Mood and Anxiety Disorder
Postpartum psychosis is often associated with what psychiatric disorders?
What is bipolar disorder?
(There's extremely strong and clinically crucial association between postpartum psychosis and an underlying bipolar disorder.)
Cigarette smoking induces which cytochrome enzyme resulting in rapid metabolism of medications such as Olanzapine?
What is CYP1A2 enzyme?
(Cigarette smoking induces CYP1A2 enzyme which metabolize and lower the blood level of Clozapine and Olanzapine)
A 30-year-old woman presents for follow up after bariatric surgery. Four weeks after surgery, she developed vertigo and headache. A family member reports that she has been confused for the past week. Physical exam reveals restricted eye movements on lateral gaze. What treatment is indicated for her condition?
What is thiamine?
(Classic triad of Wernicke's encephalopathy (confusion, ophthalmoplegia, ataxia))
In the reward pathways implicated in the neurobiology of addiction, dopaminergic neurons project to the nucleus accumbens. The cell bodies of these neurons reside in which area of the brain?
What is ventral tegmental area?
(Mesolimbic dopamine pathway- ventral tegmental area to nucleus accumbens)
What neurotransmitter is the precursor to melatonin?
What is Serotonin?
Brain imaging showing hyperactivity in a brain circuit involving orbitofrontal cortex, basal ganglia, and thalamus is seen in what psychiatric disorders?
What is OCD?
(Hyperactivity in the cortico-striato-thalamo-cortical loop is linked to OCD)
To avoid lowering the oral absorption of ___, the patient is counseled to take the antipsychotic medication with meal?
What is Ziprasidone (Geodon)? or What is Lurasidone (Latuda)?
(500 calories- Geodon and 350 calories- Latuda)
What brain region is affected earliest in the course of Alzheimer dementia?
What is hippocampus?
Conversion from a substance-induced first psychotic episode to schizophrenia is most highly associated with which substance?
What is cannabis?
A patient with anorexia is hospitalized and re-feeding begins as part of her medical treatment. What electrolyte abnormality can be avoided by closely monitoring the rate of re-feeding?
What is hypophosphatemia?
(Hypophosphatemia is the hallmark electrolyte abnormality in re-feeding syndrome)
A patient with treatment-resistant depression has a rapid antidepressant response to a single dose of intravenous ketamine. Antagonism of which receptor has been most implicated in this treatment response?
What is NMDA receptor?
A patient believes the television is sending special messages intended just for the patient. What is the term that best describes this symptom?
What is delusion of reference?
A patient is brought to the emergency department by family members who report that the patient has a history of depression and has recently been complaining of hearing voices. Two days ago, the patient stopped speaking and began maintaining unusual postures for hours at a time. During examination the alert patient says nothing and sits without moving. What is the appropriate acute pharmacologic intervention?
What is lorazepam (Ativan) challenge?
(Dx: Catatonia)
When a patient in alcohol withdrawal is experiencing hallucinations, the presence of _______ would suggest a diagnosis of alcohol hallucinosis rather than delirium tremens?
What is clear sensorium?
(Alcoholic hallucinosis would typically have a clear sensorium (alert, oriented, and able to think) while delirium tremens would have global confusion)
Following gastric bypass surgery, continued abuse of what substance could more readily lead to life-endangering consequences than before surgery?
What is alcohol?
(Gastric bypass surgery alters the anatomy and physiology of alcohol absorption, leading to a much higher and faster peak blood alcohol concentration. This significantly increases the risk of toxicity and the development of alcohol use disorder.)
What severe adverse events related to carbamazepine treatment is more commonly found in people of Asian descent than in other ethnic groups?
What is Stevens-Johnson syndrome?
(HLA-B*1502 allele (common in Asian populations) is linked to the risk of Stevens-Johnson syndrome with carbamazepine.)
A 30-year-old patient with treatment-resistant schizophrenia is on clozapine. The patient presents to the emergency department with dyspnea, orthostatic hypotension and a heart rate of 130 bpm. Complete blood count is normal except for an elevated eosinophil count. Electrocardiogram shows non-specific T-wave changes. What test is most likely to be helpful in guiding the acute management of this patient?
What is Troponin?
(Troponin level is extremely important in a patient treated with Clozapine and exhibiting signs of Myocarditis)
A patient with schizoaffective disorder is being treated with electroconvulsive therapy (ECT). After the electrical stimulus is delivered, the patient has a prolonged seizure, requiring anticonvulsant medication. What mood stabilizer would be most likely to cause this side effect?
What is Lithium?
(Concurrent lithium use can lower the seizure threshold and increases the risk of neurotoxicity).
A patient with opioid use disorder develops QTc prolongation, which medications for Opioid Use Disorder likely caused this side effect?
What is Methadone?
Without evident distress, a patient calmly reports to the psychiatrist, "Since I was last here, my significant other dumped me." The doctor responds by pointing out the discrepancy between the patient's affect and the content described, and asks for the patient's thoughts about this. The psychiatrist's response is an example of which psychotherapeutic intervention?
What is confrontation?
A psychiatry consultation is requested regarding a medically hospitalized patient endorsing suicidal ideation. The patient has a history of bipolar disorder and was admitted for vancomycin-resistant enterococci (VRE) bacteremia. On examination the patient's heart rate is 105 bpm, blood pressure is 171/95 mm Hg, respiratory rate 18/min, temperature is 100.9° F (38.3° C.) The patient has tremors of the upper extremity, hyperreflexia, myoclonic jerks, is not oriented to time or place, and appears to be responding to visual hallucinations. The patient's current medications include linezolid, lithium, sertraline, and risperidone. What is the most likely diagnosis?
What is Serotonin Syndrome?
(Core symptom cluster (autonomic instability, neuromuscular hyperexcitability, altered mental status). High-yield drug interaction (linezolid, an MAOI, with an SSRI)).
A 24-year-old female patient with schizophrenia, stable on risperidone 4 mg daily, reports that she has not had a menstrual period for the past four months. A prolactin level is significantly elevated. This side effect is due to the blockade of dopamine in which pathway?
What is tubero-infundibular pathway?
A 64-year-old man presents to the emergency room after two days of increased confusion and odd behavior. His wife shares that he has been intermittently confused for two years, describing behaviors like yelling at people she cannot see... his golf swing has been shaky and slow while his steps are smaller. The couple sleeps in separate beds because he recently started kicking in his sleep. What is his most likely diagnosis?
What is Lewy Body Dementia?
(Core features: fluctuating cognition, visual hallucinations, and parkinsonism. REM sleep behavior disorder is also a highly suggestive feature.)
What is the most specific laboratory test for identifying heavy alcohol consumption?
What is carbohydrate-deficient transferrin (CDT)?
(While liver function tests (like GGT) can be suggestive, carbohydrate-deficient transferrin (CDT) is the most specific laboratory marker for sustained, heavy alcohol use.)
A 62-year-old man suffers bilateral posterior cerebral artery strokes. He insists that his vision is normal and that he has been having trouble seeing because the "lights were dim" or his "glasses were not on". His visual problem is best described as:
What is anosognosia? or What is Anton's syndrome?
(Anton's syndrome is a classic example of anosognosia (a deficit of self-awareness) in the setting of cortical blindness.)