Somatic Symptom/Eating
Differentiate Somatic symptom disorder vs. illness anxiety disorder
Somatic Symptom: Physical symptoms arising in absence of underlying medical condition
Illness Anxiety: Anxiety/fear of having or acquiring a serious undiagnosed illness.
What are some common manifestations of conduct disorder? What does it commonly precede?
Aggression towards people/animals, destruction of property, theft/deceitfulness, law-breaking
Antisocial PD
Each cycle of sleep, REM sleep _______ and non REM sleep ________. Therefore, REM sleep disorders tend to happen in the ______ half of the night and non-REM sleep disorders tend to happen in the ______ half of the night
Increases, decreases, second, first.
Psychotic symptoms in schizophrenia are closely associated with altered functioning of which neurotransmitter?
Dopamine.
When does Acute stress disorder become post-traumatic stress disorder?
1 month after stressor ends.
What is the most common type of manifestation in somatic symptom disorder?
Pain symptoms (GI, Headache, Joint pain)
Which is true about Oppositional Defiant Disorder?
A)Often precedes antisocial disorder
B)Common with ADHD
C)Aggression towards animals
D)Needs to be >12 for diagnosis
B) Common with ADHD
Also common with conduct disorder
In which of the following does the patient not recall any events of their parasomnia?
Nightmare Disorder
Night Terror
Sleepwalking
Sleep Paralysis
Night terror
Differentiate brief psychotic episode vs. schizophreniform vs. schizophrenia based on timeline.
Brief psychotic episode: >1 day but return to normal baseline within 1 month.
Schizophreniform: episode lasts >1 month but <6 months
Schizophrenia: Continuous disturbance for >6 months.
what are medications we should NOT use in PTSD patients?
Benzodiazepines (high abuse potential, SUD is common in PTSD)
What medication is contraindicated in patients with depression and anorexia nervosa or bulimia?
Wellbutrin (lowers the seizure threshold, dangerous with purging disorders)
What is first line treatment for mild/moderate post partum depression vs. severe PP depression?
Mild/mod = Psychotherapy alone (no meds)
Severe = Brexanolone (Progesterone analog IV over 60 hrs)
Which of the following has a strong association with neurocognitive disorders such as Parkinson's/Dementia?
REM sleep behavior disorder
Sleep Paralysis
Narcolepsy
Pediatric Insomnia
REM Sleep Behavior Disorder (75% diagnosed with neurocognitive disorder within 15 yrs of sleep symptoms)
A 34 year old patient has had a lasting delusion of her dead mother trying to talk to her, she doesn't hear anything but feels as though she often is talking to her via her thoughts. This has been ongoing for the last 3-4 months, but has not been affecting her job or her relationships, she just feels that she needs to "take time to talk to her" every day for a few minutes. She is not taking any substances and has no prior medical or mental health history. What would be the most likely diagnosis?
Delusion disorder
What is the best medication in a patient dealing with insomnia secondary to nightmares in PTSD?
Prazosin (alpha blocker)
Which of the following are potential physical exam findings in a Bulimia patient?
A) Underweight
B) Teeth Staining
C) Hyperactive bowel sounds
D) Pallor
E) Scarring/cuts on skin over dorsal (posterior) metacarpophalangeal joints
C, E
A 42-year-old man is referred to the office for mental health evaluation. The patient says he has a long-standing fear of criticism and rejection. He also has feelings of inadequacy and refuses to try new activities because of his fear of embarrassment. The patient has held the same entrylevel position at his workplace for the past 14 years despite several opportunities for promotion. The patient is unmarried and has only had one intimate relationship, which lasted only a few weeks. He has few friends other than those in his model airplane club. Which of the following personality disorders is the most likely diagnosis?
(A) Avoidant
(B) Dependent
(C) Paranoid
(D) Schizoid
(E) Schizotypal
A) Avoidant
A)Modafinil
B)Oxybate
C)Orexin Anatagonist (Suvorexant)
D)Clomipramine
E)Vyvanse
Oxybate
Pitolisant, SNRIs/TCAs also good for cataplexy.
What are some reasons why most patients with schizophrenia often stop using medication?
What are 5 types of symptoms in ASD/PTSD?
Intrusional (recurring thoughts/flashbacks), Dissociative (derealization), Avoidant (Avoiding triggers), Arousal (insomnia), Negative (anhedonia, depressed mood)
What are some ways to tell an epileptic seizure vs. a psychogenic non-epileptic seizure?
Epileptic seizures will often have eyes open, no preserved awareness, bowel/urinary incontinence, and a post-ictal phase of confusion/fogginess.
PNES seizures will be the opposite
Random!!
A 26-year-old man with a history of involuntary eye blinking and snorting comes to the office because he is distressed about increasing frequency of these tics over the past six months. The patient says the episodes currently occur numerous times during the day. Medical history includes development of eye blinking at 12 years of age and development of snorting at 16 years of age. Psychotherapy and exercises initially reduced the frequency of these episodes. Because the patient is embarrassed by his tics, his performance at work has decreased and he now declines most invitations to social gatherings. Which of the following medications is the most appropriate therapy for this patient?
(A) Carbamazepine
(B) Fluvoxamine
(C) Methylphenidate
(D) Risperidone
(E) Venlafaxine
D) Risperidone (Antipsychotic)
A 5-year-old boy is brought to the clinic by his mother because she is worried about changes in his behavior during the past few months. The patient's mother says he has had episodes that occur sporadically at night during which he sits up in bed screaming, crying incoherently, and intensely frightened. She says it is initially difficult to calm him down, and he is usually sweating, breathing rapidly, and tremulous. The patient eventually calms down after 10 to 15 minutes and then falls asleep. Which of the following questions is most appropriate to confirm the suspected diagnosis of sleep terror disorder in this patient?
(A) Do his arms and legs jerk during sleep?
(B) Does he have nightmares?
(C) Does he to go to sleep late?
(D) Does he watch violent movies?
(E) Does he wet the bed?
(B) Does he have nightmares?
Pharm buzzround:
-(1st/2nd) generation antipsychotics will help with positive and negative symptoms?
-Clozapine is used for _______.
-Zyprexa (Olanzapine) has a main side effect of _____
-Risperdal has the highest potential for _______ symptoms
-smokers taking _____ or _____ will need a higher dose than normal due to inducing activity of CYP enzymes.
2nd
Refractory Schizophrenia
Metabolic effects eg. Weight Gain
Prolactin-Associated
Clozapine or Olanzapine.
SURPRISE!
A 55-year-old woman comes to the office because she has a 20-year history of repetitive actions and is tired of wasting time by repeating these actions. The patient says she repeatedly checks the doors in her house to make sure they are locked, washes her hands several times per hour, and checks her electrical appliances three times each morning before she leaves for work. Medical history includes second-degree atrioventricular block. Which of the following medications is the most appropriate initial therapy for this patient's psychiatric disorder?
(A) Clomipramine
(B) Clonazepam
(C) Methylphenidate
(D) Quetiapine
(E) Sertraline
(E) Sertraline