Psychiatry

Question 1

Recommendations for suicidal risk screening among asymptomatic adultscent?

Answer 1

I: insuffienct

Question 2

Bipolar disorder, can u use antidepressant alone?

Answer 2

It can switch to hypomania or mania, so mood stabilizer is required

Question 3

Pruritus effective non pharmacological treatment?

Answer 3

Stress reduction

Question 4

Acute stress disorder and PTSD, which medication is helpful?

Answer 4

SSRI

Question 5

Benzodiazepine use in acute stress disorder?

Answer 5

Increase incidence of PTSD

Question 6

Antipsychotic for Acute stress disorder and PTSD?

Answer 6

May be helpful for PTSD
But no in Acute stress disorder

Question 7

Diazepam ( benzones ) withdrawl

Answer 7

Over several weaks, specially if used for a long period of time

Question 8

Which medication have shown an effect to prevent suicide risk in patient with depression?

Answer 8

Lithium ( in both unipolar and bipolar depression )

Question 9

Bipolar 1, on lithium and 2nd generation antipsychotic, not improving, what to do?

Answer 9

ECT (Electroconvulsive therapy)

Can be used in severe, or treatment resistant mania

Should be used after adequate medication trial, or when mania is considered life threatening

Question 10

ECT indications?

Answer 10

1- Catatonia
2- Severe suicidality
3- Food refusal leading to nutritional compromise
4- Psychotic symptoms
5- History of positive response to ECT

Question 11

Is there a difference in suicidal risk after initiating different classes of Anti depressant?

Answer 11

All SSRI, SNRI, TCA, MAOI carries the same risk

SNRI and TCA are lethal in overdose
But SSRI not

Question 12

Define remission in depression, and when to consider withdrawl of antidepressant?

Answer 12

Remission: 2 months without symptoms (follow up every 1-2m until remission achieved)

Withdrawl: at least 4-6 months after remission achieved

Question 13

Antisocial personality disorder treatment?

Answer 13

Group based CBT is the first line

Question 14

How to monitor patients with borderline personality disorder?

Answer 14

Drug screen not indicated unless comorbid substance abused is suspected

Question 15

Somatoform Disorders

Answer 15

Is symptoms voluntarily “patients is production the symptoms”
of involunatrly?

Involuntarily:

• Physical symptoms: Somatic symptoms disorder
• Neurological symptoms “motor or sensory”: Conversion disorder (functional neurological disorder )
• Preoccupation with symptoms: Illness anxiety disorder “previously known as hypochondriasis”

Voluntarily:

Wants sick rule: Factitious disorder
Wants secondary gain: Malingering

Question 16

Criteria for Somatic symptom disorder

Answer 16

• 6m
• > 1 real physical symptoms
• Psychosocial impairment due to worrying about the symptoms

Illness anxiety disorder is the same criteria but WITHOUT A PHYSICAL SYMPTOMS (USUALLY MILD OR ABSENT”

Question 17

Functional neurological disorder ( Conversion disorder ) criteria

Answer 17

• > 1 abnormal neurological disorder not explained by other diagnosis
• Psychosocial impairment

Question 18

Factitious disorder

Answer 18

• Intentionally falsification of symptoms to assume “sick rule”
• Can be imposed on self or on another so they can play the “caregiver rule”

Question 19

Malingering disorder

Answer 19

Intetionally produces symptoms for secondary gain

• Patient not happy by negative results

Question 20

Whom happy with negative results?

Answer 20

• invoulntary
• voluntary usually NOT happy

Question 21

Which of the following medications can be used in illness anxiety disordered

Answer 21

• CBT is the first line
• SSRI is the 2nd line

Question 22

Eating disorders

Answer 22

• Binge eating: recurrent binge eating episodes. With NO weight compensatory behavior.
• Bulimia nervosa: recurrent binge eating episodes. With weight compensatory weight behavior
• Anorexia nervosa: restrictive eating + fear of weight gain + body image distortion

Question 23

Bulimia nervosa Most effective treatment?

Answer 23

• CBT

Question 24

Refeeding syndrome characteristics?

Answer 24

• HypoKALEMIA
• HypoPHOSPHATEMIA
• HypoMagnesemia
• Volume overload and Edema

Can leads to life threatnining Seizure and Arrhythmia

Question 25

Factitious stroke?

Answer 25

• Absence of facial weakness.
• Fluctating weakness

Question 26

Which are important early symptoms of autism spectrum disorders?

Answer 26

• No babbling by 9 months
• No pointing of gesture by 12 months
• No orientation to name by 12 months
• No single word by 16 months
• No pretended or symbolic play by 18 months
• No 2 word meaningful spontaneous phrases by 24 months

Question 27

The only antipsychotic medications that has higher efficacy than other is?

Answer 27

CLOZAPINE
“not used as first line due to its increased risk of agranulocytosis?