Psychiatry EOR Flashcards
What are the symptoms of serotonin syndrome?
Mental status changes Autonomic instability (Tachy, diarrhea, diaphoresis, mydriasis) Neuromuscular abnormalities (Clonus, hyperreflexia, tremor, seizures)
Is serotonin syndrome fast or slow onset?
Fast onset
What criteria is used to diagnosis serotonin syndrome?
Hunter criteria
What is the treatment for serotonin syndrome?
Benzodiazepines
Hydration/Cooling
Cyproheptadine
What syndrome presents very similar to serotonin syndrome, but is caused by exposure to halogenated anesthetics(halothane) or depolarizing muscle relaxants (Succinylcholine, suxamethonium)?
Malignant hyperthermia
What is the pharmacologic treatment for malignant hyperthermia?
Dantrolene
What syndrome presents similarly to serotonin syndrome, but develops slowly, and is associated with slowed neuromuscular activity rather than hyperactivity.
Neuroleptic malignant syndrome.
What medications can cause neuroleptic malignant syndrome?
Neuroleptic agents (antipsychotics - such as haloperidol, fluphenazine, clozapine) Antiemetics (metoclopramide, promethazine) Withdraw from dopamine agonist therapy
Where are neuromuscular symptoms most profound in a patient with serotonin syndrome?
In the lower extremities.
Is autism spectrum disorder more common in males or females?
Males
What 2 criteria must be met to diagnose autism spectrum disorder? (From the DSM-5)
- Persistent deficits in social communication and interaction
- Restricted, repetitive patterns of behavior, interests, or activities.
Patients who are diagnosed with conduct disorder have a high likelihood of developing which personality disorder?
Antisocial personality disorder.
What is the mechanism of actions for benzodiazepines?
Potentiation of endogenous gamma-aminobutyric acid type A. (GABA)
What are the signs and symptoms of benzo withdrawal?
Anxiety, insomnia, tremor, diaphoresis, nausea, vomiting, palpitations, headache, and poor concentration.
Is benzo withdrawal fatal?
Yes
What is the mechanism of action of ampheteamines?
Increased release of catecholamines through inhibition of monoamine oxidase.
Inhibition of dopamine receptors is the mechanism of action of what type of medications?
Antipsychotics
What can be used for sleep in a patient who has insomnia and is being tapered off benzodiazepines?
Melatonin.
What illicit drug is known commonly as angel dust?
Phencyclidine (PCP)
What are some common physical exam findings in a patient who ingested PCP?
HTN, tachycardia, nystagmus (horizontal, vertical, or rotatory), and behavior changes.
Argyll Roberston pupil most commonly occurs with what condition?
Neurosyphilis
What is an argyll robertson pupil?
A pupil that accommodates when the patient is asked to focus on near and distant objects alternatively, but does not react to light exposure.
Which modern anesthetic is derived from phencyclidine?
Ketamine.
What are the core characteristics of schizotypal personality disorder?
Cognitive and perceptual disturbances (magical thinking, paranoia, suspiciousness, and ideas of reference), interpersonal difficulties, oddities of behavior or appearance, and disorganized thought or speech.
What is the pharmacologic treatment for schizotypal personality disorder?
Guanfacine (alpha 2A adrenergic agonist) can help with cognitive organization and anxiety.
Stimulant medications may also be prescribed, but they may increase anxiety.
What are ideas of reference?
The belief that irrelevant and innocuous things in the world have great personal significance.
What is agoraphobia?
Fear of panic symptoms
True or false: most phobias improve spontaneously over time without treatment.
False, phobias tend to be lifelong in the absence of treatment.
What are the 5 types of specific phobias? Name an example of each.
Animal - fear of spiders Natural environment - fear of storms Blood-Injection-Injury - fear of medical procedures with needles Situational - fear of flying Other - fear of costumed characters
Unstable interpersonal relationships, unstable self image, recurrent suicidal behavior, feelings of emptiness, difficulty controlling anger, and paranoid ideation are all symptoms of ______.
Borderline personality disorder
Which of the borderline personality disorder’s diagnostic criteria is most commonly found in individuals with the disorder?
Affective instability.
What is the diagnostic criteria for Bipolar II disorder?
At least one hypomanic episode and at least one episode of major depression.
What is a hypomanic episode?
Just a less severe manic episode.
What is the difference between Bipolar I and Bipolar II disorder?
Bipolar I has full on manic episodes, bipolar II does not.
What are the first line treatment options for hypomanic episodes?
Olanzapine and risperidone (second gen antipsychotics)
What are the first line treatments for patients with bipolar disorder who present with a depressive episode?
