Psychiatry

MOA of busprione? What drug to avoid with use?

5HT-1A partial agonist. MAOi.

Patient starts SSRI and has mild MDD in remission. What to do with SSRI? What about if MDD was severe?

What is the black box warning for SSRI in patients younger than 24?

Continue same does for 6 months, then taper.

May require lifelong.

Suicide.

Bupropion MOA? AE?

NDRI. Lowers seizure threshold.

Mirtazapine MOA? AE?

A2 antagonist which increases NE and 5HT.

Weight gain.

Trazodone MAO?

5HT2A ANTAgonist.

MOA of tricyclics? AE? TCA OD TX?

NE and 5HT Reuptake inhibitor. Anticholergic (Dry mouth, constipation, urinary retention).

Sodium bicarbonate

Duloxitine vs Venlafaxine:

Which is worse on BP?

Venlafaxine.

What does St John’s wort do? Why risk?

CYP Inducer = ramps up metabolism of drugs = lower efficacy

MOA of first generation/typical antipsychotics? Examples? AE?

Dopamine blockers. Haldol, toridazine. EPS, hyperprolactinemia (Gynecomastia, glactorrhea, amenorrhea), neuroleptic malignant syndrome. Weight gain!

MOA of second generation ATYPICAL antipsychotics? First line? Which one for refractory schizophrenia/psychosis? AE?

5HT2 and dopamine blockers. Yes. Clozapine. Aforementioned.

• QTc prolongation m

• Weight gain

• AGRANULOCYTOSIS and sialorrhea (drooling) with Clozapine. Weekly CBC for the first 6 months then monthly.

Describe and treat the following EPS:

• Acute dystonia

• Dyskinesia

• Akathesia

• Tardive dyskinesia

• Involuntary muscle spasm. Benzotropine or diphenhydramine (anti-chol)

• Parkinson. Benzotropine or Amantadine

• Restlessness. Propranolol

• FACIAL movement. Benzotropine.

What to monitor for lithium use?

• TSH

• Renal function (nephrogenic diabetes Insipidus)

• Ataxia and fine tremor

What to monitor for patients on the first line for acute mania, valproic acid?

• LFTs

• Platelets

What age does autism Present? What are some symptoms? What first to rule out?

present? What are some symptoms?

– how to differentiate from fragile X?

– how to differentiate from Rhett syndrome?

Two years of age. Cannot make eye contact, repetitive behaviors and activities. Do hearing screen.

• Trinucleotide CGG boy with macro orchid

• Girl X linked. NORMAL DEVELOPMENT THEN REGRESSION - hand movement. Watch out for epilepsy.

Criteria for ADHD? Treatment?

Must have 2 or more settings where the child is hyperactive. Presents before age 12.

• Stimulants: Amphetamines

• Non stimulants: atomoxetine.

Difference between a tic and Tourette syndrome? TX?

• Tic involves sudden non-rhythmic movement. Transient.

• Tourette involved many tics that occurs many times per day and has lasted greater than 1 year.

• Haldol, pimozide. Do not give stimulants as it worsens symptoms.

MOA of schizophrenia: What causes positive symptoms? And what causes negative symptoms?

What are the positive symptoms, negative?

Differentiate these diagnosis:

• Patient comes in with schizo symptoms for less than 1 month? Triggered by stress.

• Patient comes in with schizo symptoms that are within 1-6 months? Dude thinks the government is spying on him.

• Patient comes in with schizo symptoms for more than 6 months with SIGNIFICANT functionality deficits. CIA planted a chip in his brain.

• Patient comes in saying that famous actor loves her, refuses to believe otherwise. Lasted over 1 month.

• Patient presents with hallucinations. She also has severe depression and mania.

• Dopamine causes both. Increased in limbic, decreased in frontal cortex.

• Hallucinations, hearing voices and monologues, disorganized speech. Flat affect, avolition.

• Brief psychotic

• Schizophreniform

• Schizophrenia

• Delusional

• Schizoaffective

SIGECAPS for MDD? How long must symptoms last?

• Patient only has 2 symptoms of depression that lasted 2 years.

Sleep, intereast, guilt, energy, concentration, appetite, psychomotor, suicide. Must have depressed mood and Anhedonia + 5 for 2 weeks.

Persistent DD (Dysthymia do not confuse with cyclothymia).

DIG FAR for bipolar. 1 vs 2?

Treatment?

Distractabiliy, Insomnia due to no need for sleep, Grandosity (inflated self esteem), flight of ideas, agitation, recklessness (Gambling, sex).

• Check for how affected symptoms are to life. If great, then likely type 1.

• Type 2 always have depression.

