Depresso Expresso
SIG-E-CAPS - what does it stand for and what is it for/help with???
Sleep disturbance, loss of interest or pleasure, feelings of guilt or worthlessness, decreased energy, decreased concentration, appetite change, psychomotor agitation or retardation, suicidal ideation
Diagnosis of Major Depression Disorder
Actual Diagnosis is by using DSM-5 criteria!!! SIG-E-CAPS helps remind us of this
PHQ-2&9 are just a SCREENING tool - THIS WILL BE ON EXAM
Your neighbor is a 50 year old man doesn't do much. The only thing you ever see him do is water and take care of his great big garden. The only people who ever visit are his parents, even they don't come around often. And when you say hi, he just grunts, and barely waves back. No wonder why he doesn't have a wife or even a girlfriend. What type of disorder is this?
Schizoid Personality Disorder
Name 3 typical antipsychotics and a common side effects
Haldol, loxitane, navane, prolixin, thorazine
EP effects liek akathisia (most common- sensation of motor restlessness) dystonia, parkinsonism
A 24 year old Marquette PA student comes into your office. She says her boyfriend asked her the other day if she had a black eye. Shocked, she explained back to him that they were just the dark circles under her eyes from lack of sleep. She tells you that since fall semester started, she typically stays up till 12am studying, wakes up at 5am, drinks at least 3 caffeinated drinks during the day, and tries to get in some exercise before bed. What is the recommended treatment for this patient?
CBT-I
Insomnia is the most common sleep disorder
What is the most common mental health disorder in the US
Anxiety disorders
What is the first line medication treatment for depression? Name the class and most likely drug as it has the fewest side effects -
What is the BBW associated with it?
Bonus if you can tell me the one that will never be the answer, double bonus if you know why
SSRIs and likely sertraline as it has the fewest drug interactions at lower dose
BBW: under age of 24 suicidality
Paroxetine - has anticholinergic side effects, short half life, and many drug interactions
A 25 year old female presents to the ED with her ex boyfriend after she was standing outside his house smelling of gasoline with matches. He says she has gone crazy and is trying to kill herself. Privately she tells you that she never even had matches in her hands but she just wanted to prove that he still cared. What is her diagnosis and what is the GOLD STANDARD TX
Boarderline personality disorder
DBT - Dialectical Behavior Therapy
A 24-year-old man is brought to the clinic by his roommate, who says he's been "acting super weird" for the past 2 months. The patient believes that aliens are controlling his thoughts through the microwave, frequently talks to himself, and once spent a whole afternoon stacking chairs into a pyramid "to communicate with the mothership." He’s had no prior psychiatric history, is still attending his online classes, and has maintained his part-time job at a coffee shop. Physical exam is unremarkable, and urine tox screen is negative. What is his likely diagnosis?
Schizophreniform disorder - lasted more than 1 month but less than 6 months
A 45 year old pale, female presents to your office with complaints of aches in her legs when she drives up to her daughters house to help with the new baby. Her daughter lives 3 hours away, and the new born is now 4 months old. She has been making this drive once a week since the baby was born, but also notices this urge to stand up when she has been rocking the baby to sleep. Her symtoms only seem to be relived when she stands. However, this wakes the baby. She is wondering if there is anything you can do to help?
What labs would you order and ?
Obtain a CMP, glucose, and CBC
Treat her = IDA
Dopamine agonist: pramipexole, ropinirole
Starting fall semester before every exam, you feel an overwhelming sense of dread. As the days get closer, you experience sweaty palms, racing thoughts, and a constant feeling that you won’t be able to remember anything on the test. The night before the exam, you can barely sleep, and the morning of, you feels nauseous. During the exam, your hands shake as you write down yet another number to go back to on your tiny microscopic whiteboard. You have trouble focusing on the questions, constantly thinking, “What if I fail? What if I forget everything I studied?” When you finish the exam, you are convinced that you did terribly, despite getting immediate positive feedback. What is this and how do you treat it?
Performance Anxiety - Propranolol
A depressed 16 year old patient comes int you office. He is currently on sertraline for depression but states it has not been working for the past few months. He also is complaining of the inability to focus in school, and sexual dysfunction. He also has a past medical history of epilepsy. What medication would treat all of his sx and been a good add on except it CANNOT be presecribed due to his PMH?
