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UWorld > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Pt intentially produce SS for the purpose of assuming the “sick role”. Dx?

A

Factitious disorder.

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2
Q

Pt intentially produce SS for the purpose of secondary gain (drugs, avoiding work, financial gain, etc.). Dx?

A

Malingering.

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3
Q

Pt reports motor or sensory neurologic deficits that are incompatible with recognized neurological diseases. Dx?

A

Conversion disorder.

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4
Q

Excessive preoccupation with having a serious illness with few or no Sx and negative workups. Dx?

A

Illness anxiety disorder.

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5
Q

Excess anxiety about ≥1 unexplained symptoms that the patient experiences. Dx?

A

Somatic symptom disorder.

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6
Q

Paranoid personality disorder Sx?

A

Suspicious
Distrustful
Hypervigilant

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7
Q

Schizoid pesonality disrder Sx?

A

Loner
Detached
Unemotional

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8
Q

Schizotypal personality disorder Sx?

A

Eccentric

Odd thoughts, perceptions, behavior

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9
Q

Antisocial personality disorder Sx?

A

Disregard/violate rights of others

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10
Q

Borderline personality disorder Sx?

A 
Chaotic relationships
Sensitive to abandonment
Labile mood
Impulsive
Inner emptiness
Self-harm
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11
Q

Histrionic personality disoder Sx?

A

Dramatic
Superficial
Attention-seeking

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12
Q

Narcissistic personality disorder Sx?

A

Grandiosity
Entitlement
Lack of empathy

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13
Q

Avoidant personality disorder Sx?

A

Avoidance due to fears of criticism/rejxn

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14
Q

Dependent personality disorder Sx?

A

Submissie
Clingy
Needs to be cared for

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15
Q

OCD personality disorder Sx?

A

Rigid, controlling, perfectionist

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16
Q

Neuroleptic malignant syndrome is mediated by dysfxn of what neurotransmitter?

A

Dopamine. D2 receptor antagonism results in movement issues, autonomic instability, confusion, and fever.

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17
Q

Pt being treated for psychosis with muscle rigidity, AMS, and blood pressure issues who also has a high fever. Dx?

A

Neuroleptic malignant syndrome

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18
Q

Elderly woman with fluctuating disturbances in behavior. She has a fever and was recently placed on antibiotics for “some kind of infxn” says her son. Dx?

A

Delirium. Mood changes, anxiety, agitation, and sleep disturbances are classic.

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19
Q

What are SE of electroconvulsive therapy?

A

Anterograde and retrograde amnesia.

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20
Q

Electroconvulsive therapy indicated for?

A

Major depressive episode
Bipolar depression
Bipolar mania
Catatonia

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21
Q

20s female presents with abd bloating, HA, fatigue, and mood swings. She says they last about a week and then subside. She has had these cyclically for years. Hx of depression. Denies any depression Sx now or suicidal thoughts. Dx?

A

Premenstrual dysphoric disorder (PMDD).

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22
Q

Next step in management of a Pt. with symptoms of premenstrual dysphoric disorder?

A

Menstrual diary. These determine relationship of symptoms to menstrual cycle phase.

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23
Q

Clozapine indications?

A

Rx-resistant schizophrenia and schizoaffective disorder

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24
Q

Clozapine SE?

A

Neutropenia Agranulocytosis rarely - Pts. required to be part of registry to monitor neutrophil counts before dispensing drugs.

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25
Q

Amantadine indications?

A

Parkinsonism. It is a dopaminergic agent.

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26
Q

Benztropine indications?

A

Acute dystonia. Has strong anticholinergic properties.

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27
Q

What is akathisia?

A

Restlessness.
a = without
kathazein = sitting

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28
Q

Abrupt discontinuation of benzos can result in?

A

Withdrawal symptoms within 1-2 days. Sx include seizures, psychosis, tremors, insomnia, anxiety. This is potentially life threatening.

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29
Q

An elderly female reports decreased total sleep time, more waking at night, and sleepiness earlier in the evening with earlier morning awakening, and a need to take naps during the day. Dx?

