Psych treatments: Childhood, mood, and psychosis

Question 1

What is the treatment for mental retardation

Answer 1

Genetic counseling for expectant mothers, special education, and behavior therapy to reduce negative behaviors

Question 2

The four pervasive developmental disorders occur before age 3 and include autistic disorder, rett disorder, childhood disintegrative disorder, and asperger disorder. What is the treatment for autistic disorder and childhood disintegrative disorder

Answer 2

Make them achieve independant living, use behavior modification programs

If aggressive, antipsychotics

Question 3

The four pervasive developmental disorders occur before age 3 and include autistic disorder, rett disorder, childhood disintegrative disorder, and asperger disorder. What is the treatment for rett disorder?

Answer 3

Symptomatic

1. ) Behavior therapy for self injurious behavior
2. ) Physiotherapy for muscular dysfunction

Question 4

The four pervasive developmental disorders occur before age 3 and include autistic disorder, rett disorder, childhood disintegrative disorder, and asperger disorder. What is the treatment for asperger syndrome

Answer 4

None

Question 5

What is the treatment and side effects for attention deficit hyperactivity disorder

Answer 5

First line: Methylphenidate and dextroamphetamine - side effects are insomnia, decreased appetite, and headache

Second line: Atomexetine (NE reuptake inhibitor) - even though second line, less side effects so choose this on USMLE

Question 6

Two disruptive behavior disorders are oppositional defiant disorder (argue but don’t break law) and conduct disorder (breaks laws). What is the treatment for oppositional defiant disorder

Answer 6

ODD: Teach parents appropriate child management skills

Question 7

Two disruptive behavior disorders are oppositional defiant disorder (argue but don’t break law) and conduct disorder (breaks laws). What is the treatment for conduct disorder

Answer 7

Behavior intervention - rewards for prosocial or nonaggressive behavior

If aggressive, use antipsychotics

Question 8

What is the treatment for tourette disoder

Answer 8

Antipsychotics (dopamine antagonists), i.e. risperidone

Question 9

What is the most common medical cause of major depression and must be ruled out

Answer 9

Hypothyroidism

Question 10

What is the treatments for depression

Answer 10

SSRI’s and cognitive psychotherapy to develop positive ways of thinking

Question 11

What is depression + neuropathic pain treated with

Answer 11

Desvenlafaxine

Question 12

What is depression but people who are afraid of weight gain and sexual side effects given

Answer 12

Buproprion

Question 13

For bipolar disorder, what other causes must be ruled out

Answer 13

Cocaine and amphetamines - get urine drug screen

Question 14

If someone with bipolar disorder is in the acute manic stage, what medications should you use

Answer 14

Lithium

Can also use valproic acid, atypical antipsychotics

Question 15

If someone with bipolar disorder is in the depression stage, what medications should you use

Answer 15

Lithium or lamotrigine

Question 16

Atypical depression is composed of reverse vegetative symptoms, depression worse in evening, and feeling of heaviness. What is the treatment

Answer 16

SSRI’s or MAOi’s

Choose SSRI’s on USMLE if both given, but MAOi’s are usually the answer

Question 17

What is the treatment for seasonal affective disorder

Answer 17

Phototherapy and buproprion

Question 18

What is the treatment for postpartum blues, postpartum depression, and postpartum psychosis. Postpartum depression and above have negative feelings towards babies

Answer 18

Postpartum blues: Supportive

Postpartum depression: Antidepressants. Postpartum psychosis: Antipsychotics and lithium

Question 19

Bereavement (grief) lasts less than 6 months. What is the treatment

Answer 19

Psychotherapy (never medical therapy)

Question 20

What is the treatment for serotonin syndrome

Answer 20

Stop SSRI, symptomatic treatment, and cyproheptadine

Question 21

What is the difference between brief psychotic disorder, schizophreniform, and schizophrenia

Answer 21

Duration of time

Brief psychotic is only hallucinations, delusions, disorganized speech, and disorganized behavior

Schizophreniform has added negative symptoms

Schizophrenia is really bad functioning - affects men earlier but affects both groups equally

Question 22

Like mania, what must be ruled out with brief psychotic disorder, schizophreniform, and schizophrenia

