Psychiatry VII Flashcards
What is the next step in management for a patient that requires antipsychotics, but develops tardive dyskinesia while taking risperidone?
Switch to clozapine
newly added to UWorld = treatment of tardive dyskinesia with valbenazine (VMAT2 inhibitor)
What is the next step in management for a patient with recurrent episodes of psychosis due to medication non-adherence? The patient responds well to oral antipsychotics.
Long-acting injectable antipsychotics
What is the next step in management for an elderly patient with major depression with psychotic features that has lost a significant amount of weight and is refusing to eat/drink?
Electroconvulsive therapy (ECT)
ECT is appropriate for severely depressed geriatric patients who require rapid intervention; antidepressants + antipsychotics would take too long to be effective
What is the next step in management for that begins SSRI therapy for anxiety that develops worsening anxiety and insomnia?
Decrease the SSRI dose
patients with anxiety disorders are more sensitive to the activating side effects of SSRIs and may benefit from starting at a low dose or temporary dosage reduction
What is the pharmacotherapy of choice in pediatric depression patients?
SSRIs, especially fluoxetine
What is the preferred pharmacotherapy for alcohol withdrawal in the hospital setting?
IV lorazepam (benzodiazepine)
intermediate-acting with no liver metabolites, therefore it is preferred in patients with possible liver disease
What is the recommended first-line treatment for moderate-severe premenstrual syndrome and premenstrual dysphoric disorder?
SSRIs
What is the recommended immediate treatment for patients with panic disorder that are acutely symptomatic?
Benzodiazepines
benzodiazepines can also be used temporarily to treat panic disorder while waiting for SSRIs/SNRIs to take effect
What is the recommended long-term treatment for patients with panic disorder?
CBT and/or SSRIs
What is the recommended maintenance pharmacotherapy for a patient with bipolar disorder that is not adequately controlled with monotherapy?
lithium or valproate + a second-generation antipsychotic (e.g. quetiapine)
monotherapy typically begins with a mood stabilizer (e.g. valproate, lithium, lamotrigine)
What is the recommended maintenance treatment for a patient with a history of kidney disease that presents with bipolar I disorder?
Valproate
lithium and valproate are first-line treatments, however lithium has potential nephrotoxic effects; other effective treatment options include quetiapine and lamotrigine
What is the recommended next step in management in assessing a patient with suspected premenstrual syndrome (PMS)?
Menstrual diary
What is the recommended pharmacotherapy for a patient with a history of alcohol abuse that requests a medication to reduce cravings? He is currently drinking 6-7 beers a day. There is no evidence of hepatitis or cirrhosis.
Naltrexone
contraindicated in patients taking opioids and those with acute hepatitis or liver failure; acamprosate may be used to decrease cravings but is initiated after abstinence is achieved
What is the recommended pharmacotherapy for Tourette disorder refractory to alpha-agonists (e.g. clonidine, guanfacine)?
Antipsychotics
the only FDA approved drugs are the first-generation antipsychotics haloperidol and pimozide; second-generation antipsychotics (e.g. risperidone) are increasingly preferred due to favorable side effect profile
What is the recommended treatment for a child with intermittent sleep terrors?
Reassurance
most cases resolve spontaneously in 1-2 years; frequent, persistent, and/or distressing sleep terrors may be treated with low-dose benzodiazepines
What is the recommended treatment for bereaved patients who meet criteria for major depressive disorder?
psychotherapy + antidepressants
bereaved patients that meet criteria for MDD should be treated for MDD
What is the recommended treatment for dissociative identity disorder?
Trauma-focused psychotherapy
DID is associated with severe childhood trauma
What is the recommended treatment for oppositional defiant disorder?
psychotherapy and parent management training
What is the recommended treatment for post-stroke depression?
CBT and/or SSRIs
post-stroke depression is underdiagnosed and associated with increased disability and mortality
What is the recommended treatment for seasonal affective disorder?
Bright light therapy +/- an antidepressant
most often characterized by depression with fall-winter onset and spring-summer remission
What is the treatment for both conduct disorder and antisocial personality disorder?
Psychotherapy (e.g. CBT)
What is the treatment for cocaine intoxication?
[…], α-blockers
benzodiazepines, α-blockers
note: β-blockers are contraindicated
What is the treatment for cocaine intoxication?
benzodiazepines, […]
benzodiazepines, α-blockers
note: β-blockers are contraindicated
What is the treatment for delirium tremens?
Benzodiazepines
e.g. lorazepam
What is the treatment for opioid overdose?
Naloxone
What is the treatment for PCP intoxication?
[…], rapid-acting antipsychotics
benzodiazepines (preferred), rapid-acting antipsychotics
What is the treatment for PCP intoxication?
benzodiazepines (preferred), […]
benzodiazepines (preferred), rapid-acting antipsychotics
What is the treatment for postpartum blues?
Reassurance and monitoring
follow up to assess for possible postpartum depression
What is the treatment for postpartum depression?
CBT and/or SSRIs
What is the treatment for postpartum psychosis?
Hospitalization and antipsychotics
may use electroconvulsive therapy if insufficient
What is the treatment of choice for adjustment disorder?
Psychotherapy
therapy should focus on improving coping skills and promoting a return to functioning
What is the treatment of choice for an adult with suspected ADHD and a history of substance use disorder?
Atomoxetine
stimulants are the most effective treatment but have potential for misuse/addiction; second-line non-stimulant options in adults include bupropion and TCAs
What is the treatment of choice for chronic insomnia?
Cognitive behavioral therapy
medications are rarely effective for insomnia long-term
What is the treatment of choice for hoarding disorder?
Cognitive-behavioral therapy
hoarding disorder is characterized by difficulty discarding possessions regardless of their actual value
What is the treatment of choice for patient’s with a specific phobia?
CBT with exposure
What is the treatment of choice for patients that present with catatonia?
benzodiazepines or ECT
What is the treatment of choice for treatment-resistant schizophrenia and schizoaffective disorder?
Clozapine
clozapine is also indicated in schizophrenic and schizoaffective patients with recurrent suicidality
What is the treatment of choice to prevent adverse cardiac effects in patients with suspected TCA overdose?
Sodium bicarbonate
What laboratory tests are most important to monitor in patients taking second-generation antipsychotics (e.g. olanzapine)?
fasting glucose and lipid levels
due to metabolic side effects
What muscular symptom is associated with neuroleptic malignant syndrome?
Lead-pipe rigidity
versus hyper-reflexia and myoclonus in serotonin syndrome
What neuroimaging finding is most consistently found in patients with schizophrenia?
Ventriculomegaly (particularly of the lateral cerebral ventricles)
What neurotransmitter is decreased in Alzheimer disease?
acetylcholine
