Rotations Psych Dit 2009

Front 1

Neurotransmitters

1) What NT changes do you see in the following dz'es:
a) Anxiety Disorders?
b) Depression?
c) Mania?
d) Alzheimer's?
e) Huntington's?
f) Schizophrenia?
g) Parkinson's?

Back 1

1)
a) Inc NE, Dec Serotonin, Dec GABA
b) Dec NE, Dec Dop, Dec Serotonin
c) Inc NE, Inc Serotonin
d) Dec ACh
e) Dec ACh, Dec GABA
f) Inc Dopamine
g) Dec Dopamine, Inc ACh

Front 2

Mood Disorders

1) @ what point does grief / bereavement become pathological?

Back 2

1) When any of the following are found:
1. Depression criteria met for @ least 2 wks after the first 2 months following the loss
2. Generalized feelings of helplessness, hopelessness, worthlesness, guilt
3. Suicidal Ideation
4. Distressing feelings do not diminish in intensity by 6 mos
5. Inability to move-on, trust others or reengage in life by 6 mos

Front 3

Depression

1) What medical cond'ns can cause severe depression?

Back 3

1) Hypothyroidism
Hyperparathyroidism
Parkinsons
ACA Stroke
Pancreatic CA
CNS Neoplasms

Front 4

Depression

1) What medications are known for causing sx of depression in pts?

Back 4

1)
-Sedatives: ETOH, Benzos, -Antihistamimnes
-Stimulant Withdrawal
-Methyldopa (For HTN in pregnancy)
-1st Generation Antipsychotics (Haloperidol)
-Antinausea drugs: Metoclopramide & Prochlorperazine
-Glucocorticoids
-Insufficient thyroid replacement --> Hypothyroidism
-alpha-IFN (used in viral hepatitis)

Front 5

Suicide

What are some RF for suicide?

Back 5

SAD-PERSONS

-Sex = Male
-Age < 19 or > 45
-Depression
-Prior attempts @ suicide
-ETOH
-Rational thought process (or lack there of)
-Support (emotional and social) lacking
-Organized plan for suicide
-No spouse
-Sickness

Front 6

Atypical Depression

1) What are the sx of atypical depression?

2) What medications work well for atypical depression?

Back 6

1) Hypersomnia;
Hyperphagia;
Hypersensitive to Rejection;
Psychomotor agitation

2) MAOI's > TCAs

Front 7

Seasonal affective disorder

1) What is the first-line treatment for seasonal affective disorder?

Back 7

1) Light Therapy

Front 8

DO THE CATEGORIZE THE ANTI-DEPRESSANTS ON P.2 OF PSYCH

Back 8

DO THE CATEGORIZE THE ANTI-DEPRESSANTS ON P.2 OF PSYCH

Front 9

Serotonin Syndrome

1) Which drugs should not be taken with SSRIs bc of the risk of Serotonin Syndrome?

2) What are the characteristic features of serotonin syndrome?

3) What is the tx of serotonin syndrome?

Back 9

1)
-Other SSRIs
SNRIs
-MAOIs
-St. John's Wart
-Tryptophan
-Cocaine, Amphetamines, Ecstasy
-Dopamine

2)
-Mental Status Changes
(Anxiety, Agitation, Delirium, Restlessness, Disorientation)

-Autonomic Excitation
(Diaphoresis, Tachycardia, Hyperthermia, HTN, Vomiting, Diarrhea)

-Neuromuscular Hyperactivity
(Tremor, Muscle Rigidity, Myoclonus, Hyperreflexia)
(Ocular Clonus: slow, continuous, horizontal eye mvts)
(Spontaneous or inducible clonus)
(Babinski's Sign BL)

3) Lots more, but here's the ones involving drug:
-Sedation of agitation w/:
Benzos
-If agitation despite benzos:
Serotonin Antags (Ciproheptidine)

Front 10

Serotonin Withdrawal Syndrome

1) Sx of SWS?

2) Which 2 SSRIs --> Worst SWS?

Back 10

1) days w/in d/c of SSRI -->
dizzy, nausea, fatigue, muscle aches, chills, anxiety, irritability

2) Paroxetine,
Venlafaxine

Front 11

TCAs

1) What eval should take place in kids prior to beginning TCAs?

2) What are the sx of TCA OD?

3) How to manage TCA OD?

Back 11

1) EKG

2) Cardiac:
Conduction Abnorms,
Tachy,
Hypo-TN

CNS Toxicity:
Sedation,
Obtundation,
Coma,
Seizures

Anticholinergic:
Mydriasis,
Xerostoma,
Ileus,
Urinary Retention

3) NOT ALL INCLUSIVE, but hits major points:
-ABCs
-Activated Charcoal
-Gastric lavage if ingested < 2 hrs ago
-QRS > 100 msec -->
Trial Na-HCO3-
-If seizures -->
Benzos, barbituates and/or propofol
-If seizures: NO PHENYTOIN

Front 12

MAOI AEs

1) What foods should be avoided when taking MAOIs in order to avoid a tyramine induced HTN-sive crisis?

Back 12

1) Fermented cheese;
Smoked or aged meats;
Chianti;
Most beers and wine;
Soy sauce, Shrimp paste, miso soup;;
Sauerkraut;
Avocados;
Brewer's yeast and yeast extracts

Front 13

Buproprion

1) In who is buproprion CI'ed?
Why?

