General Questions

Question 1

What is the treatment and dose for Acute Manic Episode?

Answer 1

Haloperidol. Dose is 2-5 Mg PO or IM. Takes 20-30 min to work

Question 2

Define Borderline Personality Disorder (Micropsychotic Episodes)?

Answer 2

BPD patients under stress can express symptoms of chronic feelings of emptiness, mood/affect lability, self mutilation, and intense anger and impulsivity.

Question 3

Why schizotypal personality D/O patients don’t benefit from psychotherapy?

Answer 3

Because they lack capability, stable sense of self, and trust to be able to engage in therapy. If under stress and worsened psychotic symptoms treat with low dose antipsychotic.

Question 4

Which personality D/O associated with somatization D/O?

Answer 4

Histrionic Personality D/O in females, Antisocial in males.

Question 5

How to treat somatization D/O patient?

Answer 5

Admit patient’s consternation. Schedule frequent visits, treat any associated psychiatric symptoms (depression anxiety…etc.)

Question 6

Which antipsychotics don’t cause weight gain?

Answer 6

Ziprasidone and aripiprazole.

Question 7

What is the benefit and side effect of Nefazodone?

Answer 7

It doesn’t cause sexual dysfunction. It’s main SE is hepatitis and liver failure.

Question 8

Define Treatment Resistant Depression?

Answer 8

major depressive episodes that do not respond satisfactorily after two trials of antidepressant monotherapy; however, the definition has not been standardized.

Question 9

Define Treatment Refractory Depression?

Answer 9

Unipolar major depressive episodes that are highly resistant to treatment and do not respond satisfactorily to many sequential treatment regimens. However, the definition has not been standardized. The definition stipulates that patients are refractory to or refuse the following:

◾Antidepressants – several (eg, three to six) trials with different drugs and classes
◾Adjunctive drugs – multiple (eg, two to four) trials with different drugs
◾Electroconvulsive therapy (ECT) – at least one course
◾Adjunctive psychotherapy – at least one trial

Question 10

What is word salad?

Answer 10

Word salad may describe a symptom of mental conditions in which a person attempts to communicate an idea, but words and phrases that may appear to be random and unrelated come out in an incoherent sequence instead. Often, the person is unaware that he or she did not make sense. It appears in people with dementia and schizophrenia, as well as after anoxic brain injury.

Question 11

What is clang associations?

Answer 11

Words or phrases strung together because of the sounds they make, not because of the meaning they convey.

Question 12

What is flight of ideas?

Answer 12

Rapid shifting from one idea to another. Often seen in Mania.

Question 13

What is Abnormal Involuntary Movement Scale (AIMS)?

Answer 13

A standard clinical examination and rating scale that should be administered to patients receiving neuroleptics. It is useful for the detection of tardive dyskinesia.

Question 14

How long is ECT seizure to be effective?

Answer 14

25 seconds at least. If more than 180s treat with barbiturates or IV diazepam.

Question 14

What is the most important SE of venlafaxine?

Answer 14

Increased blood pressure in doses above 300 mg daily.

Question 15

Which antipsychotics are associated with most anticholinergic effect?

Answer 15

Clozapine, Chlorpromazine, and Olanzapine.

Question 16

Why haloperidol is not given IV?

Answer 16

It causes QT prolongation.

Question 17

What is the rate of sudden death with antipsychotics?

Answer 17

(1.8 per 1,000 person years) is almost ten-fold the rate of death related to clozapine-associated agranulocytosis

Question 18

Which antipsychotics are associated with severe sedation?

Answer 18

Although any antipsychotic can cause sedation in some patients, severe sedation is most common with low potency medications such as chlorpromazine, clozapine, and quetiapine. These side effects are usually most severe during the first weeks of treatment and often require gradual titration of the antipsychotic. Sedating medications may be best tolerated at bed time.

Question 19

What is pimozide indication? What are the most common side effects?

Answer 19

Suppression of severe motor and phonic tics in patients with Tourette’s disorder who have failed to respond satisfactorily to standard treatment. Sedation (70%), akathisia (40%), akinesia (40%), drowsiness (35%), behavior changes (22% to 25%), somnolence (up to 25% in children). Xerostomia (25%), constipation (20%). Abnormal ECG (3%) Depression (10%), insomnia (10%), speech disorder (10%).

