Depression
Which neurotransmitter is most strongly implicated in the pathophysiology of major depressive disorder?
Serotonin (also norepinephrine and dopamine implicated, but serotonin most prominent)
Which class of medication is considered first-line pharmacologic therapy for generalized anxiety disorder (GAD)?
SSRIs or SNRIs
Which neurotransmitter is most associated with initiating sleep in the hypothalamus?
GABA
Which neurotransmitter pathway is primarily associated with the positive symptoms of schizophrenia?
Mesolimbic dopamine pathway
Which medication is considered first-line for acute mania in bipolar I disorder?
Lithium (or valproate)
According to DSM-5, how long must symptoms persist for a diagnosis of major depressive disorder?
≥2 weeks
What is the minimum symptom duration required for a DSM-5 diagnosis of GAD?
≥6 months
What is the first-line treatment for primary insomnia according to AASM guidelines?
Cognitive Behavioral Therapy for Insomnia (CBT-I)
Name one high-potency typical antipsychotic and one low-potency typical antipsychotic.
High potency: haloperidol; Low potency: chlorpromazine
How long must symptoms last for a hypomanic episode per DSM-5 criteria?
≥4 consecutive days
Which antidepressant is contraindicated in patients with a history of seizures?
Bupropion
Which benzodiazepine has the shortest half-life, making it more prone to withdrawal symptoms?
Alprazolam
Which medication for insomnia is a melatonin receptor agonist?
Ramelteon
What is the mechanism of tardive dyskinesia?
Dopamine receptor upregulation and supersensitivity after chronic blockade
Which bipolar subtype does not involve full manic episodes?
Bipolar II disorder
What is the black box warning for all antidepressants in patients under age 25?
Increased risk of suicidal thoughts and behaviors
Why is propranolol sometimes prescribed in performance anxiety, and what is its mechanism of action?
Reduces peripheral sympathetic symptoms (tachycardia, tremor) by blocking beta-adrenergic receptors
Describe the difference between narcolepsy type 1 and type 2.
Type 1 = cataplexy + hypocretin deficiency; Type 2 = no cataplexy, usually normal hypocretin
How does aripiprazole’s mechanism differ from other second-generation antipsychotics?
Partial dopamine D2 agonist (others are antagonists)
Describe the risk of antidepressant monotherapy in bipolar disorder.
Risk of switching to mania or rapid cycling
A patient on an SSRI develops hyperreflexia, clonus, and hyperthermia after adding a triptan for migraines. What is the most likely diagnosis and first-line intervention?
Serotonin syndrome; discontinue serotonergic agents immediately, supportive care, possible cyproheptadine
A 35-year-old with panic disorder reports worsening anxiety after starting fluoxetine. Explain the mechanism behind this paradoxical reaction and the management strategy.
Initial SSRI dose can increase serotonin signaling in certain circuits, causing activation/jitteriness; reduce dose or add short-term benzodiazepine
A patient with narcolepsy is prescribed modafinil. What is the drug’s mechanism of action and one notable drug-drug interaction?
Increases hypothalamic histamine release via dopamine reuptake inhibition; interacts with CYP3A4 inducers/inhibitors
A patient on clozapine presents with fever, sore throat, and malaise. What is your next immediate step in management?
Stop clozapine and obtain urgent CBC to evaluate for agranulocytosis
A patient with bipolar disorder presents with lithium toxicity. List three common causes of elevated lithium levels despite stable dosing.
Dehydration, drug interactions (NSAIDs, ACE inhibitors, thiazides), renal impairment