Psych

Question 1

Obsessive Compulsive personality disorder

Answer 1

pre-occupied with orderliness, perfectionism and Control.
Egosyntonic nature of symptoms (believe he is superior)

No insignt to his behaviour.

Question 2

MDD diagnosis:

Answer 2

symptoms > 2 weeks

5/9 symptoms:

SIGECAPS:
S: Suicidlity
I: loss of interest
G: guilt/ worthlesness
E: Energy low
C: concentration low
A: apetite
P: psychomotor agitation
S: sleep disturbance (insomina)

Question 3

DD of Depressed mood

Answer 3

1. MDD > 2 weeks
2. Persistent depressive disorder (chronic depressed mood > 2 years, with 2 symptoms)
3. Adjustmant disorder (known within 3 months of a known stressor)

Question 4

Management of adjustmant disorder ?

Answer 4

Psychotherapy

Question 5

Buproprion is Contraindicated in

Answer 5

Bulemia Nervosa

Question 6

CF of Tardive Dyskinesia

Answer 6

Lipsmacking
Choreoathetoid movement ( trunk movment)

Question 7

Pathophysiology of Tardive dyskinesia

Answer 7

Hypersensitivity of dopamine receptors, in view of prolonged blockage of D2 receptors by anti-psychotics.

MC in first generation anti-psych and resperidone

Question 8

Schizoid Personality disorder

Answer 8

lonely, detached, unemotional

Question 9

Schizotypal

Answer 9

unusual thoughts, perception or behavior.

Question 10

Borderline personality disorder ( Cluster C)

Answer 10

He is on the border of impulsivity, anger and suicidal ideation.
Unstable relationsips

Question 11

CF of catatinia

Answer 11

Unresponsivness
mutism
staring blankly
waxy flexebility
posturing

Question 12

Management of catatonia ?

Answer 12

1. benzo (lorazepam)
2. Electroconvulsive therapy

Question 13

MDD with psychotic features ?

Answer 13

loss of concentration
lack of energy
Inability to sleep

delusions or hallucinations related to low self esteem.

Question 14

Indications of Hospitalization in Anorexia Nervosa ?

Answer 14

1. bradycardia
2. dehydration
3. BMI less than 15
4. electrolyte imbalance
5. hypothermia

Question 15

Malingering

Answer 15

falsification of info to gain external reward

Question 16

Factitious disroder

Answer 16

Falsification of symptoms without obvious external reward

Question 17

Rx of ADHD ?

Answer 17

Methylphenidate ( addictive)
Atomoxetine

Question 18

DD between somatic symptom disorder and Illness anxiety disorder ?

Answer 18

1. SSD: the pre-occupation with a specific symptom, causing distress and functional impairment
2. IAD: worry about being ill with nonsymptoms.

Question 19

REM sleep behavior disorder

Answer 19

• Common in patients with neurodegenrative diseases (parkinsons or dementia).
• Absence of atonia while in REM cycle.
• Able to wake up patient where he is at first confused and then fully awake

Question 20

Sleep Terro ?

Answer 20

Unable to awaken the sleeping person.

Question 21

nightmare

Answer 21

Patient remembers disturbing sleep content, but there is no motor activity

Question 22

Mnagament of MDD ?

Answer 22

1- single episode: continue treatment for 6 months, if well, consider tapering
2- If patient has recurrent episodes: consider maintenance to 1-3 years
3- In case of highly recurrenl episdoes: to be taken indefinitely

Question 23

Management of Acute dystonias ?

Answer 23

Benztropine or Diphenhydramine

( Anticholinergic and Anti-muscarinic).

Question 24

Pharmaco

Question 25

Indication of MOA-I

Answer 25

Refractory depression

Question 26

Mechanism of Action of MOA-I ?

Answer 26

Inhibits the metabolism of monoamines ( NEP, Seretonin and Dopamine) also inhibits the metabolism of tyramine

Question 27

Mech of action of tyramine ?

Answer 27

Facilitate the release of Monoamines, leading to sympathomimetic symptoms like HTN and headaches causes a hypertensive crisis.

Question 28

Serotonin Syndrome ?

Answer 28

Altered mental status ( confusion, anxiety, delerium) Autonomic symptoms ( tachycardia, htn, vomiting, dilated pupils, hyperthermia, diaphoresis) Neuromuscular Hyperactivity ( myoclonus, hyperreflexia ad tremor).

Question 29

How to avoid Serotonin syndrome ?

Answer 29

All anti-depressants should be stopped 2 weeks before initiating MOA-I

Question 30

Management of Psychotic depression ?

Answer 30

1-Anti-depressant + anti-psychotic 2- or ECT ECT has a faster onset of action.

Question 31

Indications of ECT

Answer 31

1- RX resistance 2- Psychotic Features 3- Emergency: pregnancy, inability to eat and drink, imminent risk of suicide

Question 32

Benzo Withdrawal

Answer 32

Anxiety Restlessness Insomnia tremors psychosis and seizures

Question 33

SE of valproate

Answer 33

drug induced liver injury

Question 34

Addictions

Question 35

What type of food contain tyramine ?

Answer 35

cured cheese, meat, alcohol

Question 36

Chronic Methamphetamine Use

Answer 36

1- Pasranoid delusions ( including visual) 2- Tactile hallucinations 3- skin picking (skin sores), bruxism (decayed teeth with poor dentition). 4- agressive bahviour Symptoms of ympathetic overactivity becuase it is a CNS stimulant

Question 38

Mech of action of Bupropione

Answer 38

Norepinephrine and Dopamine reuptake inhibitor.

Question 39

Indication of Bupropione

Answer 39

Augmentation of effect of SSRI