Treatment

Question 1

Depressive Disorders

Answer 1

Antidepressants

• *SSRIs (fluoxetine)
• SNRIs
• Bupropion
• TCAs
• Lithium
• MAOIs

Psychotherapy

• CBT
• IPT
• Insight oriented (psychoanalytic) therapy

ECT

• TMS
• VNS
• DCS

Surgery

Ketamine infusion

Alternative

• Exercise
• St. John’s Wort
• Ayurvedic meds
• Mediation
• S-adenosylmethionine
• Omega-3
• Gluten-free diet
• Probiotic supplements
• Cuentos, vision quest, walkabout

Question 2

Panic Disorder

Answer 2

SSRIs - decrease amygdala activity

CBT - reduce phobic avoidance, decrease cognitive distortions

Question 3

Eating Disorders

Answer 3

Weight restoration

Inpatient hospitalization (<75% ideal body weight)

Partial hospitalization (75-90% ideal body weight): group based, CBT, family therapy

Intensive outpatient: group therapy, family therapy

Question 4

Anorexia Nervosa

Answer 4

Family therapy (treatment of choice for <18yo & living at home)
Psychoeducation
Self-help
Nutritional management
SSRIs (fluxoetine) (may be useful for depression or anxiety but not for AN alone)
Atypical antipsychotics (olanzapine decreases anxiety, insomnia, & body image distortions)
Benzos (decrease pre-meal anxiety)

Question 5

Bulimia Nervosa

Answer 5

CBT
IPT (CBT for BN)
Family therapy
Psychoeducation
Self-help
SSRIs (fluoxetine) (high-dose helpful, useful also if depression or anxiety comorbidity

Question 6

Depression

Answer 6

Antidepressants
- old: TCIs, MAOIs
- new: SSRIs (fluoxetine & escitalopram in peds), SNRIs, SDRIs
CBT
IPT

Question 7

Mania

Answer 7

Mood Stabilizers

• Lithium
• Anticonvulsants (valproate, carbamazepine, lamotrigine)

OR

Antipsychotics

Question 8

Schizophrenia

Answer 8

Antipsychotics
- old: Typicals
- new: Atypicals
Clozapine (blocks 5HT & DA)
- first line, effective in treatment-resistant SCZ
*no difference across meds about how good they are at reducing positive symptoms
*none improve cognitive symptoms or reduce negative symptoms
Psychosocial treatments
- Psychoeducation
- Psychotherapy
- Case management
- Family issues
- Suicide prevention

Question 9

Anxiety disorders (OCD, PTSD, GAD, phobias, PD)

Answer 9

Antidepressants +/- sedative for prevention

Anxiolytics (Benzos) for acute symptoms

Question 10

BD

Answer 10

Polypharmacy
Mood stabilizers 
- Lithium (mania)
- Anticonvulsants (rapid cycling & mixed states)
- Lamotrigine (bipolar depression)
Atypical antipsychotics (acute mania, risperidone & aripiprazole in peds)
Adjunctive meds 
- Atidepressants (ex. fluoxetine, treat bipolar depression)
- Benzos (ex. clonazepam, initiate sleep, reduce agitation)
- Anxiolytics (sleep aids)
- Typical antipsychotics
Psychotherapy
- Psychoeducation
- CBT
- Interpersonal & social rhythms therapy
- Family focused therapy
- ECT

Question 11

Delirium

Answer 11

Benzos - avoid unless suspect alcohol or benzo withdrawal
Typical & Atypical antipsychotics (preoperative haloperidol, risperidone, olanzapine, quetiapine, aripiprazole)
Orientation protocol
Therapeutic activities
Non-pharmacological sleep protocol
Sleep-enhancement protocol
Early mobilization protocol
Vision protocol
Hearing protocol
Dehydration protocol
Reduce polypharmacy

Question 12

Separation Anxiety Disorder, Social Phobia, OCD, PTSD

Answer 12

SSRI

CBT

Question 13

GAD

Answer 13

SSRI
SNRI
GAD

Question 14

School Refusal

Answer 14

Benzos

Question 15

ADHD

Answer 15

Stimulants (methylphenidate, mixed amphetamine salts)
Atomoxetine
Clonidine
Guanfacine
Bupropion

Question 16

Smoking cessation

Answer 16

Bupropion

Question 17

Oppositional Defiant Disorder (ODD) & Conduct Disorder (CD)

Answer 17

Behavioral therapy
Environmental interventions
Limit-setting & maintaining incentives

Question 18

Autism & ASD

Answer 18

Atypical antipsychotics: risperidone

Behavioral treatments

Question 19

Panic Disorder

Answer 19

Upregulate prefrontal cortex
- SSRIs or other anti-depressants (not bupropion)
- CBT
Dampen amygdala hyperarousal
- Benzos

Question 20

GAD

Answer 20

Short-term benzos
Long-term antidepressants (esp SSRIs)
CBT
Buspirone (5HT agonist)

Question 21

Specific Phobia

Answer 21

Behavioral approach

Question 22

Social Anxiety Disorder

Answer 22

CBT (esp group)
SSRIs
Beta-blockers (for performance anxiety)

Question 23

PTSD

Answer 23

Serotonergic antidepressants
Exposure-based CBT
Eye movement desensitization & reprocessing (EMDR)
Mood stablizers
Antipsychotics
NOT Benzos

Question 24

OCD

Answer 24

Serotonergic antidepressants
Exposure & response prevention
higher dose SSRIs
Psychosurgery (cingulotomy)

Question 25

Body Dysmorphic Disorder

Answer 25

Exposure & response prevention

High dose SSRI

Question 26

Personality Disorders (general principles)

Answer 26

Treat comorbidity
Maintain boundaries (esp for borderline personality disorder)
Avoid countertransference (be respectful & empathic)
Long-term treatment usually required
Get support
Psychotherapy
- CBT (most)
- Dialectical behavioral therapy (DBT) for borderline, reduces impulsivity
- psychodynamic psychotherapy (insight oriented therapy)

Question 27

Cognitive-Perceptual Personality Disorders:

• suspicious / paranoid
• odd communication
• dissociation / hallucinations

Answer 27

Antipsychotics (neuroleptics)

Question 28

Affective Personality Disorders:

• emotion dysregulation
• intense anger

Answer 28

SSRIs

Antipsychotics

Question 29

Affective Personality Disorders:

• rejection sensitivity
• chronic emptiness
• social anxiety / avoidance

Answer 29

SSRIs

MAOIs

Question 30

Impulsive-Behavioral Personality Disorders:

• sensation-seeking
• cognitive impulsivity
• aggressive
• binges (substances, sex)
• suicide / self-mutilation

Answer 30

SSRIs
Lithium
Antipsychotics
MAOIs
Anticonvulsants