Clerkship - Psychiatry

Front 1

What are the 4 main mood d/o's?

Back 1

MDD
Dysthymic D/O
Bipolar D/O
Cyclothymia

Front 2

What are the main symptoms of depression?

Back 2

SIG E CAPS
Sleep (increased or decreased)
Interest - anhedonia
Guilt/Wothlessness

Energy - decreased

Concentration
Appetite - increased or decreased
Psychomotor changes
Suicidal ideation

Front 3

What is the average age of onset for MDD?

Back 3

3rd to 4th decade of life

Front 4

What is the recurrence rate of MDD after two prior episodes?

Back 4

70% (50, 70, 90 rule)

Front 5

What are the three categories that one should consider when making differential diagnoses of psychiatric disorders?

Back 5

Psychiatric
Organic (an underlying inherent medical condition that may be affecting a psychiatric condition)
Pharmacologic

Front 6

What other psychiatric disorders may appear like MDD and should be in your differential?

Back 6

substance-induced mood disorder
cocaine withdrawl
bereavement
schizoaffective disorder
dysthymia
dementia
bipolar d/o
adjustment d/o with depressed mood

Front 7

What organic cause for depression-like symptoms should be tested in every suspected case of MDD since it is common and treatable?

Back 7

hypothyroidism; check TSH

Front 8

According to the DSM-IV, what is the criteria for a diagnosis of MDD?

Back 8

At least 5 symptoms of depression (one must be depressed mood or anhedonia)
Sx must persist for at least two weeks and must lead to social and occupational dysfunxn
Must not be caused by drugs, meds, medical conditions or bereavement

Front 9

What is the time cut-off for differentiating between normal bereavement and MDD?

Back 9

bereavement lasting > 2mos

Front 10

What does it take to receive a diagnosis of "double depression"?

Back 10

2+ episodes of major depression during a 2-year period

Front 11

What are the three main categories of pharmacotherapy for MDD?

Back 11

SSRIs
MAOIs
TCAs

Front 12

What class of drugs are the first-line therapy for MDD?

Back 12

SSRIs

Front 13

ECT is generaly reserved for what type of MDD?

Back 13

REfractory or catatonic depression

Front 14

For the following definition provide the psychiatric term:

affect

Back 14

the outward expression, including facial expression, of the patient's internal emotional state

Front 15

For the following definition provide the psychiatric term:

circumstantiality

Back 15

indirect speech that is delayed in reaching the point, but does eventual reach desired goal

Front 16

For the following definition provide the psychiatric term:

Clanging

Back 16

association of words with similar sounds but not similar meaning

Front 17

For the following definition provide the psychiatric term:

compulsions

Back 17

conscious, stereotyped behaviors or thoughts that the patient manifests to prevent the distress or anxiety induced by an obsession

Front 18

For the following definition provide the psychiatric term:

delusions

Back 18

fixed, false, beliefs that are not consistent with the patient's cultural background and cannot be altered by reasoning

Front 19

For the following definition provide the psychiatric term:

depersonalization

Back 19

the self is felt to be unreal or detached from reality

Front 20

For the following definition provide the psychiatric term:

echolalia

Back 20

persistent repitition of the words or phrases of one person

Front 21

For the following definition provide the psychiatric term:

Flight of ideas

Back 21

rapid, continuous use of words with constatn shifting between connected ideas

Front 22

For the following definition provide the psychiatric term:

hallucinations

Back 22

false sensory perceptions

Front 23

For the following definition provide the psychiatric term:

ideas of reference

Back 23

a pt's belief that an object (e.g., radio or tv) is speaking to or about him or her

Front 24

For the following definition provide the psychiatric term:

illusions

Back 24

misinterpretations of actual stimuli

Front 25

For the following definition provide the psychiatric term:

loosening of associations

Back 25

flow of thought with random shifting of ideas from one subject to another

Front 26

For the following definition provide the psychiatric term:

mood

Back 26

the patient's subjectinve, internal emotional state

Front 27

For the following definition provide the psychiatric term:

neologisms

Back 27

new words, often created by combining syllables of other words

Front 28

For the following definition provide the psychiatric term:

obsessions

Back 28

recurrent, intrusive thoughts, impulses, or images that cause anxiety and that the patient attempts to suppress or neutralize in order to decrease anxiety

