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MTB STEP 3 (J) > MTB 3 - Psychiatry > Flashcards

MTB 3 - Psychiatry Flashcards

1
Q

What are the different time courses for schizophrenia, schizophreniform, and brief psychotic disorder?

A

Schizophrenia - > 6 months

Schizophreniform > 1 month but

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2
Q

What is the treatment for delusional disorder and schizotypal personality disorder?

A

Psychotherapy

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3
Q

What percentage of those with schizophrenia attempt suicide?

A

50%, 10% are successful.

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4
Q

For how long should you give antipsychotics after the first psychotic episode?

A

6 months with longterm psychotherapy

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5
Q

What are two other indications for antipsychotics other than treating schizophrenia?

A

Sedation when benzos are contraindicated.

For movement disorders like Huntington’s or Tourette’s

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6
Q

What are 2 pharmacologic effects a/w low-potency antipsychotics?

A
  1. alpha blockade leading to orthostatic hypotension

2. anticholinergic effects leading to urinary retention, dry mouth, blurry vision, delirium.

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7
Q

What are you worried about if a patient on thioridazine complains of chest pain and SOB?

A

Thioridazine is a/w prolonged QT and arrhythmias. Get an EKG!

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8
Q

What strange side effect is associated with long-term thioridazine use?

A

Retinal pigmentation. Routine eye exam is necessary for chronic therapy. Also impotence and inhibition of ejaculation (from the alpha-blocker effect) are seen.

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9
Q

What are some lesser side effects of low potency antipsychotics?

A

Impotence and inhibition of ejaculation (from the alpha-blocker effect) are seen. Weight gain d/t hyperprolactinemia, also galactorrhea and amenorrhea.

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10
Q

What are the different time courses a/w extrapyramidal symptoms?

A 
Acute dystonia - within first week
Bradykinesia (Parkinsonism) - Within weeks
Akathisia - Weeks to chronic use
Tardive dyskinesia - Months to years
NMS - anytime
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11
Q

What phenomenon is commonly seen after discontinuation of antipsychotics d/t side effects?

A

A worsening of tardive dyskinesia.

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12
Q

What can be an adjunct therapy for akathisia?

A

Beta-blockers or benzos.

Try swtiching to a newer antipsychotic.

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13
Q

C/c avoidant personality d/o and social phobia

A

Avoidant personality d/o does not think that there is anything wrong with his behavior.

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14
Q

C/c the time courses of acute stress disorder and PTSD

A

ASD is when the symptoms occur within 1 month of the stressor and last less than 1 month

PTSD is when symptoms last longer than 1 month.

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15
Q

What are three important components of the diagnosis of PTSD?

A
  1. Re-experiencing of the traumatic event
  2. Avoidance of stimuli
  3. Increased arousal
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16
Q

What is the most effective therapy to prevent PTSD following a traumatic event?

A

Group psychotherapy. Benzos for actue anxiety, SSRIs can help.

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17
Q

What is the timeline for generalized anxiety disorder?

A

Excessive, poorly controlled anxiety that occurs everyday for more than 6 months.

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18
Q

What is the treatment for generalize anxiety disorder?

A

Supportive psychotherapy with relaxation training

SSRIs, venlafaxine, buspirone, and benzos.

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19
Q

Medications for OCD?

A

SSRIs and clomipramine.

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20
Q

What is notable about the side effect profile of buspirone that is relavant to people working a normal day?

A

It is the best option for people with occupations that involve operating machinery

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21
Q

Is there a withdrawal syndrome with buspirone?

A

No.

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22
Q

What is the time course definition of major depression?

A

Depressed mood and anhedonia lasting at least 2 weeks.

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23
Q

What is the time course definition of dysthymic disorder? What is the treatment?

A

Low-level depressive symptoms that persist for 2 years. Psychotherapy is best, if fails, SSRI.

24
Q

You have hospitalized a patient for acute mania. What is your first drug of choice? What do you use for acute mania?

A

DOC: Lithium (takes 1 weeks to act)

For acute mania: antipsychotics

25
Q

When do you give antidepressants to those with bipolar disorder?

A

Only when there is a history of recurrent depression. ONLY give with mood stabilizers (to prevent inducing mania)

26
Q

What is the definition of rapid-cycling bipolar disorder? How would you treat it.

A

> 4 episodes of mania per year. Treat by gradually stopping all antidepressants, stimulants, caffiene, benzos, and alcohol

27
Q

What drug has been shows to decrease suicidal ideation in those with bipolar disorder?

A

Lithium

28
Q

A 32 year old pt w bipolar d/o who is on lithium has a positive pregnancy test. How do you manage her bipolar d/o going forward?

A

Discontinue lithium. ECT therapy is best for first trimester pats with anic episodes.

29
Q

What is it called when a patient has recurrent episodes of depressed mood and hypomanic mood for at leaset 2 years? What is the treatment for this disorder? What drug is best in this disorder?

A

Cyclothymia. Psychotherapy is the best option. Divalproex if functioning is impaired. Divalproex is more effective than lithium.