Quetiapine and lurasidone
Which medication for treating bipolar disorder is associated with an increased risk of Ebstein anomaly following in utero exposure?
Lithium
What is an Ebstein anomaly?
A congenital heart defect in which the tricuspid valve is in the wrong position and blood leaks backwards causing the heart to work less efficiently and causing enlargement of the heart.
What are the symptoms of opioid intoxication?
Decreased mental status and decreased respiratory drive.
Does opioid intoxication cause miosis or mydriasis?
Miosis
What is the treatment for opioid intoxication?
Naloxone, ventilation and supplemental oxygen if necessary.
What medication is the antidote for benzodiazepine intoxication?
Flumazenil
Why should you be cautious of using flumazenil?
You can put the patient into benzo withdrawal and refractory seizures, which can be deadly.
Why is hemodialysis not an effective treatment for opioid intoxication?
The volume of distribution of opioids is too wide.
How long after abrupt cessation of short acting opioids (such as heroin) do withdrawal symptoms begin?
12-24 hours
When do opioid withdrawal symptoms peak?
3 days
When do opioid withdrawal symptoms taper off?
7 days
Is opioid withdrawal lethal?
No
What is the role of clonidine in acute opioid withdrawal?
lonidine is an alpha-2 adrenergic agonist that counters the noradrenergic hyperactivity found in opioid withdrawal.
What are the cluster A personality disorders?
Schizotypal
Paranoid
Schizoid
What are the cluster B personality disorders?
Borderline
Antisocial
Histrionic
Narcissistic
What are the cluster C personality disorders?
Dependent
Avoidant
Obsessive-compulsive
Which nonintravenous benzodiazepine and route of administration combination provides the fastest onset of anxiolytic effects?
Intranasal midazolam.
What are positive symptoms of schizophrenia?
Hallucinations, delusions, disorganized behavior or thoughts.
What are negative symptoms of schizophrenia?
Decreased expression, apathy, avolition, and flat affect.
What is associated with a poorer prognosis is schizophrenia, positive for negative symptoms?
Negative symptoms - usually treatment resistant
What medications are first generation antipsychotics?
Chlorpromazine and haloperidol
What medications are second generation antipsychotics?
Aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and ziprasidone.
What are side effects of first generation antipsychotics?
Neuroleptic malignant syndrome
Extrapyramidal symptoms such as TD, akathisia, and dystonia.
What are side effects of second generation antipsychotics?
Agranulocytosis, metabolic effects (weight gain, insulin resistance, hyperglycemia.)
Which antipsychotic drug has a black box warning of neutropenia?
Clozapine.
A 10-year-old boy presents to the clinic with his mother, who is concerned about his poor school performance. She reports he makes careless mistakes, has difficulty maintaining attention, and is easily distracted during class. Which of the following medications for treating the suspected condition has a black box warning for misuse and dependence?
Methylphenidate
What are the labeled indications, other than attention-deficit/hyperactivity disorder, for clonidine?
Hypertension and vasomotor symptoms associated with menopause.
What is the treatment for pedophilic disorder?
Hormonal therapy, such as leuprolide acetate.
Pedophilic disorder is a specific type of what broader category of disorders?
Paraphilic disorders
How long must sexual urges be present to be diagnosed with paraphilic disorder?
6 months
Which paraphilic disorder refers to an individual receiving intense sexual arousal from rubbing against a nonconsenting individual?
Frotteuristic disorder.
What medication is contraindicated in treatment of MDD or GAD in a patient with anorexia nervosa? Why?
Bupropion - it increases incidence of seizure in patients with an eating disorder.
What is refeeding syndrome?
Marked electrolyte and fluid shifts that may occur while initiating refeeding in patients with anorexia nervosa, leading to rhabdomyolysis, congestive heart failure, and seizures.
What are risk factors for developing schizophrenia?
Birth during late spring or winter, living further from the equator, childhood trauma or CNS infections, cannabis use during adolescence.
Which type of hallucination is most common in schizophrenia?
Auditory.
If not properly managed, conduct disorder may transition into what disorder in adulthood?
Antisocial personality disorder.
What is the first line treatment for oppositional defiant disorder?
Parent training combined with outpatient psychological treatment
What would be the most appropriate treatment for bipolar disorder in an obese female with liver disease?
Lithium, because antipsychotics have metabolic side effects such as increased blood glucose and cholesterol
What labs should be conducted regularly in a patient taking lithium?
Serum lithium levels, thyroid function, electrolytes, kidney function, and EKGs.
Which pharmacologic agents used in the treatment of bipolar I disorder cause weight gain?
The antipsychotics, especially olanzapine, risperidone, and haloperidol.
What is malingering?
An individual creating false medical or psychiatric symptoms for external reward or gain.