Answer 22

Cocaine and amphetamine abuse - always get urine drug screen

Question 23

After distinguishing schizophrenia from the other forms, schizophrenia can be further divided into paranoid, catatonic, disorganized, residual and undifferentiated. What is the paranoid type

Answer 23

Delusions and hallucinations of persecutory type

Question 24

After distinguishing schizophrenia from the other forms, schizophrenia can be further divided into paranoid, catatonic, disorganized, residual and undifferentiated. What is the catatonic type

Answer 24

Psychomotor disturbances - stupor, rigidity, excitement, posturing

Question 25

After distinguishing schizophrenia from the other forms, schizophrenia can be further divided into paranoid, catatonic, disorganized, residual and undifferentiated. What is the disorganized type

Answer 25

Disinhibited with little contact with reality. Early age of onset and worst prognosis

Question 26

The five kinds of psychosis are paranoid, catatonic, disorganized, residual and undifferentiated. What is the residual type

Answer 26

Lack of positive symptoms

Question 27

After distinguishing schizophrenia from the other forms, schizophrenia can be further divided into paranoid, catatonic, disorganized, residual and undifferentiated. What is the undifferentiated type

Answer 27

Not meet criteria for other types

Question 28

After distinguishing schizophrenia from the other forms, schizophrenia can be further divided into paranoid, catatonic, disorganized, residual and undifferentiated. What are all five types summed up

Answer 28

1. ) Paranoid: Delusions and hallucinations of persecutory or grandiose type 2. ) Catatonic: Psychomotor disturbances 3. ) Disorganized: Disinhibited behavior, disheveled, and bizarre emotional responses 4. ) Residual: Only negative symptoms 5. ) Undifferentiated: Not meeting criteria for other types

Question 29

Someone with psychosis presents as acutely psychotic. What is the treatment

Answer 29

Atypical antipsychotic and ensure patient safety

Question 30

Someone with psychosis presents as acutely psychotic in an emergency situation. What is the treatment

Answer 30

IM injection of olanzapine or ziprasidone

Question 31

Someone with psychosis is not compliant with their medications. What should you give them

Answer 31

Long acting antipsychotic

Question 32

If patient does not respond to antipsychotic, what is the second line treatment

Answer 32

Clozapine

Question 33

What are the side effects of olanzapine and who should you avoid it in

Answer 33

Weight gain and diabetes. Avoid in obese patients and diabetics

Question 34

What is the side effects of risperidone

Answer 34

Highest chance of movement disorders. Medium risk of obesity and diabetes If movement disorder does occur, best management strategy is replace with clozapine

Question 35

What is the side effects of quetiapine

Answer 35

Lowest chance of movement disorders. Medium risk of obesity and diabetes

Question 36

What is the side effects of ziprasidone

Answer 36

QT prolongation, avoid in patients with conduction defects. Lowest chance of weight gain and obesity

Question 37

What is the side effect of clozapine

Answer 37

1. ) Agranulocytosis - monitor CBC regular basis 2. ) Lowers seizure threshold 3. ) Lowest chance of movement disorder (EPS) of all

Question 38

What is the treatment for delusional disorder

Answer 38

Atypical antipsychotics

Question 39

What is neuromalignant syndrome and its treatment?

Answer 39

Side effect of dopamine antagonists (antipsychotics) that results in muscle rigidity (main hallmark) with hyperthermia, altered mental status, fever Leads to elevated CPK levels, and potential complication is rhabdomyolysis leading to myoglobinuria Treated with Dantrolene (muscle relaxant) and bromocriptine (dopamine agonist)

Question 40

What is serotonin syndrome and its treatment?

Answer 40

Induced by having too much serotonin (i.e. combining SSRI and MAOi) causing clonus (rhythmic contractions) with hyperthermia, altered mental status, and dilated pupils Treated by stopping SSRI and give cyproheptadine

Question 41

What are the similarities and differences between serotonin syndrome and neuromalignant syndrome

Answer 41

Similarities: Both cause altered mental status with hypertonia and autonomic overdrive (hyperthermia, tachy, hypertension, etc) Differences: Neuromalignant syndrome has a lot of rigidity in all muscle groups, while serotonin syndrome has clonus (rhythmic contractions) with mild hypertonicity. Serotonin syndrome has hyperreflexia and neuromalignant syndrome has hyporeflexia