Psychosocial Disorders

Question 1

Physiology of chronic alcohol use on receptors and how this changes in acute alcohol withdrawal

Answer 1

Progressive desensitization of GABA receptors and upregulation of N-methyl-D-aspartate receptors

Acute alcohol withdrawal produces a hyperexcitable state due to loss of GABA inhibitory effect and increase in N-methyl-D-aspartate excitatory neurotransmission

Question 2

Mechanism of action for varenicline

Answer 2

Nicotinic acetylcholine receptor partial agonist

Used for smoking cessation

Question 3

Somatization vs. Hypochondriasis

Answer 3

Somatization: wide variety of complaints, long and complicated medical problems, no apparent cause causing psychological distress

Hypochondriasis: physical symptoms disproportionate to demonstrable organic disease; a fear of disease and conviction that one is sick; persistent and unsatisfying pursuit of medical care

Question 4

Treatment options for cocaine-induced chest pain

Answer 4

1. Benzos
2. Nitrates
3. CCB - verapamil
4. Alpha-blockers - phentolamine
5. Antiplatelets/antithrombotics - aspirin
6. Antidysrhythmic - sodium bicarb

Question 5

How long does acute stress disorder symptoms last?

Answer 5

30 days

Question 6

Common adverse effects of tramadol

Answer 6

• Dizziness, vertigo, headache, drowsiness
• Constipation, n/v, xerostomia, dyspepsia
• Weakness
• Seizures
• Watch out for serotonin syndrome

Question 7

Clinical presentation of acute graft-versus-host disease

Answer 7

1-12 weeks post-transplant

• Nonspecific rash (generally maculopapular, could have brown discoloration with peripheral scaling
• Mucositis
• Diarrhea, can be accompanied by nausea, anorexia, emesis, bleeding, abd pain

Question 8

How long can an acute grief reaction last?

Answer 8

6 months

Question 9

Recommended tx for acute grief reaction?

Answer 9

Natural adaption to death with support from friends and family. No role for psychiatric evaluation unless becomes complicated grief