psychiatry

Question 1

how long does a major depression have to last to be called major depressive episode?

Answer 1

at least 2 weeks.

Question 2

what are criteria for major depressive disorder?

Answer 2

two or more major depressive episodes at least 2 months apart.

Question 3

what brain area is hypometabolic in depression?

Answer 3

dorsolateral prefrontal cortex.

Question 4

what brain areas are hypermetabolic in depression?

Answer 4

orbitofrontal cortex and subcallosal cingulate gyrus

Question 5

what brain area is the target for ECT in depression?

Answer 5

subcallosal cingulate gyrus.

Question 6

how long do manic symptoms have to last to be called an “acute manic episode?”

Answer 6

one week

Question 7

what is a mixed episode?

Answer 7

both depression and manic criteria are met over a 7 day period.

Question 8

what is the difference between mania and hypomania?

Answer 8

in a hypomanic episodes elevated mood is present for at least 4 days, but patient has insight without functional impairment.

Question 9

what is the difference between Bipolar I and Bipolar II.

Answer 9

Bipolar I is at least one episode of acute mania, bipolar II is at least one episode of hypomania.

Question 10

what is cyclothymic disorder?

Answer 10

attenuated form of bipolar disorder lasting several years. periods of hypomania with depressive sx between.

Question 11

what duration defines an acute psychotic episode?

Answer 11

> 1 day

Question 12

what is schizophreniform disorder?

Answer 12

symptoms of schizophrenia lasting more than one month but less than 6 months.

Question 13

what class of medications is safest in older adults for depression?

Answer 13

SSRIs

Question 14

what is the difference between conduct disorder and ODD?

Answer 14

conduct disorder is more severe and includes aggression towards people and animals.

Question 15

What is the difference between conduct disorder and anti-social personality disorder?

Answer 15

anti-social personality disorder can’t be given to people under age 18. Ppl with conduct disorder often go on to meet criteria for anti-social personality disorder.

Question 16

what is the difference between chronic depressive disorder and dysthymic disorder?

Answer 16

in chronic depressive disorder there are clear cut major depressive episodes with residual depression between. In dysthymic disorder people describe always being depressed without major episodes.

Question 17

what enzyme catalyzes the first step of serotonin synthesis?

Answer 17

tryptophan hydroxylase.

Question 18

what enzyme catalyzed the 2nd step of serotonin synthesis?

Answer 18

L-amino acid decarboxylase

Question 19

what class of MAO enzyme catalyzes serotonin metabolism?

Answer 19

MAO-A

Question 20

where is the principal site of seratonergic neuron cell bodies?

Answer 20

raphe nucleus

Question 21

what is the difference between suicide rates in caucasions vs african americans?

Answer 21

in caucasians the suicide risk increases with increasing age, in african americans the rate decreases after the 4th decade.

Question 22

what ethnicity has the highest suicide rate?

Answer 22

Native americans.

Question 23

which personality disorder has the highest risk of suicide?

Answer 23

borderline.

Question 24

which SSRIs have the least drug-drug interactions?

Answer 24

citalopram and escitalopram

Question 25

how or SSRIs metabolized?

Answer 25

p450 system

Question 26

which dopiminergic receptors are implicated in schizophrenia?

Answer 26

D2

Question 27

which dopaminergic pathways are implicated in schizophrenia?

Answer 27

mesolimbic and mesocortical pathways.

Question 28

what are the 3 cluster A personality disorders?

Answer 28

1. paranoid 2. schizoid 3. schyzotypal

Question 29

what is the difference between factitious disorder and malingering?

Answer 29

in factitious disorder the secondary gain is assuming the role of the patient, in malingering there is other secondary gain, such as money.

Question 30

what are the 3 cluster C personality disorders?

Answer 30

1. avoidant- excessive fear of criticism and rejection 2. dependent 3. obsessive compulsive

Question 31

which TCA antidepressant is used to treat overactive bladder? Due to activity at which receptor?

Answer 31

Imipramine. Muscarinic.

Question 32

which TCA has the most alpha adrenergic and muscarinic activity?

Answer 32

Amitriptyline

Question 33

which TCA has the least alpha adrenergic activity and so is least likely to cause postural hypotension?

Answer 33

Nortriptyline

Question 34

Which TCA is the most sedating? Due to what action?

Answer 34

Doxepin. Anti-histimine activity.

Question 35

which SSRI has the highest anti-cholinergic side effects?

Answer 35

Paroxetine

Question 36

which anti-psychotics have the most side effects?

Answer 36

Chlorpromazine and thioradazine.

Question 37

what is the treatment of acute dystonia in anti-psychotic use?

Answer 37

Benztropine

Question 38

What is adjustment disorder?

Answer 38

response to stressor that is greater than expected and occurs within 3 months of the stressor. Does not persist beyond 6 months of the stressor.

Question 39

which SSRIs are more likely to cause hyponatremia?

Answer 39

Fluoxetine and paroxetine

Question 40

what is the mechanism of action of Benzodiazepines?

