Psychiatry

Question 1

1 month history of delusions; otherwise high-functioning, normal behavior.

Answer 1

Delusional disorder.

Question 2

Schizophrenic symptoms lasting >1 month but

Answer 2

Schizophreniform disorder.

Question 3

Schizophrenic symptoms lasting >1 day but

Answer 3

Brief psychotic disorder.

Question 4

Schizophrenic symptoms lasting >6 months.

Answer 4

Schizophrenia.

Question 5

Sx of amphetamine intoxication

Answer 5

Agitation, irritability, paranoia, delerium, chest pain, palpitations, tachcardia, hypotension, mydriasis, arrhythmias, seizures, hyperthermia, intracerebral hemorrhage.

Question 6

Sx of PCP intoxication

Answer 6

Physical aggression, severe agitation, impulsivity, psychosis, paranoia, nystagmus, hypertension, tachycardia, ataxia, dysarthria, muscle rigidity, seizures, coma.

Question 7

Differences between LSD and PCP intoxication

Answer 7

LSD: visual hallucinations and intensified perceptions.
PCP: agitation and aggression.

Question 8

Shyness, feelings of inferiority, and a desire to make friends that is overridden by an intense fear of embarrassment or rejection.

Answer 8

Avoidant personality disorder.

Question 9

First-line treatments for OCD are _ or _.

Answer 9

SSRIs; clomipramine (tricyclic).

Question 10

Definition of “magical thinking”

Answer 10

The belief that one’s thoughts can control events in a manner not explained by natural cause and effect. It also includes the attribution of casual incidents to supernatural forces.

Question 11

Definition of perseveration

Answer 11

The repetition of words or ideas during a conversation.

Question 12

Major risk factors for suicide

Answer 12

SADPERSONS: Sex, Age, Depression, Previous attempts, EtOH (or other substance) use, Rational though loss, Social support (lack of), Organized plan, No spouse or significant other, Sickness or injury.

Question 13

This atypical antipsychotic is less likely to cause the movement disorders commonly associated with the use of other antipsychotic medications.

Answer 13

Clozapine.

Question 14

A major side effect of clozapine is _, which means one must _.

Answer 14

Agranulocytosis; monitor WBC count.

Question 15

Besides agranulocytosis, another major side effect of clozapine is _.

Answer 15

a lowered seizure threshold.

Question 16

Sx of heroin withdrawal

Answer 16

Muscle spasms, joint pain, nausea and vomiting, diarrhea, abdominal cramps, rhinorrhea, lacrimation, sweating, mydriasis, irritability, autonomic instability (hypotension).

Question 17

How do antipsychotic medications (risperidone) cause hyperprolactinemia?

Answer 17

Antipsychotics cause dopamine blockade, and dopamine is a prolactin-inhibiting factor. Therefore, they can cause gynecomastia, galactorrhea, menstrual dysfunction, and decreased libido.

Question 18

Indications for ECT

Answer 18

Severe depression, depression in pregnancy, refractory mania, neuroleptic malignant syndrome, catatonic schizophrenia.

Question 19

Adverse reactions of ECT

Answer 19

Amnesia (anterograde or retrograde), prolonged seizures, delirium, headache, nausea, skin burns.

Question 20

These two second generation antipsychotics cause the most weight gain.

Answer 20

Olanzapine and clozapine.

Question 21

Disorder characterized by a significant mood episode (depressive or manic) with concurrent psychotic symptoms in addition to a period of psychosis without mood symptoms of at least 2 weeks.

Answer 21

Schizoaffective disorder.

Question 22

_ is a dopamine and serotonin antagonist that can cause weight gain and hyperprolactinemia, the latter of which can lead to amenorrhea and galactorrhea.

Answer 22

Risperidone.

Question 23

This disorder is characterized by excessive anxiety about multiple events, in conjunction with 3 or more of the following symptoms for at least 6 months: impaired sleep, poor concentration, easy fatigability, irritability, muscle tension, and restlessness.

Answer 23

Generalized anxiety disorder.

Question 24

A history of _ or _ are absolute contraindications for buproprion.

Answer 24

Seizures; anorexia nervosa/bulimia (due to electrolyte abnormalities).

Question 25

Is lorazepam or midazolam used for the immediate treatment of panic attacks?

Answer 25

Lorazepam.

Question 26

A type of extrapyramidal side effect that develops within hours to days of initiation or dose escalation of antipsychotics; characterized by muscle spasms or stiffness in the head and neck, including tongue protrusions or twisting, facial grimacing, torticollis, opisthotonus, and oculogyric crisis.

Answer 26

Acute dystonic reaction.

Question 27

Treatment of acute dystonic reaction.

Answer 27

Anticholinergic medication (benztropine) and/or antihistamines (diphenhydramine) that have significant anticholinergic activity.

Question 28

Treatment of choice for OCD.

Answer 28

SSRIs.

Question 29

Rush of intense fear or discomfort that peaks within minutes accompanied by >=4 cognitive or physical symptoms (e.g., palpitations, lightheadedness, nausea, fear of dying).

Answer 29

Panic attack.

Question 30

Comorbidities of panic disorder (4).

Answer 30

Major depression, bipolar disorder, agoraphobia, substance abuse.

Question 31

This medication is unique in that it has shown superiority in treatment-resistant schizophrenia associated with persistent suicidality.

Answer 31

Clozapine.

Question 32

Serious adverse effects of clozapine.

Answer 32

Agranulocytosis, seizure, myocarditis, and metabolic syndrome.

Question 33

Recommended treatment for an acutely psychotic patient experiencing command auditory hallucinations but denying suicidal/ homicidal intent.

Answer 33

Voluntary/ involuntary hospitalization.

Question 34

Difference between conversion, factitious, and malingering disorders.

Answer 34

Conversion: unintentional.
Factitious: intentional, to assume the ‘sick’ role.
Malingering: intentional, with motivation of secondary gain.

Question 35

Following acute stabilization, patients with bipolar disorder should receive the following maintenance therapy:

Answer 35

1) Atypical antipsychotics are preferred for mild to moderately ill patients.
2) Monotherapy with lithium or valproic acid can be used as alternative therapy.
3) For more severe episodes, combination therapy with lithium or valproate plus atypical antipsychotics is usually preferred over monotherapy.

Question 36

Hyperkinetic movement disorder that is a side effect of medications; typically presents within 1-6 months after starting the medication.

Answer 36

Tardive dyskinesia.

Question 37

The most likely atypical antipsychotic to cause EPS.

Answer 37

Risperidone.

Question 38

The least likely atypical antipsychotic to cause EPS.

Answer 38

Clozapine.

Question 39

Symptoms include fever, rigidity, altered mental status, and autonomic instability.

Answer 39

Neuroleptic malignant syndrome.