AAFP: Psychogenic Flashcards
The diagnosis of delirium is based on:
a. Hx and physical findings
b. Complete metabolic panel results
c. Toxicology screening results
d. EEG findings
e. MRI of the brain
a. Hx and physical findings
No laboratory tests, imaging studies, or other tests are more accurate than clinical assessment.
A 58 yo female consults you about smoking cessation. She has been intolerant of varenicline (Chantix) but tells you her sister was able to stop smoking with the use of bupropion (Wellbutrin). A history of which one of the following would be a relative contraindication to the use of bupropion?
a. CAD
b. Depression
c. Eczema
d. Hypothyroidism
e. Seizures
e. Seizures
Bupropion should not be used with MAOI or in patients with seizure or eating disorders.
Bupropion can be used for the treatment of depression.
A 24 yo female complains of irritability, anxiety, and feeling restless. These symptoms began 3 months ago after she was in a car accident. She has become very socially withdrawn and is experiencing PTSD. In addition to recommending trauma-focused psychotherapy, which one of the following meds would be most appropriate?
a. Buspirone
b. Clonazepam (Klonopin)
c. Quetiapine (Seroquel)
d. Topiramate (Topamax)
e. Sertraline (Zoloft)
e. Sertraline (Zoloft)
SSRIs and SNRIs are considered first-line treatment for PTSD.
A 79 yo female had a total knee replacement yesterday. She has mild dementia as a result of a stroke 10 years ago, but her dementia has been stable since then. Last night she became confused and agitated, striking out at nurses, and could not be consoled. Which one of the following would be most appropriate at this time?
a. Soft restraints
b. CT of the head
c. Adequate pain control
d. Sedating SSRI such as paroxetine (Paxil)
e. Lorazepam (Ativan) IV as needed
c. Adequate pain control
This patient has postop delirium, which is associated with an increased mortality rate. Reorientation and pain mgmt are important mgmt strategies.
Benzos, antipsychotics, antidepressants, and restraints are not helpful and may make the situation worse.
What is the drug of choice when treating serotonin syndrome?
IV Diazepam
Benzodiazepines such as lorazepam or diazepam
An 85 yo male admitted to the hospital for SOB is diagnosed with terminal lung cancer. He decides he would like to receive home hospice care. Over the course of the hospitalization, he becomes increasingly confused and forgets where he is and why he is there. He appears depressed with a flat affect. He repeatedly tries to get out of bed, and pulls at his IV line and catheter. Which one of the following medications would be most appropriate for treating these symptoms?
a. Haloperidol
b. Nortriptyline (Pamelor)
c. Pentobarbital (Nembutal)
d. Lorazepam (Ativan)
e. Mirtazapine (Remeron)
a. Haloperidol
Antipsychotic medications are the drug of choice to improve delirium. CNS depressants such as benzodiazepines and barbiturates should be avoided because they can make delirum worse. Nortriptyline has anticholinergic side effects and can also cause delirium.
A 24 yo female presents to your office with a complaint of fatigue and concentration problems. She thinks she is depressed because she is always worried about something. She says she has difficulty sleeping at night because she can’t stop thinking and worrying. Her constant worrying has started to affect her relationships and she is finding it difficult to work. She is willing to go to therapy but would also like to start a medication. Which one of the following would be most appropriate?
a. Buspirone (BuSpar)
b. Lorazepam (Ativan)
c. Clonazepam (Klonopin)
d. Sertraline (Zoloft)
e. Pregabalin (Lyrica)
d. Sertraline (Zoloft)
SSRis are first-line medications in the treatment of GAD. They also help treat the concomitant depression that exists in many patients with GAD.
Buspirone is effective in the treatment of anxiety, but does not help with depression. The same is true for benzos.
Pregabalin has been used in Europe for treatment of GAD, but the FDA has not approved this use.
Staff members in your practice often complain about one of your patients. He exhibits odd behaviors and beliefs, and is always very anxious about his visit and about when he will be seen, despite long familiarity with your practice. Which one of the following personality disorders best fits the description of this patient?
a. Antisocial
b. Borderline
c. Dependent
d. Narcissistic
e. Schizotypal
e. Schizotypal
This patient most likely has schizotypal personality disorder. These patients have problems with social and interpersonal relationships, which are marked by significant anxiety and discomfort, and they also exhibit odd thinking, speech, and perceptions. This disorder is classified as being in the cluster A personality disorder group.
