BMB 3 - Miscellaneous

Question 1

Patients with ADHD have ___creased dopamine/norepinephrine in the ___________.

Answer 1

Patients with ADHD have decreased dopamine/norepinephrine in the striatum.

Question 2

How do you manage patients during the transition time between psych medications (due to the required washout period)?

Answer 2

Cross titration

(a full washout will not work for a lot of patients)

Question 3

If an individual has a list of specific worries, then what does this say about their anxiety?

Answer 3

It is likely specific social worries and not generalized anxiety disorder;

if they had episodic, sudden-onset bouts in particular situations, this would sound more like panic disorder

Question 4

Which is more likely to progress to schizophrenia, schizoid disorder or schizotypal disorder?

Answer 4

Schizotypal disorder

Question 5

True/False.

Antisocial personality disorder is almost always preceeded by conduct disorder.

Answer 5

True.

Question 6

What is here described: an individual shows many attempts to engage with people due to her fear of abandonment. She is not avoidant and has a need for closeness; however, she ends up self-sabotaging her relationships because she cannot tolerate vulnerability.

Answer 6

Borderline personality disorder

Question 7

A patient presents with mood symptoms and then becomes increasingly paranoid.

Is this schizoaffective disorder?

Answer 7

No, schizoaffective will present with psychosis FIRST

Question 8

Where is GABA synthesized?

What is the rate-limiting enzyme?

Answer 8

The nucleus accumbens

Glutamate decarboxylase

Question 9

Where is norepinephrine synthesized in the CNS?

What is the rate-limiting enzyme?

Answer 9

The locus coeruleus (pons)

Tyrosine hydroxylase

Question 10

Where is serotonin synthesized?

What is the rate-limiting enzyme?

Answer 10

The raphe nucleus (medulla)

Tryptophan hydroxylase

Question 11

For less than one month following an acute stressor, a patient presents with feelings of fear, hopelessness, and horror when reflecting on the event.

What is the diagnosis?

Answer 11

Acute stress disorder

Question 12

For greater than one month following an acute stressor, a patient presents with feelings of fear, hopelessness, and horror when reflecting on the event.

What is the diagnosis?

Answer 12

PTSD

Question 13

How is acute stress disorder managed?

Answer 13

CBT

Question 14

How is PTSD managed?

Answer 14

CBT, SSRIs, venlafaxine, prazosin

Question 15

What is here described?

Emotional S/Sy (depression/anxiety) that occur within 3 months of an identifiable psychosocial stressor (divorce, illness, flood) lasting < 6 months once the stressor has ended.

Answer 15

Adjustment disorder

(if S/Sy persist past 6 months, it is GAD.)

Question 16

How is adjustment disorder managed?

Answer 16

CBT, SSRIs

Question 17

GAD follows at least a ____-month timeframe.

Answer 17

GAD follows at least a 6 -month timeframe.

Question 18

While adults need ____ presenting S/Sy to be diagnosed with GAD, children need only ____.

Answer 18

While adults need three presenting S/Sy to be diagnosed with GAD, children need only one.

Question 19

What are the first-line treatments for GAD?

Answer 19

CBT, SSRIs, SNRIs

(Buspirone and benzos are second-line.)

Question 20

Panic attacks involve ≥ ___ of the S/Sy of a panic attack plus at least ____ month of fear of future attacks, worry of the ramifications, or behavioral changes related to the attacks.

Answer 20

Panic attacks involve ≥ 4** of the S/Sy of a panic attack plus at least **1 month of fear of future attacks, worry of the ramifications, or behavioral changes related to the attacks.

Question 21

How is panic disorder treated?

Answer 21

CBT, SSRIs, venlafaxine

(Benzos are second-line.)

Question 22

For diagnosis, phobia disorders must last longer than _____ months.

Answer 22

For diagnosis, phobia disorders must last longer than 6 months.

Question 23

Are there any disqualifiers to a diagnosis of an anxiety disorder in a patient?

Answer 23

Yes: another mental disorder, delirium, intoxication

(If pt has any of these, they do not have an anxiety disorder.)

Question 24

True/False.

One can have a substance-induced anxiety disorder/

Answer 24

True.