Front 29

For the following definition provide the psychiatric term:

perseveration

Back 29

persistent response to a revious stimulus when a new stimulus is presented

Front 30

For the following definition provide the psychiatric term:

poverty of thought

Back 30

having only a few thoughts, which lack variety and richness

Front 31

For the following definition provide the psychiatric term:

pressured speech

Back 31

rapid speech that is increased in amount and difficult to understand or interrupt

Front 32

For the following definition provide the psychiatric term:

tangentiality

Back 32

inability to have goal-directed thought (can't get from A to B at all)

Front 33

For the following definition provide the psychiatric term:

thought blocking

Back 33

abrupt interruption in a train of thought before the thought or idea is completed (brain fart)

Front 34

For the following definition provide the psychiatric term:

thought broadcasting

Back 34

belief that one's thoughts are being transmitted to others

Front 35

T/F Depression is associated with an increased risk of diabetes and insulin resistance?

Back 35

True

Front 36

what are the differences between MDD and dysthymic d/o?

Back 36

Dysthymic d/o does NOT:
lead to socia or occupational dysfunction
does not require hospitalization

Front 37

For the following drug class state the MOA and SFX:

SSRIs

Back 37

fluoxetine (prozac), sertraline (zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram(Celexa), escitalopram(Lexapro)

MOA: 5-HT-specific reuptake inhibitor
SFX: agitation, anxiety, neuromuscular restlessness (akathisia), sexual dysfunction; increased suicide risk in adolescents (except prozac)

Front 38

For the following drug class state the MOA and SFX:

tricyclic antidepressants (TCAs)

Back 38

amitriptyline, imipramine (tofranil), desipramine (norpramin), clomipramine (anafranil), nortriptyline, doxepin

MOA: block reuptake of NE and 5-HT

SFX: anticholinergic effects (more in thrid generation than 2nd, arrhythmias, seizures

Front 39

For the following drug class state the MOA and SFX:

monoamine oxidase inhibitors (MAOIs)

Back 39

Phenilzine (nardil), tranylcypromine (Parnate), isocarboxazid

Moa: nonselective MAO inhibition

SFX: HTN crisis, tyramine reaction (no wine and cheese)

Front 40

What is the difference between bipolar I and bipolar II d/o?

Back 40

Bipolar I: manic-depression
Bipolar II: MDE plus at least one hypomanic episode

Front 41

What are the signs ans sx of mania?

Back 41

DIG FAAST
Distractibility
Insomnia
Grandiosity
Flight of Ideas
increase in goal-directed Activity; psychomotor Agitation
pressured Speech
Thoughtlessness - seeks pleasure without regard to consequences

Front 42

What percentage of Bipolar patients will commit suicide?

Back 42

10-15%

Front 43

What is the DSM-IV criteria for a diagnosis of Bipolar I d/o?

Back 43

only a single manic episode is required for dx. Manic epsiode is defined as the presence of an elevated, expansive, or irritable mood with at least three signs sx from DIG FAAST

Front 44

What psychiatric conditions should be considered in the differential for Bipolar I d/o?

Back 44

Schizophrenia, schizoaffective d/o, cyclothymia, BPD, ADHD

Front 45

What organic conditions should be considered int he differential of Bipolar d/o?

Back 45

brain tumors, CNS syphilis, encephalitis, metabolic disorders, hyperthyroidism, MS

Front 46

What pharmacologic factors should be considered int he differential for Bipolar d/o?

Back 46

cocaine, amphetamines, corticosteroids, anabolic steroids, INH, captopril, antidepressants

Front 47

What is cyclothymia?

Back 47

at least 2 years of cycling hypomanic and dysthymic episodes without MDE, manic or mixed episodes. the pt must not be symptom free for > 2 mos at a time

Front 48

What is the treatment of choice for cyclothymia?

Back 48

mood stabilizer. Antidepressants alone may increase the rate of cycling and precipitate manic episodes

Front 49

If a patient with major depression is responding well to his current dose of medication, hwat should the maintenance dose be and for how long should you treat?

