Psychiatry

Question 1

_____ (Bipolar I/II) is characterized by one or more manice or mixed episodes, usually accompanied by major depressive episodes.

Answer 1

Bipolar I

Question 2

_____ (Bipolar I/II) is characterized by one ore more major depressive episodes accompanied by at least on HYPOmanic episode.

Answer 2

Bipolar II

Question 3

Treatment of acute mania involves:

Answer 3

• Antipsychotics in conjunction with benzos

- Initiation of a mood stabilizer like lithium

Question 4

1st line for acute psychosis includes:

Answer 4

Oral atypicals- Risperidone, clozapine, olanzapine, Haldol

Mood stabilizers- Lithium, Valproic Acid

Question 5

Psychosis is the prominent feature in 4 clinical d/o that are frequently encountered in the ED:

Answer 5

1. Schizophrenia
2. Schizophreniform
3. Delusional D/o
4. Brief Psychotic D/o

Question 6

For a diagnosis of schizophrenia the patient can exhibit both positive and negative symptoms for A MINIMUM OF ___ MONTHS.

Answer 6

6

Question 7

Positive v. Negative symptoms of Schizophrenia…

Answer 7

1. Positive- hallucinations, delusions, disorganized speech, catatonia
2. Negative- blunted affect, lack of spontaneity, anhedonia, emotional withdrawal, impaired cognitive ability

Question 8

For treatment of BOTH positive and negative sx of Schizophrenia give Idone’s and Apine’s!!

Answer 8

-Risperidone, Clozapine, Quetiapine, etc.

Question 9

_____ is identical to Schizophrenia but for less than 6 months. Usually it is a brief psychotic d/o lasting less than 4 weeks in response to

Answer 9

Schizophreniform

Question 10

_____ disorder is characterized by persistent, non-bizarre delusions that do not cause impairment of social functioning

Answer 10

Delusional

• Typically onset occurs in mid-to-late adulthood, with women > men
• *Persecutory delusions, delusions of infidelity on the part of a significant other, or delusions of being ill or having body odor are common

***Treatment- Supportive, though psychotherapy may play a role

Question 11

Psychosis that lasts from 14 days- 1 month and is typically associated with a stressful life event is known as _____.

Answer 11

Brief psychotic disorder

*Antipsychotics may be required but the disease is usually self-limited

Question 12

RFs for depression include:

Answer 12

Hx of depression in family, alcohol, substance abuse, female gender, prior depression

Question 13

Episodes of major depression typically last from 6-12 months. What are some medication options?

Answer 13

1. SSRI- fluoxetine, paroxetine, sertraline
2. TCAs- amitriptyline, despramine, etc.
3. MAOIs- phenelzine
4. Mixed group- venlafaxine, bupropion, trazodone, etc.

Question 14

A diagnosis of ____ is characterized by excessive anxiety and worry (apprehension expectation), occurring more days than not for at least 6 months, about a number of events or activities

Answer 14

GAD

Question 15

Anxiety and worry (with regard to GAD) are associated with 3 or more of the following:

Answer 15

• Restlessness or feeling keyed up or on edge
• Being easily fatigued
• Difficulty concentrating or mind going blank
• Irritability
• Muscle tension
• Sleep disturbance

Question 16

The peak age of onset of panic disorder is mid-20s. Signs and symptoms include:

Answer 16

•Recurrent, unexpected panic attacks that begin suddenly, peak in intensity within 10 min, and include a sensation of intense fear along with at least 4 of the following:

1. Palpitations or increased heart rate, sweating, trembling, shaking, shortness of breath, or a feeling of choking
2. Chest pain or discomfort; nausea or abdominal distress; dizziness or lightheadedness
3. Derealization or depersonalization
4. Fear of losing control or going crazy; fear of dying
5. Paresthesias, chills, hot flashes

Question 17

For a dx of panic disorder at least 1 attack must be followed for 1 month or more by 1 of the following:

Answer 17

• Persistent worry about additional attacks (anticipatory anxiety)
• Worry about the implications of the attack
• A change in baseline function secondary to the attack

Question 18

Treatment of panic disorder involves:

Answer 18

Psychotherapy (CBT) with SSRIs

• TCAs and MAOIs are 2nd line choices
• In the ED–> Benzos may be used for immediate relief, but long-term use of these drugs should be avoided in some patients in light of their addiction potential

Question 19

Symptoms of PTSD must be present for > 1 month and are classified according to their duration:

Answer 19

• Acute = symptoms present for <3 months
• Chronic = symptoms present for >3 months
• Delayed onset = symptoms start >6 months after the traumatic event.

Question 20

Treatment of PTSD involves-

Answer 20

SSRIs and mood stabilizers are 1st line

• Anxiolytics such as benzos and alpha-agonists may be used
• CBT and support groups

Question 21

Withdrawal from alcohol begins in _____ hours after last drink. Lasts 4-7 days.

Answer 21

12-24 hours

Question 22

Inpatient management needed for alcohol withdrawal if there is a history of:

Answer 22

seizures, delirium, mental instability, suicidal or homicidal ideation, psychosis, unstable environment, or no support or transportation available

Question 23

What is given to help manage alcohol withdrawal?

Answer 23

• Thiamine, folate, and B6 supplementation
• Supplement Mg
• IV benzos q 10-15 mins PRN
• Phenobarbital or propofol for refractory DTs

Question 24

False + on opiod drug screen if you’ve ingested:

Answer 24

-Rifampin, quinolone, or poppy seeds

Question 25

Managing withdrawals from different drugs:

Answer 25

1. Benzos/barbiturates- ABCs, activated charcoal 2. Cocaine- self-limited, detox not required (acute OD managed with benzos and severe agitation managed with haldol) 3. Opiates- treat with naloxone, buprenorphine, or clonidine

Question 26

Some suicide facts...

Answer 26

Women more likely to attempt, men more likely to complete. Men more likely to commit suicide by violent means such as firearm use; women more likely to commit suicide by drug ingestion

Question 27

RFs for suicide include:

Answer 27

``` S- sex (male) A- age D- depression P- previous attempt E- ethanol R- rational thought S- sickness O- organized pain N- no spouse S- social support lacking ```

Question 28

Depressed individuals are often at greatest risk for suicide in the first few weeks after starting an antidepressant because:

Answer 28

Their energy may return before the depressed mood lifts