1
Q
characterized by the inability to maintain interpersonal relationships, impulsivity without regard for consequences, a distorted self-image, and fear of abandonment.
A
Borderline Personality Disorder (BPD)
2
Q
maladaptive emotional or behavioral response within 3 months to an identifiable psychosocial stressor (e.g., a breakup) that does not meet the diagnostic criteria for other mental disorders.
A
Adjustment Disorder
3
Q
Timeline for adjustment disorder
A
less than or equal to 6-months
4
Q
when a patient has a depressed mood on most days for ≥ 2 years, and has never had a symptom-free period longer than 2 consecutive months
A
Persistent Depressive Disorder (PDD) [Dysthymia]
5
Q
Sudden onset of psychiatric symptoms < 1 month after a specific event. the event in question must be a traumatic event with exposure to actual or threatened death, serious injury, or sexual violation,
A
Acute Stress Disorder (ASD)
6
Q
Present with body image disturbance and physical signs of malnutrition (hypothermia, dry skin, hair loss, muscle wasting, bradycardia, hypotension, and electrolyte disturbances)
A
Anorexia Nervosa
7
Q
What is the recommended class of pharmacotherapy for Alzheimer dementia?
A
Acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine)
8
Q
What is the clinical use for galantamine, rivastigmine, and donepezil?
A
Alzheimer’s Disease (AD)
9
Q
Memantine is a(n) ____ receptor antagonist used to treat _________
A
Memantine is a(n) NMDA receptor antagonist used to treat Alzheimer’s Disease (AD).
Memantine treats moderate or greater AD. e.g. Mini-mental state examination score of 18/30 or lower.
10
Q
What 3 things does acetazolamide treat?
A
- Idiopathic Intracranial Hypertension (IIH)
- Normal Pressure Hydrocephalus (NPH)
- Altitude sickness
11
Q
What sign/symptom distinguishes Alzheimer’s Disease (AD) from Normal Pressure Hydrocephalus (NPH)?
A
gait disturbances
AD and NPH both have dementia, urinary incontinence, and ventriculomegaly, but only NPH has gait issues.
12
Q
What CT finding may be found in patients with late-stage Alzheimer disease?
A
Diffuse cortical and subcortical atrophy
13
Q
What neurotransmitter is decreased in Alzheimer disease?
A
Acetylcholine
14
Q
Early-onset familial cases of Alzheimer disease are associated with mutations in what genes?
A
Presenilin-1 and 2 (PSEN1/2)
15
Q
How do you distinguish Alzheimer’s Disease from CJD?
A
Alzheimer’s disease is slow-onset memory loss and CJD is fast-onset.
16
Q
Alzheimer disease is characterized histologically by ________ plaques in gray matter
A
Alzheimer disease is characterized histologically by neuritic (senile) plaques in gray matter
16
Q
Opiod overdose results in death how?
A
Severe respiratory depression
17
Q
Benzodiazepine overdose results in death how?
A
CNS depression
18
Q
What are distinguishing features of phencyclidine overdose
A
agitation, aggression, and nystagmus
19
Q
What neuroimaging is seen in schizophrenia?
A
Enlargement of lateral ventricles
20
Q
What neuroimaging is seen in Huntington’s Disease?
A
Caudate nucleus (basal ganglia) atrophy
21
Q
What neuroimaging is seen in Wernicke-Korsakoff syndrome?
A
atrophy of mammillary bodies
22
Q
What neuroimaging is seen in Fahr disease and sometimes in certain metabolic diseases like hypoparathyroidism ?
A
Basal ganglia calcifications
23
Q
What are the 3 C’s of TCA’s?
A
- Cardiac arrhytmias
- Convulsions (seizures)
- Coma
24
What reverses a TCA overdose and why?
Intravenous sodium bicarbonate alkalinizes plasma so that protein binding of TCAs (weak bases) can prevent the drug from binding to the fast sodium channels and increases extracellular sodium concentration
25
What reverses beta-blocker poisoning?
Glucagon
26
What reverses insulin poisoning?
glucagon
27
What reverses atropine poisoning?
Physostigmine
## Footnote
or any acetylcholinesterase inhibitor
28
What reverses acetaminophen (Tylenol) poisoning?
