Psych

Question 1

Major Depression requirements for dx

Answer 1

2 weeks with 5 or more symptoms of SIGECAPS if anhedonia or depressed mood

Sleep, interest, guilt, energy,, concentration, appetite, psychomotor (leaden paralysis or antzy), suicide

Question 2

True or false, hyperparathyroidism can cause depression?

Answer 2

Yes, think calcium and psychiatric overtones

Question 3

Dopamine blockers canc ause depression

Answer 3

Like metaclopramide, prochlorperazine, haloperidol

Question 4

Med used for viral hepatitis that causes depression?

Answer 4

Interferon alpha

Question 5

Atypical depression is what?

Treatment?

Answer 5

Like Karly.

Responds to MAOi’s (though SSRI is first line)

Question 6

Peripartum depression is up to 4 weeks later. Psychotic features can happen b/c of depression

Answer 6

oh!

Important to differntiate mood disorder secondary to pyschoses and schizoaffective

Question 7

Persistent depressive disorder

Answer 7

2 years or longer without 2 months without symptoms.

Need depressed mood plus 2 SIGECAPS

Question 8

Desvenlafaxine, duloxetine, milnacipran, venlafaxine are what?

Answer 8

SNRIs and dizziness, serotonin syndrome, SEX DYSFUNCITON!

Question 9

Serotonin syndrome sx?

Answer 9

Mental status change, autonomic excitation, neuromuscular hyperactive, OCULAR CLONUS

Question 10

Drugs that increase risk of serotonin. ESPECIALLY the antibiotic

Answer 10

SSRI, SNRI, MAOIs, St johns, tryptophan (precursur)

LINEZOLID

Question 11

Tx of serotonin syndrome?

Answer 11

Discontinue
Supportive and vitals
Benzos for sedation
If temp above 41, PARALYZE and mechanically cool

If still agitated, use cyproheptadine

Question 12

What is cyproheptadine used for?

Answer 12

Still agitated after bento given after serotonin syndrome

it is serotonin antagonist

Question 13

Neuromalignant syndrome vs Serotonin syndrome?

Answer 13

NMS is gradula onset and rigidity wearas 5HT is hyperkinesis and clonus

both have autonomic instability, hyperthermia and muscle problems

Question 14

Bupropion mechanism?

what is nice about it?

Bad about it? (contraindications)

Answer 14

weight loss, keeps awake, NO SEXUAL DYSFUNCTION

Lowers seizure threshold

Question 15

Mirtazapine mechanism. Side effect?

Answer 15

Alpha 2 blocker, so more adrenergic.

Causes sedation and wt gain

Question 16

TCA overdose

Answer 16

Tri C’s

Cardiotoxic, tachy, hypotension
CNS toxic (coma, seizure)
AntiCholinergic

Question 17

Tx of TCA overdose?

Answer 17

ABC
Activated charcoal
Cardiac monitoring

DRUG LEVEL
SODIUM BICARB
BENZOS IF SEIZURE

Question 18

ECT indication

Answer 18

Depression refractory, psychotic depression, severe suicidality, mania, psychosis, rapid response required…

Question 19

What does bipolar II disorder need for dx?

Answer 19

Major depressive and at least one hypomanic episode

Question 20

Manic episode requires what for dx?

Answer 20

3 symptoms of DIG FAST

1 weeks
Impair funcitoning or require hospitalization or psychotic feature

Question 21

Does hypomania impair functioning or cause psychosis?

Answer 21

Nope

Question 22

Tx bipolar?

Answer 22

Lithium

Anticonvulsants (If renal failure)
Atypical antipsychotics added if above don’t work
ECT could be done

Question 23

Depression history should be sure to look for episodes of mania.

Answer 23

B/c SSRI could send to mania

Question 24

Tx for Neph Diabetes Insip if needing lithium?

Answer 24

HCTZ and amiloride b/c amiloride blocks sodium channels that allow sodium into renal cells

Question 25

Ebstein anomoly is what?

Answer 25

Tricuspid into RV. RV hypoplasia, Regurg. Patent Foramen ovale

Question 26

Lithium side effects?

Answer 26

LMNOP Movement Metallic taste Nephrogen Diab Insip hypOthyroid (or any thyroid issue) Preggers issue (ebstein)

Question 27

Cyclothymic disorder is what? tx?

Answer 27

2 years of hypomanic or depressive symptoms going back and forth Tx mood stabilizers and psychotherapy (like mini bipolar!)

Question 28

Dissociative identity disorder Derpersonalization/derealization

Answer 28

Id is multiple personalities/identities Depersonaliztion is detachment from body Derealization is feelings things around aren't real )in a dream state)

Question 29

Panic disorder dx when? Tx?

Answer 29

4 symptoms causing panic attack THEN MALADAPTIVE behavior of fear of them. Worry at least one month Tx by: CBT SSRI Benzos to stop acute panic attack (bentos can cause rebound)

Question 30

GAD Dx: LENGTH OF TIME? Tx Deression and anxiety same monkey in different shirt

Answer 30

Worry happening more days than not for 6 months with at least three symptoms! Tx: SSRI, SNRI or BUSPIRONE CBT can help

Question 31

Social anxiety tx?

Answer 31

Must be interfering or worrying about them CBT, SSRI, SNRI Benzo and Beta blockers may help for performance.

Question 32

Buspirone is what?

Answer 32

Second line anti anxiety med. Can be added to help the SSRI and SNRI (which are first line) Affinity for serotonin and dopamine receptors