Answer 40

agonist at GABAa receptors.

Question 41

What are the 4 cluster B personality disorders?

Answer 41

narcissistic, antisocial, borderline, histrionic

Question 42

what class of medication are Venlafaxine and duloxetine?

Answer 42

SNRIs

Question 43

what is the main difference between mechanism of action of SNRIs and TCAs?

Answer 43

SNRIs selectively inhibit serotonin and norepinepherine reuptake, TCAs also have muscarinic, histaminergic and alpha-adrenergic action.

Question 44

what is mechanism of action of buproprion?

Answer 44

inhibits reuptake and increases pre-synaptic release of norepinephrine and dopamine. Does not have serotonergic affects.

Question 45

what class of drug are Trazodone and nefazodone?

Answer 45

Antagonism at 5-HT2 receptors.

Question 46

what is one major adverse affect of Trazodone?

Answer 46

priapism

Question 47

what is schizoaffective disorder?

Answer 47

psychotic disorder with a concomitant mood disorder. there must be at least a 2 week period during which psychotic symptoms are present without prominent mood symptoms.

Question 48

what are the risks of using atypical antipsychotics in people with dementia?

Answer 48

increased risk of mortality and thromboemoblic events.

Question 49

what is the length of trial needed before determining if an anti-depressant is ineffective? What percentage of people respond to their first anti-depressant?

Answer 49

6 weeks, 50%

Question 50

which aspects of schizophrenia are atypical anti-psychotics better at treating?

Answer 50

negative symptoms

Question 51

Which atypical antipsychotics are most likely to cause weight gain?

Answer 51

Clozapine and olanzapine.

Question 52

which atypical antipsychotics are least likely to cause weight gain?

Answer 52

ziprasidone and apripiprazole

Question 53

Which atypical antipsychotic is least likely to cause QT prolongation?

Answer 53

Aripiprazole

Question 54

which atypical antipsychotic can cause myocarditis?

Answer 54

clozapine

Question 55

which atypical antipsychotic can cause agranulocytosis?

Answer 55

clozapine

Question 56

which atypical antipsychotic has the most muscarinic action and co can lead to dry mouth, urinary retention, confusion and constipation?

Answer 56

Olanzipine

Question 57

Which atypical antipsychotic has the most anti-histamine affects and so is the most sedating?

Answer 57

Quetiapine

Question 58

Which atypical antispychotic is the least likely to cause EPS?

Answer 58

Clozapine

Question 59

which atypical antipsychotic has a dose dependent increased risk of seizures?

Answer 59

clozapine

Question 60

what is the mechanism of action of memantine?

Answer 60

NMDA antagonist

Question 61

which mood stabilizing drug is contraindicated in sick sinus syndrome?

Answer 61

Lamotrigine

Question 62

Personality disorder with reasonable but frequent paranoid thoughts.

Answer 62

Paranoid

Question 63

personality disorder with blunted emotions and affect, dislike of relationships and social activities, preference for solitude.

Answer 63

Schizoid

Question 64

Personality disorder with discomfort with social interactions, social anxiety, bizarre and eccentric beliefs and behaviors.

Answer 64

schizotypal

Question 65

what is the demographic most likely to complete suicide?

Answer 65

men 75-85

Question 66

what is the risk of relapse after 1 major depressive episode?

Answer 66

50%

Question 67

what allele increases risk of impulsive, compulsive, and addictive disorders?

Answer 67

D2A1

Question 68

what substance is decreased in those attempting suicide?

Answer 68

5-HIAA

Question 69

in which anti-psychotic is there the highest risk of akisthesia/EPS?

Answer 69

Haldol

Question 70

which anti-psychotic is most likely to cause QT prolongation?

Answer 70

Thioridazine

Question 71

which antipsychotic can cause thyroid dysfunction?

Answer 71

Quitiepine

Question 72

which antipsychotic is most likely to cause orthostatic hypotension and dizziness?

Answer 72

Risperidol

Question 73

which antipsychotic is most likely to cause hepatic dysfunction?

Answer 73

Olanzipine

Question 74

in what lithium serum level range does delirium, abnormal EEG and renal toxicity occur?

Answer 74

2.0-2.5 mEq/L

Question 75

what are early symptoms of lithium toxicity?

Answer 75

diarrhea, vomiting, drowsiness, muscle weakness, incoordination

Question 76

which antidepressant is most likely to cause hypertension?

Answer 76

Venalfaxine

Question 77

which antipsychotics are least likely to cause weight gain?

Answer 77

Milnidone and loxapine

Question 78

injection of what substance can confirm panic disorder by precipitating a panic attack?

Answer 78

Sodium lactate

Question 79

at what phase of pregnancy should lithium be discontinued due to large shifts in serum level?

Answer 79

delivery

Question 80

what is the main affect of EtOH on sleep architecture?

Answer 80

decreased REM

Question 81

which SSRI has the highest chance of causing adverse drug-drug interactions?

Answer 81

fluvoxamine