Psychiatry

Question 1

Pts with brief psychotic disorder presenting with agitation. Tx?

Answer 1

Lorazepam NOT haloperidol Note: should be 1st sedated with benzodiazepine and then an appropriate antipsychotic Note: if a patient has a history of torticollis or adverse reaction to typical anti-psychotics, then AVOID repeated use of haloperidol.

Question 2

A drug that is antimuscarinic antiparkinsonian that is used to treat side effects of typical antipsychotics?

Answer 2

Trihexyphenidyl

Question 3

How to diagnose a major depressive episode?

Answer 3

Presence of 5 or more of: - Depressed mood - Anhedonia - Anergia - Insomnia/hypersomnia - Weight loss/gain - Agitation - Guilt - Lack of concentration - Suicidal ideation

Question 4

Why is Bupropion preferred by many as an anti-depressant?

Answer 4

Bupropion is preferred by many people as an anti-depressant because it is more energizing and has fewer side effects than SSRIs or SNRIs. However, it lowers seizure threshold.

Question 5

25 y/o pt has been on Fluoxetine. he is experiencing side effects such as agitation and sexual dysfunction. Tx?

Answer 5

Discontinue and replace with Mirtazapine

Question 6

Panic disorder is often associated with?

Answer 6

Agoraphobia in 50% of panic disorder pts

Question 7

Define agoraphobia?

Answer 7

• Fear of being in places or situations from which escape might be difficult or help isnt available. - these situations are avoided - the fear isnt better explained by another mental disorder

Question 8

Antiphospholipid antibody syndrome is associated with?

Answer 8

• frequent miscarriages - thromboembolic events - elevated PTT

Question 9

T/F panic disorder is associated with claustrophobia

Answer 9

False

Question 10

Dementia pts Tx

Answer 10

DO NOT attempt pharmacotherapy with anti-psychotics first. Must exhaust non-pharm options first.

Question 11

Characteristics ass with borderline personality disorder?

Answer 11

• instability in interpersonal relationships - marked impulsivity - emotional instability - mood lability

Question 12

Antisocial pts patterns?

Answer 12

persistent patterns of: - deceitfulness - impulsivity - disregard to rights of others

Question 13

Schizotypal pts patterns?

Answer 13

• uncomfortable in interpersonal situations - emotionally distant - difficult to engage - isolative - exhibit strange or quasi delusional beliefs

Question 14

Describe pts with dependent personalities

Answer 14

They struggle with the self perception that they are unable to function adequately without the help of others. They have trouble with: - decision making - motivation - responsibility - fear abadonment

Question 15

Narcissistic pts patterns?

Answer 15

display a grandiose sense of self-importance, demanding, haughty and self absorbed, insist on special status and treatment in the physician patients relationships

Question 16

what should be avoided in depressed suicidal pts?

Answer 16

AVOID TCAs in depression, especially after suicidal ideation, due to increased risk of overdose.

Question 17

T/F: Males are at lower risk of completed suicide

Answer 17

False. Males have higher risk for completed suicide (M:F = 3:1) while females are higher risk for suicide attempts (M:F=1:4)

Question 18

Best predictor of compelted suicide?

Answer 18

History of attempted suicide

Question 19

How do you distinguish between Anorexia and Bulimia?

Answer 19

To distinguish, loss of control while eating is unique to Bulimia.

Question 20

DSM-V criteria for Anorexia?

Answer 20

• Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
• Intense fear of gaining weight or becoming fat, even though underweight.
• Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight. Subtypes include restricting type (no recurrent episodes of binge eating or purging behaviour in last three months), as well as binge-eating/purging type (recurrent episodes of binge eating or purging behaviour in last three months)

Question 21

DSM-V criteria for Bulimia?

Answer 21

• Recurrent episodes of binge eating characterized by BOTH of the following: 1) Eating in a discrete amount of time (within a two hour period) large amounts of food. 2) Sense of lack of control over eating during an episode.
• Recurrent inappropriate compensatory behavior in order to prevent weight gain (purging).
• The binge eating and compensatory behaviors both occur, on average, at least once a week for three months.
• Self-evaluation is unduly influenced by body shape and weight.
• The disturbance does not occur exclusively nervosa.

Question 22

clinical features of neonatal narcotic drug withdrawal?

Answer 22

Question 23

side effect of chlorpromazine that involves torticollis and retrocollis?

Answer 23

Acute dystonia

Acute dystonia is marked by sudden muscle spasms in the form of torticollis and retrocollis and trismus. most common in young pts and in men recieving high doses of chlorpromazine.

Question 24

Akathisia is marked by?

Answer 24

• restlessness
• agitation
• inner tension

Question 25

Pseudoparkisonism is a side effect of what drugs?

Answer 25

antipsychotic drugs like pehothizine derivatives

Question 26

Tardive dykinesia is marked by?

Answer 26

abnormal movements in any part of the body

Question 27

Neuroleptic malignant syndrome?

Answer 27

• hyperthermia
• altered consciousness
• autonomic changes

Question 28

Best medication to treat Tardive dyskinesia?

Answer 28

Clozapine

Question 29

Best mgm of oro-bucco-lingual sterotypy in a pt on long term chlorpromazine?

Answer 29

Discontinue the drug by gradual taper and replace with clozapine or quetiapine

Question 30

female pts treated for psychotic disorder presenting with amenorrhea

Answer 30

HYPERPROLACTINAEMIA.

Question 31

what does anti-psychotics do in relation to dopamine?

Answer 31

Typical Anti-psychotics are often dopamine receptor antagonists. This causes decrease in Dopamine. Since Dopamine binds lactorophs and prevents prolactin release, DECREASED Dopamine -> hyperprolactinaemia, which in turn leads to:

• Amenorhea
• Weight gain
• Sexual dysfunction

NOTE: Risperidone is an ATYPICAL anti-psychotic known to cause hyper-prolactinaemia.