Westchester

Question 1

What is the center for the subcortical primary affects (Panksepp’s basic feelings), particularly the NEGATIVE ones like fear, rage and grief?

Answer 1

Periacqueductal gray

Question 2

In Borderline Personality Disorder, the amygdala is (larger/smaller) volume than normal and has exaggerated reactivity.

Answer 2

smaller

Question 3

What is the word for “requires increasing dosages to get an effect”?

Answer 3

tachyphylaxis

Question 4

What are black box warnings associated with clozapine?

Which is the only one that is dose dependent?

Answer 4

1) agranulocytosis
2) myocarditis
3) seizure (the only one that is dose dependent; >900 mg)
4) cardiovascular collapse (esp. when used with a benzo)
5) hypersalivation/aspiration pneumonia

Question 5

What are the Frontal Lobe Functions?

Answer 5

SOAP

sequencing, organizing, abstracting, planning

Question 6

For which pathologies is ECT a treatment?

Answer 6

1) depression (postpartum, persistence of suicidality in the light of treatment resistance)
2) mania
3) schizophrenia (but not as good for that)

Question 7

What are side effects of ECT? What are absolute contraindications?

Answer 7

Rare: headache, some memory loss.
There are no absolute contraindications (pregnancy, anorexia, etc. ok). But use a LOW dose of antiseizure meds and use it AFTER the ECT, not before. Also: space-occupying lesions; MI within 3 months

Question 8

Which antipsychotics should be used in Parkinson’s patients?

Answer 8

Those that are less dopamine-blocking, like:

1) quetiapine
2) clozapine

Question 9

Which atypical antipsychotic is most associated with weight neutrality?

Answer 9

ziprasidone

Question 10

Compare typical and atypical antipsychotics.

Answer 10

Typical antipsychotics are:

1) associated with more EPS
2) more galactorrhea (with the exception of risperidone)
3) more tardive dyskinesia
4) more NMS
5) more D2 blockade as mechanism

Question 11

Typical antipsychotics are more associated with galactorrhea than atypical antipsychotics, with the exception of

Answer 11

risperidone

Question 12

Clozapine

Answer 12

atypical antipsychotic: weekly CBCs (risk of agranulocytosis)
anticholinergic (as much as antitryptiline)
orthostatic hypotension
myoclonic jerking
seizures at doses >900 mg
myocarditis
significant weight gain
NO stiffness of EPS
treatment-refractory patients

Question 13

olanzapine (Zyprexa)

Answer 13

SIGNIFICANT weight gain

metabolic syndrome –> diabetes (must test fasting glucose/lipid level, BMI, waist circumference)

Question 14

quetiapine (Seroquel)

Answer 14

LEAST likely to cause EPS (less dopamine blockade; use in Parkinson’s)
used in bipolar depression and bipolar mania
sedative

Question 15

aripiprazole (Abilify)

Answer 15

dopamine partial agonist/antagonist (as a low dose it is an agonist and used in depression)
VERY long half life (75-150h)

Question 16

ziprasidone

Answer 16

most weight neutral
metabolized by cytochrome P450 3a4
prolongation of QT = risk for Torsades
SHORT half life (BID drug)

Question 17

How do you treat akisthisa?

Answer 17

propanolol (or other beta blockers)

benzos

Question 18

What are suicide risk factors?

Answer 18

prior attempts (BIGGEST risk factor)
FH
60
high/drunk
psychiatric disease
stressors
Native Americans
hoplessness
anxiety
akisthisia
command hallucinations

Question 19

How do you treat a dystonic reaction and why does it work?

Answer 19

INTRAMUSCULAR cogentin (benztropine) or benadryl
These are ACh blockers.  Dystonic reactions are caused by a relative increase in NE over DA

Question 20

How do you treat tardive dyskinesia?

Answer 20

1) stop the medications
2) vitamin E?
NOTE: tardive dyskinesia may be permanent

Question 21

Postpartum psychosis is associated with which psychiatric disorder?

Answer 21

Bipolar

Question 22

What are the psychiatric symptoms associated with suicide?

Answer 22

1) hopelessness
2) impulsivity/aggression
3) anxiety/akasthisia
4) command hallucinations

Question 23

What are the only 2 medications that provide protection against suicide?

Answer 23

1) lithium

2) clozapine

Question 24

Name 3 drugs that can augment antidepressants

Answer 24

1) aripiprazole
2) quetiapine
3) lithium

Question 25

Antidepressants can increase suicidality in people up to age __

Answer 25

24