N-acetylcysteine (NAC)
## Footnote
look for hepatic toxicity like RUQ pain and jaundice
29
example of this defense mechanism would be someone leaving a magazine article about annoying eating habits (loud chewing, chewing with mouth open, etc.) on a coworker's desk in reaction to feeling annoyed with the coworker's eating habits during lunch breaks.
Passive aggression
30
a mature defense mechanism that makes realistic provisions for difficult situations in the future, e.g., going over course notes in preparation for a lecture the next morning.
Anticipation
31
redirection of impulses and emotions from a target that is perceived as threatening or unacceptable to another that is perceived as more acceptable or less threatening; e.g., a manager may take out his frustration at the company CEO on subordinates; a child might take out his anger at his parents on his dog.
Displacement
32
the expression of repressed or unconscious emotions in an impulsive and unrestrained manner; e.g., knocking over one's desk after getting fired.
Acting Out
33
a defense mechanism in which individuals reshape their perception of an upsetting reality to be more acceptable. Is usually associated with psychotic disorders.
Distortion
34
experience and/or express psychological distress as somatic symptoms (e.g., pain)
Somatization
35
refers to the transient interruption of the thought process, e.g., when a person suddenly forgets the reason for calling a friend.
Blocking
36
persistent obsession with their health and/or the possibility of developing a disease.
Hypochondriasis
37
Prior to beginning lithium therapy, patients should be screened to ensure adequate ____ and ____ function
Prior to beginning lithium therapy, patients should be screened to ensure adequate **thyroid** and **renal** function
38
What teratogenic effect is associated with maternal lithium use?
Ebstein Anomaly
39
Which first-line mood stabilizer is associated with U waves and flattened/inverted T waves on ECG?
Lithium
40
What type of diabetes is associated with lithium use?
Nephrogenic DI
41
In what part of the nephron is lithium primarily reabsorbed?
PCT
42
Diagnosis of a manic episode requires an elevated and/or irritable mood for at least ____ plus at least three ____ criteria
Diagnosis of a manic episode requires an elevated and/or irritable mood for at least **1 week** plus at least three **DIG FAST** criteria
43
What are the manic episode criteria?
DIG FAST
44
Overdose of benzodiazepines = CNS depression with ____ vitals Overdose of benzodiazepines and alcohol = CNS depression with ____ vitals
normal, abnormal
45
What drugs can't be combined with benzodiazepines?
Any other CNS depressant:
* alcohol
* barbiturates
* first gen antihistamines
* antipsychotics
* opiods
46
What is firstline treatment for maintenance of panic attacks?
SSRIs
SNRIs
47
What treats an acute panic attack?
Benzodiazepines:
* lorazepam
* diazepam
* alprazolam (Xanax)
## Footnote
lam and pam drugs
48
What are the Extrapyramidal symptoms in order of occural?
* **A**cute **D**ystonia - sustained muscle contractions that lead to abnormal postures and movements
* **A**kathisia - restlessness and moving
* **P**arkinsonisms - movement symptoms like slowness, stiffness, tremor, and balance problems
* **T**ardive Dyskinesia - tongue and lip smacking
## Footnote
ADAPT
49
What are the first-line medical treatments for chronic persistent symptoms of restless legs syndrome?
Gabapentin or pregabalin (α2δ Ca2+ channel inhibitors)
50
What is the most common comorbidity with Tourette Syndrome?
ADHD
## Footnote
manifests as impulsivity and inattention
51
Stimulus Control Therapy
52
What are two antidepressant meds that generally do not cause sexual side effects?
* Bupropion
* Mertazapine
53
First-line: Intravenous Lorazepam
Second-like: ECT
## Footnote
Diagnosis is Catatonia.
54
What drug class is first-line for non-malignant catatonia and if that doesn't work what is the treatment?
benzodiazepines and ECT after a week
55
used to treat acute dystonia, akathisia, and bradykinesia, which are extrapyramidal side effects of typical antipsychotics like haloperidol.
Benztropine
56
What medication is first-line treatment for serotonin syndrome?
Cyproheptadine
57
What two things does dantrolene treat?
* Neuroleptic Malignant Syndrome (NMS)
* Malignant Hyperthermia
58
A somatic symptom-related disorder characterized by neurological symptoms (e.g., paralysis, weakness, visual disturbances) that are not explained by a recognized neurological disease or other medical conditions, and are not intentionally produced.
