Uworld

Question 1

BIpolar depression being treated and patient develops a rash. what caused it?

Answer 1

Lamotrigine - anticonvulsant but commonly used as a mood stabilizer and specifically used in bipolar depression.

10% of patients develop a drug rash. Stop the drug as son as this happens.

Drug rash happens more oftne when co-perscribed with valproate

Question 2

Annorexia treatment?

Answer 2

CBT + nutritional rehab is first line.

IF this doesnt work then second line is olanzapine (2nd gen antipsychotic)

Hospitalize when BMI below 15 or when bradycardia, hypotension (below 80/60) or hypothermia are present

Question 3

Bullemia treatment

Answer 3

Fluoxitine

Bupropion is contraindicated in eating disorders

Question 4

Lithium toxicity

Answer 4

Nausea / vomitting

confusion, ataxia, tremors / fasiculations

Drug interactions (increase lithium levels with):
volume depletion (decrased GFR)
Thiazides
Nsaids (not aspirin)
ACE inhibitors
Tetracyclines

Question 5

What is first line treatment in bipolar depression?

Answer 5

1st line therapy below.

2nd gen antipsychotics: Quetiapine and Lurasidone.

Anticonvulsants: Lamotrigine

Question 6

Why cant you give 1st line antidepressants in bipolar?

Answer 6

bupropion, citalopram, venlafaxine etc will all percipiate mania.

Question 7

What do you give patients who have only had a partial response to 1st line anti-depressant therapy?

Answer 7

Add a 2nd antidepressant with a different MOA

however be careful to never mix a MAO-i (phenelzine) with an SSRI or TCA

Question 8

OCD treatment

Answer 8

1st line = CBT - Exposure and response prevention techniques

+/- SSRI

Question 9

SLE Diagnosis

Answer 9

Screening - antinuclear protein

Specific = Anti-DS DNA, Anti-SMith, Anti-U1 Ribonucleoprotein

Question 10

Adjustment disorder treatment

Answer 10

adjustment disorder - marked distress or functional impairment within 3 months of stressor. cannot go over 6 months.

Treatment of choice - psychotherapy.

Question 11

GAD

Answer 11

must be present for 6 months or more for diagnosis!

worry in multiple areas.

Treatment:
SSRI (buspirone) or SNRI (venlafaxine)

can add CBT

Question 12

Bipolar 1 vs Bipolar 2 vs Cyclothymia

Answer 12

BP 1 = Mania +/- major depression (MD not required for diagnosis)

BP 2 = Hypomania and 1 or more Major depressive episodes (MUST be present for diagnosis)

Cyclothymia - 2 or more years of fluctuating hypomania and depressive episodes that never meet the criteria for hypomania or major depressive episodes

Question 13

Panic disorder treatment

Answer 13

1st line = CBT - psychotherapy

2nd line - SSRIs or TCAs or Benzos

Question 14

PCP presentation and treatment

Answer 14

agitation, delusions of strength, psychosis, agression, HTN , Tachy
Nystagmus (horizontal, vertical or rotary)

Treatment is supportive

for the agression give Benzos (prefferably the parenteral formulations (Lorazempam / diazepam) because agitated patients cant take meds by mouth

Haloperidol is used as 2nd line treatment in pcp intoxication resistant to benzos.

HOwever antipsychotics lower seizure threshold and are contraindicated in patients with seizures.

Question 15

antisychotic contraindicatoins

Answer 15

seizure disorder.

antipscychotics lower seizure threshold

Question 16

somatic symptom disorder vs illness anxiety disorder

Answer 16

somatic symptoms disorder - anxiety over 1 or more unexplained symptoms (SYMPTOMS ARE PRESENT). Patient must have this anxiety over the symptoms for more than 6 months for diangosis!

Treate somatic symptom disorder by constant follow ups with patients and minimizing specialist refferals / labs. Try CBT first if that doesnt work then 1st line pharm is an SSRI (Fluoxetine)

Illness anxiety disorder - anxiety / fear over having a specific illness when minimal or no symptoms are present!

Question 17

Neuroleptic Malignant syndrome treatment

Answer 17

hyperthermia, autonomic instability, lead pipe rigidity, altered sensorium

Treatment:
1. STOP the antipsychotic (both 1st and 2nd gen can cause it)

2. supportive care fluids / cooling (must give fludis because rhabomylsis frequently leads to myoglobinuria and kidney failure).
3. Dantrolene or Bromocripitine or Amantadine.

Question 18

Serotonin syndrome

Answer 18

Triad of autonomic instability, AMS, And Neuromuscular instability (hyperreflexia, myoclonus).

Treatment = cyprohepatadine –> serotonin antagonist.

Question 19

treatment of akasthisia?

Answer 19

propanolol

Question 20

Depersonalization / derealization disorder
vs
Dissociative amneisa
vs
Dissociative identitiy disorde

Answer 20

Depersonalization - Feeling like your detached form yourelf, being an outside observer of ones self.

Derealization disorder - experiencing surroundings as unreal

Dissociative amnesia - inability to recal important personal information, usually of a truamatic or stressful nature.

Dissociative identity disorder - 2 or more distint personality states
associated with severe trauma/ abuse

Question 21

Bipolar 1 vs schizoaffective

Answer 21

In bipolar 1 disroder - the psychotic symptoms occur exclusively durring manic or depressive episodes

In Schizoaffective - delusions / hallucinations persist even when Manic / depressive episodes are not present.