What personality disorder can involve self-harm for attention-seeking without deception?
Borderline personality disorder.
How often should an adult patient be screened for unhealthy alcohol use in primary care?
Once every 12 months
What are the three clinical findings that comprise the triad associated with Wernicke encephalopathy?
Encephalopathy, oculomotor dysfunction, and gait ataxia.
What differentiates mild, moderate, and severe oppositional defiant disorder?
The number of settings where the oppositional behavior takes place (one, two, or three settings, respectively).
What are the adverse effects of stimulant medications?
Decreased appetite, poor growth or weight loss, insomnia, social withdrawal, headache, increased heart rate, increased blood pressure, and exacerbation of tics disorders.
What are the three core findings associated with ADHD?
Hyperactivity, impulsivity, and inattention
What are the 3 classic findings in conduct disorder?
Aggression, lying, and stealing.
What are the 3 classic findings in ODD?
Defiant behavior, hostility, and inattention.
What abnormal CBC finding is often seen in patients with anorexia nervosa?
Leukopenia
What electrolyte abnormality is often seen in patients with anorexia nervosa?
Hypokalemia
What is the term to describe fine, downy, dark hair sometimes seen in anorexia nervosa?
Lanugo.
What are the three core features of anorexia nervosa?
Restriction of energy intake relative to requirements leads to significantly low body weight.
Intense fear of gaining weight or persistent behavior interfering with weight gain.
Disturbance in body image.
What are the two types of anorexia nervosa?
Restricting
Binge-eating and purging type
Intoxication with what drug can cause hallucinations, psychosis, catatonia, hyperreflexia, tachycardia, hypoglycemia, and lactic acidosis?
PCP
What is the first line treatment for illness anxiety disorder?
CBT
What is the pharmacologic treatment of choice for illness anxiety disorder?
An SSRI
A 7-year-old boy presents to the clinic with his mother who is concerned because he has been craving ice for the past 2 months. She reports that he consumes about 10 cups of ice per day. Which nutritional deficiency is the history most concerning for?
Iron
What acid base abnormality can be expected in a patient with bulimia nervoas?
Metabolic alkalosis
What chronic problem may be noted in patients with bulimia nervosa who use ipecac syrup to purge?
pecac-induced myopathy, including cardiomyopathy that may be irreversible.
What electrolyte abnormalities may be noted in bulimia nervoas?
Hyponatremia, hypophosphatemia, hypomagnesemia.
True or false: women who begin antidepressants for postpartum depression should continue treatment for 6 to 9 months after symptom resolution.
True.
How long after delivery do symptoms of postpartum blues usually start?
2-3 days
How long after delivery do symptoms of postpartum depression usually start?
Within the first few months postpartum
How soon should symptoms of postpartum blues resolve?
within 2 weeks.
What is the second line treatment for ADHD?
Atomoxetine
Prenatal exposure to what agent is consistently associated with the development of attention-deficit/hyperactivity disorder?
Tobacco.
What is the daily caloric requirement for a healthy woman of normal weight?
30 kcal/kg/day. Patients who have recently normalized their weight generally require 45 to 50 kcal/kg/day to maintain a normal weight.
How long must anxiety symptoms be present for GAD to be diagnosed?
6 months
What effect can SSRIs have on a patients EKG?
They can cause QT prolongation
True or false: selective serotonin reuptake inhibitors reduce the risk of suicide in depressed patients.
False, there is no clear evidence of an increased or decreased risk.
What second generation antipsychotic is most likely to cause hyperprolactinemia?
Risperidone
What are the symptoms of hyperprolactinema?
Hypogonadism, oligomenorrhea, amenorrhea, galactorrhea, and decreased bone mineral density.
What is an alternative treatment for schizophrenia if a patient experiences hyperprolactinemia on an antipsychotic?
Aripiprazole
What is the treatment of choice for treatment resistant schizophrenia?
Clozapine
What lab needs to be checked each time before clozapine is refilled?
CBC - check for agranulocytosis
True or false: antipsychotic medications are most beneficial for treating the negative symptoms of schizophrenia.
False. Negative symptoms are difficult to treat and most pharmacotherapeutic agents lack efficacy in treating these symptoms.
What is the mechanism of action for stimulants in the treatment of ADHD?
Blocking reuptake of Dopamine and norepinephrine
Name 4 stimulants used for ADHD.
Methylphenidate
Dexmethylphenidate
Dextroamphetamine
Dextroamphetamine-amphetamine
What non-stimulant medications can be used for ADHD?
Atomoxetine
Guanfacine
Clonidine
What is the MOA of atomoxetine?
SNRI
What is the MOA of guanfacine and clonidine?
