Elmo Loves Green Wednesday (Psych)

Question 1

An anorexic patient is displaying depressive symptoms and you wish to start them on an anti-depressant. Which one are you sure to avoid?

Answer 1

bupropion - it is contraindicated in anorexic patients because it is known to lower the seizure threshold

Question 2

Name 2 SSRIs that are better taken in the morning in order to avoid insomnia

Answer 2

SSRIs in general are normally administered in the am because of the potential to induce anxiety and insomnia. Especially: fluoxetine (Prozac); sertraline (Zoloft)

Question 3

Name an SSRI which may be useful in pts displaying insomnia as depressive symptom

Answer 3

paroxetine (Paxil)

Question 4

SSRIs commonly are associated with sexual dysfunction SE due to the increased serotonin activity at the 5-HT receptor site. Which SSRI is associated with the highest rate of sexual SE? Which is least likely to cause these effects?

Answer 4

Paroxetine (Paxil) – Most likely Fluvoxamine (Luvox) – Least likely

Question 5

SSRIs are contraindicated with MAO inhibitors because the combination can lead to a sudden increase in systemic serotonin (serotonin syndrome) S/Sx of serotonin syndrome include:

Answer 5

heat stroke, vascular collapse, fever, tachycardia

Question 6

There are currently 3 SNRIs available in the US:

Answer 6

venlafaxine (Effexor); desvenlafaxine (Pristiq); and duloxetine (Cymbalta)

Question 7

SNRIs have the potential to produce more adverse effects as compared to SSRIs, secondary to noradrenergic activity. There are higher rates of ______

Answer 7

dry mouth, constipation, nausea, and insomnia

Question 8

Two dose-related side effects occur with venlafaxine (Effexor):

Answer 8

Nausea and Hypertension

Question 9

Abrupt discontinuation of SNRI therapy is not recommended, especially:

Answer 9

Venlafaxine (Effexor) This can produce a discontinuation syndrome similar to that of SSRIs

Question 10

Because of its appetite stimulation, _______ may be a good choice for low-weight elderly or ill patients

Answer 10

Mirtazapine (Remeron)

Question 11

If insomnia is problematic in the patient with major depression, _______ may be the best choice within the SSRI class

Answer 11

Paroxetine (Paxil)

Question 12

If the patient is taking drugs metabolized by CYP3A4, then avoiding ________ is recommended

Answer 12

Fluoxetine (Prozac)

Question 13

Currently, _____ is the only SSRI approved by the FDA for the treatment of depression in children age 8 and up

Answer 13

Fluoxetine (Prozac)

Question 14

Escitalopram (Lexapro) is labeled for use in children age ___ and older

Answer 14

12

Question 15

For children and adolescents with depression, caution has been expressed with many agents, especially:

Answer 15

Paroxetine (Paxil); and Venlafaxine (Effexor)

Question 16

St John’s wort appears to be well tolerated for depression, with the most frequent SE reported as:

Answer 16

nausea, fatigue, restlessness, rash, and photosensitivity

Question 17

St John’s wort should not be taken in combination with any other antidepressant because of the risk of serotonin syndrome, especially in which population?

Answer 17

Elderly

Question 18

What are the features of Borderline Personality Disorder?

Answer 18

PRAISE: Paranoid ideas, Relationship anxiety, Angry outbursts - affective instability - abandonment fears, Impulsive behavior - identity disturbance, Suicidal behavior, Emptiness

Question 19

People with this disorder display a lifelong pattern of voluntary social withdrawal without psychosis. They can be thought of as “people who like to live in lighthouses”

Answer 19

Schizoid Personality Disorder (Cluster A)

Question 20

Those with this disorder are characterized as having a peculiar appearance and odd thought patterns and behavior in the absence of psychosis. These patients tend to become socially isolated.

Answer 20

Schizotypal Personality Disorder (Cluster A)

Question 21

You are seeing a 25 year old female you have newly diagnosed with depression and would like to begin treatment with an SSRI. Which SSRI is most appropriate?