- Cluster A: Paranoid, schizoid, and schizotypal
- Cluster B: Antisocial, borderline, histrionic, and narcissistic
- Cluster C: Avoidant, obsessive-compulsive, and dependent
In the hospital setting, the use of atypical antipsychotics is most appropriate for which one of the following conditions?
a. Hospital-associated insomnia
b. ICU-associated delirium
c. Resistance to care in patient with dementia
d. Aggression in a patient with dementia
b. ICU-associated delirium
Atypical antipsychotics may reduce the duration of delirium in adult intensive-care patients, and are recommended by the American College of Critical Care Medicine in their clinical practice guidelines for the mgmt of pain, agitation, and delirium in adult patients in the ICU.
The American Psychiatric Association (APA) recommend not using antipsychotics as a first choice to treat the behavioral and psychological symptoms associated with dementia, such as aggression and resistance to care. These drugs have limited benefit and can cause serious harm, including stroke and premature death.
An 85 yo male is brought to your office by his family because they are concerned that he may be depressed. Which one of the following is most likely in a depressed patient in this age group?
a. Suicidal ideation
b. Somatic symptoms
c. Depressed mood
d. Preoccupation with guilt
b. Somatic symptoms
Somatic complaints are seen in up to two-thirds of primary care patients with depression, and are more likely in certain groups, including pregnant women, children, the elderly, and low-income groups.
Which one of the following is the only medication that has consistent evidence for decreasing depressive symptoms in children and adolescents?
a. Fluoxetine (Prozac)
b. Venlafaxine (Effexor XR)
c. Nortriptyline (Pamelor)
d. Aripiprazole (Abilitfy)
e. Paroxetine (Paxil)
a. Fluoxetine (Prozac)
Fluoxetine is the only medication with consistent evidence showing that it improves depression symptoms in children and adolescents, including a Cochrane review of three randomized trials.
A 40 yo obese AA male presents with a history of excessive daytime drowsiness. At home, he falls asleep shortly after starting to read or watch television. He admits to nearly crashing his car twice in the past month because he briefly fell asleep behind the wheel. Most frightening to the patient have been episodes characterized by sudden loss of muscle tone, lasting about 1 minute, associated with laughing. An overnight sleep study shows decreased sleep latency and no evidence of obstructive sleep apnea. Appropriate tx includes which one of the following?
a. Methylphenidate (Ritalin)
b. Zolpidem (Ambien) at bedtime
c. Carbidopa/levodopa (Sinemet)
d. Weight reduction
e. Avoidance of daytime napping
a. Methylphenidate (Ritalin)
Clinical hx and lab findings presented are consistent with a dix of narcolepsy. In addition to the sleepiness, the patient also has cataplexy, which is manifested in this case by episodes of sudden weakness when laughing and is almost pathognomonic for narcolepsy.
Treatment involves improving both the quantity and quality of sleep during the night, which can be accomplishd with sodium oxybate. This improves daytime alertness and catalexy.
Scheduling naps is the second important aspect of management. The third important step is the use of stimulants such as methylphenidate to improve function during the day.
Which one of the following medications used for anxiety has also been shown to reduce the symptoms of IBS?
a. Buspirone
b. Clonazepam (Klonopin)
c. Divalproex sodium (Depakote)
d. Risperidone (Risperdal)
e. Citalopram (Celexa)
e. Citalopram (Celexa)
IBS sx improve with several different medications and alternative therapies. Exercise, probiotics, abx, antispasmodics, antidepressants, psychological treatments, and peppermint oil all have evidence that they may improve IBS symptoms.
A Cochrane review of 15 studies involving 922 patients found a beneficial effect from antidepressants with regard to improvement in pain and overall symptom scores compared to placebo. SSRIs used in these trials included citalopram, fluoxetine, and paroxetine, and TCAs included amitriptyline, desipramine, and imipramine.