Alpha-2 adrenergic agonists
What is the black box warning for methylphenidate?
High potential for abuse and dependence
What rare but potentially fatal syndrome may occur during treatment for anorexia nervosa?
Refeeding syndrome.
What is the gold standard instrument used for panic disorder?
The Panic Disorder Severity Scale (PDSS).
What fear-related beliefs are associated with agoraphobia in patients without panic disorder?
Fear of illness, fear of being trapped due to a physical limitation, and bodily preoccupation.
Narcissistic personality disorder is in what cluster of personality disorders?
Cluster B
In addition to narcissistic personality disorder, which other personality disorder is marked by a lack of empathy for others?
Antisocial personality disorder.
What anxiety-related psychological disorder is closely associated with panic disorder?
Agoraphobia.
What is the non-pharmacologic treatment for agoraphobia?
CBT
A 16-year-old boy presents with his mother due to behavioral concerns. She is concerned he has antisocial personality disorder. What is the minimum age requirement for diagnosis of antisocial personality disorder?
18
Which personality disorders are part of the cluster A characteristics, where individuals may often appear eccentric or odd?
Paranoid, schizoid, and schizotypal.
All of the following are predisposing factors for PTSD except: ACEs Low socioeconomic status Female sex Being married Psychiatric disease
Being married - there is higher incidence of PTSD in patients who are divorced, separated, or widowed.
Which antihypertensive medications are sometimes used in the treatment of post-traumatic stress disorder?
Alpha-blockers and clonidine.
What is the first line medication for lowering blood pressure in a patient intoxicated with amphetamine?
Benzodiazepines (Lorazepam)
What medication should be avoided in a patient intoxicated with a stimulant, such as amphetamines or cocaine? Why?
Beta blockers should be avoided due to unopposed alpha receptor stimulation.
Which antidepressant medication can cause a false positive for amphetamines on a urine drug assay?
Bupropion.
What is the most common side effect of sertraline?
Diarrhea
What antidepressant has the lowest risk of sexual dysfunction?
Bupropion
What severe side effect can clozapine cause?
Neutropenia.
What factor in a patients history doubles their risk of female sexual arousal disorder?
History of sexual abuse
What antiepileptic drugs are associated with sexual dysfunction?
Lamotrigine, gabapentin, and topiramate.
Which personality disorder is characterized by detachment from social relationships due to a lack of desire for them?
Schizoid.
Avoidance of occupational activities that may involve criticism, is a feature of which personality disorder?
Narcissistic personality disorder
Inappropriate sexually seductive or provocative behavior, is a feature of which personality disorder?
Histrionic personality disorder
Preoccupation with unjustified doubts about the trustworthiness of others, is a feature of which personality disorder?
Paranoid personality disorder
How long must symptoms be present for a diagnosis of persistent depressive disorder or dysthymia?
2 years
What is the first-line therapy for treatment of bipolar major depression?
Quetiapine or lurasidone.
Which vitamin is commonly deficient in individuals with chronic alcohol use disorder and can lead to Wernicke encephalopathy?
Vitamin B1, also known as thiamine.
What is the typical age of onset of social anxiety disorder?
Onset is typically in adolescence.
What is the minimum neutrophil level recommended before treatment initiation with clozapine?
1,500 neutrophils/microliter.
What is the difference between OCD and OC personality disorder?
OCPD is characterized by a pattern of excessive perfectionism and strict control that sometimes leads to ritualized behavior. Obsessive thoughts do not occur in this disorder, and repetitive behaviors are not done relative to the obsessive thoughts.
SSRIs are the first line pharmacologic treatment for OCD. What is the best SSRI for OCD?
Trick question - none have been found to be superior in treating OCD.
Does OCD require a higher or lower dose of SSRIs when compared to the dose used to treat depression?
Higher
True or false: there is a strong link between suicidal ideation and obsessive-compulsive disorder.
True.
Munchausen syndrome by proxy is now known by what name?
Medical child abuse
How is factitious disorder distinguished from malingering?
The fabrication of symptoms in malingering is motivated by a clear external reward, such as time off from work or opioid pain medications.
What is circumstatial speech?
The patient goes on a long tangent of unrelated conversation before arriving at an answer.
What is tangential speech?
The patient goes on a long tangent of unrelated conversation and never arrives to the answer of your question.
What is verbigeration?
Verbigeration is word salad, which is disorganized, repetitive words, where words are strung together that do not make logical sense.
What are neologisms?
The creation of new, idiosyncratic words.
What is the duration of symptoms for a patient with schizophreniform disorder?
< 6 months.
What is the classic electrolyte abnormality associated with refeeding syndrome?
Hypophosphatemia.
What is hypercarotenemia?