Back 49

maintain the current dose (the dose that got you better will keep you well) for a duration of 6-9 months

Front 50

What are the negative symptoms of schizophrenia?

Back 50

affective flattening, alogia (diminsihed flow and spontaneity of speech), avolition (lack of initiative or goals)

Front 51

What are the positive symptoms of schizophrenia?

Back 51

ideas of reference, grossly disorganized speech/behavior, delusions (e.g., paranoia), hallucinations

Front 52

What medical conditions may present with psychotic symptoms?

Back 52

deliria
dementia
severe hypothyroidism
hypercalcemia

Front 53

What signs in a patients history or presentation clue the physician into a medical explanation for psychotic behavior?

Back 53

no prior psychiatric history
late age of onset
positive review of systems

Front 54

What two categories of medications are more likely to causes psychotic states?

Back 54

steroids
anticholinergics

Front 55

What is the main side effect of clozapine that prevents it from being a first-line treatment against schizophrenia?

Back 55

agranulocytosis

Front 56

List the main atypical antipsychotics

Back 56

risperidone
olanzapine
quetiapine
ziprasidone
aripiprazole

Front 57

What is the benefit of atypical antipsychotics over older antipsychotics?

Back 57

atypicals treat both postivie and negative symptoms of schizophrenia

Front 58

What are the main side effects of older antipsychotics?

Back 58

extrapyramidal symptoms (dystonias, parkinsonial symptoms, akathisia), hyperprolactinemia, tardive dyskinesia

Front 59

What drug is given to reduce the parkinsonian and dystonic reactions of atypical antipsychotics?

Back 59

anticholinergic drugs like benztropine

Front 60

What is the treatment for panic disorder?

Back 60

SSRI and cognitive behavioral therapy; short acting benzos (alprazolam)can control symptoms but should not be used long term

Front 61

How does the DSM-IVdefine a panic d/o?

Back 61

at least one panic attack not caused by substance abuse or other mental illneses, followed by concern about another attack or the implications of another attack; can occur with or without agoraphobia

Front 62

What distingusihes a panic d/o from other anxiety d/os that may produce a panic attack?

Back 62

the hallmark of a panic disorder is UNEXPECTED panic attacks not provoked by any particular stimulus; also the fear associated with panic disorder is the fear of having another attack--not of the stimulus

Front 63

What other disorder is commonly seen in patients with panic d/o?

Back 63

major depressive disorder

Front 64

What is the likely dx of a pt who presents with depressed mood for several months and weight gain without increased appetite?

Back 64

mood disorder secondary to hypothyroidism; depression causes weight gain but usually 2/2 increased appetite

Front 65

For the following medical condition, state the mood disorder(s) it may most likely cause: Parkinson dz

Back 65

depression

Front 66

For the following medical condition, state the mood disorder(s) it may most likely cause: Huntington dz

Back 66

depression or mania

Front 67

For the following medical condition, state the mood disorder(s) it may most likely cause: Wilson dz

Back 67

Mania

Front 68

For the following medical condition, state the mood disorder(s) it may most likely cause: CVA

Back 68

depression or mania

Front 69

For the following medical condition, state the mood disorder(s) it may most likely cause: cerebral neoplasm

Back 69

depression or mania

Front 70

For the following medical condition, state the mood disorder(s) it may most likely cause: cerebral trauma

Back 70

depression or mania

Front 71

For the following medical condition, state the mood disorder(s) it may most likely cause: encephalitis

Back 71

depression or mania

Front 72

For the following medical condition, state the mood disorder(s) it may most likely cause: MS

Back 72

depression or mania

Front 73

For the following medical condition, state the mood disorder(s) it may most likely cause: temporal lobe epilepsy

Back 73

mania

Front 74

For the following medical condition, state the mood disorder(s) it may most likely cause: hyperthyroidism

Back 74

depression or mania

Front 75

For the following medical condition, state the mood disorder(s) it may most likely cause: hypothyroidism

Back 75

depression

Front 76

For the following medical condition, state the mood disorder(s) it may most likely cause: hyperparathyroidism