Conversion Disorder / Functional Neurological Symptom Disorder
59
What is first-line treatment for conversion disorder?
patient education
60
Is characterized by the disruption of identity into at least two distinct personality states in combination with recurrent memory gaps. In addition to these two criteria, a diagnosis requires that the symptoms cause significant social or occupational impairment and that the symptoms must not be related to substance use, other medical conditions, or be part of an accepted cultural or religious practice.
Dissociative Identity Disorder (DID)
61
Characterized by memory gaps that lead to clinically significant social and/or occupational impairment
Dissociative Amnesia
62
What medication and MOA?
1st gen antipsychotic with dopamine blockage
## Footnote
ADA**P**T
63
Decreased REM latency
64
Dissociative Amnesia
65
Delusional Disorder
66
What is the biggest risk factor of electroconvulsive therapy (ECT)?
retrograde amnesia
67
What drug is used for maintenance therapy in in patient's with chronic psychotic disorders like schizoaffective disorder
Fluphenazine (Phenothiazines)
68
What is the main adverse effect of Phenothiazines
impaired thermoregulation
## Footnote
Adverse effect is believed to be due to the drug's effect on the hypothalamus, which leads to inappropriate responses
69
When is perphenazine indicated as a treatment method in patient's with Alzheimer's Disease?
When they are experiencing antipsychotic effects like hallucinations
70
What pharmacotherapy is used to treat acute dystonia in someone who experiences adverse effects of a first generation antipsychotic
* Benzotropine
* Diphenhydramine
## Footnote
Anticholinergic effects
71
This type of tremor has an abrupt onset and is triggered by a physical (e.g., injury), somatic (e.g., migraine headache), or psychological event (e.g., death of a family member). It is a high-amplitude tremor that worsens under observation and betters with distraction
Functional tremor
72
Tremor most commonly caused by cerebellar issues (e.g. stroke and MS) and increased movement in a finger-to-nose test.
Intention tremor
## Footnote
you will see cerebellar symptoms like ataxic gait, dysdiadokinesis, dysmetria, and other symptoms.
73
Tremor that occurs when the body is fully relaxed and supported against gravity
Resting tremor
## Footnote
Classical Parkinson's pill rolling tremor
74
Tremor that worsens with movement, and has a normal neurological exam. Is most commonly symmetric and slowly progressive,
Essential tremor
75
Is used to promote alcohol cessation in patients with alcohol use disorder and to manage withdrawal symptoms after acute opioid detoxification.
Naltrexone
## Footnote
Taking Bupropion with Naltrexone is a proven weight loss treatment called contrave
76
A 6-year-old boy is brought to the physician because of inability to concentrate and difficulties completing assignments at school. His mother says that he frequently interrupts others during conversations at home and that his teachers often reprimand him for talking excessively in school. He refuses to play with the other children and often has physical altercations with his classmates. He can jump up and down, but he cannot hop on one foot. He eats without assistance but has difficulty using silverware. He cannot follow three-step directions. There is no family history of serious illness. Examination shows a small head, wide-spaced eyes, and short palpebral fissures. His upper lip is thin and flat. He has a sunken nasal bridge and a small jaw. There is a grade 3/6 pansystolic murmur heard best along the left lower sternal border. Which of the following is the most likely cause of these findings?
Fetal Alcohol Syndrome
77
most common preventable cause of intellectual disability in the United States.
Fetal Alcohol Syndrome (FAS)
78
Are effective for treating sleep-onset insomnia and/or sleep maintenance insomnia, depending on their half-life.
Zaleplon and other Z-drugs
79
A 71-year-old woman comes to the office because she is having trouble staying awake in the evening. Over the past year, she has noticed that she gets tired unusually early in the evenings and has trouble staying awake through dinner. She also experiences increased daytime sleepiness, fatigue, and difficulty concentrating. She typically goes to bed between 7 and 8 PM and gets out of bed between 3 and 4 AM. She does not have any trouble falling asleep. She takes 30-minute to 1-hour daytime naps approximately 3 times per week. She has no history of severe illness and does not take any medication. Which of the following is the most likely diagnosis?
Advanced Sleep Phase Disorder
80
What can be used to treat advanced sleep phase disorder?
Timed bright light phototherapy.
