antidepressants IF hx of recurrent episodes depression

Question 28

Presentation of Pseudodemntia

Answer 28

Elderly Severe depression + memory impairment Aware/concerned of cognitive decline

Question 29

TX for Pseudodemntia

Answer 29

SSRI | - reversible with AD

Question 30

Dysthymia Presentation

Answer 30

Depressed mood most of the day, continuous | Sx's for more than 2 YEARS

Question 31

TX for Dysthymia

Answer 31

ADs + Psychotherapy

Question 32

Cyclothymia Presentation

Answer 32

Hypomanic episodes + Mild depression | Sx's for more than 2 YEARS

Question 33

TX for Cyclothymia

Answer 33

Pscyhotherapy + - Lithium - Valproic Acid - Carbamezapine

Question 34

Atypical Depression Presentation

Answer 34

Reverse vegetative sx's - increased sleep, weight, appetite Mood worse in evening Pts feel "heavy"

Question 35

TX for Atypical Depression

Answer 35

SSRIs or MAOIs

Question 36

Seasonal Affective Disorder

Answer 36

Wt gain, increased sleep, lethargy in winter | TX: Phototherapy

Question 37

How long do grief sx's last?

Answer 37

Up to 1 year, typically less 6 months

Question 38

TX for grief

Answer 38

Supportive therapy | Medical tx = wrong

Question 39

ADs safe in pregnancy

Answer 39

SSRIs - except Paroxetine (Paxil) | TCAs

Question 40

SSRIs first line TX for

Answer 40

``` MDD Bipolar Anxiety disorders Panic disorder, OCD, Social phobia, GAD Bulimia nervosa ```

Question 41

AD for enuresis

Answer 41

Imipramine

Question 42

AD for severe insomnia

Answer 42

Trazodone

Question 43

``` Postpartum blues Presentation Onset Sx's Mother's feelings TX ```

Answer 43

Immediately after birth -> 2 weeks Sadness, mood, lability, tearfulness No negative feelings twd baby Supportive

Question 44

``` Postpartum Depression Presentation Onset Sx's Mother's feelings TX ```

Answer 44

W/in 1-3 months after birth Depressed mood, Wt/sleep changes, excess anxiety May have negative feelings twd baby ADs

Question 45

``` Postpartum Psychosis Presentation Onset Sx's Mother's feelings TX ```

Answer 45

``` W/in 2-3 weeks after birth Depression, delusions, thoughts of harm May have thoughts of harming baby APs, Lithium, maybe ADs Step 3 says avoid meds if breastfeeding, choose ECT ```

Question 46

AE of ECT

Answer 46

Transient memory loss | Induced transient intracracranial pressures

Question 47

AE's of TCAs

Answer 47

``` HypoTN Dry mouth Constipation Arrhythmias - QT prolongation Sexual AE's Weight GAIN GI disturbances Insomnia ```

Question 48

AE's of MAOI's

Answer 48

HTN w tyramine

Question 49

AE's of SSRI's

Answer 49

HA Wt changes Sexual AE's GI disturbances

Question 50

AE's of Lithium

Answer 50

``` Acne Weight gain Tremors GI disturbances Nephrotoxic Teratogenic Leukocytosis DI - polyuria, Hypothyroidism SEVERE = confusion, ataxia, lethargy, abnormal reflexes ```

Question 51

AE's of Valproic Acid

Answer 51

``` Weight gain Tremors GI disturbances Alopecia Teratogenic Hepatotoxic Toxicity - Hyponatremia, coma, death ```

Question 52

Presentation of Serotonin Syndrome

Answer 52

Cognitive: confusion, agitation, hallucinations, hypomania Autonomic: sweating, tachycardia, hyperthermia, N/D, shivering Somatic: tremors, myoclonus

Question 53

Management of Serotonin Syndrome

Answer 53

1. Stop SSRI 2. Tx fever, diarrhea, HTN 3. Cyproheptadine = serotonin antagonist