30
Q

How long do symptoms last in grief vs. depression? How long does it take pt to return to baselien level of functioning?

A 
Grief = lasts up to one year
Depression = symptoms last longer than a year

Baseline level of function
Grief = returns within 2 months
Depression = pt does not return to baseline functioning

31
Q

When would you consider giving antidepressants with prolonged grief?

A

6 months

32
Q

In what context is post-partum depression usually observed? What is the treatment?

A

After the second birth. The treatment is antidepressants.

33
Q

In what context is postpartum psychosis usually seen?

A

After the first birth. Mood stabilizers or antipsychotics and antidepressants.

34
Q

What sort of treatments would you consider if the patient is breastfeeding and is diagnosed with postpartum psychosis?

A

Avoid medications, consider ECT.

35
Q

What is the beggist complaint associated with ECT therapy and what is the time course of these effects? ECT is contraindicated in patients with what medical conditions?

A

Transient memory loss - worsens with prolonged therapy and resolves after several weeks. ECT is contraindicated in patients with space-occupying intracranial lesions.

36
Q

How long should you treat with anti-depressants following the first depressive episode?

A

6 months and then attempt to taper.

37
Q

What drug would you consider for a patient with depression who is concerned about weight gain or sexual dysfunction? What serious adverse effect does this drug have?

A

Buproprion. Lowers the seizure threshold.

38
Q

What drug would you consider for a patient with depression who is concerned about poor appetite, recent weight loss, or insomnia?

A

Mirtazepine

39
Q

Depression + chronic pain = consider giving what drug?

A

Amitriptyline

40
Q

SSRIs are safe in pregnancy except for which SSRI?

A

Paroxetine.

41
Q

What is first line for bipolar disorder?
What is first line for rapid-cycling bipolar disorder?
What is second line for bipolar disorder?

A

Lithium
Divalproex (depakote)
Carbamazepine (AE: agranulocytosis and sedation)

42
Q

Elderly patient with bipolar d/o w renal failure, hyponatremia w nausea, vomiting, confusion, tremors, increased DTRs, +/- seizures. What should you think about? What is the treatment?

A

Think lithium o/d. Treatment is dialysis.

43
Q

SSRI + migraine (triptan) =/- MAOI, what are you thinking of? What is the treatment?

A

Serotonin syndrome.

IVF, cyproheptidine to decrease serotonin production, benzo to decrease muscle rigidity

44
Q

Diagnostic criteria for somatoform disorders?

A

4 pain
2 GI
1 sexual
1 pseudoneurologic

45
Q

How would you treat anorexia/bulemia?

A 
Hospitalize
IVF
Olanzipine
SSRIs (especially fluoxetine)
Behavioral psychotherapy
46
Q

Young female who is underweight because of food restriction +/- excessive exercise and has not had a menstrual period for 3 cycles or more. What percentage of these pts also purge?

A

Anorexia nervosa. 50% purge.

47
Q

Young female with normal weight with frequent episodes of binge eating followed by guilt, anxiety, and self-induced vomiting, laxative, diuretics, or enema use.

A

Bulemia nervosa. Food restriction is not a feature of bulimia.

48
Q

Bonus: what is a risk associated with prolonged ipecac syrup use?

A

cardiomyopathy

49
Q

What is the first line treatment for body dysmorphic disorder?

A

SSRI

50
Q

What are tests that you should order when you are considering a diagnosis of alcohol dependence?

A

Tox screen
To look for secondary effects of alcohol abuse: elevated GGTP, AST, ALT, LDH
HIV, HCV, HBV, PPD

51
Q

What is the most effective management of alcohol abuse or the most effective way to prevent relapse?

A

AA

52
Q

What are the symptoms a/w Wernicke-Korsakoff syndrome?

A

Opthalmoplegia
Ataxia
Confusion/amnesia
Nystagmus

53
Q

If you are treating a patient with underlying liver disease for acute alcohol dependence, what meds would you consider? What about in a patient without liver dysfunction?

A

With liver dysfunction: short-acting benzos (lorazepam, oxazepam)
Without liver dysfunction: long acting (chlordiazepoxide/diazepoxide)

54
Q

Naloxone and acamprosate only decrease relapse rate in alcohol dependence when given with what?

A

Psychotherapy

55
Q

Explain the time course of the sequelae of alcohol withdrawal

A

6 hours: minor withdrawal - insomnia, tremors, mild anxiety, HA, diaphoresis, palpitations
12-24 hours: Alcoholic hallucinosis: visual hallucinations +/- auditory and tactile hallucinations
48 hours: Withdrawal seizures: tonic-clonic seizures
48-96 hours: Delerium tremens: hallucinations, disorientation, tachycardia, hypertension, low grade fever, agitation, diaphoresis.

56
Q

In a patient with alcohol dependence, hallucinations + mental status changes, what is the (specific) diagnosis?

A

This is delerium tremens, NOT alcoholic hallucinosis.

MTB STEP 3 (J) (3 decks)

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