psych

Question 1

GAD diagnostic criteria

Answer 1

excessive worry, more often than not, for at least 6 months

not d/t substance or medical condition

3 of the following symptoms:
- edginess or restlessness
- tiring easily; fatigue common
- impaired concentration
- irritability
- muscle aches or soreness
- difficulty sleeping

Question 2

SSRIs

Answer 2

• first line for GAD & depression
• increased suicide risk week 1
• 4-6 weeks for full effect
• can try different SSRIs if not responsive to one agent
• do not give with MAOI
• follow up in 1 week
• must taper off
• continue in hospital!

AEs: HA, sexual dysfunction, serotonin syndrome, GI upset, dizziness,

Question 3

SNRIs

Answer 3

second line for GAD

venlafaxine (Effexor)
- 37.5 mg/day initially
- can titrate to 75 mg QD after 4-7 days
- increase in increments <75 mg q 4 days up to 225 mg/day
- may cause hypertension!!!
- do not give with MAOIs

AEs: same as SSRIs

Question 4

rule out differentials for panic attack

Answer 4

pheochromocytoma
thyrotoxicosis
hypoglycemia

Question 5

meds for panic disorder

Answer 5

SSRIs
SNRIs
MAOIs
BDZs

Question 6

meds for GAD

Answer 6

SSRIs
SNRIs
TCAs
MAOIs
buspirone
benzos
clonidine
propranolol

Question 7

TCAs

Answer 7

second line for GAD & depression

lethal in overdose

may have more side effects d/t antihistamine and anticholinergic properties

AE: sedation, constipation, blurred vision, dry mouth, QT prolongation

Question 8

MAOIs

Answer 8

third line for depression

dietary restrictions - low tyramine diet (caviar, meats, cheeses)

can cause hypertensive crisis without dietary adherence

Question 8

MDD treatment

Answer 8

SSRI, then ECT therapy

Question 9

suicide risk factors

Answer 9

SADPERSONAS

sex - male
age - 25-65
depression
previous attempts
ethanol
rational thinking loss
social support loss
organized plan
no spouse
availability of lethal means
sickness

Question 10

what to do w mood stabilizers in the hospital

Answer 10

continue!!!
check serum level and adjust dose if necessary
psych consult if not psychologically stable

Question 11

lithium considerations

Answer 11

low therapeutic index
supra therapeutic ->kidney injury

mild intoxication - confusion, tremor, nystagmus
severe intoxication - N/V, agitation, seizures, bradycardia, hypotension

treat toxicity with fluids, GI decontamination, hemodialysis (severe neurological symptoms or lithium >4)

Question 12

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Answer 12

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Question 13

schizophrenia positive symptoms

Answer 13

delusions, hallucinations, conceptual disorganizations

Question 14

schizophrenia negative symptoms

Answer 14

anhedonia, loss of function, decreased emotional expression, impaired concentration, diminished social engagement

Question 15

cornerstone of schizophrenia treatment

Answer 15

typical & atypical antipsychotics

Question 16

antipsychotics adverse effects

Answer 16

QTc prolongation
weight gain
hyperglycemia
hyperlipidemia
impaired temp regulation
water intoxication

clozapine (clozaril) - agranulocytosis leading to seizures - check weekly WBCs

Question 17

acute agitation treatment

Answer 17

benzos - lorazepam, midazolam
first gen antipsychotics - haldol, droperidol
2nd gen antipsychotics - olanzapine, ziprasidone, risperidone

Question 18

AEs of testosterone

Answer 18

hypertension
polycythemia
hyperlipidemia
hyperglycemia

Question 19

AEs of estrogen

Answer 19

increased risk of thrombosis
hypertension
hyperprolacinemia
migraines

Question 20

serotonin syndrome criteria

Answer 20

serotonergic agent AND one of the following

• spontaneous clonus
• inducible clonus PLUS agitation or diaphoresis
• ocular clonus PLUS agitation or diaphoresis
• tremor PLUS hyperreflexia
• hypertonia PLUS temperature >38 PLUS ocular or inducible clonus

Question 21

serotonin antagonist

Answer 21

cyproheptadine

Question 22

s/s of serotonin syndrome

Answer 22

AMS, muscle rigidity, hyperreflexia, hyperactive bowel sounds, diaphresis

Question 23

neuroleptic malignant syndrome

Answer 23

life threatening idiosyncratic reaction to dopamine antagonists characterized by fever, AMS, muscle rigidity, autonomic dysfunction

Question 24

tardive dyskinesia

Answer 24

involuntary neurological movement disorder caused by the use of dopamine antagonizing drugs

Question 25

tardive dyskinesia treatment

Answer 25

ingreza (valbenazine) austudo (deutetrabenazine)

Question 26

NMS treatment

Answer 26

lower BP - clonidine muscle relaxants - dantrolene (but check LFTs before!) dopamine agonists - bromocriptne

Question 27

diagnostics for eating disorder

Answer 27

electrolytes - ca, mg, phos LFTs CBC UA w tax TSH EKG BMI <13 - CXR (risk for opportunistic infx) amenorrhea >6 mos - bone mineral density

Question 28

eating disorders reasons for emergency hospitalization

Answer 28

hypokalemia, severe electrolyte imbalance, hypoglycemic coma, symptomatic bradycardia, severe hypotension, dehydration, syncope, seizures, QTc prolong, marasmus w BMI <14, psych instability

Question 29

consequences of prolonged anorexia

Answer 29

leukopenia with lymphocytosis, elevations in BUN, metabolic acidosis, hypokalemia with purging long term - osteoporosis refeeding syndrome

Question 30

medical consequences of bulimia

Answer 30

fluid and electrolyte disturbances cardiac conduction abnormalities

Question 31

common exam findings for bulimia

Answer 31

dental erosion, parotid gland enlargement

Question 32

number one cause of delirium

Answer 32

infection

Question 33

bulimia meds

Answer 33

SSRI