Psychiatry UWORLD

Question 1

Indications for ECT

Answer 1

• severe depression refractory to antidepressents
• depression in pregnancy
• refractory mania
• neuroleptic malignant syndrome
• catatonic shcizophrenia

Question 2

Medication for refractory schizophrenia

Answer 2

Clonzapine

*Leukopenia SE.

Question 3

Long-term SE of lithium

Answer 3

nephrogenic diabetes insipidus
Hyperparathyroidism w/ hypercalcemia
thyroid dysfunction

Question 4

treatment of Akathisia (SE medication, dose dependent)

Answer 4

Reduction of antipsychotic dose and tx with beta blocker (propranolol) or a benzodiazepine (lorazepam)

Question 5

conversion disorder

Answer 5

sudden onset of a neurological symptom (eg bilateral LE weakness) that is incompatible with normal neurological examination/ clinical findings.

precipitated by stress and patients can present as hysterical or strangely indifferent (la belle indifference) to their symptoms

Question 6

somatic symptoms disorder

Answer 6

one or more persistent physical symptoms w/ disproportionate and excessive anxiety, concern and energy devoted to symptoms.

IN contrast to conversion, in SSD the symptoms are by definition physiological

Question 7

Treatment of panic disorder immediate vs long-term

Answer 7

immediate: benzo

Long-term: SSRI/ SNRI/ CBT (cognitive behavioral therapy)

Question 8

how long do antidepressants take to respond?

Answer 8

6-8 wks

Question 9

tx specific phobia

Answer 9

behavioral therapy

Short acting benzos may help acutely but have a limited role

Question 10

tx of Kleptomania

Answer 10

cognitive behavioral psychotherapy is tx of choice

Question 11

Patient fails SSRI for depression. What is next medication?

Answer 11

Antidepressant with a different mechanism of action, such as serotonin norepinephrine reuptake inhibitor

Question 12

Alcohol withdrawal symptoms and timing

Answer 12

1. mild withdrawal: anxiety, insomnia, tremors, diaphoresis, palpitations, GI upset, intact oritentaion (6-24hr last drink)
2. Seizures : 12-48
3. Alcohol hallucinosis: visual, auditory, or tactile: intact oritentation, stable vital signs. 12-48
4. Delirium tremens: confusion, agitation, fever, tachycardia, HTN, diaphoresis, hallucinations (48-96)

Question 13

Which type of medication can cause seizures following abrupt discontinuation?

Answer 13

Alprazolam (Xanax) aka short acting benzo

Question 14

important side effect of buproprion

Answer 14

inhibits reuptake of NE, D, 5-HT
** Decreased seizure threshold** seen in higher doses

AVOID in seizure disorder as well as eating disorders

Question 15

patient on risperidone has bradykinesia, masked facies, and micrographia… what is tx?

Answer 15

anticholinergic: benztropine is indicated to help reduce this patient’s EPS.

Question 16

Post partum blues

vs

Post partum depression

vs

Postpartum psychosis

Answer 16

1. 2-3 days. Mild depresison/tearfulness/irritability
   tx: reassurance and monitoring
2. within 4 weeks
   Moderate-severe depression, SIGECAPS
   tx: antidepressants, psychotherapy
3. days to weeks
   delusions, hallucinations, thought disorganization, bizarre behavior
   tx: antipsychotic; hospitalize– do not leave mother alone with infant – risk of infanticide

Question 17

Ecstasy intoxication can cause what type of syndrome? and electrolyte change?

Answer 17

Serotonin syndrome: autonomic dysregulation, high fever, altered mental status, neuromuscular irritability, and seizures

Hyponatremia

Question 18

Adjustment disorder with depressed mood vs MDD

Answer 18

adjustment disorder with depressed mood does not meet the SIGECAPS criteria for MDD

Question 19

treatment for hoarding disorder

Answer 19

SSRI and cognitive behavioral therapy

Question 20

Neuropsychiatric manifestations of SLE:

Answer 20

seizures
headaches
peripheral neuropathy
strokes
chorea

Question 21

Social anxiety DO (social phobia)

vs

Panic DO

vs

Specific phobia

vs.

Generalized anxiety disorder

Answer 21

Anxiety restricted to social and performance situations, ** Fear of scrutiny** and embarrassment

recurrent, *Unexpected panic attacks

Excessive anxiety about a * specific object* or situation

Chronic (>6months) multiple worries, anxiety, tension

Question 22

GAD tx:

Answer 22

cognitive behavioral therapy

SSRI or SNRI

Question 23

Narcolepsy tx:

Answer 23

1. Modafinil and armodafinil: address excessive, uncontrolled, daytime sleepiness.
2. Amphetamine stimulants: first line except has potential risk of abuse and tolerance and SE
3. Sodium oxybate: reduces cataplexy.