A

Normal age-related sleep changes. Do not prescribe benzos or nonbenzo hypnotics (zolpidem) for these normal changes. Unless the Pt. experiences significant impairment in activities of daily living/cognition, no workup/meds are necessary.

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30
Q

Advantage of bupropion?

A

No sexual SE or weight gain.

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31
Q

SE of bupropion?

A

Can worsen anxiety

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32
Q

Rx for panic disorder?

A

CBT

SSRI

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33
Q

Rx for agoraphobia?

A

CBT

SSRI

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34
Q

Antipsychotics lead to infertility how?

A

Blocking of dopamine leads to hyperprolactinemia which causes galactorrhea, menstrual irregularities, and infertility.

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35
Q

Antipsychotics with highest potential to cause infertility?

A 
Haldol
Fluphenazine
Risperidone
Paliperidone (a risperidone metabolite)
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36
Q

Dx of MDD requires?

A 
5/9 of SIGECAPS:
Sleep changes
Interest deficit
Guilt
Energy deficit
Concentration deficit
Appetite changes
Psychomotor changes
Suicidal
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37
Q

MDD Rx?

A

Psychotherapy

Antidepressants

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38
Q

MDD patients who fail first-line antidepressants might benefit from what?

A

Another first line medication in a different class (eg bupropion from an SSRI, etc.)

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39
Q

SNRI names?

A

Venlafaxine
Desvenlafaxine
Duloxetine

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40
Q

NDRI name?

A

Bupropion

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41
Q

MAOI names?

A

Phenelzine

Trancylcpromine

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42
Q

Body dysmorphic disorder Sx?

A

Preoccupation with ≥1 perceived physical defects.

Defects not observable or are only slight to others.

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43
Q

Body dysmorphic disorder Rx?

A

SSRI

CBT

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44
Q

Pediatric depression can present how?

A

Irritability rather than mood depression

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45
Q

Appropriate Rx for pediatric depression?

A

Psychotherapy and/or SSRIs (fluoxetine is DOC).

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46
Q

Within what time period would delerium tremens set in?

A

48-96 hours after last drink. Withdrawal Sx may begin within 6 hours, but severe w/d not until 2 days or so after.

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47
Q

Sx of delerium tremens?

A 
Confusion/agitation
Fever
Tachycardia
HTN
Diaphoresis
Hallucinations
Fatal in 5% of cases
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48
Q

Any time a patient has a life altering event like stroke, cancer, etc. is depression normal?

A

No and it should be treated with antidepressants and/or psychotherapy.

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49
Q

Due to risk of agranulocytosis, what antipsychotic is reserved for pts who failed 2 other antipsychotics?

A

Clozapine.

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50
Q

First-line in psychosis?

A

Second-gen antipsychotics due to lower extrapyramidal SE/tarditive dyskinesia (Quetiapine, olanzapine, ziprasidone, ariprazole, risperidone).

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51
Q

Greatest RF for suicide?

A

Prior attempt.

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52
Q

First-line Rx for alcohol use disorder?

A

Naltrexone, a mu-opioid receptor antagonist OR
Acamprosate, a glutamate modulator.
Both used to curb cravings.

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53
Q

Contraindications to naltrexone in alcohol use disorder?

A

Opioid dependence. Can precipitate withdrawal.

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54
Q

Contraindications of acamprosate?

A

Renal failure.

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55
Q

Pt with psychosis and delusions has failed Rx with 2 other second-gen antipsychotics. What is next step in management?

A

Clozapine. Used in failed attempts to control with 2 other antipsychotics. Risk of agranulocytosis.

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56
Q

Pervasive pattern of argumentative and defiant behavior toward authority figures, but not so far as to violate the basic rights of others. Dx?

A

Oppositional defiant disorder. Pattern of angry/irritable mood, argumentative/defiant, or vindictiveness for ≥6months. Blames others for own mistakes, easily annoyed.

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57
Q

Rx for Oppositional defiant disorder?

A

Psychotherapy (anger management, social skills training). No meds, unless comorbid ADHD.

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58
Q

Pt. on antipsychotics with sudden, sustained contraction of neck, mouth, tongue, and eye muscles. Dx?

A

Acute dystonia.

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59
Q

Acute dystonia Rx?

