Psyche

Question 1

Multiple suicide attempts, common lab finding

Answer 1

Decreased CSF levels of 5-hydroxyindolacetic acid (a/w lack of impulse control)

Question 2

TCA o/d sx? Rx?

Answer 2

Anticholinergic SE, QRS prolongation (Sodium Bicarb), arrhythmia, seizure (Diazepam), sedation, coma

Question 3

Suicide o/d hx depression p/w CNS depression, hypotension, flushin, hyperthermia, dilated pupils, ileus, flushing, prolonged QRS>100, QT,PR; dx/rx?

Answer 3

TCA o/d risk of Vtach/Vfib arrhythmias; rx ABC’s (O2, IVF) and Sodium Bicarbonate (reduces QRS, improves BP), Benzos for seizure

Question 4

Bradycardia, miosis, salivation post suicide attempt, dx/rx?

Answer 4

Organophosphate (anticholinesterase) toxicity; dx Atropine or pralidoxime

Question 5

Bipolar psychosis on risperidone and lithium, p/w tongue protrusion and lip smacking, dx/rx?

Answer 5

Tardive dyskinesia (extra-pyramidal sx); rx switch risperidone to clozapine

Question 6

Treatment resistant schizophrenia rx?

Answer 6

Clozapine; SE agranulocytosis, seizure, myocarditis, metabolic sx

Question 7

Panic disorder rx?

Answer 7

Acute w/ Benzo (lorazepam), long term CBT + SSRI/SNRI

Question 8

Restless leg sx rx?

Answer 8

Pramipexole (DA agonist) or Gabapentin (alpha2-Ca Ch ligand); may be secondary (ie. Iron deficiency..)

Question 9

Structural abnormalities in orbito-frontal cortex and basal ganglia a/w?

Answer 9

Obsessive Compulsive disorder

Question 10

Accelerated head growth during infancy and increased brain volume a/w?

Answer 10

Autism

Question 11

Decreased volume of hippocampus a/w?

Answer 11

PTSD

Question 12

Decreased volume of amygdala and left temporal lobe a/w?

Answer 12

Panic disorder

Question 13

Enlarged lateral ventricles a/w?

Answer 13

Schizophrenia

Question 14

Dysthymia, persistent depressive disorder

Answer 14

depressed mood for most days for at least 2 years + 2 or more of: disturbed sleep/appetite/concentration/energy(fatigue)/low self esteem/hopelessness

Question 15

Glascow Coma Scale?

Answer 15

Eye opening (1-4), Verbal Response (1-5), Motor (1-6)

Question 16

Child w/ motor and verbal ticks for >1 year; dx/rx?

Answer 16

Tourrette’s sx; rx. Risperidone (2nd gen antipsychotic), also Haldol, Pimozile, Clonidine, Guanfacine; a/w OCD and ADHD

Question 17

Common findings in Anorexia Nervosa?

Answer 17

Osteoperosis, elevated Cholesterol and Carotene, hypothalamic-pituitary axis dysfunction w/ amonorrhea, decreased estrogen, anovulation, cardiac arrhythmias (prolonged QT), Hyponatremia (others electrolyte abn if purging)