81
directly inhibit fast sodium channels and cause an intraventricular conduction delay, which manifests as wide QRS complexes. Wide QRS complexes correlate positively with the risk of seizures and ventricular tachyarrhythmias
TCAs
82
If you suspect a TCA poisoning what should you do?
* 1) Check ECG to confirm if the wide QRS intervals (>100) are present
* 2) If present administer sodium bicarbonate as a reversal agent
83
What is the diagnosis
CJD is incurable and Valproate or clonazepam are first line meds for myoclonic movement alleviation
84
A 40-year-old man is physically and verbally abusive toward his wife and two children. When he was a child, he and his mother were similarly abused by his father. Which of the following psychological defense mechanisms is this man?
## Footnote
Another example is someone dressing and acting exactly like their older sibling
Identification
85
bone fractures
## Footnote
Beers criteria: antipsychotics, antidepresants, antihistamines, antimuscarinics, and antismasmodics.
86
delayed sleep-wake phase disorder (DSWPD)
87
Lewy body dementia (LBD)
## Footnote
Parkinson's features present first, then dementia symptoms.
88
taper lorazepam
## Footnote
tapering the causative drug is the treatment of choice in patients who have a paradoxical reaction to benzodiazepines. This rare adverse effect most commonly occurs in older individuals and children
89
CBT
## Footnote
IF he didn't have a history asthma a beta-blocker like propanolol would be well suited for his performance-only social anxiety (SAD).
90
What is the diagnosis?
performance-only social anxiety (SAD)
91
What drug is contraindicated in marijuana use?
Benzodiazepines
92
decrease the frequency of nightmares and improve sleep quality in patients with PTSD, particularly in combat veterans and in patients experiencing nighttime PTSD symptoms (e.g., nightmares, sleep disturbances). Since this patient has vivid dreams of the traumatic incident on a regular basis, difficulty falling asleep, and poor sleep quality despite using a selective serotonin reuptake inhibitor (SSRI).
Prazosin
93
Prazosin treats what two things
* High blood pressure
* PTSD nightmares
94
patient's recurrent outbursts of anger (temper tantrums, physical aggression toward others) that occur in ≥ 2 settings (with parents and with peers) ≥ 3 times per week and chronic irritability between outbursts with a low mood for baseline for ≥ 12 months are consistent with what diagnosis?
Disruptive Mood Dysregulation Disorder
95
What class of drug is Duloxetine and what is it primarily used to treat?
SNRI and GAD
96
A 42-year-old biochemist receives negative feedback from a senior associate on a recent project. He is placed on probation within the company and told that he must improve his performance on the next project to remain with the company. He is distraught and leaves his office early. When he gives an account of the episode to his wife, she says, “I'll always be proud of you no matter what because I know that you always try your best.” Later that night, he tearfully accuses her of believing that he is a failure. Which of the following psychological defense mechanisms is he demonstrating?
Projection
## Footnote
another example: you are cheating on your partner so you accuse your partner of cheating on you.
97
What is the diagnosis and next step treatment?
Acute Hyperventilation Syndrome and breathing retraining
## Footnote
the condition is a diagnosis of exclusion, it is necessary to evaluate for organic causes (e.g., myocardial infarction, pulmonary embolism, diabetic ketoacidosis, asthma) that can manifest with episodic hyperventilation, lightheadedness, and chest pain. Hyperventilation syndrome is frequently associated with anxiety and/or panic disorders.
98
Narcissistic Personality Disorder
## Footnote
a grandiose sense of self-importance (as evidenced by exaggeration of achievements or talents); arrogant or haughty behavior; a sense of entitlement; a need for excessive admiration; a need to associate only with people or institutions of the highest status; a tendency to be exploitative (unwittingly or intentionally) in interpersonal relationships; a lack of empathy; envy of others or a belief that others are envious of him/her.
99
Temporal lobe epilepsy
## Footnote
temporal lobe spike on ictal EEG
100
The most common childhood epilepsy syndrome. Characterized by multiple, daily absence seizures in children between the ages of 2–12 years (peak incidence: 5–6 years). Typical episodes involve the child appearing to be daydreaming (eyes open/fluttering, staring off into space) for several seconds at a time, multiple times per day.