Back 13

1) Eating Disorder;
Seizure Disorder;
BC both of the above Buproprion lowers seizure threshold -->
Inc risk of seizure in the above scenarios in which pts already have increased risk seizures

Front 14

ECT

1) Indications for ECT?

Back 14

1)
-Depression refractory to antidepressants
-Psychotic depression
-Severe suicidality
-Depression w/ cationic stupor
-Depression w/ food refusal -->
Nutrtional compromise
-Previous good response to ECT
-Medical cond'ns in which anti-depressants can't be used (elderly)
-Bipolar / Mania
-Schizophrenia / psychosis

Front 15

Lithium tx of bipolar disorder

1) What are the potential SE of lithium use in tx of bipolar disorder?

2) Tx for nephrogenic DI caused by lithium toxicity?

Back 15

1)
-CNS depression and tremor
-Hyper / Hypo - thyroidism
-Nephrogenic DI
-GI Side FX (n/v/d, metallic taste, wt gain)

2) HCTZ + Amiloride

Front 16

Depression in pts w/ bipolar

1) How is depression managed in pts w/ bipolar disorder?

Back 16

1) Mild Depression:
Lithium or Lamotrigine

Moderate Depression:
Lithium PLUS Lamotrigine
OR
Lithium PLUS Atypical antipsychotic
(Olanzapine, Quetiapine, Risperidone)

Severe Depression:
ECT

Front 17

Adjustment Disorder w/ Depressed Mood

1) What are the diagnostic criteria for adjustment disorder?

Back 17

1)
-Emotional or Behavioral changes -->
Marked distress
OR
Impaired social fnctning
OR
Impaired occupational fnctning

-Sx develop in response to identifiable psychosocial stressor

-Sx begin w/in 3 mos of stressor

-Sx disappear w/in 6 mos of after end of stressor

Front 18

Misc

1) What is the diff b/t major depressive disorder and adjustment disorder w/ depressed mood?

Back 18

1) See psych 1 @ 31 minutes

Front 19

PTSD (Post-traumatic stress disorder)

1) How is acute stress disorder diff from PTSD?

2) What are the tx options for PTSD?

Back 19

1) Acute Stress Disorder:
Lasts < 4 wks

Post-traumatic Stress Disorder:
Lasts > 4 wks

2) 1st Line:
SSRI

Others...(see book)

Front 20

Schizophrenia

1) What are the diagnostic criteria for schizophrenia?

2) What is the spectrum of "shizo" stuff?

3) What might you see on neuroimaging of a pt w/ schizophrenia?

Back 20

1)
a. @ least 2 of the following during a 1 month period:
-Non-bizarre delusion (fixed false belief)
-Hallucination
-Disorganized speech
-Grossly disorganized or catatonic behavior
-Negative sx
(Flat affect, poverty of speech, lack of emotional reactivity)

OR

1 of the following:
-Bizarre delusion
-Auditory hallucination that consists of a voice keeping a running commentary on person's behavior of thoughts
-2 or more voices conversing w/ eachother

b. Social / Occupational dysfnctn

c. Duration of @ least 6 months

2) Brief psychotic disorder -->
Schizophreniform -->
Schizophrenia

3) Enlarged Lat and 3rd ventricles;
Dec Cortical Volume

Front 21

What are the following psychotic disorders that are often confused w/ schizophrenia:

a. Brief psychotic disorder
b. Schizophreniform disorder
c. Schizotypal
d. Schizoaffective
e. Schizoid

Back 21

a. Psychotic disorder that lasts < 1 month
b. Schizophrenia sx for < 6 months
c. Odd thinking, behavior &/or dress (dressed like a pickle)
d. Schizophrenia
+
Mood Disorder
e. Psychotic Disorder
+
Voluntary Social Isolation
"Schizoids Avoid"

Front 22

Drugs --> Psychosis

1) What drugs are known to cause psychosis in pts?

Back 22

1)
LSD
PCP
Cocaine
Amphetamines
Withdrawal from Benzos
Withdrawal from ETOH
Withdrawal from Barbituates
Steroids

Front 23

Misc Question:

Pt w/ schizophrenia w/ severe neck spasm that causes his head to be maintained in an unusual position.
a. Dx?
b. Tx?

Back 23

a. Dystonia (torticollis) due to antipsychotics

b. Diphenhydramine (Benedryl)

Front 24

LOOK UP S/S OF TARDIVE DYSKINESIA

2) What is the tx for TD?

Back 24

LOOK UP S/S OF TARDIVE DYSKINESIA

2) d/c current neuroleptic -->
Switch to neuroleptic w/ less extra-pyramidal SE

Front 25

In what time frame would be expect to see Parkinson sx SE in patients taking antipsychotics?

Back 25

4 days --> 4 months

Front 26

Neuroleptic Malignant Sx

1) What are the s/s of NMS?

2) Tx for NMS?

Back 26

1)
-Hyperthermia > 38-40 degrees celsius
-Mental Status Changes
-Muscle rigidity +/- tremor
-Autonomic instability:
Tachycardia, Tachypnea, Diaphoresis, HTN
-Rhabdomyolysis

2)
1st Line:
Dantrolene (Inhibs Ca release)

Others:
Bromocriptine,
Amantadine

Front 27

Neuroleptic SE

1) Tx for Parkinsonian sx in pts on a neuroleptic?

Back 27

1) Anticholinergics:
Diphenhydramine;
Benztropine

Dopamine Ags:
Amantadine

Front 28

Does this work

1) Why doesn't this work

2) This is annoying

3) Test

Back 28

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