Personality Disorders/Sleep/Somatic Symptom/sex

Question 1

Which personality disorder presents as being a loner, restricted range of emotions, no pleasure in activities and no close friends?

Answer 1

Schizoid personality disorder

Question 2

REM sleep behavior disorder (acting out dreams but don’t have absence of muscle tone) is highly associated with development of what type of dementia?

Answer 2

Lewy body dementia

Question 3

What is the progression of sleep cycle over 90 mins?

Answer 3

N1 –> N2 –> N3 –> N2 —> REM

Question 4

Which part of sleep do you see the following activity on EEG?
A) alpha activity, vertex waves
B) theta activity (rhythmic activity b/w 5-8 Hz)
C) K complexes w/sleep spindles or bundles
D) high amplitude delta (slow) waves
E) saw tooth waves

Answer 4

A) N1 sleep & when awake with eyes closed
B) N2 sleep
C) N2 sleep
D) N3 sleep
E) REM sleep

Question 5

RLS is a sensory-motor disorder with 4 cardinal features:
1) uncomfortable sensation to move the legs
2) discomfort worse in _________ (day OR night?)
3) discomfort worse at rest
4) discomfort improves with mvmt of affected limbs

Answer 5

NIGHT (can also disrupt sleep)

Question 6

What is the only drug approved for treatment of non 24-hr sleep wake disorder often experienced by blind patients?

Answer 6

Tasimelteon (melatonin receptor agonist)

Question 7

A man comes for a sleep study and you see increased beta activity on EEG. What medication is he likely taking?

Answer 7

Benzos

Question 8

What rare neurological condition starts in adolescence where they have hypersomnia (sleeping all the time), aggressive, and over-sexual behavior. There is no definitive tx for it outside of stimulants to increase period of wakefulness.

Answer 8

Kleine-Levin syndrome

Question 9

What are the biologic features of Borderline PD?
1. Decreased ________ (NT)
2. _______ lobe dysfunction

Answer 9

1. Serotonin
2. frontal

Question 10

What psychiatric illness has highest rate of comorbidity with Borderline PD?

Answer 10

MDD

Question 11

Antisocial and narcissistic personalities share the characteristics of being manipulative, self-serving and lacking empathy however, what differentiates them?

Answer 11

narcissistic personalities are not impulsive and aggressive

Question 12

What is the common reason for primary enuresis?

Answer 12

delayed bladder maturation (haven’t achieved control of their bladder yet)

small functional bladder capacity, high nocturnal urine production, increased detrusor activity, diminished vasopressin release, poor arousal from sleep

Question 13

What length of time must continence must have been maintained prior to incontinence to be deemed secondary nocturnal enuresis?

Answer 13

at least 6 months of continence prior to incontinence

Question 14

Which etiology theory claims somatic symptom disorder is caused by:
A) disrupted childhood attachment
B) compromise formation: expressing something that is repressed but camouflaged
C) amplification hypothesis: pts amplify and misinterpret (catastrophize) normal physiologic functions, may overly attend to interoceptive cues OR somatization is culturally acceptable communication OR somatization is reinforced

Answer 14

A) Attachment theory
B) Psychodynamic theory
C) Learning theory

Question 15

When wold you use a PHQ-15?

Answer 15

Suspicion of somatic symptom disorder b/c it measures somatic symptoms

Question 16

Ppl with somatic symptom disorder have a higher rate of _______ personality d/o seen in their male relatives.

Answer 16

Anti-social PD

Question 17

ACCEPTS model of treatment is used for what psychiatric illness?

Answer 17

Factitious disorder imposed on another

Question 18

Multiple sleep latency test is useful to assess for what dx?

Answer 18

Narcolepsy

Question 19

Which Z drug for sleep has the shortest half-life resulting in least daytime grogginess?

Answer 19

Zaleplon

Question 20

You should avoid giving Ramelteon in pts with severe _________ dx?

Answer 20

liver

Question 21

For what category of sleep disorders are Modafinil and armodafinil helpful with?

Answer 21

promoting wakefulness
ie hypersomnolence disorder, narcolepsy

Question 22

Sodium oxybate’s (activates GABA receptor) FDA indications are for what 2 things?

Answer 22

Cataplexy AND excessive daytime sleepiness

Question 23

Modafinil and Armodafinil FDA indications are to do what?

Answer 23

reduce excessive daytime sleepiness from
-narcolepsy
- OSA
- shift work sleep d/o

Question 24

What is best tx for REM sleep behavior disorder?

Answer 24

Clonazepam

Question 25

What medical condition can cause RLS?

Answer 25

Iron deficiency anemia

Question 26

What are first line agents for tx of RLS?

Answer 26

dopamine agonists
- Ropinirole, pramipexole

Question 27

What is the first line medication for treatment of premature (early) ejaculation in men, after trying behavioral techniques ( ie squeeze method, start and stop)?

Answer 27

Paxil(paroxetine) daily or as needed

Question 28

What personality disorder has the following MOA: Hyper-reactivity in amygdala during reappraisal tasks

Answer 28

Avoidant PD
heightened amygdala activity in anticipation of receiving negative social stimuli shows their tendency for anxiety in social settings.

Question 29

Sleep disturbances that are typically seen in ________ disorder include a decrease in the duration of deep sleep, a decrease in total sleep time, an increase in rapid-eye movement (REM) sleep, and decreased REM latency (time between sleep onset and the first REM cycle).

Answer 29

depressive

Question 30

Which personality disorder often coexists in bulimic patients?

Answer 30

Borderline PD