Psych treatments: Anxiety, Eating, and Sleep disorders

Question 1

Which medical conditions should be ruled out when considering an anxiety disorder, characterized by symptoms less than 30 minutes that may have agorophobia

Answer 1

Hypothyroidism, cardiac abnormalities, hypoglycemia

Question 2

What is the medical treatment for all anxiety disorders

Answer 2

SSRI’s + benzodiazapene

Do this because benzo starts acting immediately while SSRI takes some time, but once SSRI kicks in start tapering the benzo to avoid dependance.

Question 3

What is the treatment for a panic disorder vs. a panic attack

Answer 3

Panic disorder: SSRI

Panic attack: Benzodiazepene

Question 4

What is the treatment for specific phobias and social phobias (fear of any situation)

Answer 4

Behavioural modification: Systemic desensitization

Relaxation techniques

Question 5

What is the treatment for obessive compulsive disorder

Answer 5

All SSRI’s

Behaviour therapy: Exposure and response prevention

Question 6

What is the treatment of post traumatic stress disorder (more than 1 month) and acute stress disorder (2 days to 1 month)

Answer 6

SSRI: Specifically paroxetine and sertraline

Relaxation

Psychotherapy

Question 7

What is the treatment of generalized anxiety disorder

Answer 7

All SSRI’s

Venlafaxine and Buspirone

Question 8

What are some anti-anxiety medications and their special indications (the benzos)

Answer 8

Lorazepam - Given emergently through IM

Clonazepam - longer half life, give if abuse potential

Alprazolam: Given for panic disorders

Question 9

What is the risk of flumenazil

Answer 9

Can cause seizures in benzo dependant people, looks like delerium tremens

Question 10

Match the description with the intoxication: Talkative, disinhibited

Answer 10

Alcohol - treat with mechanical ventilation if severe

Question 11

Match the description with the intoxication: Euphoric, hypervigiliant, pupillary dilatation, autonomic hyperactivity, perceptual disturbances, weight loss

Answer 11

Cocaine and amphetamines. Treat intoxication with antipsychotics/benzos/antihypertensives

Question 12

Match the description with the intoxication: Impaired motor coordination, slowed sense of time, social withdrawal, increased appetite, conjunctival injection

Answer 12

Maraijuana

Question 13

Match the description with the intoxication: Ideas of reference, perceptual disturbances, impaired judgement, tremors, incoordination, dissociation

Answer 13

Hallucinogens: Treat intoxication with antipsychotics/benzos/talking down

Question 14

Match the description with the intoxication: Apathy, dysphoria, pupillary constriction, drowsy, slurred speech, coma, death

Answer 14

Opiates - treat with nalaxone

Question 15

Match the description with the intoxication: Belligerence, psychomotor agitation, violence, nystagmus

Answer 15

PCP: Antipsychotics/benzos/talking down

Question 16

Match the description with the WITHDRAWAL: Tremors, hallucinations, seizures, delerium tremens

Answer 16

Alcohol - treat withdrawal with benzos, thiamine, folic acid

Question 17

Match the description with the WITHDRAWAL: Anxiety, tremors, headache, increased appetitite, depression, risk of suicide

Answer 17

Cocaine - treat withdrawal with bupropion or bromocriptine (both mildly increase dopamine reward)

Question 18

Match the description with the WITHDRAWAL: Everything runny, including nose, eyes, diarrhea, with muscle cramps

Answer 18

Opiates - treat with clonidine, methadone, or buprenorphine

Question 19

What is the method of treatment of all somatoform disorders, which are disorders without medical explanation and include somatization, hypochondriasis, conversion, body dysmorphic disorder, and pain disorder

Answer 19

Psychotherapy - because basis is psychological in nature

Question 20

What is the difference between somatization disorder, hypochondriasis, and conversion disorder

Answer 20

Somatization: 4 pain, 2 GI, 1 sexual, 1 neuro

Hypochondriasis: Believe they have specific disease despite reassurance

Conversion: Voluntary motor and sensory functions affected in response to stressor

Question 21

What is the treatment for adjustment disorde,r, which is maladaptive reaction to IDENTIFIABLE stressor within 3 months causing impairment of function

Answer 21

Psychotherapy

Question 22

What is the treatment for all personality disorders

Answer 22

Psychotherapy

Question 23

Which personality disorders have associated short lived psychotic episodes

Answer 23

Borderline and schizotypal

Question 24

What is the most common cause of death for anorexia nervosa patient

Answer 24

Arrhythmia due to potassium deficiency (remember this because they keep throwing up)

Question 25

What is the treatment for anorexia nervosa

Answer 25

Hospitalization - dehydration, starvation, electrolyte imbalance, with psychotherapy and SSRI's

Question 26

What is the treatment for bulimia nervosa

Answer 26

No hospitalization unlike anorexia nervosa unless severe electrolyte problem, otherwise just treat with psychotherapy and SSRI's (same as anorexia nervosa)

Question 27

In what three situations do you diagnose eating disorder not otherwise specified

Answer 27

1. ) Anorexia with normal menstruation 2. ) Anorexia with normal weight 3. ) Use of compensatory behavior after eating normal amount of food (bulimia over-eat, anorexia under-eat)

Question 28

What is the diagnostic procedure and treatment for narcolepsy, charactierized by excessive daytime sleepiness

Answer 28

Forced naps during day and modafinil for alertness

Question 29

The four features of narcolepsy are sleep attacks, cataplexy, hypnogogic/hypnopompic hallucations, and sleep paralysis. What is each of them

Answer 29

Sleep attack: Irresistable sleepiness during day and feeling refreshed when waking up Cataplexy: Sudden loss of muscle tone in response to loud noise or emotions, pathognomonic Hallucinations going to sleep and waking up Sleep paralysis: Patient awake but unable to move after waking up in morning

Question 30

What is the treatments for insomnia

Answer 30

Sleep hygiene: Going to sleep and waking up at same time, avoid caffeine, avoid daytime naps Medical therapy: Zolpidem, eszopiclone, zaleplon

Question 31

The four sexual dysfunctions are impotence, premature ejacualation, dyspareunia, and vaginismus. What is the treatment for each?

Answer 31

Impotence: Psychotherapy, couples sexual therapy Premature ejaculation: Psychotherapy, stop go squeeze technique, and SSRI Dyspareunia: Psychotherapy Vaginismus: Psychotherapy and dilator therapy

Question 32

What is the treatment for paraphilias

Answer 32

Psychotherapy, aversive conditioning Medications: antiandrogens and SSRI's to reduce sexual drive

Question 33

What is the treatment for gender identity disorder

Answer 33

Sexual reassignment surgery and psychotherapy