Yellow skin on the palms, found in anorexia nervosa
Which 2nd generation antipsychotics are associated with the most weight gain and metabolic syndrome?
Clozapine and Olanzapine (++++)
Quetiapine, risperidone, and paliperidone (+++)
Which 2nd generation antipsychotics are associated with the least weight gain/metabolic syndrome?
Apripiprazole, brexpiprazole, cariprazine, pimavanserin.
Which 2nd generation antipsychotics have the highest risk of extrapyramidal symptoms and tardive dyskinesia?
Risperidone and paliperidone
Which 2nd generation antipsychotics have the highest risk of hyperproloactinemia?
Risperidone and paliperidone
Which 2nd generation antipsychotics are the most sedating?
Clozapine
Which 2nd gen antipsychotics has the most anticholinergic side effects?
Clozapine
Which 2nd generation antipsychotics have the highest risk of orthostatic hypotension?
Clozapine and iloperidone
Which 2nd gen antipsychotic has the lowest risk of orthostatic hypotension?
aripiprazole
What is the pathogenesis of hypophosphatemia in refeeding syndrome?
Starvation causes depletion of phosphate stores at baseline, but then refeeding increases phosphate demand leading to severe hypophosphatemia.
True or false: refeeding syndrome can occur with oral, enteral, or parenteral nutritional replenishment.
True.
How long should patients with obsessive-compulsive disorder and a positive response to pharmacologic therapy remain on medication?
At least 1 year.
What adverse effect does carbamazepine have on the fetus if taken during pregnancy?
What other medication shares this risk?
Neural tube defects (Spina bifida)
Valproate shares this risk.
Which antimanic medication has proven to decrease the risk of suicide in patients with bipolar disorder in clinical studies?
Lithium
What is a sudden, rapid, nonrhythmic, recurrent movement or vocalization called?
A tic.
What is 2C-1?
A synthetic drug similar to mescaline that is a stimulant at low doses and a hallucinogen at high doses.
What is a normal serum testosterone level?
300–1,200 ng/dL (10–42 nmol/L).
What are some commonly used atypical antidepressants?
Mirtazapine, trazodone, and bupropion.
What is the most common adverse effect of lithium?
Nephrogenic diabetes insipidus.
Which selective serotonin reuptake inhibitor causes the most weight gain?
Paroxetine.
What is defined as the inability to speak in social situations despite the physical ability to comprehend and speak?
Selective mutism.
What is the difference between schizophrenia and schizoaffective disorder?
Schizoaffective disorder is schizophrenia + manic or depressive episodes.
What is the difference between schizoaffective disorder and schizophreniform disorder?
Schizophreniform disorder does not have manic episodes (only depressed) and its duration is < 6 months.
What is the term for the creation of new, idiosyncratic words associated with schizoaffective disorder?
Neologisms.
What is the preferred medication to reduce agitation when initiating an SSRI?
Benzodiazepines
What are the two most common side effects of mirtazapine?
Weight gain and sedation.
What medication is used to treat benzodiazepine overdose?
Flumazenil
What is the mechanism of action of flumazenil?
Competitive antagonism of the GABA/benzodiazepine receptor complex.
What is the mechanism of action of flumazenil?
Competitive antagonism of the GABA/benzodiazepine receptor complex.
What is the mechanism of action of flumazenil?
Competitive antagonism of the GABA/benzodiazepine receptor complex.
What is the mechanism of action of flumazenil?
Competitive antagonism of the GABA/benzodiazepine receptor complex.
What is the mechanism of action of flumazenil?
Competitive antagonism of the GABA/benzodiazepine receptor complex.
How many drinks per day and per week classifies a male patient to have an increased health risk due to alcohol consumption?
More than 14 in 1 week
or
more than 4 in a single day
How many drinks per day and per week classifies a female patient to have an increased health risk due to alcohol consumption?
More than 7 drinks per week
or
More than 3 in a single day
What is the appropriate treatment for acute alcohol withdrawal?
IV benzodiazepines, such as diazepam and lorazepam, and IV fluids.
When does the pattern of schizotypal personality disorder typically begin?
During early adulthood.
What is the most efficacious treatment for severe unipolar depression that is refractory to treatment?
Electroconvulsive therapy
Name one of the few absolute contraindications to electroconvulsive therapy.
Brain tumor with associated increased intracranial pressure
True or false: anticoagulation is an absolute contraindication to electroconvulsive therapy.
False.
Which SSRI is the treatment of choice for bulimia nervosa?
Fluoxetine
Which drugs can be used for the treatment of bulimia nervosa in patients who cannot tolerate or do not respond to selective serotonin reuptake inhibitors?