• Lithium and lamotrigine are 1st line

Fear of being embarrassed or scrutinized in public. Recognizes that fear is excessive.

Social anxiety disorder.

Difference between OCD and OCPD?

• OCD is ego Dystonia = causes distresses

• OCPD is ego syntonic = does not cause distress

Patient presents from a traumatic event: Threatened and involved death/fear/horror. Patient relives

• last less than 1 month

• More than 1 month

Patient comes in with depression after losing his job 2 months ago OR a recent breakup.

First line TX?

• Acute stress disorder

• PTSD

• Adjustment disorder

• SSRI. Prazosin/BB for nightmares.

• Patient HAS abdominal pain and comes to the office for check up: negative workup each time but worries about the pain. No external gain and does not do this for attention.

• Patient with no symptoms comes in every time thinking he has lung cancer.

• Patient with neurological deficits after heightened emotion: E.g. Patient argued with husband and now has lost inability to move legs.

• Patient gives herself insulin to stay in the hospital: I run hypoglycemic all the time.

• Patient states he has 10/10 back pain and needs disability benefits.

• Patient injects herself with bacteria or inflicts illness on child.

• Somatic symptom disorder

• Illness anxiety

• Conversion disorder

• Factitious

• Malingering

• Munchausen

• Patient is a ballet/model: She has low BMI less than 18.5. A) Limits food, b) Uses laxitives/diuretics/vomits.

• Patient has normal weight/BMI but induces purging/vomiting after binge eating episodes.

• Patient is obese and has uncontrollable binge eating episodes. No purging/compensatory behaviors.

• Anorexia: Restrictive vs Purging

• Bulima

• Binge eating

The following sleep disorders:

• The patient presents with excessive daytime sleepiness with sudden collapse after laughter. Has hallucinations as he goes to sleep (hypnoGOgic). MOA?

• Patient presents with excessive daytime sleepiness with hallucinations. However NO cataplexy.

• Patient screams during sleep and is panics. Does NOT recall in the morning. REM or Non-REM?

• Patient has vivid nightmares and is able to remember his dreams. Causes him distress during the day. REM or NON-REM?

• Narcolepsy 1. Low orexin/hypocretin.

• Narcolepsy 2.

• Sleep terror. “No remeber no rem”. Non-rem.

• Nightmare disorder. Rem.

• Kid argues with teachers and parents, refuses rules but DOES NOT SHOW AGGRESSION (fights, arson, theft).

• Kid engages in fights, property destruction and legal trouble.

• Which one progresses to ‘X’ after 18 years?

• Oppositional defiant

• Conduct disorder

• Conduct disorder

Drugs of Abuse:

• Patient comes in with slurred speech and unresponsiveness. Seizures and temors develop after 24hrs.

• Patient comes in with bradycardia, BP90, miosis/pinpoint pupil.

• Patient with agitation and chest pain. Mydiarsis (dilation), BP 190. What med is contraindicated?

• Patient is combative, vertical nystagmus.

• Patient sees geometric patterns and is laughing. Mydiarsis.

• Patient with conjunctival injection, and increased appetitie.

• Alcohol

• Opioid

• Cocaine/Amphetamine

• PCP

• LSD

• THC

Cluster A:

• Patient has little intreeast in relationships. He does not fear rejection, and it does not cause him anxiety. Calls himself a loner.

• Man believes his friends are plotting against him. Builds distrust.

• Lady believes she has a special connection to the universe and can talk to her pat cat.

• Schizoid

• Paranoid

• Schizotypal

Cluster B:

• Same kid with conduct disorder now grows past age 18. Gets into legal trouble often and fights.

• Female states all her past relationships are toxic. Her friends are initially helpful, but then she gets angry at them.

• Lady exaggerates her emotions and wears appealing clothing to become center of attention.

• Man boasts about his achievement and states he needs special treatment. Boasts need for admiration.

• Antisocial

• Borderline

• Histrionic

• Narcissistic

Cluster C:

• Patient is a perfectionist, controlling. Must be a certain way. But are ego syntonic.

• Dislikes making friends because of fear of rejection/being disliked.

• Clingy and needs to be taken care of.

• OCPD

• Avoidant

• Dependent

• Patient was under halothane/succinylcholine now develops muscle rigidity and elevated temp. DX TX?

• Patient takes haldol and other antipsychotics now develops muscle rigidity and elevated temp. Started taking the med 1 week ago. DX TX?

• Patient with severe depression on SSRI and MAOi comes in with HYPERREFLEXIA, MYOCLONUS. DX TX?

• Malignant hyperthermia. Dantrolene

• Neuroleptic malignant . Dantrolene

• Serotonin syndrome. Cyproheptadine, BDZ.