Bupropion - avoid in patients with seizures, DKA, eating disorders, and anxiety
A 30 year old male walks down the street past your classroom window. As he walks by you see him pop a little kids balloon and knock over one's ice cream cone. A dog nearby wags its tail and drops a ball at his feet, hoping for a game of fetch. He picks it up (maybe he's not that bad) then you watch as he hurls the ball all the way onto I-94. Then with a smile, he continues about his day. What type of disorder is this?
Antisocial personality disorder?
What is the drug used to tx resistent schizophrenia? What adverse effect does it have?
Clonazapine, weight gain
This is Narcolepsy, sometimes seen in Monozygotic twins
Tx: Regular and adequate sleep schedule, naps, Modafinil + venlafaxine because cataplexy present
A 28-year-old woman survived a car accident 2 months ago where she was trapped in the vehicle for several hours before being rescued. Since the accident, she experiences disturbing flashbacks and nightmares about the crash. She avoids driving altogether, even though it’s necessary for her daily commute. When she’s in the car as a passenger, she becomes tense and anxious, constantly looking out for potential dangers. She feels detached from others, like she can’t relate to anyone. She often finds herself irritable or snapping at people, especially when they mention the accident. At night, she has trouble sleeping and is easily startled by loud noises. What is the diagnosis and tx?
PTSD, first line is psychotherapy, second line is SSRIs
What is the gold standard for tx for depression
What are the absolute contraindications
ECT - electroconvulsive therapy
Nothing, not even pregnancy, which is so strange but ok
A 30 year old women is watching her son take wedding pictures, watching from a far, she makes her way in, asking the bride to step out of the way. After all, she didn't spend 4 hours getting ready that day for nothing. Her mother-son choreographed dance during the wedding takes 30 minutes to complete and she has the mic for over half the night telling stories and crying about how this reminds her so much of her own wedding day. And to top it all of, she flirted with the camera man to try and get him to take pictures with her most of the night. What disorder is this?
A 24 year old patient presents to the office because her best friends insisted she go in. Her best friend is there with her and says that she has been acting crazy for the last month. She believes the her next door neighbor is in love with her, despite him telling her multiple times to get off his door step. Other than that she maintains a stable job as an ortho MA, no hallucinations, no disorganized thinking or speech, and is otherwise socially appropriate. She denies any mood symptoms, and her medical workup is unremarkable. What is this disorder?
Delusional Disorder
A 50 year old male comes into your office, everyone loves him and knows him as Big Joe because he's 6' 6'' and 300 lbs. You ask him what is going on because it is not time for his annual check up, he explains to you that he has been feeling more tired during the day, he even fell asleep in the waiting room. What disorder do you suspect Big Joe has?
Obstructive sleep apnea - this is the most common cause for day time sleepiness, often seen in obesity
A 28 year old female is working at her desk at the dermatology clinic. She is very deep in thought and begins picking at her face, when she looks up at her co-worker they gasp. She picked off her whole eyebrow. What is this and what is the tx?
Trichotillomania - CBT
Match the following with the proper tx
Perinatal Depression Normal; self limiting
Baby Blues Psych emergency; hospitalize
Postpartum Psychosis MDD; tx with SSRI
Perinatal Depression = MDD; tx with SSRI
Baby Blues = Normal; self limiting
Postpartum Psychosis = Psych emergency; hospitalize
A 40 year old male receives an invitation to a birthday party in the mail. At first he is so excited, but then he thinks to himself "what if this was a pitty invite, and they really don't want me there, or what if they do but end up not liking me?" He walks to his kitchen and sees the new workout class he would like to join, but is scared to go as he thinks he would embarrass himself. What type of disorder is this?
Avoidant Personality Disorder
A recently diagnosed skitophrenic patient presents to the ER. His temperature is 103.4, HR 130, along with AMS, muscle rigidity, and hyper salivation. What is likley causing this and how do you treat it?
This is neuroleptic malignant syndrome likey due to the antiphyscotics he was started on. Obviously step the meds and hydrate, lower temp, potentially treat with benzos or dantrolene
Label each as well remembered or little to no memory, and what part of the sleep cycle they occur in
Sleep terrors
Sleep walking
Nightmares
Sleep terrors - little to no memory, first 1/3
Sleep walking - little to no memory, first 1/3
Nightmares - remembered, second 1/2
What is the overall treatment for GAD and is it ever okay to use benzos? What should you never give benzos with? (im sorry i got tired)
SSRI
Yes, benzos okay as a short term bridge or for panic attacks
Opioids