A

Benztropine

Diphenhydramine

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60
Q

Pt on antipsychotics with restlessness, inability to sit still. Dx?

A

Akathisia.

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61
Q

Akathisia Rx?

A

Beta blocker (propanolol)
Benzo
Benztropine

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62
Q

Antipsychotic induced parkinsonianism Rx?

A

Benztropine

Amantadine

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63
Q

Gradual onset dyskinesia of mouth, face, trunk, extremities after several months of antipsychotic Rx. Dx?

A

Tarditive dyskinesia.

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64
Q

Tarditive dyskinesia Rx?

A

Valbenazine.

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65
Q

Denial?

A

Failure to accept disturbing aspect of reality

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66
Q

Displacement?

A

Transfer of feelings/impulses toward safer/more acceptable person/situation (person with new cancer Dx becomes more concerned about dying 90yo mother and ignores themselves)

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67
Q

Rationalization?

A

Justify/excuse behaviors rather than ackowledging the true motives, significance, or connsequences

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68
Q

Rxn formation?

A

Transforming an unacceptable feeling/impulse into its extreme opposite (pt with new cancer Dx with fear of dying now suddenly is fearless and super optomistic about a morbid diagnosis)

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69
Q

First-line Rx for an acute bipolar depressive episode (eg a major depressive episode during bipolar disorder)?

A

2nd gen antipsychotics (quetiapine and lurasidone) or lamotrigine (anticonvulsant)

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70
Q

SSRI given to pt with Hx of mania can lead to?

A

Precipitation of mania.

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71
Q

Postpartum depression Rx?

A

Antidepressants (SSRI)

Psychotherapy

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72
Q

CBT primary indications?

A 
Depression
General anxiety disorder
PTSD
Panic disorder
OCD
Eating disorder
Negative thought patterns
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73
Q

Psychodynamic psychotherapy primary indications?

A

Personality disorders

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74
Q

Motivational interviewing indicated for?

A

Substance use disorder (nonjudgemental, enhances motivation)

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75
Q

Dialectical behavioral therapy indication?

A

Borderline personality disorder. Emproves emotion regulation, distress tolerance, mindfulness, reduces self harm.

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76
Q

Biofeedback therapy indications?

A

Pain disorders

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77
Q

Pt presents with blank stare, not speaking, and is motionless. He has Hx of depression and psychosis and delusions. He resists efforts to move his limbs. Dx?

A

Catatonia. Characterized by immobility or excessive purposeless activity. Mutism and stupor are classic. Rx: benzos and ECT

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78
Q

Catatonia Rx?

A

Benzos

ECT

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79
Q

First-line maintenance Rx for bipolar disorder?

A

Lithium
Valproate
Quetiapine
Lamotrigine

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80
Q

Pt taking antipsychotic becomes confused with high fever and cannot move his body. BP is low and he sweats profusely. Dx?

A

Neuroleptic malignant syndrome.

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81
Q

Rx for Neuroleptic malignant syndrome?

A

Stop antipsychotics
Start dopamine agents
Supportive care (cooling, hydration)
Dantrolene or bromocriptine if refractory

82
Q

Binge-eating disorder Sx?

A

Recurrent binge eating with lack of control, but NO compensatory behaviors (eg vomiting, diuretic abuse)

83
Q

Anorexia nervosa Sx?

A

Significantly low weight (BMI<18.5).
Fear of gaining weight.
Distorted body image.
Subtypes: binge/purge, restricting

84
Q

Bulimia nervosa Sx?

A

Normal or high BMI (>18.5)
Recurrent binges
Compensatory behavior to prevent weight gain (vomiting/exercise)
Worry about shape/weight

85
Q

Narcolepsy with excessive daytime somnolence Rx?

A

Modafinil - nonamphetamine stimulant.

86
Q

When a patient does not acknowledge the problem (drinking, etc.), the physician’s tole is to?

A

Suggest that the abuse may play a role in the problem.

87
Q

Panic disorder acute Rx?

88
Q

Panic disorder long-term Rx?

A

Antidepressants

CBT

89
Q

Dx timeframe: brief psychotic disorder?

A

Up to 1 month

90
Q

Dx timeframe: Schizophreniform disorder?

