Psych

Question 1

Medical causes of psychosis?

Answer 1

CNS injury (trauma, mass, infection, CVA, seizure)
Metobolits - Porphyria, Wilson's)
Systemic dz (SLE, thyroiditis)

Question 2

What is one problem with taking St. John’s wort?

Answer 2

Drug-drug interactions, especially making OCPs less effective
Does seems to have some efficacy of mild-to-moderate depression

Question 3

Which SSRIs can be activating?

Answer 3

Fluoxetine, Buproprion

Question 4

anxiety that is persistent x 6 month

Answer 4

General anxiety disorder

Question 5

anxiety that is episodic

Answer 5

Panic disorder

Question 6

Common side effects when starting a SSRI

Answer 6

GI (nausea) and activating syx

Self-limiting

Question 7

If a pt shows improvement on max dose of an SSRi but not full resolution of depressive syx, what can you do?

Answer 7

You can add a second agent ( like a SNRI)

Question 8

What are good prognostic factors in schizophrenia

Answer 8

Acute onset
Older age at onset
Having predominant positive symptoms
Early intervention

Question 9

What is the difference between acute stress disorder and PTSD

Answer 9

Acute stress is 3-30 days past the traumatic event

PTSD is when syx are for > 1 month

Question 10

What should be considered before starting varenicline

Answer 10

Psych history and h/o SI

Has a neuropsychiatric side effects

Question 11

Tourette’s is associated with what two other psych conditions?

Answer 11

OCD

ADHD

Question 12

Non medication intervention for OCD?

Answer 12

Exposure and response prevention therapy

Question 13

Medication to reduce alcohol cravings

Answer 13

Naltrexone

Can be initiated in ppl that are still drinking but not on opioids

Question 14

Treatment for catatonia

Answer 14

Benzo or ECT

Question 15

Tx for Tourettes ?

Answer 15

Second gen anti psychotics (risperidone, aripiprazole), these are preferred because of favorable side effect profile

Question 16

Which antihypertensives can raise lithium levels?

Answer 16

Thiazides
ACEI/ARB
Seems like the ones that act on the kidney raise Lithium

Question 17

How do antipsychotics affect the mortality of elderly pts

Answer 17

Increases risk of mortality, but sometimes the benefits of short term use out weigh the risks

Question 18

Intoxication with bizare behaviors and agitation lasting 8 hours

Answer 18

PCP intox

Do better with benzos

Question 19

When do you need to HD lithium toxicity?

Answer 19

Li >4

Or >2.5 in the setting of renal failure

Question 20

What age is it typical to see kiddos with night terrors?

Answer 20

Usually age 4-12
Looks like a seizure but no accidents
Self-resolves in 1-2 years

Question 21

When a patient has anxiety and is fixated on >1 somatic symptoms

Answer 21

Somatic symptom disorder

Question 22

pt on antipsychotics has the feeling of restlessness and can’t sit still. Dx Tx?

Answer 22

Akathesia

Propanolol or reduce dose of anti psychotic

Question 23

How long does a patient have to wash out from an SSRI before starting an MAOI

Answer 23

5 weeks

if too soon, they’re at risk of serotonin syndrome

Question 24

1st line SSRI in breastfeeding mothers?

Answer 24

Sertraline or paroxetine

Question 25

What needs to be monitored in a patient taking clozapine?

Answer 25

Neutrophil counts

Increased risk of neutropenia

Question 26

After a patient gets halloo they have torticolis. What wrong?

Answer 26

Acute dystonia

Give Benadryl