Psych Geriatrics

Question 1

is GAD episodic

Answer 1

NO

Question 2

how long must you be sx to be diagnosed with GAD

Answer 2

6 mos

Question 3

dx of GAD

Answer 3

anxiety/worry are associated with at least 3 of the following 6 sx w sx present more often than not

1. restlessess or on edge
2. easily fatigued
3. difficulty concentrating/mind going blank
4. irritability
5. muscle tension
6. sleep disturbance

Question 4

tx GAD

Answer 4

psychotherapy + pharmacotherapy
SSRIs and SNRIs

Buspirone can be adjunct

Question 5

dysthymia is also called

Answer 5

persistent depressive disorder

Question 6

dx dysthymia

Answer 6

chronic depressed mood for at least 2 years
at least 2 of the following - insomnia, hypersonic, fatigue, low self-esteem, decreased/increased appetite, hopelessness, poor concentration, indecisiveness

patient is not sx free for > 2 months during the 2 year period

never had a manic episode

Question 7

tx dysthymia

Answer 7

psychotherapy + pharmacotherapy
SSRIs, SNRIs, Bupropion

Question 8

what is adjustment disorder

Answer 8

occurs when maladaptive behavioral or emotional sx develop after a stressful or non-life threatening event - relationship issues, death of a loved one, work issues, etc

Question 9

sx adjustment disorder

Answer 9

marked distress out of proportion to the severity of stressor or significant impairment in function

depressed mood, lack of enjoyment, anxiety, hopelessness, disturbance of conduct, nervousness, overwhelmed etc

Question 10

dx adjustment disorder

Answer 10

maladaptive emotional or behavioral reaction to an identifiable stressor that causes a disproportionate response than would normally be expected within 3 mos of the stressor and resolves usually within 6 mos of the stressor

Question 11

tx adjustment disorder

Answer 11

psychotherapy
can use meds but not first line

Question 12

what neurotransmitters may be affected in MDD

Answer 12

serotonin
epinephrine
norepinephrine
dopamine
acetylcholine
histamine

Question 13

dx MDD

Answer 13

at least 2 distinct episodes of at least 5 associated sx (must include either depressive mood or anhedonia) almost every day for most of the day for at least 2 WEEKS

Question 14

tx MDD

Answer 14

psychotherapy
SSRIs first line medical

Question 15

strongest RF for bipolar disorder

Answer 15

1st degree relative - FHx

Question 16

dx bipolar I disorder

Answer 16

at least 1 manic or mixed episode (only requirement) - lasts at least 1 week or less if hospitalization is required + marked impairment of social/occupational functioning

Question 17

tx bipolar I disorder

Answer 17

lithium first line

Question 18

dx bipolar II disorder

Answer 18

at least 1 major depressive episode + at least 1 hypomanic epidote

hypomania = abnormal & persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days – episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization

Question 19

tx bipolar II disorder

Answer 19

lithium first line

Question 20

neuroleptic malignant syndrome is due to blockade of what neurotransmitter

Answer 20

dopamine

Question 21

what meds are commonly associated with neuroleptic malignant syndrome

Answer 21

typical antipsychotics (MC)
atypical antipsychotics

Question 22

sx neuroleptic malignant syndrome

Answer 22

Fever + ALTERED

Autonomic instability - tachycardia, tachypnea, hyperthermia, fever, hyper salivation, incontinence
Lead-pipe muscle rigidity
Tremor
Elevated WBC
Regular-sized pupils
Excessive sweating (diaphoresis)
Delirium + Decreased DTR

Question 23

tx neuroleptic malignant syndrome

Answer 23

d/c antipsychotic
benzodiazepines (lorazepam or diazepam) + dantrolene

can also add dopamine agonists - bromocriptine, amantadine

Question 24

what is serotonin syndrome

Answer 24

life-threatening due to increased serotonergic activity in the CNS

Question 25

MCC serotonin syndrome

Answer 25

SSRIs
SNRIs
TCAs
MAO inhibitors
Bupropion
St. John’s wort

Question 26

sx serotonin syndrome

Answer 26

cognitive - metal status changes - anxiety, agitation, confusion
GI - N/V, increased bowel sounds, diarrhea
Autonomic instability - hyperthermia, tachycardia, HTN, diaphoresis
Neuromuscular hyperactivity - tremor, spontaneous clonus, hypertonia, muscle rigidity
Mydriasis!!!! - dilated pupils

Question 27

what criteria is used to dx serotonin syndrome

Answer 27

hunter criteria

Question 28

tx serotonin syndrome

Answer 28

d/c offending drugs
benzodiazepines
antipyretics - acetaminophen

Add cyproheptadine (serotonin antagonist)