Topiramate, tricyclic antidepressants, monoamine oxidase inhibitors, or trazodone.
In a patient whom you suspect restless leg syndrome, what lab(s) should you order to rule out a reversible cause?
Order iron studies to rule out restless leg due to IDA.
What is the only antidepressant that is not known to aggravate restless legs syndrome?
Bupropion.
Which atypical second-generation antipsychotics are most likely to cause hyperprolactinemia?
Risperidone and paliperidone.
What is considered first-line treatment for patients with binge eating disorder?
Cognitive behavioral therapy.
What are the two main subtypes of ADHD?
Hyperactive and impulsive
What are the possible adverse effects of stimulants?
Decreased appetite, poor growth, insomnia, social withdrawal, increased heart rate, and increased blood pressure.
Which serotonin and norepinephrine reuptake inhibitor is preferred for the treatment of post-traumatic stress disorder due to its demonstrated efficacy?
Venlafaxine.
Does opioid intoxication cause miosis or mydriasis?
Miosis
Which medication is an opioid antagonist?
Naltrexone.
Does cocaine causes miosis or mydriasis?
Mydriasis
What is crack lung?
Hemorrhagic alveolitis from inhaled cocaine.
Which other psychiatric disorder, in addition to narcissistic personality disorder, can cause grandiosity?
Manic or hypomanic episodes of bipolar disorder.
Which selective serotonin reuptake inhibitor increases the QTc interval the most?
Citalopram.
What is the name of the criteria used to diagnose serotonin syndrome?
Hunter criteria.
True or false: bupropion is recommended for tobacco cessation in pregnant patients.
False. Behavioral interventions should be the cornerstone of tobacco cessation efforts in pregnant women.
Which screening tool has been best studied and provides valuable information on illness worrying and conviction when screening for illness anxiety disorder?
The seven-item Whiteley Index.
What is the mechanism of action of first generation antipsychotics?
Antagonism of dopamine D2 receptors
What is the mechanism of second generation antipsychotics?
5-HT2a and D2 antagonism
Rapid D2 dissociation
5-HT1a agonism
What is the most common type of hallucination in a patient with schizophrenia?
Auditory.
Which four personality disorders are in cluster B?
Histrionic, borderline, antisocial, and narcissistic.
Where is abdominal pain typically located in patients with cannabinoid hyperemesis syndrome?
Periumbilical or epigastric
What history findings are common in cannabinoid hyperemesis syndrome?
Chronic cannabis use, relieved with a hot shower.
What medication can be used acutely to help alleviate symptoms of cannabinoid hyperemesis syndrome?
Haloperidol
What differentiates cyclic vomiting syndrome from cannabinoid hyperemesis syndrome?
The presence of psychological stressors as a trigger.
What differentiates cyclic vomiting syndrome from cannabinoid hyperemesis syndrome?
The presence of psychological stressors as a trigger.
What is the most common type of extrapyramidal symptom?
Akathisia
Low intracavernosal nitric oxide levels causes what?
Erectile dysfunction
What exercise has been shown to increase the risk of erectile dysfunction?
Bicycling.
What screening tool has the highest sensitivity and specificity for MDD?
PHQ-9
What foods should be avoided in patients taking monoamine oxidase inhibitors (MAOIs)?
Foods containing tyramine, including wine, cheese, liver, fava beans, and cured meats due to risk of serotonin syndrome.
What is a common comorbid condition with conduct disorder?
ADHD
When does delirium tremens occur following alcohol cessation?
48-96 hours after the patients last drink
When do withdrawal seizures most often occur after a patients last drink?
12-48 hours
What is an appropriate medication treatment for alcohol dependence?
Disulfiram or naltrexone.
What are red flags for bipolar disorder with mixed features?
Agitation, anxiety, and irritability.
Encephalopathy, oculomotor dysfunction, and gait ataxia is the triad of symptoms for what condition?
Wernicke encephalopathy
Wernicke encephalopathy is associated with what vitamin deficiency?
B1 (thiamine)
What is the name of the criteria that can be used to diagnose Wernicke encephalopathy in individuals with chronic alcohol use disorder?
Caine criteria.
What is Korsakoff syndrome?
A late neuropsychiatric finding on the same disease continuum as Wernicke encephalopathy. It is marked by anterograde and retrograde amnesia that is rarely reversible.
How long do hypomanic episodes typically last?
Episodes typically resolve within several weeks.
How long do hypomanic episodes typically last?
Episodes typically resolve within several weeks.
How long do hypomanic episodes typically last?
Episodes typically resolve within several weeks.
How long do hypomanic episodes typically last?
Episodes typically resolve within several weeks.
How long do hypomanic episodes typically last?
Episodes typically resolve within several weeks.
