Psychiatry

Question 1

MOA of risperidone?

Side effect?

Answer 1

It is a dopamine antagonist

meaning that it will cause galactorrhea (due to non-inhibition of prolactin)

Question 2

MOA of primidone?

Side effect?

Answer 2

Anticonvulsant

can cause acute intermittent porphyria

Question 3

What is the side effect of the SSRI Imiprimine?

Answer 3

It causes increased prolactin, so it can cause infertility and galactorrhea!

Question 4

What is a long term side effect of buspirone?

Answer 4

Seizures

Ppl mainly take this for GAD, OCD, PTSD

Question 5

OCD vs OC personality disorder?

Answer 5

OCD = the pts know that what they are doing is crazy and want to get rid of their behaviors

OCPD = pts think their actions are ok

Question 6

Panic Disorder

Answer 6

Pt has panic attacks, avoids areas that may make them panic, fear of public areas (agoraphobia) and has concern (>1 month) about having additional attacks

Question 7

Differentiate:

MDD
Atypical Depression
Double Depression
Adjustment Disorder
Dysthymia

Answer 7

MDD = 2 weeks of 7 SIGECAPs

Atypical = weight gain, hypersomnia, and rejection sensitivity

Double = major depressive episode w/ dysthymia (2 years of depressed mood.)

Adjustment = Some SIGECAPs but not all, occurs 3 months after an identifiable stressor

Dysthymia = milder, chronic depression for most of the time for 2 years. Resistant to tx.

Question 8

TCA toxicity?

Answer 8

3 C’s

Convulsions
Coma
Cardiac Arrythmias (long QTc)

Question 9

MUST BE OFF SSRI’S FOR 2 WEEKS BEFORE STARTING AN MAOI

Answer 9

MUST BE OFF FLUOXETINE FOR 5 WEEKS

Question 10

Differentiate:
Postpartum blues
Postpartum psychosis
Postpartum depression

Answer 10

blues = 2 weeks PP, sad, no thoughts of harm
psychosis = 2-3 weeks PP, delusions, thoughts of harm
depression = 1-3 months PP, all of the above + sleep issues and anxiety. Thoughts of harm!

Question 11

Differentiate:
BP 1
BP 2
Cyclothymic
Rapid Cycling

Answer 11

BP1 - at least 1 manic or mixed episode (at least 1 week long)
BP2 - at least 1 major depressive episode AND 1 HYPOmanic episode
Cyclothymic - chronic, less severe alternating periods of hypomania and moderate depression for >2 years
Rapid Cycling - 4+ episodes of depression or mania in 1 year!

Question 12

Antidepressants in a BP patient can cause them to go into mania

Answer 12

Always start your mood stabilizers first

Question 13

Serotonin syndrome

Answer 13

fever, myoclonus, mental status changes

Question 14

Paroxetine can cause what in fetus?

Answer 14

Pulmonary HTN, avoid in pregnant pts

Question 15

Side effects of mirtazepine?

Venlafaxine?

MAOi?

Answer 15

Weight gain and sedation

Ven = diastolic HTN

MAOi = HTN crisis if taken w/ tyramine foods. also causes weight gain and ortho hypotension

Question 16

Avoid lithium in RF pts

Answer 16

It has a narrow TI and can cause decreased renal function if levels are too high

Question 17

Side effects of carbamaxepine?

Valproate

Lamotrigine

Answer 17

carb = nausea, rash, aplastic anemia, SJS

Valproate = GI side effects, agranulocytosis

Lamotrigine = blurry vision, SJS (increase dose slowly!)

Question 18

Schizoid vs anti social vs avoidant

Answer 18

schizoid = avoid. No emotions. loners

anti-social = break laws, impulsive. in child hood this is called Conduct Disorder

avoidant = rejection sensitive and fear of being disliked so thats why they avoid

Question 19

Schizoaffective vs Schizophreniform

Answer 19

Affective = symptoms of schizophrenia and either depression or BP

Schizophreniform = schizophrenia symptoms for

Question 20

MOA of typical antipsychotics (haldol, chlorpromazine etc.)

Side effects?

Answer 20

MOA = D blockers (treats + symptoms)

can cause EPS or hyperprolactinemia
can cause anticholinergic effects
QTc elongation
NMS

THORIDAZINE CAUSES IRREVERSIBLE RETINAL PIGMENTATION

Question 21

MOA of atypical antipsychotics (clozapine, risperidone, aripiprazole, olanzapine, quetiapine)

Side effects?

Answer 21

dont know MOA. dont use clozapine unless everything else fails (it causes agranulocytosis and needs to have a weekly CBC.)

Can all cause weight gain and t2DM, but less EPS symptoms!

Question 22

EPS side effects?

Answer 22

4 hours - acute dystonia (twisted neck) tx = anticholinergics
4 days - akinesia. (pseudo parkinsons) tx = anticholinergics
4 weeks - akathesia. (restlessness) tx = BBs and antichol
4 months - TD. d/t chronic D blockade. tx = anticholinergics (although these may worsen the symptoms at first!) and change drug to clozapine or risperidone (atypicals)

Question 23

Differentiate:
Aspergers
Rett
Childhood disintegrative disorder

Answer 23

Aspergers = autism but w.o the language or cognitive delays

Rett = neurodegenerative disorder in girls (impairment in language, head growth, and coordination after 5 months of normal development.)

Childhood dis = developmental regression > after 2 years of normal development (language, bowel control, motor skills etc..)

Question 24

Mild, moderate, or profound Mental Retardation

Answer 24

mild = IQ of 50-70
mod = IQ of 35-49
profound = IQ

Question 25

What do pupils look like in these abuses:
opioids
amphetamines
cocaine
PCP

Answer 25

opioids - constriction
amphetamines - dilation
cocaine - dilation
PCP - vertical/horizontal nystagmus

Question 26

People with anorexia nervosa may still binge/purge

Answer 26

differentiate it from bulemia if they are underweight and dont see anything wrong with what they are doing

DONT GIVE BUPROPRION TO EATING DISORDER PTS B/C IT CAN LOWER THE SEIZURE THRESHOLD!

Question 27

lanugo

Answer 27

soft fine hairs that grow on pts with eating disorders

Question 28

Tx for narcolepsy?

Answer 28

Naps, benzos (stimulants) and/or SSRI’s if they have cataplexy (sudden loss of muscle tone)

Question 29

How are factitious disorders and malingering different from somatoform disorders?

Answer 29

Somatoform disorders have no conscious control or intentional process!

malingering = they are pretending to be sick for a tangible gain

Question 30

Conversion vs Somatoform?

Answer 30

somatoform - multiple symptoms in different organ systems

conversion - motor/sensory function disorders linked to a relationship of stress