Childhood Absence Epilepsy
101
What is the first, second, and third line treatment for Childhood Absence Epilepsy
* Ethosuximide
* Valproate
* Lamotrigine
102
is a dopamine agonist used to treat pseudoparkinsonism in patients taking antipsychotic drugs. However, it is only indicated if pseudoparkinsonism persists after stopping the causative drug.
Amantadine
103
vasospasm of cerebral vessels
104
Somatic Symptom Disorder
105
Behavioral Therapy
106
This medication is reserved for patients with blood lead levels ≥ 70 μg/dL or features of acute lead encephalopathy (e.g., altered mental status, vomiting, seizures). Chelation therapy can adversely affect growth rate and studies have shown that chelation therapy in children with mildly elevated BLL (i.e., < 45 μg/dL) is not associated with better neurodevelopmental outcomes when compared to patients who have not received chelation therapy.
Dimercaprol
107
Functional Neurologic Symptom Disorder
108
are the preferred initial treatment for an agitated and combative patient with acute mania.
Antipsychotics like haloperidol and risperidone
109
Indicated in patients who have recently undergone a relapse of psychosis and have an active relationship with their partners or families
Family therapy
110
task of repeating three objects immediately after they have been named is a test of
registration or immediate memory/recall
111
Patients with symptomatic stimulant intoxication (e.g., amphetamine overdose, cocaine overdose) should be treated with
Benzodiazepines
112
Illusion
113
Mood stabilizer intake
## Footnote
Nephrogenic DI is the most common complication of long-term use of lithium
114
Illness Anxiety Disorder (Hypochondriasis)
115
How long does it take for psychostimulants to take effect?
1-2 days
116
Individuals with panic disorder are at increased risk of developing other psychiatric disorders, including these six:
* MDD
* PTSD
* SUD
* GAD
* SAD
* Agoraphobia
117
What four medications have a high risk of psuedoparkinsonisms?
* Lithium
* Fluphenazine
* Metoclopramide
* Valproate
118
Reactive Attachment Disorder (RAD)
119
Is characterized by a consistent pattern of inhibited, emotionally withdrawn behavior toward caretakers.
Reactive Attachment Disorder (RAD)
120
first line treatment for alcohol withdrawal
Benzodiazepines
## Footnote
no history of liver cirrhosis use long active benzos like diazepam and chlordiazepoxide.
history of liver cirrhosis use short acting like lorazepam and oxazepam
121
Re-evaluate the patient when they are no longer sedated and if the patient is still intent on harming themselves or others then admit them involuntarily
122
____ stage” of behavioral change have not yet acknowledged the harm in behaviors such as substance abuse and therefore have no intention of change in the foreseeable future.
precontemplation
123
____ stage” of behavioral change acknowledge that there is a problem but have not yet committed to making a change.
contemplation
124
Is the first-line treatment for mild cases of nightmare disorder.
reassurance
125
Methadone or naltrexone/buprenorphine
## Footnote
methadone - long acting opioid agonist
buprenorphine - partial opioid agonist
naltrexone - opioid antagonist
126
What is this patient experiencing?
Opioid Withdrawal
127
What mood stabilizing drug commonly causes acute pancreatitis?
Valproate
128
Isolated neurological symptoms after an emotional stressor in a young female patient with a history of a psychiatric disorder (trichotillomania) with inconsistent focal neurological findings and imaging showing no abnormalities are highly characteristic of
Conversion Disorder
## Footnote
first line treatment is patient education
129
is an appetite stimulant that can be used in adults with cancer-related anorexia or cachexia
Megestrol
130
What two medications are administered prior to initiation of electroconvulsion therapy (ECT)?
* Methohexital
* Succinylcholine
131
What is the MOA of lysergic acid diethylamide (LSD)
activating 5-HT2A receptors in the CNS
132
What are the signs of a bad lysergic acid diethylamide (LSD) trip?
* anxiety
* agitation
* paranoid delusions
133
What drugs can be given to help alleviate an LSD trip?
Antipsychotics - paranoid delusions
Benzodiazepines - anxiety and agitation
134
What illicit drug commonly results in aggressive behavior
Phenylcyclidine (PCP)
135
Is a type of parasomnia characterized by short (< 60 seconds) dream enactments (e.g., yelling, moving limbs, walking, punching) due to loss of REM sleep atonia, which may lead to injury to self or others. most commonly occurs in the second half of the sleep cycle, when the proportion of REM sleep increases. Affected individuals are typically alert and orientated after awakening and remember their dreams.