How long do hypomanic episodes typically last?
Episodes typically resolve within several weeks.
In addition to paranoid personality disorder, which other personality disorders are in cluster A?
Schizoid and schizotypal personality disorders
What is the pathophysiology behind amenorrhea and osteoporosis within the female athlete triad?
Estrogen deficiency.
What are the 3 symptoms included in the female athlete triad?
Low energy availability, low bone mineral density, and menstrual dysfunction
What is the most efficacious treatment for severe major depression?
Electroconvulsive therapy.
What are the established adverse effects of selective serotonin reuptake inhibitors?
Sexual dysfunction, drowsiness, insomnia, weight gain, headache, and dizziness.
What are the side effects of benztropine?
Anticholinergic side effects, which include dry mouth, blurred vision, constipation, urinary retention, and memory impairment.
What common endocrine disorder may cause palpitations, lack of sleep, restlessness, irritability, and headaches?
Hyperthyroidism.
What are some medications that may cause a false positive for amphetamines on a drug test?
Bupropion, anti-Parkinson agent selegiline, and cold preparations containing pseudoephedrine.
What is the most commonly abused substance by schizophrenic patients?
Tobacco
What medication is contraindicated in treating cocaine-induced hypertension?
Propranolol due to unopposed alpha-constriction.
Which condition presents with neurologic symptoms that cause clinically significant distress but do not have a known medical or neurologic cause after workup?
Functional neurologic symptom disorder (previously conversion disorder).
What condition is characterized by significant fear of an object or situation that may lead to avoidance?
Specific phobia
Screening for the HLA-B 1502 allele should be done prior to starting what medication?
Carbamazepine
HLA-B 1502 allele is associated with what reaction to carbamazepine?
Stevens Johnsons syndrome
HLA-B 1502 allele is found almost exclusively in what patient population?
Patients of asian descent
How are Stevens-Johnson syndrome and toxic epidermal necrolysis distinguished?
According to the total percent of body epidermal involvement. Cases with < 10% of epidermal involvement are diagnosed as Stevens-Johnson syndrome, cases with > 30% are diagnosed as toxic epidermal necrolysis, and cases with 10–30% are considered overlap.
Which two selective serotonin reuptake inhibitors are FDA approved to treat post-traumatic stress disorder?
Sertraline and paroxetine.
A 22-year-old woman with a history of congenital prolonged QT interval presents to the clinic with dysphoria for the past 2 months. She reports she has felt fatigued, been sleeping more than usual, and had decreased appetite. She has not been interested in doing activities she previously viewed as hobbies. What medication to treat her suspected condition would require an electrocardiogram prior to initiation?
Amitriptyline
SSRIs have lower risk of QT prolongation, so they do not require a EKG prior to use.
At which corrected QT interval on a baseline ECG are tricyclic antidepressants contraindicated?
At least 500 milliseconds.
What medications can be used to treat dystonic reactions caused by first generation antipsychotics?
Diphenhydramine or benztropine
What population is at greatest risk for suicide?
Older men (> 75 years of age).
True or false: lithium is primarily excreted by the liver.
False. The kidneys primarily excrete lithium.
What is the pharmacologic treatment for serotonin syndrome?
Benzodiazepines
What differentiates schizoid personality disorder from schizotypal personality disorder?
Patients with schizoid personality disorder have no desire for companionship.
True or false: avoidant personality disorder is a cluster A personality disorder.
False, it is in cluster C. Cluster A includes paranoid, schizoid, and schizotypal personality disorders.
What is the most dangerous risk associated with methadone use?
QT prolongation
What potentially fatal dysrhythmia is associated with QT prolongation in methadone use?
Torsades de pointes.
Which illicit drugs can precipitate panic attacks?
Cocaine and amphetamines.
Which two alpha-2 adrenergic agonists may be used to treat impulsivity in conduct disorder?
Guanfacine and clonidine.
How many symptoms of hyperactivity must an adult have to be diagnosed with ADHD?
5
How many symptoms of hyperactivity must an adolescent have to be diagnosed with ADHD?
6
How long must symptoms be present in order for ADHD to be diagnosed?
6 months
What percentage of affected children have symptoms of attention-deficit/hyperactivity disorder that persist into adulthood?
60%.
Cheeses and fermented foods should be avoided in patients taking what class of medications?
MAOIs
Ingestion of tyramine containing foods while taking an MAOI can precipitate what adverse effects?
Hypertensive crisis or serotonin syndrome.
List 3 MAOIs.
Selegiline
Moclobemide
Isocarboxazid
What instructions should be given to a patient switching from any antidepressant to an MAOI?
