Psychiatry Exam Review – Mood, Anxiety, Psychotic Disorders & ADHD (copy)

Question-and-Answer flashcards covering etiology, diagnosis, and pharmacologic & non-pharmacologic management of Major Depressive Disorder, Anxiety Disorders, Bipolar Disorder, Schizophrenia, and ADHD, based on the Krysiak lecture notes.

What neurotransmitters are primarily implicated in the monoamine hypothesis of Major Depressive Disorder (MDD)?

Norepinephrine (NE), Serotonin (5-HT), and Dopamine (DA).

Which neurotrophic factor’s reduced activity is linked to depression?

Brain-derived neurotrophic factor (BDNF).

List four demographic or social risk factors for Major Depressive Disorder.

Female sex, middle age, single marital status, white race, low socioeconomic status, unemployment, or physical disability (any four).

According to DSM-5, how many symptoms and for what duration are required to diagnose MDD?

Five or more symptoms during the same 2-week period representing a change from baseline.

What mnemonic helps recall MDD symptoms?

SIG E CAPS.

In SIG E CAPS, what does “E” stand for?

Energy (loss of).

What pharmacologic class is first-line for Generalized Anxiety Disorder (GAD)?

Antidepressants (SSRIs/SNRIs).

Name two FDA-approved antidepressants for GAD.

Paroxetine, Escitalopram, Duloxetine, or Venlafaxine ER (any two).

Which medication class is second-line in GAD due to dependence risk?

Benzodiazepines.

Give three benzodiazepines used for GAD.

Alprazolam, Diazepam, Lorazepam, Clonazepam, Chlordiazepoxide, Clorazepate, or Oxazepam (any three).

What anxiolytic is second-line in GAD because of inconsistent long-term efficacy?

Buspirone (Buspar).

Name two last-line pharmacologic alternatives for GAD.

Hydroxyzine, Pregabalin, or Quetiapine (any two).

For Panic Disorder, how many symptoms must peak within what time to define a panic attack?

Four or more symptoms that peak within 10 minutes.

During a panic attack, psychological symptoms include depersonalization and .

Derealization.

What non-pharmacologic therapy (16-20 hours over 4 months) is effective for Panic Disorder?

Cognitive Behavioral Therapy (CBT).

List three SSRIs FDA-approved for Panic Disorder.

Fluoxetine, Sertraline, and Paroxetine.

Which SNRI is FDA-approved for Panic Disorder?

Venlafaxine XR.

Which neurotransmitter imbalance (excess glutamate or deficiency of GABA) is theorized to precipitate mania?

Excess glutamate or deficiency of GABA.

Hypothyroidism is associated with which bipolar phase?

Mania-like symptoms.

What medication is considered the gold-standard mood stabilizer for bipolar disorder?

Lithium.

State the typical initial daily dose range of lithium for acute mania.

600–900 mg/day in 2–3 divided doses.

Lithium follows which type of pharmacokinetics?

First-order linear kinetics.

How long after initiation is lithium’s full antimanic effect usually observed?

Approximately 6–10 days.

Give two common dermatologic adverse effects of lithium.

Acne, psoriasis, or alopecia/thinning hair (any two).

Name three drug classes that can increase lithium levels.

NSAIDs, ACE inhibitors/ARBs, and diuretics.

What boxed warning does lithium carry?

Risk of lithium toxicity requiring routine monitoring.

Give one absolute contraindication to lithium therapy.

Severe/unstable renal or cardiovascular disease, dehydration, sodium depletion, or hypersensitivity (any one).

How is lithium eliminated?

Approximately 95 % is excreted unchanged by the kidneys via glomerular filtration.

Divalproex sodium is the pharmaceutical form of what parent compound?

Valproic acid.

What is the therapeutic serum range for divalproex in bipolar disorder?

50–125 µg/mL.

State two major boxed warnings for divalproex.

Hepatic failure, pancreatitis, or teratogenic effects (any two).

Which serious skin reactions are shared adverse effects of divalproex, lamotrigine, and carbamazepine?

Stevens–Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN).

Valproate significantly increases the serum level of which mood stabilizer?

Lamotrigine.

Why must lamotrigine doses be titrated slowly?

To minimize risk of serious rash such as SJS/TEN.

An interruption of lamotrigine therapy longer than how many days requires re-titration?

