Primary Psychiatric

Question 1

Protective factors for anxiety disorder

Answer 1

Social support
Religiosity
Physical activity
Cognitive stimulation
Effective coping skills

Question 2

Drugs that mimic anxiety

Answer 2

Sympathomimetics
Salbutamol
Theophylline
Thyroxine
Caffeine
Amphetamine
WITHDRAWAL from sedatives

Question 3

Illnesses that mimic anxiety as per dsm

Answer 3

Endocrine (HyperThyroid, pheo, hypoglycaemia,hyperadrenocortisolism)
CVDisroder (CHF, PE)
Reso
B12, porphyria
Hypoxia
Ischenia
Metabolic changes (hypercalcemia, hypoglycaemia)

Question 4

Comorbid anxiety and depression leads to what deleterious effect

Answer 4

-increase in severity of illness
-increased suicidaity
-increase cognitive decline
-chronic course

Anxiety in general

-other places list worse QOL and worse mortality

Question 5

Illnesses that mimic panic attacks as per DSM

Answer 5

-vestibular dysfunction
-seizures
-cardiac (SVTas, afib,
-COPD
-hyperT4
-hyperparathyroidism
-pheo

Question 6

Differences in anxiety presentation young vs old

Answer 6

• more worry
  -more sleep disturbance
  -late onset usually signals depression
  -may be related to medical cause
  -late onset agoraphobia becomes more common (and not related to panic disorder)
  -GAD: more health, more about fam
  -OCD: more hand washing, more sinning
  -greater cognitive function impairment

Question 7

Mechanism for how anxiety affects cognitive impairment

Answer 7

-may be bidirectional
-can’t stop HPA axis, increased CRF, inc cortisol, alters NMDA activity and get synaptic and morphological change of hippocampus and prefrontal
- or increase in B amyloid 42 and tau hyperphosphorylation due to high HPA
-possible telomere shrinkage

Question 8

Differences in early vs late schizophrenia

Answer 8

More women
More positive symptoms
More variability in profile of cognitive deficits
Respond to Lower doses of meds
Larger thalamic volumes
More paranoid subtype, more persecutors and partition delusions
More organized delusions
Higher premorbid functioning

Question 9

AD vs schizophrenia

Answer 9

• schizophrenia has more thought control delusions, auditory hallucinations, family history of major mental Illness, more single and socially isolated

Vs AD
More visual hall and someone stealing delusions

Question 10

Service needs for patients with schizophrenia

Answer 10

Bio
Med management

Psycho
Mood and cognition monitoring

Social
Accessible services
Social integration
Social rehab
Coordination of care with primary care providers

Question 11

Psychosocial interventions for patients with schizophrenia that have been shown to improve functioning

Answer 11

Cognitive behavioural social skills training
Functional adaption skills training
CBT for psychotic symptoms
Cognitive training
Supported employment
Preventative health care programs like case managers

Question 12

Def of catalepsy vs posturing

Answer 12

-passive induction of a posture held against gravity (patient can be repositioned that the patient maintains)

Vs
Spontaneity’s and active maintenance of a posture against gravity (patient does thus spontaneously)

Question 13

Ways to improve nausea associated with Li

Answer 13

-dose at night
-slower titration
-take with food
-slow release preparations

Question 14

Meds that could cause late onset mania

Answer 14

Steroids
Thyroxine
Dopimanergic agents
Antidepressants
B2 agonists

Question 15

Benefits to lithium tx

Answer 15

-most effective mood stabilizers and treats all phases
-inexpensive
-reduces risk of suicide
-potential for Neuro protection
-decreased short term mortality

Question 16

As per paper, some psychosocial interventions used in bipolar

Answer 16

Mostly extrapolated from young data
HOPES- combines skills training and health management intervention
-medication adherence (MAST BD study)

Question 17

Factors that determine cognitive and functional abilities in persons with late life schizophrenia

Answer 17

-progression of the disease itself
-aging
-medical comorbidities
-medications
-allostatic load

Question 18

Differential for late onset anxiety

Answer 18

-depression
-dementia
-delirium
-withdrawal from substance
-medication tox (salbutamol thyroid one)
-physical illness (svts, hypoglycaemia)

Question 19

Comorbiditu of anxiety with depression leads to what deleterious effects

Answer 19

-treatment refractory
-severity of illness
-suicidal ideation and completed suicide
-increased cognitive decline
-chronic course

Question 20

Harm reduction approaches to prescribing z drugs

Answer 20

-assessing risk for drug drug interactions
-using lowest effective dose for the shortest period of time
-intermittent dosing
-regularly assessing and noting response to the intervention