Psych1

Question 1

Fever (T>104), confusion, muscle rigidity, and autonomic instability after initiating atypical antipsychotic:

Answer 1

NMS. This rxn is commonly seen after starting typicals but may also be observed in atypical antipsych

Question 2

Pt has delirium, diaphoresis, HTN, tachycardia, ^ temp, dilated pupils, bilateral tremors, and hyperreflexia after stopping SSRI yesterday and switching to phenelzine:

Answer 2

Serotonin Syndrome. Need to DC SSRI at least 2 weeks before starting a MAOi. Serotonin syndrome is characteristic for triad of AMS, autonomic dysregulation, and neuromuscular hyperactivity.

Question 3

MOA of mirtazapine:

Answer 3

Antidepressant: serotonin modulator

Question 4

MOA of bupropion:

Answer 4

NE/Dopamine Reuptake inhibitor

Question 5

Why is bupropion contraindicated in bulimia?

Answer 5

Bupropion lowers seizure threshold. Bulimia patients typically have electrolyte abnormalities predisposing them to seizures.

Question 6

What’s the difference between conversion disorder and somatic symptom disorder?

Answer 6

conversion disorder - neuro symptoms incompatible with known neurologic disease, often acute onset assoc with stress.

Somatic symptom disorder - excessive anxiety and preoccupation with > 1 unexplained symptom.

Question 7

OCD vs OCPD:

Answer 7

OCD - true obsession&raquo_space; anxiety and result in compulsive ritualistic behaviors to reduce it. Egodystonic.

OCPD - impairment and distress related to pervasive need for control and perfection. Egosyntonic.

Question 8

Stillbirth happens. Leave for privacy or stay for questions?

Answer 8

Stay for questions/reassurance + support

Question 9

MOA of risperidone:

Answer 9

Atypical Antipsychotic. Blocks D2c and 5-HT R