A

1 months to 6 months (no fxnal decline required as in schizophrenia)

91
Q

Dx timeframe: Schizophrenia?

A

≥6months (requires fxnal decline)

92
Q

Schizophrenia-like symptoms with concurrent mood disorder?

A

Schizoaffective disorder.

93
Q

Delusional disorder Sx?

A

1 or more delusions for >1 month, but WITHOUT other psychotic symptoms and normal fxn aside from delusions

94
Q

Obessions and compulsions in OCD are defined by?

A

Obsessions: recurrent/intrusive thoughts
Compulsions: Repeated behaviors/mental acts in response to obessions

95
Q

OCD Rx?

A

SSRI

CBT (exposure and response prevention)

96
Q

Pt is increasingly restless with increasing dosage of his antipsychotic meds. His hallucinations are gone. Dx?

A

Akathisia due to meds. Rx: give beta blocker (propanolol 1st line) and reduce the antipsychotic dose

97
Q

Pt with fear of heights who cannot even walk up stairs or take elevators finds relief with benzos in acute setting. What other Rx might help?

A

CBT with exposure therapy

98
Q

Lithium toxicity Sx?

A

Acute: GI (NVD)
Chronic: Confusion, agitation, ataxia, tremors, fasciculations

99
Q

Lithium drug interactions leading to toxicity?

A

Thiazides
NSAIDs
ACEI
Some ABx

100
Q

Management of severe lithium OD?

A

In severe cases, hemodialysis may be needed.

101
Q

Adjustment disorder Sx?

A

Impaired fxning after a change or secondary to a change in one’s life

102
Q

Oppositional defiant disorder Sx?

A

Angry
Argumentative, Vindictive
for 6 months or more

103
Q

Separation anxiety disorder Sx?

A

Extreme, persistent anxiety with separation. Excessive worry about losing parents, whomever.
Physical Sx result (HA, stomach ache, etc.)

104
Q

MC SE of Olanzapine?

A

Weight gain

Sedation

105
Q

MC SE of Clozapine?

A

Leukopenia and agranulocytosis.

106
Q

Nephrogenic DI SE of what drug?

107
Q

Onset of postpartum depression?

A

4-6 weeks, but can occur up to a year after birth

108
Q

Onset postpartum blues (not depression)?

A

2-3 days resolving in 2 weeks.

109
Q

Onset postpartum psychosis?

A

Variable: days - weeks

110
Q

Postpartum depression Rx?

A

Antidepressants

Psychotherapy

111
Q

Conversion disorder Sx?

A

Sudden onset of neurological Sx without a recognizable neurological condition (lady loses eyesight after seeing child drown, but PE is normal)

112
Q

Another name for illness anxiety disorder?

A

Hypocondriasis

113
Q

Rx of MDD with psychotic features (delusion/hallucinations)?

A

Combo antidepressant and antipsychotic OR ECT

114
Q

What psychiatric symptoms are NOT present in delusional disorder?

A

Mood symptoms (depression, mania)

115
Q

Major depressive mood or manic episode concurrent with schizophrenia symptoms. Dx?

A

Schizoaffective disorder.

116
Q

How can bipolar with psychotic features, schizophrenia, and schizoaffective disorder be differentiated?

A

Bipolar and MDD with psychotic features: only presents with psychosis during mood episodes. Schizoaffective: has significant mood symptoms with psychotic Sx and psychotic Sx without mood sx
Schizophrenia: mood symptoms are brief

117
Q

Complications of anorexia nervosa?

A 
Hypothermia
Malnutrition
Dehydraton
Orthostasis
Arrhythmia (brady esp)
Refeeding syndrome
118
Q

When does an anorexic patient require hospitalization?

A 
When they become medically unstable due to their condition. Complications include:
Hypothermia
Malnutrition
Dehydration
Orthostasis
Arrythmias (bradycardia)
Refeeding syndrome
119
Q

SAD PERSONS acronym?

A 
Suicidality assessment:
Sex
Age
Depression
Previous attempt
EtOH/drugs
Rational thought (psychotic?)
Support
Organized plan
No spouse/GF/BF
Sickness or injury
120
Q

All depressed patients should be screened for?