REM sleep behavior disorder
136
Cyclothymic Disorder (CD) / Cyclothymia
137
present at an early age with difficulties in both verbal and nonverbal communication, such as adapting to social settings (e.g., being quiet during a performance) and using communication methods adequately (e.g., body language, eye contact). There is no restricted and repetitive behaviors or sensory sensitivity characteristic.
Social Communication Disorder
138
A condition in which a child consistently refuses to speak when expected to (e.g., when asked a question in school) although their communication skills are not impaired.
Selective Mutism
139
What medications treat tardive dyskinesia (TD)?
* Val**benazine**
* Tetra**benazine**
* Deutetra**benazine**
## Footnote
These are vesicular monoamine transporter-2 (VMAT-2) inhibitors
140
A condition in which estimated fetal weight or abdominal circumference is below the 10th percentile for gestational age.
Fetal growth restriction / Intrauterine growth restriction (IUGR)
141
What is first-line treatment for body dysmorphia disorder (BDD)?
* SSRIs and CBT
142
What is the condition and the second most common condition
Fragile X Syndrome and Mitral Regurgitation from MVP then focal seizures next common.
143
What medication is contraindicated in bipolar disorder and why?
SSRI's because they can trigger a manic episode or cause rapid cycling
144
What is first and second-line therapy for bipolar depression
* first-line: 2nd generation antipsychotic (e.g. quietapine)
* second-line: mood stabilizers such as lamotrigine and lithium
145
Fluphenazine
## Footnote
flu-like symptoms - decreased core body temperature, hyporeflexia, dilated pupils, and paradoxical removal of clothing
146
Group of drugs with antipsychotic and antiemetic properties that acts predominantly by dopamine receptor (D1 and D2) receptor antagonism but also has antimuscarinic, alpha blocker, and antihistaminergic effects.
Phenothiazines
147
An α2 adrenergic agonist, is used in the treatment of tics associated with Tourette syndrome.
* Guanfacine
* Clonidine
148
Is the preferred drug for severe cataplexy in narcolepsy
Sodium Oxybate
149
Is a recommended treatment option for patients with narcolepsy who have persistent excessive daytime sleepiness despite lifestyle modifications
Modafinil
150
Treatment with an MAOI because of an increased risk of serotonin syndrome
151
What is the patient experiencing
Serotonin Syndrome and Sumatriptan for acute migraines
## Footnote
Sumatriptan is a serotonin receptor agonist
152
Schizoaffective Disorder
153
Schizoid Personality Disorder
154
C
## Footnote
use carbonic acid buffer curve and then for every 10 mmHg CO2 above 40 add 1 HCO3-
155
Factitious Disorder
156
Chlorpromazine
157
High potency antipsychotics examples
* Haloperidol
* Trifluoperazine
* Fluphenazine
* Pimozide
## Footnote
**Hal** **Tri**es to **Fl**y **Pi**es HIGH in the sky. high potency - EPS
158
Low potency antipsychotics examples
* Chlorpromazine
* Thioridazine
## Footnote
Anti-HAM symptoms (Histamine/Adrenergic/Muscarinic)
159
is used in the treatment of gastroparesis, nausea, and vomiting
Metoclopramide
160
What is the first-line medication for GAD?
* SSRI
* SNRI
161
What is the second-line medication for GAD?
* Buspirone
162
SSRI and SNRIs (e.g. Fluoxetine and Duloxetine
163
Major Depressive Disorder (MDD)
164
What is decreased in this patient?
* Dopamine - increased
* Ach and GABA - deceased
165
MDMA / Ectasy / Molly
166
TSH levels
167
CBT
168
If a patient experiences mood episodes with any hypomanic/manic episodes then what medications should be used?
Mood stabilizing medications:
* Lithium
* Divalproex
* Atypical Antipsychotics
169
polysomnography primarily diagnosis what two conditions?
* sleep apnea
* narcolepsy
170
Narcolepsy arises from deficient production of ____ in the hypothalamus
Orexins
## Footnote
orexins induce secretion of monoamines like norepinephrine that promote wakefulness
171
Anticholinergic effect (Cholinergic blockade)
172
refers to cognitive impairment resulting from MDD
psuedodementia
173
Post-traumatic stress disorder (PTSD)
174
Valproic Acid
## Footnote
a rare adverse effect is acute pancreatitis. More common are hepatotoxicity, bone marrow toxicity, and alopecia
175
How many of the SIGE CAPS symptoms must a person have for MDD?
