Psychosomatic Medicine (4-17-14)

Question 1

Anxiety Disorders

Answer 1

Muscle tension

chronic neck or back pain

Question 2

Panic Disorder

Answer 2

feel they are having a heart attack or are dying

Question 3

Depression

Answer 3

Loss of appetite
fatigue
insomnia

Question 4

Psychotic Disorders

Answer 4

bizarre somatic delusions = “snakes in their belly”

less bizarre delusions = pregnant or cancer

Question 5

Hyperthyroidism

Answer 5

psychotic

Should be in differential diagnosis of someone who presents as manic for the first time.

Question 6

Hypothyroidism

Answer 6

depression

Thyroid function is routinely screened for in depressed pts.

Question 7

Cushing’s Disease

Answer 7

depression

Question 8

Multiple Sclerosis

Answer 8

depression or mania

Question 9

Parkinson’s Disease

Answer 9

depression, dementia

Question 10

Huntington’s Disease

Answer 10

depression, dementia, psychosis

Question 11

Pheochromocytoma

Answer 11

anxiety

Question 12

Pancreatic cancer:

Answer 12

depression

Depression can be the presenting sx of pancreatic cancer

Question 13

Brain tumors

Answer 13

mood disturbances or psychosis

Question 14

HIV/AIDS

Answer 14

mood changes, dementia

Question 15

Wilson’s Disease

Answer 15

psychosis

Question 16

Systemic Lupus Erythematosis

Answer 16

psychosis

Question 17

Acute Intermittent Porphyria

Answer 17

psychosis

Question 18

Tertiary Syphilis

Answer 18

mania or psychosis

Question 19

Anorexia criteria

Answer 19

BMI < 18

amenorrhea

Question 20

Anorexia: Medical complications

Answer 20

1. electrolyte abnormalities
2. renal dysfunction, due to dehydration
3. seizures, due to electrolyte abnormalities
4. cardiac arrhythmias
5. vitamin deficiencies
6. esophageal tears
7. osteoporosis – due to more than just the amenorrhea, though not completely understood

Question 21

Bulimia criteria

Answer 21

binge eating (more than normal in 2hrs)
at least 2x/week for 3months
average body weight or a bit overweight

Question 22

Bulimia: Medical complications

Answer 22

1. severe electrolyte abnormalities
2. dehydration
3. gastric rupture
4. esophageal tears
5. inflammation of salivary glands
6. erosions of teeth and nails due to self-induced vomiting—can be a clue to this behavior
7. do NOT usually dev. amenorrhea or osteoporosis**

Question 23

correlation between eating disorders and..

Answer 23

OCD

comorbid depression + anxiety

Question 24

treatment for eating disorders

Answer 24

fluoxetine

Question 25

what meds should you never give for bulimia?

Answer 25

MAOIs

Bupropion

Question 26

Beta-blockers

Answer 26

depression

esp. older ones (propanolol)

Question 27

Interferon

Answer 27

suicidal depression

Patients with a significant psychiatric history should not be treated with interferon.

Question 28

Corticosteroids

Answer 28

hypomania or mania –> buy extravagant trips

Question 29

Chantix

Answer 29

nightmares
changes in mood, sometimes depression
Patients with severe psychiatric disorders should not take Chantix.

Question 30

Atypical Antipsychotic Agents (clozapine, ziprasidone, risperidone, quetiapine, olanzapine, aripiprazole):

Answer 30

metabolic syndrome

insulin resistance

Question 31

Lithium

Answer 31

hypothyroidism

diabetes insipidis

Question 32

Valproic acid

Answer 32

bone marrow suppression (esp. thrombocytopenia)
fulminant hepatic failure
pancreatitis

Question 33

Carbamazepine

Answer 33

severe bone marrow suppression
aplastic anemia
Routine CBCs are required