Question 25

n PTSD, the __________ fails to turn off the stress response, and the hippocampus might _____-consolidate memories associated with trauma.

Answer 25

n PTSD, the prefrontal cortex fails to turn off the stress response, and the hippocampus might over-consolidate memories associated with trauma.

Question 26

Why are reactive attachment disoder and disinhibited social engagement disorder diagnosable at 9 months of age?

Answer 26

This is when an infant should be exhibiting separation anxiety and stranger weariness

Question 27

A child from a difficult, neglectful home presents with disinhibition and an apparent ‘latching’ into strangers as if they were his caregivers.

What is the diagnosis?

Answer 27

Disinhibited social engagement disorder

Question 28

A child from a difficult, neglectful home presents wit h no apparent desire or ability to bond with his caregivers.

What is the diagnosis?

Answer 28

Reactive attachment disorder

Question 29

What does the mnemonic ‘PTSD is HARD’ indicate?

Answer 29

H: hyperarousal (2x of these S/Sy)

A: avoidance (1x of these S/Sy)

R: re-experiencing (1x of these S/Sy)

D: distress (2x of these S/Sy)

Question 30

True/False.

Adjustment disorder only occurs due to non-life-threatening stressors.

Answer 30

True.

Question 31

Name a partial opioid agonist used in treating opioid addiction.

Name a full opioid agonist used in treating opioid addiction.

Answer 31

Buprenorphine

Methadone

Question 32

A patient has episodes of concurrent mania and depression.

What is this termed?

Answer 32

Mixed manic episode

Question 33

What is the difference between a depressive episode and a major depressive episode?

Answer 33

The significance of duration and severity

Question 34

Bipolar disorder is associated with a thinning of patient ______ matter.

Answer 34

Bipolar disorder is associated with a thinning of patient gray matter.

Question 35

Manic episodes involve ≥ ____ of the DIG FAST criteria for ≥ ____ week.

Answer 35

Manic episodes involve ≥ 3** of the DIG FAST criteria for ≥ **1 week.

Question 36

What is hypomania?

Answer 36

Manic symptoms for a shorter period of time and with no psychotic features

(impairment is typically less severe)

Question 37

A 28-year-old female presents with more than one episode of mania.

What is the diagnosis?

Answer 37

Bipolar I

Question 38

A patient presents with separate episodes of hypomania and depression.

What is the diagnosis?

Answer 38

Bipolar II

Question 39

What does it mean if a patient’s bipolar disorder is rapid-cycling?

Answer 39

≥ 4 mood episodes (manic, hypomanic, mixed, major depressive) within 1 year (in any combination)

Question 40

How is bipolar mania treated?

What if it has psychotic features?

Answer 40

Mood stabilizers

Add an atypical antipsychotic

Question 41

Which mood stabilizers are used for acute mania?

What about bipolar mania and maintenance?

Answer 41

Lithium, valproate;

carbamazepine

Question 42

In major depression, there is typically cortisol ______secretion and __creased glucocorticoid receptor expression.

Answer 42

In major depression, there is typically cortisol hypersecretion and decreased glucocorticoid receptor expression.

Question 43

In PTSD, there is typically cortisol ______secretion and __creased glucocorticoid receptor expression.

Answer 43

In PTSD, there is typically cortisol hyposecretion and increased glucocorticoid receptor expression.

Question 44

CB__ is the main endocannabinoid receptor in the CNS.

CB__ is the main endocannabinoid receptor in the immune system.

Answer 44

CB 1 is the main endocannabinoid receptor in the CNS.

CB 2 is the main endocannabinoid receptor in the immune system.

Question 45

True/False.

CB1 and CB2 (endocannabinoid receptors) are GPCRs acting via G_i.

Answer 45

True.

Question 46

Can we as physicians prescribe marijuana?

Answer 46

No, we can only recommend it.

Question 47

Why do drugs like benzodiazepines cause withdrawal symptoms?

Answer 47

Due to altering of the GABA:glutamate balance (usually 1:1)

Question 48

Which sleep aids should be avoided in treating the elderly?

Answer 48

Benzodiazepines

Z drugs

Antihistamines