5 and 1 of the 5 has to be anhedonia or feeling of hopelessness/depression
176
What are the criteria for persistent depressive disorder (PDD) (dysthymia)?
3 SIGE CAPS that have lasted for years on most days than not.
177
First-line treatment for a pregnant woman diagnosed with BPD
Electroconvulsive Therapy (ECT)
## Footnote
most mood stabilizers are teratogenic (e.g. lithium and valproate leading to Ebstein anomaly and neural tube defects respectively)
178
first-line treatment for female orgasmic disorder?
patient education and directed masturbation followed by partner incorporation
179
First-line treatment for Avoidant Personality Disorder?
CBT
180
What condition does this person have?
Avoidant Personality Disorder
## Footnote
usually non assertive and suppress emotional expression.
181
What condition is this?
Hyperemesis Gravidarum (HG) - this patient has the Wernicke's encephalopathy triad (highlighted) so treat with vitamin B1
182
What neurotransmitter is responsible for hyperactive and inattentive pathways of ADHD?
hyperactivity - dopamine
inattentive - norepinephrine
## Footnote
Hence you treat with a dopamine norepinephrine reuptake inhibitor (NDRI). i.e. methylphenidate
183
What medications help treat Huntington's Disease (HD)?
* Tetrabenazine
* Deutetrabenazine
## Footnote
VMAT2 inhibitors depleting monoamine neurotransmitters like dopamine
184
What is first and second-line treatment for OCD?
* 1st - CBT (pyschotherapy)
* 2nd - SSRIs
185
What medication augments SSRI therapy for OCD?
atypical antipsychotic - risperidone
186
Can you use SNRIs for OCD treatment?
second-line treatment for adults only with OCD. not for pediatric patients.
187
SSRI or SNRI
## Footnote
contraindicated in bipolar beause of risk of mania
188
Inpatient Nutritional Rehab
189
Bipolar II disorder
## Footnote
Treat with Quietapine (atypical antipsychotic)
190
Nephrogenic Diabetes Insipidus caused by Lithium toxicity
## Footnote
Most common side effect of long term lithium use is nephrogenic DI
191
short-acting opioid agonist
192
What medication is contraindicated because of risk of acute opioid withdrawals in patients being treated for opioid use disorder with methadone
Mixed agonist and antagonist opioid analgesics
193
IV benzodiazepine (lorazepam)
194
What is first-line treatment for non malignant catatonia?
Benzodiazepines
195
What two pharmacotherapies treat Neuroleptic Malignant Syndrome (NMS)?
* Dantrolene
* Bromocriptine
## Footnote
Discontinuing the causative psychotic is also important!
196
Haloperidol or another antipsychotic to calm the patient followed by mood stabilizer for long term treatment
197
Treat with an antipsychotic and mood stabilizer. Avoid Lithium because elevated serum creatinine (Valproic acid and quietapine) will work.
198
bath salts
## Footnote
In contrast to amphetamines, bath salts have a longer duration of effect, and symptoms can last for hours up to several days. Cocaine presents similarly, but lasts a couple hours at maximum.
199
Schizotypal Personality Disorder
200
Reduce Ropinirole
## Footnote
Dopamine agonists can result in impulse control disorder (ICD)
201
What condition?
Vascular Dementia and Cognitive Training
202
hyperactivity in the locus ceruleus is in what condition?
Anxiety disorders
203
Benzodiazepine
## Footnote
treat acute panic with benzodiazepines like lorazepam
204
Pupils are dilated a lot. Get a toxicology screening
205
Barbiturate overdose. Treat with assisted respiration and urine alkalinization
206
Haloperidol
207
Patient has Separation Anxiety Disorder and first-line treatment is psychotherapy called parent-child interaction therapy
208
What lab should be checked?
Lipids; olanzapine and the apines can cause dyslipidemia
209
Mechanisms of action of phencyclidine (PCP)
* Inhibition of NMDA receptors
* Activation of dopaminergic neurons
210
Mechanism of action of lysergic acid diethylamide (LSD)
Stimulation of 5HT2A and dopamine D2 receptors
211
Mechanism of action of caffeine.
