Qbank: Psych Extra Review

Question 1

What is the tx for MDD after 1st failed trial with an SSRI?

Answer 1

After failed trial of SSRI in MDD patient, try 2nd medication from the SAME class of drugs. Only after 2 failed trials in same drug class do you consider a new drug class.

Question 2

What is a Delusion disorder?

Answer 2

Delusion disorder: non-bizarre delusions for at least 1 month

Question 3

What is Brief psychotic disorder?

Answer 3

BPD: positive psychotic sxs for more than 1 day but less than 1 month.

Question 4

What is the acute vs. long-term tx for Panic disorder?

Answer 4

Panic disorder acute tx: Benzos; long-term tx: SSRIs or TCAs

Question 5

What is the tx for performance anxiety?

Answer 5

Beta-blockers (e.g. propanolol)

Question 6

Compare the dominant feelings in grief vs dominant feelings in major depressive episode.

Answer 6

Grief: loss + emptiness
MDD: anhedonia + persistent depressed mood

Question 7

What is used to tx anti-psychotic induced akathisia?

Answer 7

Propanolol

Question 8

What is the most likely atypical anti-psychotic to cause EPS, especially at high dosages?

Answer 8

Risperidone

Question 9

What are examples of EPS symptoms?

Answer 9

Cogwheel rigidity, bradykinesia, tremor, akathisia

Question 10

What are symptoms of excess dopamine blockade?

Answer 10

Bradykinesia, masked facies, micrographia

Question 11

What medications is used to help reduce EPS symptoms in patient taking anti-psychotics?

Answer 11

Benztropine (anticholinergic)

Question 12

How long does it take for most antidepressants to provide symptomatic relief?

Answer 12

4-6 weeks

Question 13

How long should an antidepressant be used to treat a single episode of major depression?

Answer 13

6 months

Question 14

How long should an antidepressant be used to treat multiple episodes of depression?

Answer 14

> 6 months

Question 15

What is the DSM-5 diagnostic criteria for Conduct disorder?

Answer 15

Conduct disorder: at least 3 behaviors (out of 15 problem behaviors grouped into 4 main categories: aggression toward people and animals, destruction of property, serious violation of rules, deceitfulness or theft), have been present w/in previous 12 months, at at least 1 present in the last 6 months. Greatest risk for developing antisocial personality disorder as adults.

Question 16

What atypical antipsychotic is least likely to cause EPS?

Answer 16

Clozapine but it is considered to be a medication of last resort b/c it can cause agranulocytosis.

Question 17

What is akathisia?

Answer 17

Akathisia is a subjective feeling of restlessness that compels patients to move around (e.g. repeated leg crossing, weight shifting, stepping in place). Etiology: antipsychotic use
Treatment: beta-blockers provide some relief

Question 18

What is dystonia?

Answer 18

Dystonia can occur between 4hrs and 4 days after receiving an antipsychotic medication, characterized by muscle spasms or stiffness, tongue protrusion or twisting, opisthotonus and oculogyric crisis.
Treatment: anticholinergics (e.g. benztropine) or antihistamines (e.g. diphenhydramine)

Question 19

What is the recommended treatment for Hoarding disorder according to DSM 5 criteria?

Answer 19

Cognitive behavioral therapy has been shown to improve symptoms, and early trials with SSRIs have demonstrated efficacy.

Question 20

What is the difference between: Dissociative fugue, Dissociative identity disorder, Dissociative amnesia and Depersonalization disorder?

Answer 20

Dissociative fugue: characterized by sudden, unexpected travel away from home accompanied by inability to recall one’s identity or one’s past. At times, patients with condition will assume new identities.

Dissociative identity disorder: presence of 2 or more distinct identifies that alternatively assume control of the person’a behavior.

Dissociative amnesia: one or more episodes of inability to recall important personal information.

Depersonalization disorder: persistent or recurrent feelings of detachment from one’s own physical or mental processes in the context of an intact sense of reality.

Question 21

What is first-line treatment for GAD? What is second-line treatment for GAD?

Answer 21

First-line: Cognitive behavioral therapy + SSRIs (like escitalopram) or SNRIs

Second-line: Benzodiazepines (used when antidepressants are ineffective or poorly tolerated but should be avoided in patients with a history of substance abuse or comorbid depression) or Buspirone

Question 22

What are the most common withdrawal symptoms experienced in heroin withdrawal?

Answer 22

Muscle spasms, joint pain, nausea and vomiting, diarrhea, abdominal cramps, rhinorrhea, lacrimation, sweating , irritable, dilated pupils, HTN (autonomic instability)

Question 23

What are FDA-approved first-line treatments for OCD?

Answer 23

Clomiramine (Anafranil) - - a TCA
Fluoxetine (Prozac) - - SSRI
Fluvoxamine (Luvox) - - only SSRI approved just for OCD
Paroxetine (Paxil) - - SSRI 
Sertraline (Zoloft) - - SSRI

Question 24

What is Folie a deux?

Answer 24

Folie a deux: induced psychotic disorder (IPD), involves delusions or hallucinations that are transmitted from on individual to another.

Question 25

What is the difference between Competency vs. Capacity?

Answer 25

Competency: is a legal definition determined in court.

Capacity: is used in medical situations to determine if someone has the ability to give informed consent to receive or refuse therapy.

Question 26

What neuroimaging finding is most commonly associated with SCZ?

Answer 26

Enlargement of cerebral ventricles

Question 27

What neuroimaging finding is most commonly associated with Autism?

Answer 27

Increased total brain volume

Question 28

What neuroimaging finding is most commonly associated with OCD?

Answer 28

Abnormalities in orbitofrontal cortex & striatum

Question 29

What neuroimaging finding is most commonly associated with Panic disorder?

Answer 29

Decreased volume of amygdala

Question 30

What neuroimaging finding is most commonly associated with PTSD?

Answer 30

Decreased hippocampal volume

Question 31

Difference between Somatic symptom disorder vs. Illness anxiety disorder (formally hypochondriasis)?

Answer 31

Somatic SD: excessive anxiety & preoccupation with >1 unexplained symptoms

Illness anxiety disorder: fear of having a serious illness despite few or no symptoms & consistently negative evaluations

Question 32

What is Pramipexole?

Answer 32

Pramipexole is a DA agonist used to treat symptoms of Parkinson’s disease and restless legs syndrome.

Question 33

What pharmacological treatments are used in Tourette Disorder?

Answer 33

Antipsychotics:

• First Generation Neuroleptics (pimozide, haloperidol, fluphenazine)
• Second Generation Neuroleptics (risperidone)

Alpha-2-agonists:

• Clonidine
• Guanfacine

Question 34

What is the side effect profile of Methylphenidate?

Answer 34

Nervousness, decreased appetite, weight loss, insomnia and abdominal pain.