A

Suicidal ideation, intent, plan.

121
Q

Active suicidality requires what two things?

A

Intent and plan. They often need to be hospitalized.

122
Q

Pts with a single episode of MDD should continue antidepressants for how long?

A

6 months following the acute response.

123
Q

Pts with recurrent, chronic, severe episodes of depression should continue antibiotics for how long?

A

1-3 years or indefinitely.

124
Q

MDD effects on the hypothalamic-pituitary-adrenal axis?

A

Hyperactive HPA lead to increased cortisol levels.

125
Q

A pt with elevated mood and psychotic features likely has?

A

Mania. Psychosis only occurs in mania, rather than hypomania where no psychosis occurs.

126
Q

Mania vs hypomania?

A

Hypomania does not lead to impairment or hospitalization like mania.

127
Q

Bipolar 1 Sx?

A

Mania (impairment) with depressive episodes. Depression not required for Dx.

128
Q

Bipolar 2 Sx?

A

Hypomania (nonimpaired) with ≥1 major depressive episode.

129
Q

Cyclothymic disorder Sx?

A

≥2 years fluctuating, mild hypomania and depression Sx that do not reach criteria for hypomanic or major depressive episodes

130
Q

DIGFAST acronym?

A 
Manic episode criteria - 3+ of following:
Distractibility
Impulsivity
Grandiosity
Flight of ideas
Activity
Sleep
Talkativeness/pressured speech
131
Q

Impaired social communication and interactions and restricted/repetitive patterns of behavior in a 2-3 year old may indicate?

132
Q

Autism Rx?

A 
Early Dx/intervention
Multimodal Rx (speech, behavioral, educational services)
Drugs if psych comorbidities
133
Q

Survivors of sexual assault are at increased risk for?

A

PTSD
Depression
Suicidality and attempts

134
Q

An elderly male with loss of interest in food and activities also presents with auditory hallucinations. He is losing weight. He has poor sleep and ruminates on prior events like treating his brother poorly when younger. A trial of SSRIs has failed to manage the Sx. Dx and Rx?

A

Major depressive disorder with psychotic symptoms. This patient failed the SSRI and is a candidate for ECT. Antidepressants take 6-8 weeks to respond and must be combined with antipsychotic drugs to treat MDD with psychotic features. ECT is appropriate in a patient with severe depression who is not eating.

135
Q

Social anxiety disorder Sx?

A

Social phobia. Marked anxiety about ≥1 social situation for ≥6 months. Fear scrutiny of others.

136
Q

Social anxiety disorder Rx?

A

SSRI/SNRI
CBT
ß-blocker or benzo for performance-only subtype

137
Q

Hoarding disorder Rx?

A

CBT

SSRIs have limited efficacy.

138
Q

SE of TCAs?

A

AMS
Sz
Cardiac conduction delay (QRS duration>100msec associated with increased risk arrhythmias)
Anticholinergic Fx

139
Q

Panic disorder key idea

A

Unexpected panic attacks

140
Q

Generalized anxiety disorder key idea

A

Chronic multiple worries (work, relationship, kids, etc.)

141
Q

Social anxiety disorder key idea

A

Fear of scrutiny

142
Q

Dysthymia key idea?

A

(aka persistent depressive disorder) Characterized by chronic depressed mood

143
Q

Dysthymia definition

A

Persistent depressive mood with ≥2 other depressive symptoms lasting ≥2 years.

144
Q

Dysthymia differs from MDD how?

A

Dysthymia never reaches criteria for MDD. MDD requires depressed mood + 5/9 SIGECAPS criteria for Dx.

145
Q

Second generation antipsychotic MOA?

A

Serotonin 2A and dopamine D2 receptor antagonism

146
Q

Common SE of risperidone?

A

Prolactin elevation

Some alpha and histamine agonist activity

147
Q

What antidepressant inhibits reuptake of NE and DA?

148
Q

Venlafaxine MOA/class?

149
Q

TCA MOA?

A

Like SNRI, Serotonin and NE reuptake inhibition.

150
Q

Define major depressive episode

A

≥2 weeks depressed mood with associated symptoms (anhedonia, sleep issues, etc.)