Question 20

Describe pharmacotherapy for Tourette D/O.

Answer 20

Treat with drugs that block dopamine receptors, such as fluphenazine, pimozide, and tetrabenazine, which depletes neuronal dopamine. These drugs appear to have a similar response rate, reducing the frequency and intensity of tics by approximately 60 to 80 percent. Tetrabenazine, which depletes dopamine by inhibiting vesicular monoamine transporter type 2 (VMAT2), is particularly useful because it is as effective as the typical neuroleptics, but it does not cause tardive dyskinesias

Question 21

What is the treatment of performance anxiety?

Answer 21

Propranolol

Question 22

Define Beck’s cognitive triad.

Answer 22

Negative thoughts regarding self, world and the future.

Question 23

Which brain area and functions are tested by Wisconsin Card Sorting Test?

Answer 23

The WCST allows the clinician to assess the following “frontal” lobe functions: strategic planning, organized searching, utilizing environmental feedback to shift cognitive sets, directing behavior toward achieving a goal, and modulating impulsive responding.

Question 24

How to treat performance anxiety?

Answer 24

Propranolol

Question 25

Which symptom of depression takes longer time to disappear?

Answer 25

Suicidality. Patients at higher risk of suicide when starting treatment.

Question 26

What is the role of hippocampus and which psych illnesses it’s involved with?

Answer 26

The hippocampus has an important role in memory formation and stress modulation. Hippocampal dysfunction is implicated in numerous psychiatric disorders, including major depressive disorder, PTSD, schizophrenia, and dementia.

Question 27

Which psych illnesses is the amygdala involved in?

Answer 27

Mood and anxiety disorders.

Question 28

What is narrative experiential listening?

Answer 28

Narrative–experiential listening is based on the idea that all humans are constantly interpreting their experiences, attributing meaning to them, and weaving a story of their lives with themselves as the central character. This process goes on continuously, both consciously and unconsciously, as a running conversation within each of us. The conversation is between parts of ourselves and between ourselves and what Freud called “internalized objects,” important people in our lives whose images, sayings, and attitudes become permanently laid down in our memories. This conversation and commentary on our lives includes personal history, repetitive behaviors, learned assumptions about the world, and interpersonal roles. These are, in turn, the products of individual background, cultural norms and values, national identifications, spiritual meanings, and family system forces.

Question 29

Explain the important listening attitudes?

Answer 29

The centrality of inner experience
There are no bad historians
The answer is always inside the patient
Control and power are shared in the interview
It is OK to feel confused and uncertain
Objective truth is never as simple as it seems
Listen to yourself, too
Everything you hear is modified by the patient’s filters Everything you hear is modified by your own filters
There will always be another opportunity to hear more clearly

Question 30

What is projective identification?

Answer 30

Projective identification is a term first used by Melanie Klein (1946) to describe a process whereby parts of the ego are thought of as forced into another person who is then expected to become identified with whatever has been projected.

Question 31

What is expansive mood?

Answer 31

Lack of restraint in expressing one’s feelings, frequently with an overvaluation of one’s significance or importance. irritable Easily annoyed and provoked to anger.

Question 32

What is elevated mood?

Answer 32

An exaggerated feeling of well-being, or euphoria or elation. A person with elevated mood may describe feeling “high,” “ecstatic,” “on top of the world,” or “up in the clouds.”

Question 33

What is the mode of action of inhalants?

Answer 33

Inhalants act as central nervous system (CNS) depressants. CNS depression is thought to be mediated by alteration of neuronal membrane function at glutamate or gamma amino butyric acid receptors.

Question 34

What is Glue-sniffer’s rash?

Answer 34

An eczematoid dermatitis with erythema, inflammatory changes, and pruritus that occurs in the perioral area and extends to the midface. It is caused by the drying effects of hydrocarbons.

Question 35

What is impulsivity?

Answer 35

Predisposition toward rapid unplanned reactions to stimuli without regard to the negative consequences.

Question 36

What is the difference between protoimperative and protodeclarative pointing?

Answer 36

Protodeclarative pointing: is pointing to the object to share with the care giver.
Protoimperative pointing: is the infant points to an object, usually out of reach, in order to obtain it

Question 37

What are the five main negative symptoms of schizophrenia?

Answer 37

Avolition, flat affect, alogia, anhedonia, asociality.