3. Psych/Behavioral

Question 1

What is a common finding on neuroimaging of patients with schizophrenia?

Answer 1

Enlargement of the lateral cerebral ventricles

Question 2

Adjustment disorder time frame?

Answer 2

Occurs within 3 months of the stressor. Emotional or behavioral sx (eg anxiety, depression, disturbance of conducts) with an identifiable stressor.

Question 3

What are first-line treatments for smoking cessation?

Answer 3

Nicotine replacement therapy (patches)
bupropion - bulimia is a contraindication
varenicline

Question 4

How can antipsychotic meds (Eg risperdal) cause infertility?

Answer 4

Dopamine antagonism –> hyperprolactinemia –> galactorrhea, amenorrhea, infertility
Second-gen antipsychotics are most likely to inc prolactin

Question 5

OCD tx?

Answer 5

SSRI

Exposure and response prevention-based psychotherapy (type of CBT)

Question 6

Chronic abuse of what substance can cause paranoid delusions, auditory, visual, and tactile hallucinations (bugs crawling under the skin), wt loss, tooth decay, and excoriations due to skin picking?

Answer 6

Chronic Methamphetamine abuse

Question 7

College student with withdrawal from what substance can cause acute depression with suicidal ideation. Other features include fatigue, hypersomnia, inc dreaming, hyperphagia, impaired concentration.

Answer 7

Cocaine withdrawal

Question 8

What should you do with a patient who just made a suicide attempt and is guarded and evasive when answering questions regarding suicidal intent if parents want to take the patient home/to other physician?

Answer 8

Hospitalize (involuntarily if necessary) for treatment and stabilization - even without parental or guardian consent

Question 9

Boy with recurrent thoughts of stabbing his mother with images that play in his mind over and over. Most approp tx?

Answer 9

OCD - fluoxetine

Obsession = recurrent intrusive, anxiety-provoking thoughts, urges, or images.

Question 10

Differentiate panic disorder ad somatic symptom disorder

Answer 10

Similar bc both can have preoccupation with unexplained symptoms and high health care use. Difference is that panic disorder is acute and resolves in minutes. Does not persist between attacks.

Question 11

What age range is imaginary friends, pretend play, and telling stories with fanciful details normal and healthy inn children?

Answer 11

3-6yo

Question 12

If a patient has explicitly requested that you dont speak with his spouse, what do you say if she asks for his health information?

Answer 12

” I hear your concerns, but I am not able to confirm whether he is a patient at this clinic.”

Disclosing that the indiv is even a patient at the clinic is a breach of his confidentiality

Question 13

Acute dystonia d/t antipsychotic treatment can be managed with what drugs?

Answer 13

Anticholinergics (benztropine) or antihistamines (diphenhydramine)

Question 14

When is electroconvulsive therapy used to treat major depression?

Answer 14

patients who are not eating or drinking (especially geriatric patients)

Question 15

Sx of TCA overdose? Tx?

Answer 15

CNS depression, hypotension, anticholinergic effects (Dilated pupils, hyperthermia, intestinal ileus), QRS prolongation.
ABCs and sodium bicarb to improve bp, shorten QRS and prevent arrhythmia.

Question 16

What can decrease risk of relapse in patients with schizophrenia?

Answer 16

Minimizing conflict and stress in the home.

Question 17

How can you differentiate normal age-related changes in cognitive function from a neurocognitive disorder?

Answer 17

Normal age-related changes should not impair daily functioning (eg self-care, finances, medication management)

Question 18

MDMA (aka ecstasy and molly) is what type of drug. Sx of intoxication?

Answer 18

Synthetic amphetamine with hallucinogenic properties. Causes euphoria, inc sexual desire, and empathy.
Intoxication: HTN, tachy, hyperthermia, serotonin syndrome, and hyponatremia.

Question 19

Patients with cocaine-associated chest pain should be treated intially how?

Answer 19

IV benzos to improve sx of psychomotor agitation, reduce myocardial o2 demand, and alleviate cardiovascular sx. See ST depression on EKG
Note: beta blockers are contraindicated - ca cause unopposed alpha adrenergic stim and worsen coronary vasoconstriction.