Answer 21

ZOLOFT All Are Category C except Paxil though some have some serious related risks Paxil (Paroxetine) - Ventricular Outflow Defects Prozac (Fluoxetine ) - VSD Celexa (Citalopram) - Neural Tube defects

Question 22

A 21 year old female presents to your office for the ninth time during this last year. You suspect the individual of suffering from a somatozation disorder. This time she presents with complaints of a seizure yesterday and has a third party acknowledge that one did actually occur? What lab could you check to verify if the patient did actually have a real seizure?

Answer 22

Prolactin

Question 23

The presence of _____________ symptoms in a patient with schizophrenia are thought to predict a worse outcome?

Answer 23

Negative

Question 24

A 56 year old female is seen at a follow up visit for depression and complains of unimproved S/S over the past year. She is currently on Effexor and you don’t want to increase the dose due to BP issues. If you choose to augment with another medication, what would be the best choice?

Answer 24

MIrtazapine (Remeron) + SNRI = “California Rocket Fuel”

Question 25

The 3 major symptom categories required for the diagnosis of PTSD are?

Answer 25

Re-experiencing, Dissociation (avoidance), Hyperarousal (anxiety

Question 26

A 24 year old male reports to your clinic accompanied by this wife with odd behaviors and little sleep for the past 5 days. On examination you find he his hyperverbal, hyperactive, demonstrates flight of ideas and is easily distracted. You suspect Bipolar disorder and does not appear to be a canidate for inpatient treatment at this time. What 2 labs should be obtained initially before commencing treatment to R/O other causes?

Answer 26

Urine Drug screen, Thyroid Panel

Question 27

What symptom of bipolar disorder may be treated in order to prevent manic episodes?

Answer 27

Sleep Disturbance

Question 28

A 21 year old male patient with a history of depression is hospitalized after a manic episode that led to legal troubles. He is currently on prozac. What medication adjustments should be made?

Answer 28

Stop the antidepressant and start either a mood stabilizer or atypical antipsychotic

Question 29

You are seen a 26 year old female in the clinic you have just diagnosed with mild depression after clinical interview and Hamilton Rating Scale. She has no SI/HI. What is your treatment recommendation?

Answer 29

Referral to Therapy

Question 30

Which Benzodiazapine is used specifically to treat anxiety associated sleep disorders?

Answer 30

Temazepam (Restoril)

Question 31

What does SIGECAPS stand for?

Answer 31

S = sleep I = interest G = guilt/worthlessness E = energy C = concentration A = appetite P = psychomotor disturbances S = suicide ideation

Question 32

Lithium is known to cause what congenital heart problem?

Answer 32

Epstein’s anomaly - downward displacement of the tricuspid valve into the right ventricle and right ventricular hypoplasia

Question 33

The mental status exam is used to describe: A. behavior, hearing, emotions, cognition, comprehension B. Behavior, speech, emotions, comprehension, IQ C. Speech, emotion, comprehension, behavior, perceptual processes D. Speech, behavior, emotion, cognition, perceptual processes E. IQ, hearing, perceptual processes, speech, cognition

Answer 33

D. Speech, behavior, emotion, cognition, perceptual processes

Question 34

Valproic Acid (Depakote) is a mood stabilizer and anti-epiletic drug. What lab value do you need to be sure to monitor on these patients?

Answer 34

Liver function tests

Question 35

The difference between bipolar I and bipolar II is the manic episodes. With bipolar I mania lasts _______ and causes marked impairment in functioning and can lead to hospitalization and/or psychosis. Bipolar II hypomania lasts _______ and is a change in functioning from baseline as observed (often) by others. A. 2 weeks, 1 week B. 1 week, 2 weeks C. 1 week, 4 days D. 4 days, 1 week E. 10 days, 5 days

Answer 35

C. 1 week, 4 days

Question 36

What are the different clusters of personality disorders?

Answer 36

Cluster A – odd, eccentric Cluster B – dramatic, emotional, erratic Cluster C- anxious, fearful

Question 37

Clozapine is used to treat schizophrenia and off-label for bipolar. It carries 5 black box warnings. Name as many as you can.

Answer 37

Agranulocytosis Seizures Myocarditis “other adverse cardiovascular and respiratory effects” “increased mortaility in elderly patients with dementia-related psychosis”