Psych

Question 1

Are you allowed to arrange for removal of gun in Suicidal pt?

Answer 1

Yes even law enforcement can be involved

Question 2

Acute manic pt on lithium should have lithium checked. If lithium level 0.7 what to do next?

Answer 2

Can incr lithium dose to target goal 1.0. Need higher target goal within the 0.6-1.2

Question 3

Slurred speech, confusion, tremors, ataxia in someone on lithium due to

Answer 3

Chronic lithium toxicity - if lithium level high. Usually if added new med like thiazide, ace inh

Question 4

What level do u treat lithium toxicity and how?

Answer 4

Lithium level >4

Or between 2.5 to 4 with neurologic symptoms OR aki

Question 5

Is adam levine right ? Does adhd persist in adulthood?

Tx?

Answer 5

2/3 will have persistence into adulthood. Have less hyperactivity but more impulsive and inattentive. Need to tx otherwise risk of academic underachievement, unemployment, substance use

Tx with stimulant- no research shows incr substance abuse even if fam or personal hx

Question 6

Excessive preoccupation with many symptoms over 6 months is (but neg workup)

Answer 6

Somatic symptom disorder. Causing social and occupational impairment.

Vs illness anxiety disorder which is hypochondriasis

Question 7

What are favorable factors in pt with schizo?

Answer 7

Female, >40, acute onset, identifiable precipitant, mainly positive symp, no fam hx, good fam support

Question 8

Pt on haldol now w restlessness, desire to pace and move around has. What is tx?

Answer 8

Akathisia. Tx w b blocker like propranolol!

Question 9

If pt intolerant to one ssri next drug is

Answer 9

Another ssri. Common side effects are nausea, insomnia, SEX dysfunction

Note that trazodone is not as effective and side effects are sedation, n, postural hypotens

Question 10

Schizo pt who had been managed well on fluphenazine w persistent neg symp but no delusions/hallucinations. What is most appropriate tx?
Switch to second gen antipsyh
Social skills training

Answer 10

Ss training!!

Question 11

What is fluvoxamine? Tx?

Answer 11

Ssri ie for ocd

Question 12

Pt who abuses drugs comes in altered, tachy htn with bl vertigo nystagmus took what? What to do next

Answer 12

Pcp

Place in quiet room first
Then if still agitated benzo

Question 13

Depressed pt (1st ep) w improvement in symptoms wants to know when we can take off ssri

Answer 13

Keep ssri for 6 mo after improvement

Question 14

Metastatic ca Pt requesting physician assisted suicide- next step is
Talk about hospice
Ask why they feel that way

Answer 14

Why they feel that way

Question 15

Normal grief lasts for how long

Answer 15

Months and can have wishes of death without plan and can have visions or hear persona voice