Back 76

depression

Front 77

For the following medical condition, state the mood disorder(s) it may most likely cause: hypoparathyroidism

Back 77

depression

Front 78

For the following medical condition, state the mood disorder(s) it may most likely cause: uremia

Back 78

depression or mania

Front 79

For the following medical condition, state the mood disorder(s) it may most likely cause: cushing syndrome

Back 79

depression

Front 80

For the following medical condition, state the mood disorder(s) it may most likely cause: addison dz

Back 80

depression

Front 81

For the following medical condition, state the mood disorder(s) it may most likely cause: SLE

Back 81

depression

Front 82

For the following medical condition, state the mood disorder(s) it may most likely cause: rheumatoid arthritis

Back 82

depression

Front 83

For the following medical condition, state the mood disorder(s) it may most likely cause: folate deficiency

Back 83

depression

Front 84

For the following medical condition, state the mood disorder(s) it may most likely cause: Vitamin B12 deficiency

Back 84

depression or mania

Front 85

For the following medical condition, state the mood disorder(s) it may most likely cause: HIV

Back 85

depression

Front 86

What is rapid cycling bipolar disorder?

Back 86

Occurrence of at least four episodes--both retarded depression and hypomania/mania--in a year

Front 87

What does it mean to have a labile mood?

Back 87

mood and/or affect that switches rapidly from one extreme to another.

Front 88

What demographic of pts is more likely to expereince bipolar d/o with severe mood dysregulation--multiple mood swings every day consisting of short periods of euphoria followed by longer periods of irritability?

Back 88

Children can average between 3-4 cycles per day

Front 89

What is the difference between ADHD, ODD, and CD?

Back 89

ADHD: distractibility, impulsivity and hyperactivity that is present on a daily basis prior to age 7
ODD (opp. definat d/o) - defiantly opposes the wishes of others and breaks minor rules
CD (conduct d/o) - defiantly breaking major social rules

Front 90

What may help differentiate bipolar d/o and ADHD diagnosis in childhood?

Back 90

Age - if the behavior is in preschool-aged children, it is more likely to be ADHD or ODD as bipolar is exteremly rare in this age range

Front 91

What is the pharmacotherapy for a child with bipolar, with psychosis?

Back 91

Mood stabilizers (lithium, carbamazepine, divalproex) and antipsychotics. Antidpressants may trigger manic episiodes

Front 92

The treatment of bipolar disorder in children involves what two aspects?

Back 92

psychotherapy and psychopharmacotherapy

Front 93

What is the MS side effect of ECT?

Back 93

anterograde memory loss

Front 94

What signs may distinguish major depression from dementia in elederly patients?

Back 94

Pts with deperession tend to display transient cognitive impairments that are reversiblewith tx
Depressed patients make little effort during cognitive testing exam, while demented patients exert effort
Demented patients have little insight into their intellectual difficulties

Front 95

What treatment is available for elderly patients who are depressed but cannot tolerate medication?

Back 95

ECT

Front 96

What are the MC category of mental d/os in the US, affecting 5-10% of the population?

Back 96

phobias

Front 97

What is the MOA of buspirone?

Back 97

serotonin type 1A receptor agaonist

Front 98

Define Generalized Anxiety Disorder?

Back 98

anxiety and worry about several events and activities for a majority of the day over a 6-month time period

Front 99

What percentage of patients with GAD have an associatedmental disorder?

Back 99

50-90%

Front 100

Grave's disease, pulmonary embolism, hyperthyroidism, Sjorgren syndrom and seizure disorders may present like which Axis I clinical d/o?

Back 100

Generalized Anxiety d/o

Front 101

What are the three main agents used in the treatment of GAD?

Back 101

buspirone, benzos, and SSRIs

Front 102

How do you distinguish between schizoaffective disorder and acute mania?

Back 102

a longitudinal history of the pts illness will show psychosis in the absence of mood symptoms in schizoaffective disorder

Front 103

What is the psychotherapeutic treatment for OCD? psychopharmacological?

Back 103

therapeutic: exposure/response therapy; child exposed to the least anxiety -provoking trigger first, then work up to higher levels

pharm: SSRI (fluoxetine, sertraline, fluvoxamine)