Inhibition of adenosine receptors
212
Agoraphobia
## Footnote
areas outside the home when alone (e.g., going for a walk), open spaces (e.g., bridges, parking lots), enclosed spaces (e.g., stores, theaters), lines or crowds, and public transportation;
213
Cocaine Use
214
What is the condition?
pseudodementia treated with an SSRI
215
are the most common cause of neuroleptic malignant syndrome (NMS)
High-potency antipsychotics such as haloperidol
216
GABA-A Antagonist (flumazenil)
217
Family therapy is indicated for what two conditions?
* Oppositional Defiant Disorder (ODD)
* Conduct Disorder
218
serotonin blockade is associated with what effect?
antiemetic
## Footnote
i.e. ondansetron
219
Niacin (B3) deficiency results in pellegra, clasically presents with the triad of?
* Dementia
* Diarrhea
* Dermatitis
## Footnote
3D's of B3
220
What two opioid medications are strongly associated with delirium?
* Meperidine
* Tramadol
## Footnote
agonist at the mu-opioid receptors in the brain and spinal cord
221
What is the treatment for refractory obsessive-compuslive disorder (OCD)?
atypical antipsychotics (i.e. Risperidone)
222
sense of invulnerability
223
What condition does he have?
Obstructive sleep apnea (OSA)
224
Delusion Disorder
## Footnote
being conspired against is common in delusional disorder. Being conspired against is distinct from others out to get you. conspiring is specific, deliberate, and organized plot and out to get you is a more broad/generalized feeling of being targeted with malicious intent
225
What is the genetics of Rett syndrome?
MECP2
226
What is the triad of congenital rubella?
* Cataracts
* PDA
* Sensorineural deafness
227
What is the genetics of Williams Syndrome
microdeletion on chromosome 7
228
Discontinue diphenhydramine
## Footnote
It is a first gen antihistamine. Constipation is an anticholinergic effect!
229
What medication is sometimes used in schizoaffective disorder or schizotypical disorder to address mood symptoms?
Lithium carbonate (Lithium)
230
Lithium induced nephrogenic diabetesis insipidus (NDI)
231
Naltrexone (good for moderating patient's drinking)
## Footnote
disulfiram can be helpful in patients who are motivated to stay sober from alcohol but for this patients who is unsure about discontinuing alcohol it is not a good because it makes you sick when you drink
232
Assess patient's informed decision-making capacity
## Footnote
history of TBI and substance use make it necessary to test if patient is cognizant
233
What are the two most common side effects for a benzodiazepine?
* rebound anxiety
* delirium (especially older patients')
234
Factitious disorder
## Footnote
Decreased c-peptide levels indicate exogenous insulin administration
235
Bipolar Disorder
236
Delirium
237
abnormal eye tracking is found in patients with what condition?
Schizophrenia
238
enlargement of the third and lateral ventricles on a CT scan of the head occurs in what?
Cerebral aqueduct (of Sylvius) stenosis
## Footnote
most common cause of congenital hydrocephalus
239
Nonsuppression of cortisol after administration of 1 mg of dexamethasone is seen in what condition?
Cushing syndrome
240
What psychiatric condition do you see an increased sensitivity to lactate infusions?
Panic attacks
241
in this sleeping condition muscle atonia is lost in the REM cycle. Patient can kick partner in bed, choke partners out, etc.
REM sleep behavior disorder
242
are vital signs normal or abnormal in delirium?
abnormal - see tachycardia, tachypnea, hypertension, and hyperthermia.
243
What reverses organophosphate poisoning?
atropine
## Footnote
anticholinergic drug that works as a competitive, reversible antagonist of muscarinic acetylcholine receptors
244
What symptoms does organophosphate poisoning have?
* Diarrhea
* Bradycardia
* Miosis
* Diaphoresis
## Footnote
farmers and nerve gas attacks
245
overdose of this substance results in flank pain, hematuria, HAGMA, and calcium oxalate urine crystals
ethylene glycol poisoning
## Footnote
MUD PIL**E**S
246
overdose of this substance results confusion, headache, and red skin after a barbecue (indoor bbq especially).
carbon monoxide poisoning
247
overdose of this substance results confusion, blurred vision, HAGMA, and and a history of alcohol use
Methanol poisoning
## Footnote
**M**UD PILES