Current therapy must be discontinued for at least 2 weeks prior to starting the MAOI
Which antidepressant requires discontinuation for 5 weeks prior to initiating a monoamine oxidase inhibitor?
Fluoxetine.
What is the preferred pharmacotherapeutic agent for treatment of bulimia nervosa?
fluoxetine
Which SSRI has the longest half life?
Fluoxetine
Which selective serotonin reuptake inhibitor is the most likely to cause weight gain?
Paroxetine
What is the mechanism of action of buspirone?
It affects the serotonergic system by blocking 5HT1A autoreceptors.
Which class of medication is used to treat erectile dysfunction caused by a selective serotonin reuptake inhibitor?
Oral phosphodiesterase type 5 inhibitors.
What is considered the first-line treatment for factitious disorder?
Psychotherapy
During an EEG, low voltage, sawtooth waves, while electromyography indicates atonia is what type of sleep?
REM sleep
What stage of sleep is dreaming associated with?
REM Sleep
Which neurons are inhibited during rapid eye movement (REM) sleep resulting in atonia?
Alpha motor neurons.
At what months of age should screening for autism spectrum disorder occur?
18 and 24 months
What screening tool is recommended to screen for autism spectrum disorder?
Modified checklist for autism in toddlers
True or false: children with autism spectrum disorder typically have a smaller than average head circumference.
False. Their head circumference is usually larger than average.
Sedation is most commonly associated with which SSRI?
Paxil
What selective serotonin reuptake inhibitor is associated more commonly with nausea and vomiting?
Fluvoxamine.
What are the BMI ranges for mild, moderate, severe, and extreme anorexia nervosa?
Mild - BMI >17
Moderate - BMI 16-16.99
Severe - BMI 15-15.99
Extreme - BMI < 15
What type of secondary amenorrhea occurs in patients with anorexia?
Functional hypothalamic amenorrhea.
What is the most common clinical manifestation of PTSD?
Sleep disturbance
Which receptor does lorazepam act on?
Gamma-aminobutyric acid (GABA).
What is the first line treatment for specific phobias?
CBT that includes real-world exposure
What stage of sleep do sleep terrors, sleep walking, and confusional arousals occur?
Non-REM sleep
Which laboratory abnormality is typically seen in children with restless leg syndrome?
Iron deficiency.
What are the causes of false positives for opioids on a urine drug test?
Ingestion of poppy seeds, rifampin, and fluoroquinolones (ciprofloxacin, moxifloxacin, and levofloxacin).
What is alprostadil?
An arterial smooth muscle relaxer that can be injected into the penis to cause an erection.
What is the mechanism of action of TCAs?
Inhibits reuptake of norepinephrine and serotonin, increases synaptic concentration of both neurotransmitters
What is the typical finding on electroencephalography in patients with neuroleptic malignant syndrome?
Generalized slow-wave activity.
What is the treatment for cannabis withdrawal?
dronabinol or gabapentin
Which second-generation antipsychotics cause the least amount of weight gain?
Ziprasidone, aripiprazole, and lurasidone.
What are 3 first line therapy options for smoking cessation?
Nicotine replacement therapy (gum or patches)
Bupropion (sustained release)
Varenicline
Which first line therapy for smoking cessation works by partial agonism to nicotinic receptors?
Varenicline
What are the common side effects of varenicline?
Nausea and sleep disorders
What is the optimal serum concentration of lithium?
0.8 to 1.2 mEq/L.
What two classes of medications should a patient with Bipolar I in a manic episode be prescribed?
An antipsychotic and a mood stabilizer
What is the first line mood stabilizer, in absence of contraindications?
Lithium
What are the contraindications to lithium?
Impaired renal function, pregnancy, Brugada syndrome
What are some side effects of valproate?
Hepatotoxicity, thrombocytopenia, pancreatitis
Which personality disorders are most likely comorbid in a patient with adjustment disorder?
Cluster B personality disorders (i.e., antisocial, borderline, histrionic, and narcissistic).
Which serotonin and norepinephrine reuptake inhibitor is approved for the treatment of panic disorder?
Venlafaxine.
What is the first line treatment for borderline personality disorder?
Dialectical behavioral therapy
What second generation antipsychotic is contraindicated in patients with history of substance abuse?
Quetiapine
What is the SSRI of choice for treatment of postpartum depression?
Sertraline (or paroxetine)
What dietary deficiencies has shown to be a factor in ADHD?
Iron, zinc, and omega 3 fatty acids
What is the mechanism of action of cocaine?
Blocking of the reuptake of biogenic amines
Which SNRI is also a first line treatment for neuropathic pain?
Duloxetine
Regurgitation within 10 minutes of finishing most meals is a classic sign of what disorder?
Rumination syndrome