151
Q

Additional benefits of bupropion?

A

Mild stimulant effects (for fatigue)
Smoking cessation
Helps with weight loss
NO sexual SE

152
Q

Bupropion contras

A

SZ

Eating disorders

153
Q

Sudden onset psychosis in a child/adolescent would stim a search for?

A

Reversible conditions (medical issues/substance abuse).

154
Q

Common medical causes of psychosis in children are?

A 
SLE
Thyroiditis
Metabolic disorders
Electrolyte disorders
CNS infxn
Epilepsy
155
Q

Best statement for nonadherence in Pts?

A

Empathic/nonjudgemental
Say something confirming/understanding
“It can be hard…”

156
Q

REM sleep behavior disorder basic idea?

A

Dream enactment due to muscle atonia absence (kicking stuff, violent movements in bed, injury during sleep)

  • awaken immediately (no latency as in terrors)
  • recall dreams (unlike terrors)
157
Q

REM sleep behavior disorder may indicate what in elderly?

A

Neurodegeneration

158
Q

Nightmare disorder basic idea?

A

Vivid recall of disturbing dream content

159
Q

Nocturnal seizures basic idea?

A

SZ in kids at night - typical Sz activity only they occur at night

160
Q

Restless legs syndrome basic idea?

A

Urges to move legs - sleep distrubances - involuntary, jerking of legs during sleep, but no dream enactment

161
Q

Sleep terrors basic idea?

A

Non-REM sleep arousal disorder in kids

  • period of confusion before becoming alert
  • no recall of dreams
162
Q

Sleepwalking basic idea?

A

Non-REM sleep arousal disorder

- similar to terrors in that no recall of dream and there is confusion period

163
Q

Borderline personality disorder Rx?

A

Psychotherapy and pharmacotherapy to target mood issues/psychosis

164
Q

Bipolar 1 basic idea?

A

Full mania with or without major depressive episodes

165
Q

Bipolar 2 basic idea?

A

Hypomanic episodes (nonimpairment of life) with major depressive episodes

166
Q

Avoidant vs dependent personality disorder behaviors?

A

Avoidance of relationships due to fear of criticism/rejection vs Submissive and clingyness - requiring to be cared for rather than overtly fearing rejection as in avoidant

167
Q

First approach to Pts who experience a traumatic incident and have early signs of acute stress disorder?

A

Educate on range of reactions to normalize experience

168
Q

Acute stress disorder definition?

A

Trauma leads to ≥3 days but less than 1 month of intrusive memories, nightmares, flashbacks with intense rxns.
Amnesia, detachment, avoidance can occur

169
Q

Acute stress disorder treatment?

A

Trauma-focused CBT
Drugs for sleep/anxiety (no SSRIs until PTSD develops)
Monitor for PTSD development

170
Q

PTSD treatment?

A

SSRIs are first line

171
Q

Panic disorder main idea?

A

Unexpected panic attacks (differ from specific triggered attacks as in social anciety disorder/phobia)
Fear of future attacks
Avoidant behavior

172
Q

What psych med is contra’d in Sz, anorexia, bulemia?

A

Bupropion. It enhances Sz risk and worsens weight loss.

173
Q

60s female presents with anxiety about her children leaving for college has been drinking alcohol to fall asleep each night. Labs reveal elevated AST/ALT and macrocytosis. Likely Dx?

A

Alcohol use disorder. Women who consume >7 drinks/wk or >3/day or men who consume >14/wk or >4/day are within the definition. The elevated LFTs and macrocytosis are incidental findings that raise suspicion for alcohol abuse.

174
Q

What factor delineates normal aging memory issues from dementia?

A

Cognitive deficits that interfere with everyday activity. Dementia results in fxnal impairments that necessitate assistance. e.g. cannot operate appliances, loses interest in socializing, gets lost for hours in familiar areas

175
Q

What is the key to somatic symptom disorder management?

A

Frequent, regularly scheduled visits to PC. This will minimize unnecessary testing, interventions, and referrals and will help ID psychological stressors by forming a strong Pt-Dr bond.

176
Q

Worrisome SE of varenicline?

