Power point deck

Question 1

Incidence of mania in population and in identical twins?

Answer 1

1% population

80-90% in id twins

Question 2

Mania 1st episode in 75 year old?

Answer 2

Likely medical cause

Right frontal hemisphere stroke

Question 3

Medication for manic person?

Answer 3

Acute hallucinations and agitation: haloperidol, clonazepam

Maintenance: lithium, valproic acid, carbamazepine

Question 4

Treatment for lithium overdose?

Answer 4

fluid resuscitation

Emergent dialysis: greater than 4, or greater than 2.5 with kidney disease or other severe symptoms

Question 5

Contraindications for lithium therapy

Answer 5

Severe renal disease, MI, diuretics, MG, pregnancy or breastfeeding

Question 6

Bipolar treatment for pregnant women?

Answer 6

Clonzepam, esp first trimester

Question 7

Bipolar with elevated LFTs and hepatitis?

Answer 7

Valproate (also causes n/v/d and rash)

Question 8

Bipolar with steven’s johnson syndrome?

Answer 8

Lamotrigine, but less often carbamazepine

Question 9

Bipolar with agranulocytosis?

Answer 9

Carbamazepine
If ANC less than 1000 d/c med
above that monitor with weekly CBC

Question 10

Bipolar and increased AFP in pregnant female

Answer 10

Valproate or carbamazepine, likely Neural tube defect

Question 11

Therapeutic levels of lithium, valproate, and carbamazepine?

Answer 11

Lithium: .6-1.2
Valproate: 6-12
Carbamazepine: 60-120

Question 12

MDD: Most important first question and risk factors?

Answer 12

Assess for suicidal ideation

Prior Attempt, >45, white, male, serious illness, detailed plan, no support, ETOH, drug use

Question 13

Polysomnogram findings of MDD and atypical lab test results?

Answer 13

Shortened REM latency, more frequent REM

Dexamethasone suppression test-> failure to suppress

Question 14

Uncomplicated bereavement

Answer 14

No suicidal ideation except thoughts of being with loved one, No psychosis except hearing/seeing loved one, May rarely treat with antidepressants

Question 15

Adjustment disorder

Answer 15

Sxs initiate less than 3 months after major life stressor, sxs out of proportion with stressor, must resolve within 6 months

Question 16

Patient eating more, gaining weight, sleeping more, “leaden paralysis” in morning

Answer 16

Atypical depression, hypersensitive to rejection, may affect social functioning, treat with MAOi

Question 17

First line treatment for MDD, OCD, bulimia, anxiety, PTSD, or premature ejaculation?

Answer 17

SSRI

Question 18

SSRI that does not require tapering?

Answer 18

Fluoxetine

Question 19

SSRI with the most drug-drug interactions?

Answer 19

Paroxetine

Question 20

SSRI with the fewest drug-drug interactions?

Answer 20

Citalopram

Question 21

Myoclonic jerks, n/v/d, tachycardia, high BP, hyperreflexia?

Answer 21

Serotonin syndrome, usually SSRI and MAOi combined

Question 22

SSRI treatment with loss of erection or ejaculation?

Answer 22

Switch to bupropion unless history of bulimia, seizures, or alcoholism

Question 23

Antidepressant for old, skinny, sad ladies?

Answer 23

Mirtazapine, Inc appetite and sleep.

Question 24

Treatment for hypertensive crisis on MAOi?

Answer 24

IV phentolamine

Question 25

TCA overdose most common cause of death and treatment?

Answer 25

Arrhythmia -> Torsades de Pointes, v-fib,

Tx: Activated charcoal w/in 2 hours, otherwise sodium bicarbonate

Question 26

Schizophrenia incidence in general population, siblings, and identical twins?

Answer 26

1% gen pop, 10% siblings, 50% id twins

Question 27

Treatment for schizoaffective disorder?

Answer 27

Antipsychotic and SSRI if depressed or Lithium if manic

Question 28

Treatment for MDD with psychotic features?

Answer 28

Antipsychotics and SSRI or ECT (esp in Preggers)

Question 29

What are low potency typical antipsychotics, high potency, and what different side effects do they have?

Answer 29

Low: Chlorpromazine, Thioridazine, less EPS more Anti-ACh
High: Haloperidol, Fluphenazine: More EPS

Question 30

For non adherent psychotic patients, what med changes can be made?

Answer 30

decanoate forms of drugs every 2-4 weeks

Question 31

Antipsychotic with prolonged QT and pigmentary retinopathy?

Answer 31

Thioridazine

Question 32

Jaundice and purple-grey metallic rash?

Answer 32

Chlorpromazine

Question 33

What is the first step when a patient presents with panic disorder (SOB, palpitations, chest pain)

Answer 33

Rule out medical causes: EKG, cardiac enzymes, echocardiogram, TSH/T4, urine drug screen

Question 34

Treatment for GAD?

Answer 34

Buspirone with short term benzodiazepines to bridge

Question 35

OCD treatment and associated disorder?

Answer 35

SSRIs first line, but clomipramine is most effective

Strong association with Tourettes

Question 36

Signs of lithium toxicity

Answer 36

Coarse tremor, confusion, ataxia, diarrhea

Tremor and diarrhea are specific to lithium among mood stabilizers

Question 37

Psychotherapy for borderline personality disorder?

Answer 37

Dialectical behavioral therapy, a variant of cognitive behavioral therapy

Question 38

Dissociative amnesia

Answer 38

Inability to recall important personal information or history, usually of a traumatic nature. It is reversible, and patients may display amnesia to events one day, but recall them later.

Question 39

TCA overdose complications?

Answer 39

supraventricular tachyarrhythmias; ventricular tachycardia; prolongation of the PR, QRS, and QT intervals; bundle branch blocks; and ST or T wave changes
Orthostatic hypotension
Anti-cholinergic side effects

Question 40

Lewy Body dementia

Answer 40

Intermittent confusion, hallucinations, psychotic behavior, often unusual sensitivity to EPS from neuroleptics.

Question 41

Naltrexone

Answer 41

Mu-opioid antagonist useful for alcohol dependence treatment. Reduces relapse rate, cravings, and severity of relapse

Question 42

Buprenorphine

Answer 42

Partial Mu agonist, used in opioid dependence therapy

Question 43

What can be done to minimize the side effects of ECT?

Answer 43

Unilateral electrode placement

Question 44

Prevention of PTSD?

Answer 44

Propranolol