Psychiatry

Question 1

Adverse effects of trazodone

Answer 1

priapism

common: sedation, weight gain

Question 2

Tarasoff Warning

Answer 2

Duty to warn
In cases where a patient makes explicit threats towards another person and has the means to carry this threat out, there is a duty to warn this vulnerable person (ok to breach HIPAA)
Best done in consultation with hospital’s legal team

Question 3

Rogers Guardianship

Answer 3

Where the court determines the guardian will be given authority to agree to extraordinary treatment for this patient
Usually refers to treatment with antipsychotic meds, but it may include other intrusive treatments and procedures

Requires the patient and guardian appear before a judge

Question 4

Bipolar disorder

Answer 4

mood disorder characterized by episodes of mania, hypomania, and major depression

Question 5

Bipolar I disorder

Answer 5

at least one manic episode and episodes of hypomania and depression

Question 6

Bipolar II disorder

Answer 6

absence of manic episodes

Question 7

Bipolar disorder treatment

Answer 7

1st line: lithium
2nd line: lamictal
valproic acid
quetiapine (Seroquel)

avoid antidepressants as mono therapy – may trigger a manic episode

Question 8

serotonin syndrome: S/Sx

Answer 8

mental status changes (anxiety, agitation, delirium, restlessness)
diaphoresis
tachycardia
hypertension
hyperthermia
vomiting
diarrhea

Neuromuscular manifestations:
-muscle rigidity
-myoclonus
-hyperreflexia
-tremor

Question 9

serotonin syndrome: management

Answer 9

discontinue all serotonergic agents
supportive care
sedation with benzodiazepines
serotonin antagonists (antidote: cyproheptadine)

Question 10

Medications that increase the risk of lithium toxicity

Answer 10

diuretics
ACEIs
NSAIDs

Question 11

Tool used to screen patients for depression

Answer 11

Beck Depression Inventory for Primary Care

Question 12

Mild and major depression criteria

Answer 12

Symptoms:
-depressed mood
-anhedonia (diminished interest or pleasure in activities)
-fatigue or lack of energy
-hypersomnia or insomnia
-feelings of worthlessness and inappropriate guilt
-diminished concentration
-recurrent or obsessive thoughts of death and SI
-weight loss or weight gain
-psychomotor agitation or retardation

mild: 2-5
major: >5

Question 13

drug with the highest rate of extrapyramidal effects

Answer 13

haldol