More than 5 days.

Which HLA allele must be screened in Asian patients before starting carbamazepine?

HLA-B*1502.

Carbamazepine induces which liver enzyme system?

CYP450 (especially CYP3A4).

What electrolyte disturbance is carbamazepine (and oxcarbazepine) known to cause?

Hyponatremia (SIADH).

List the four major dopaminergic pathways affected by antipsychotics.

Mesolimbic, Mesocortical, Nigrostriatal, and Tuberoinfundibular pathways.

Overactivity in the mesolimbic pathway leads to which schizophrenia symptoms?

Positive symptoms.

DSM-5 requires at least how many months of continuous signs for schizophrenia diagnosis?

Six months.

Classify psychotic disorders by duration:

Brief psychotic episode, Schizophreniform disorder, and Schizophrenia, respectively.

Give two examples of first-generation antipsychotics (FGAs).

Haloperidol, Chlorpromazine, or Fluphenazine (any two).

Give two examples of second-generation antipsychotics (SGAs).

Risperidone, Olanzapine, Quetiapine, Aripiprazole, Ziprasidone, or Lurasidone (any two).

What intensive community program provides non-pharmacologic support for schizophrenia?

Assertive Community Treatment (ACT).

Which two neurotransmitters are primarily dysregulated in ADHD?

Dopamine and Norepinephrine.

How many symptoms and for what duration are required to diagnose ADHD in children?

Six or more symptoms for at least 6 months.

What is the most common ADHD subtype?

Combined type.

What line of therapy are stimulants for ADHD?

First-line agents.

Amphetamine stimulants primarily act by stimulating release of which neurotransmitters?

Dopamine and Norepinephrine (and serotonin at high doses).

Methylphenidate primarily acts by inhibiting reuptake of which neurotransmitters?

Dopamine and Norepinephrine.

What is the usual dosing frequency for immediate-release stimulant formulations?

Two or three times daily (BID/TID).

What black box warning is present on all stimulant medications?

High potential for abuse and dependence.

List two common adverse effects of stimulant therapy.

Appetite suppression/weight loss, insomnia, GI distress, headache, or irritability (any two).

Which transdermal stimulant product may cause permanent skin depigmentation?

Methylphenidate patch (Daytrana).

Which medication class is second-line for ADHD when stimulants are ineffective or not tolerated?

Non-stimulants (atomoxetine, ER guanfacine, ER clonidine, viloxazine).

Describe the mechanism of guanfacine and clonidine in ADHD.

Central alpha-2-adrenergic agonists that inhibit presynaptic NE release and improve prefrontal cortex blood flow.

Atomoxetine is classified as what type of pharmacologic agent?

Selective Norepinephrine Reuptake Inhibitor (NRI).

Give two potential adverse effects of guanfacine or clonidine.

Sedation, hypotension, or dizziness (any two).

Why must stimulants and MAOIs not be co-administered within 14 days?

Risk of hypertensive crisis.

Which second-generation antipsychotic is first-line as monotherapy for bipolar depression?

Quetiapine (or lurasidone with lithium/divalproex).

What combination product containing an SSRI and SGA is second-line for bipolar depression?

Fluoxetine/Olanzapine (Symbyax).

Name two environmental or prenatal risk factors for ADHD.

Maternal smoking, lead exposure, developmental delays, prematurity/ASD, or genetic predisposition (any two).

What non-pharmacologic therapy is often combined with medication for ADHD?

Behavioral interventions (parent/teacher training, structured schedules, classroom management).

Transcranial magnetic stimulation (TMS) is a non-pharmacologic option for which mood disorder?

Bipolar disorder (also used in depression).

Which mood stabilizer can cause weight gain and hypothyroidism by affecting T4-to-T3 conversion?

Lithium.

Hyperammonemia is a notable adverse effect of which bipolar medication?

Valproic acid / Divalproex.

What serious hematologic adverse effect is associated with carbamazepine?

Agranulocytosis or aplastic anemia.

Which long-acting injectable antipsychotic requires post-injection monitoring for severe sedation/delirium?

Olanzapine pamoate LAI (Zyprexa Relprevv).

For Panic Disorder, avoidance of which substances is recommended non-pharmacologically?

Nicotine, alcohol, and caffeine.