Psych

Question 1

A patient has had a depressed mood more often than not for the last 2yrs, but has not had any major depressive episodes. What is the likely diagnosis? What is the concern?

Answer 1

Dysthymic disorder

Develop MDD (76%)
Develop bipolar disorder (13%)

Question 2

What are examples of SSRIs?

Answer 2

Fluoxetine
Sertraline
Paroxetine
Citalopram
Escitalopram

Question 3

What significant side effects are associated with SSRIs?

Answer 3

Sexual dysfunction
Decreased platelet aggregation
Blackbox warning

Question 4

What are examples of SNRIs? When are they used? What are significant side effects?

Answer 4

Venlafaxine and duloxetine

First-line for depression + comorbid neurologic pain
Second-line for depression that doesn’t respond to SSRI

Nausea, dizziness, insomnia, sedation, constipation, HTN…more benign than TCAs

Question 5

What are examples of TCAs?

Answer 5

Imipramine
Amitriptyline
Desipramine
Nortriptyline

Question 6

What are significant side effects of TCAs?

Answer 6

Easy to OD…causes prolonged QT

sedation, wt. gain, sexual dysfunction, anticholinergic symptoms

Question 7

What are examples of MAOIs?

Answer 7

Phenelzine
Isocarboxazid
Tranylcypromine
Selegiline

Question 8

What are significant side effects of MAOIs?

Answer 8

Dry mouth, indegestion, dizziness

Tyramine (cheese, aged meats, beer) –> HTN crisis

Question 9

How does bupropion work? What is nice about it?

Answer 9

Inhibits uptake of dopamine and NE

Doesn’t cause sexual dysfunction

Question 10

What can be used to treat depression with significant insomnia?

Answer 10

Trazodone…does something with serotonin

Mirtazapine…blocks alpha2-receptors and serotonin receptors –> increaseed adrenergic neurotransmission

Question 11

What is the major difference between ‘manic’ and ‘hypomanic’?

Answer 11

Manic –> significant impairment of ability to function

Hypomanic –> no significant impairment of ability to function

Question 12

What is cyclothymia?

Answer 12

Rapid cycling of hypomania and mild depression lasting longer than 2 years with no normal mood lasting longer than 2 months

Question 13

What is a big difference between ‘bereavement’ and ‘adjustment disorder’?

Answer 13

Bereavement does not impair one’s ability to function

Adjustment disorder causes a significant impairment of ability to function

Question 14

What psychotic disorder is increased in patients with mitral valve prolapse?

Answer 14

Panic disorder

Question 15

What drug is used for anxiety disorders when abuse or sedation is a concern?

Answer 15

Buspirone…does something with dopamine and serotonin receptors

Question 16

What is a potential concern for the kid of a woman who was malnourished or ill during pregnancy?

Answer 16

Schizophrenia

Question 17

What is necessary to diagnose schizophrenia?

Answer 17

2 or more of the following for at least 1 month in the last 6 + impaired social function for at least 6 months

Delusions, hallucinations (auditory), disorganized speech, disorganized or catatonic behavior…these make up the “positive symptoms”
Or negative symptoms: social withdrawal, flat affect, apathy, anhedonia, or lack of motivation

Question 18

What are examples of atypical antipsychotics?

Answer 18

Clozapine, olanzapine, quetiapine
Risperidone, ziprasidone, paliperidone
Sertindole
Aripiprazole

Question 19

How do Atypical antipsychotics work? What are significant side effects?

Answer 19

Block dopamine and serotonin receptors

Anticholinergic effects, weight gain, arrhythmias, seizures

Question 20

Which atypical antipsychotic is most effective?

Answer 20

Clozapine…but causes agranulocytosis…so only for refractory psychosis

Question 21

What are examples of high-potency neuroleptics?

Answer 21

Haloperidol, droperidol
Fluphenzine, perphenazine, trifluoperazine
Loxapine
Thiothixene

Question 22

How do high-potency neuroleptics work? When are they used? What are significant side effects?

Answer 22

Block D2 dopamine receptors

Emergency control of psychosis or agitation
Strong positive symptoms

Extrapyramidal effects
Tardive dyskinesia
Neuroleptic malignant syndrome

Question 23

What are the low-potency neuroleptics? What significant side effects do they have?

Answer 23

Thioridazine, chlorpromazine

Anticholinergic effects…some is seen with high-potency, but not as much

Question 24

What is schizophreniform?

Answer 24

Symptoms of schizophrenia, but has lasted longer than 1 month and less than 6 months

Return to normal after psychotic episode…often develop true schizophrenia later

Question 25

What is schizoaffective disorder?

Answer 25

Presence of mood disorder an psychotic symptoms...but does not meet criteria for either diagnosis alone Psychotic symptoms happen during normal mood for longer than 2 weeks Treat both disorders

Question 26

What is delusional disorder?

Answer 26

One or more distinct realistic delusions lasting longer than 1 month If it is an unrealistic delusion, then it is either schizophreniform or schizophrenia

Question 27

What is it called when psychotic symptoms last less than a month?

Answer 27

Brief psychotic disorder

Question 28

A patient has signs of a personality disorder, but can function normally in society. What does this person have?

Answer 28

Personality trait

Question 29

There are three clusters of personality disorders. How are they broadly classified?

Answer 29

``` A = weird B = wild C = wimpy/worried ```

Question 30

What are the three cluster A disorders?

Answer 30

Paranoid Schizoid- negative symptoms of schizophrenia Schiotypal- paranoia, eccentric and inappropriate behavior, social anxiety, odd beliefs

Question 31

What are the four cluster B disorders?

Answer 31

Antisocial- aggressive to people/animals; no remorse; men Borderline- fear of abandonment; splitting (all good or all bad); women Histrionic- Dire need for attention; believes relationships are more intimate than they are Narcissistic

Question 32

What are the three cluster C disorders?

Answer 32

Avoidant Dependent Obsessive-compulsive- perfectionist

Question 33

How long does a person have to have a preoccupation with fear of having a serious illness before being diagnosed with hypochondriasis?

Answer 33

6 months

Question 34

How does fibromyalgia differ from conversion disorder and pain disorder?

Answer 34

Conversion disorder and pain disorder are related to stressful events

Question 35

A patient develops a pain after a stressful situation, but no specific injury. Are analgesics likely to help?

Answer 35

Not if it is true pain disorder

Question 36

What should NOT be used to treat delirium or dementia related agitation?

Answer 36

Benzos or anticholinergics

Question 37

What is required to diagnose ADHD?

Answer 37

6 inattentive symptoms OR 6 hyperactivity or impulsivity symptoms BEFORE 7yo that limit ability to function

Question 38

What is required to diagnose Conduct Disorder?

Answer 38

Aggressive behavior to people or animals Destruction of property Deceitfulness/theft Violation of serious rules 1+ above if less than 10yo 3+ above if more than 10yo

Question 39

What is difference between Conduct Disorder and Oppositional Defiant Disorder?

Answer 39

ODD does NOT have illegal or destructive activity

Question 40

What is required to diagnose Tourette Syndrome?

Answer 40

Tics last longer than 1 yr and start before 21yo Coprolalia (obscene tics) is seen in 40% of cases