A

Mood changes
Suicidality
CV events in those with previous CV Hx

177
Q

Pt with prior bulemia Hx asking for smoking cessation assistance. He tried verenicline, but had “weird side effects”. What is best management?

A

Nicotine patches or nicotine replacement therapy

178
Q

Pt with prior bulemia Hx asking for smoking cessation assistance. He tried verenicline, but had “weird side effects”. What is best management?

A

Nicotine patches or nicotine replacement therapy. Bupropion and varenicline are other effective Rx, but are contra’d in this pt.

179
Q

Biggest factor that differentiates a normal stress reaction vs a pathologic one?

A

Normal stress rxns have an absence of fxnal impairment.

180
Q

2nd generation antipsychotics lead to what SE?

A

Metabolic syndrome:
Weight gain
Hyperglycemia (including new-onset DM)
Dyslipidemia

181
Q

Monitoring guidelines for 2nd generation antipsychotics?

A

BMI
Fasting glucose/lipids
BP
Waist circumference

182
Q

What is paradoxical agitation?

A

Agitation (hence, paradoxical) that occurs about 1 hour after administration of benzos. Typically occurs in elderly.

183
Q

Generalized anxiety disorder DSM-5 criteria?

A 
Excessive worry about multiple issues ≥6months. 
3 or more:
Restless
Fatigue
Concentration issues
Irritable
Muscle tension
Sleep issues
184
Q

Rx for Generalized anxiety disorder?

A

CBT

SSRIs or SNRIs

185
Q

Pt has sustained contrxn of neck muscles and his face appears to have an odd grin. He is new “crazy meds”. Rx?

A

Acute dystonia requires Benztropine or diphenhydramine

186
Q

Pt is incredibly restless and cannot sit still. He is on new “crazy meds”. Rx?

A

Akathisia requires Propanolol 1st. Benzodiazepines or benztropine next.

187
Q

Pt. taking new “crazy meds” complains of tremor and rigidity. Rx?

A

Parkinsonianism requires benztropine or amantadine (antiviral and antiparkansonian drug).

188
Q

Pt. taking several months of “crazy meds” arrives at the office with trouble moving his mouth, face, trunk, and his arms. He says the drugs took the voices away, but these movement problems make eating real tough. Rx?

A

Valbenazine. Tarditive dyskinesia occurs slowly over many months (usually >6) of Rx with antipsychotic meds.

189
Q

Time periods for acute stress disorder vs PTSD?

A

ASD <1 month

PTSD >1 month

190
Q

Phencyclidine (PCP) can pop false positive on a standard drug test with exposure to what common drugs?

A 
Dextromethorphan
Diphenhydramine
Doxylamine
Ketamine
Tramadol
Venlafaxine
191
Q

1st line mood stabilizers for bipolar disorders?

A

Lithium

Valproate

192
Q

2nd line mood stabilizers in bipolar disorders?

A

Quetiapine

Lamotrigine

193
Q

What must be considered before giving mood stabilizers for bipolar disorders?

A

Lithium is contra’d in renal impairment. It is excreted by the kidneys unchanged. Valproate should be used if Cr elevated.

194
Q

What labs are to be checked before mood stabilizers given in new onset bipolar disorder?

A

Creatinine to evaluate for renal impairment. Lithium cannot be used in renal impairment as it will build to toxic levels.

195
Q

SE of valproate?

A

Hepatotoxicity

Thrombocytopenia

196
Q

Labs checked in long-term valproate use?

A

LFTs

CBC (platelet counts)

197
Q

What is considered an “adequate trial” of an antidepressant?

A

≥6 weeks with adequate dose of drug

198
Q

Appropriate management of depression in a patient who has been taking an appropriately dosed SSRI for ≥6 weeks?

A

Switch to another SSRI or another first-line antidepressant (bupropion, mirtazapine, or a serotonin modulator like vilazodone)

199
Q

When are TCAs and MAOIs considered in depression?

A

After failure of several trials of other antidepressants. These drugs have lower tolerability by patients and are more toxic.

200
Q

What is required when switching from SSRIs to MAOIs?

A

2 week minimum washout period between stopping taking SSRI and starting to take MAOI. Fluoxetine requires 5 week washout as it has longer half life.

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