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20 Cards in this Set
- Front
- Back
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81. What anxiolytic is prescribed for social phobia and what is the benefit?
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a. SSRIs and buspirone
b. benefit: decreased fear associated with social situations |
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82. Usage guidelines for benzodiazepines?
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a. Do not change dosages abruptly
b. use the lowest dose and the elderly c. advise against using machinery or driving |
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83. benzodiazepines listed from shortest to longest half-life?
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1. Alprazolam (Xanax)
2. lorazepam (Ativan) 3. diazepam (Valium) |
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84. usage guidelines for buspirone?
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a. Therapeutic effect can take up to one week
b. can be used safely with other sedative-hypnotics (no additive effect) c. best option for people with occupations where driving or machinery is involved, as there is no sedation or cognitive impairment. d. No withdrawal symptoms |
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85. diagnosis of major depressive disorder?
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a. Depressed mood or anhedonia
b. and c. depressive symptoms lasting two weeks. |
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86. Four classes of medical causes of depression to rule out?
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1. Hypothyroidism (check TSH. For second management is thyroxine)
2. Parkinson's disease 3. medications 4. substance disorders |
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87. medications associated with depression?
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a. Corticosteroids
b. beta blockers c. antipsychotics (especially in the elderly) d. respirine e. true by discontinuing medication and switching to an alternative |
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88. treatment of depression caused by substance disorders (alcohol, amphetamines)?
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a. Treat with detoxification and antidepressants.
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89. Treatment of major depressive disorder?
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a. Admit the patient. If there is suicidal/homicidal ideation or paranoia.
b. Beginning antidepressant medications (SSRI Is the first drug of choice) c. give benzodiazepines if agitated d. electroconvulsive therapy is the best choice if the patient is acutely suicidal (works quicker than antidepressants), or for patients worried about side effects from medications. |
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90. Note: in patients with unipolar psychotic depression, the combination antidepressant and antipsychotic is more effective than monotherapy with either drug.
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90. Note: in patients with unipolar psychotic depression, the combination antidepressant and antipsychotic is more effective than monotherapy with either drug.
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91. Dysthymic disorder?
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a. Characterized by low level depression symptoms that are present on most days for at least two years.
b. However, the question may describe superimposed acute major depression, which is common in these patients. c. Do not hospitalized patients unless their suicidal ideation. |
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92. Treatment of dysthymic disorder?
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a. Long-term individual, insight oriented psychotherapy is the best treatment.
b. If this fails, the trial of SSRIs is the next step in management. |
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93. Seasonal affective disorder?
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a. Depressive symptoms in the winter months (shorter daylight hours) and absence of depressive symptoms during summer months.
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94. Treatment of seasonal affective disorder?
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a. Phototherapy
b. or sleep deprivation. |
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95. Diagnosis of bipolar disorder?
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a. Depression, mania, or mixed symptoms for at least one week that cause distress or impaired functioning.
b. The questionwill describe the history of both manic symptoms and depressive symptoms, as well as periods of normal mood. |
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96. Note: Bipolar disorders, the most commonly missed diagnosis on the usmle, because it can easily be mistaken for depression or mania alone.
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96. Note: Bipolar disorders, the most commonly missed diagnosis on the usmle, because it can easily be mistaken for depression or mania alone.
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97. Rapid cycling bipolar?
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a. Indicated by >4 episodes of mania per year.
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98. Media symptoms?
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a. Grandiosity
b. less need for sleep c. excessive talking or pressured speech d. racing thoughts or flight of ideas e. distractibility f. goal focused activity at home or at work g. sexual promiscuity. |
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99. CCS tip: if the history suggest drug use, first get a drug screen to rule out amphetamine use as a cause of mania. If the history gives elevated blood pressure or low TSH, consider medical conditions, such as pheochromocytoma and hyperthyroidism.
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99. CCS tip: if the history suggest drug use, first get a drug screen to rule out amphetamine use as a cause of mania. If the history gives elevated blood pressure or low TSH, consider medical conditions, such as pheochromocytoma and hyperthyroidism.
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100. The five steps in the management of acute mania?
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1. Hospitalize
2. I know I mood stabilizers to induce remission. Lithium is the drug of choice (takes one week for effect) 3. antipsychotics to control acute mania. Risperidone is the drug of choice. 4. Give IM Depot phenothiazine in noncompliant, severely manic patients. 5. Give antidepressants ONLY in patients with recurrent episodes of depression in only with mood stabilizers (to prevent inducing manic episode). |