Question 20

Patient with a history of alcohol abuse, lack of history of psychosis, and abrupt onset of auditory hallucinations shortly after hospitalization are most consistent with what?

Answer 20

Alcoholic hallucinosis - type of alcohol withdrawal syndrome (alert sensorium, visual hallucinations primarily, stable vitals. 12-24h after last drink and resolves after)

Question 21

What is the time course of pospartum blues, postpartum depression, and postpartum psychosis. Tx?

Answer 21

1. Blues: 2-3 d onset, resolves in 2 wks. Reassurance and monitoring
2. Depression: within 4 wks. Antidepressants, psychotherapy
3. Psychosis: days to weeks. Antipsychotics, antidep, mood stabilizers, hospitalization, do not leave mom alone with infant

Question 22

PCP and LSD intoxication present similarly. What are hallmarks of each to distinguish one from the other

Answer 22

PCP: agitation, aggression, NYSTAGMUS more in PCP
LSD: visual hallucinations, intensified perceptions

Question 23

How long should patients with a single episode of major depressive disorder continue antidepressants for?

Answer 23

4-9mo to reduce risk of relapse.

If recurrent, chronic, or severe episodes of MDD, consider maintenance tx for 1-3 years or indefinitely.

Question 24

NMS is caused by dysregulation of what neurotransmitter?

Answer 24

Dopamine - D2 receptor ANTAGONISM

Question 25

Delusional disorder in which the same delusion is present in individuals who share a close relationship. Dx? Best next step?

Answer 25

Folie a deux (Shared psychotic disorder)

Best is to separate the pair to break the chain of reinforcing each other’s beliefs

Question 26

Differentiate between specific phobia vs social anxiety disorder

Answer 26

Specific phobia: Anxiety about specific object/situation

Social anxiety: fear of scrutiny and embarrassment in social and performance situations

Question 27

Differentiate somatic symptom disorder, conversion disorder, and factitious disorder

Answer 27

1. somatic symptom disorder: excess anxiety/preoccupation with >=1 unexplained sx
2. conversion: neuro sx incompatbile with neuro dz (acute onset and stress related)
3. Factitious disorder: intentional false sx to assume sick role (vs malingering - wat secondary gain)

Question 28

If a patient asks about antidepressants and risk of becoming suicidal what is an appropriate response?

Answer 28

The slight risk must be weight against the greater risk of suicide in untreated depression

Question 29

What does DIGFAST stand for and what disorder is the mnemonic used for?

Answer 29

Distractibility, impulsivity, grandiosity, flight of ideas, activity, sleep, talkativeness/pressured speech
Manic episode in bipolar d/o.

Question 30

How do you treated neuroleptic malignant syndrome? Sx?

Answer 30

Stop neuroleptics or restart dopamine agents (bromocriptine, amantadine - reverse dopamine blockage). Supportive care (cooling, hydration). Dantrolene
Sx: severe hyperthermia, autonomic instability, lead-pipe rigidity, altered sensorium, elevated CK and WBC

Question 31

Condition in which a nonpsychotic woman presents with signs and sx of early pregnancy and the belief she is pregnant, but eval excludes pregnancy. Dx? MOA?

Answer 31

Pseudocyesis - somatization of stress –> hypothal-pituitary-ovarian axis affected causing early preg sx.
Manage with psych eval and tx

Question 32

T/F: chronic alcohol use may result in insomnia and/or anxiety?

Answer 32

True

Labs: 2:1 AST:ALT, inc GGT, pancytopenia

Question 33

What sleep disorder involves dream enactment that occurs during REM sleep if muscle atonia is absent? IF awakened, patients are fully alert and recall their dreams. What is this a possible sign of in older patients?

Answer 33

REM sleep behavior disorder

Older pt = neurodegeneration prodrome (Parkinsons or Lewy body dementia)

Question 34

Antipsych drugs can cause tardive dyskinesia (invol hyperkinetic mvts) or dystonia (mm spasms or stiffness). How can you treat these?

Answer 34

Tardive dyskinesia: switch to clozapine (antipsych drug least likely to cause EPS). Need not monitor WBC bc risk of neutropenia
Dystonia: Benztropine and diphenhydramine