Psychopharmacology
Just Say No
Why are kids so annoying?
Syndrome Schmindrome
A Mixed Bag
100
The dose of carbamezepine (Tegretol) often has to be adjusted due to this phenomenon
What is auto-induction?
100
These drugs have recently caused the CDC to release this statement: The "CDC does not know of a virus or condition that would reanimate the dead (or one that would present zombie-like symptoms)" despite releasing a Zombie Preparedness Guide in 2011.
What are bath salts?
100
A 5-year-old boy does not show any interest in other children and ignores adults other than his parents. He spends hours lining up his toy cars or spinning their wheels but does not use them for “make believe” play. He rarely uses speech to communicate. Choose the most appropriate diagnosis:
What is autism.
Autistic disorder is characterized by lack of interest in social interactions, severely impaired verbal and nonverbal communication, stereotyped behaviors, and a very restricted range of interests. Children with autism do not have imaginative and imitative play and can spend hours lining and spinning things or dismantling toys and putting them together.
Mentally retarded children are develop- mentally delayed but their social interaction and interest in people are
appropriate for their mental age.
Asperger’s disorder present with the same impairments in social interactions, range of interests, and imagination found in autism but they do not have language deficiencies.
100
Common symptoms that present with neuroleptic malignant syndrome
What is fever, autonomic instability, leukocytosis, tremor, elevated CPK, riguidity?
100
This medication class is the initial treatment of catatonia
What are benzodiazepines?
200
This mechanism leads to tardive dyskinesia in long-term antipsychotic use.
What is the upregulation of dopamine receptors due to dopamine blockade?
200
A patient comes in for a surgery and is recovering in the post-op area when he starts to develop tremors, autonomic instability, confusion, and agitation. He is given this medication.
What are benzodiazepines?
200
An 8-year-old boy with a history of MDD treated with fluoxetine (Prozac) is brought to the pediatric emergency department after running into the street in front of a car on the way home from school. The boy says that he wants to be dead and refuses to say more. The boy was not hit by the car, and physical and laboratory examinations are normal.Which of the following symptoms of MDD is seen more commonly in children than in adolescents?
What is psychomotor agitation. Depressive disorders are not rare in children and often children with depression have relatives who also suffer from depression or another mood disorder. The incidence of de- pression is estimated to be 0.9% in preschoolers, 1.9% in school-age chil- dren, and 4.7% in adolescents. The incidence is considerably higher among children with neurological or medical illnesses. The diagnosis can be diffi- cult because younger children’s symptoms differ from the symptoms of de- pression usually displayed by adults. Often, aggression and irritability re- place sad affect, and poor school functioning or refusal to go to school may be the prominent manifestations. Psychotic symptoms are present in one- third of cases of childhood major depression.
200
A kid is brought to the hospital multiple times for treatment of hypoglycemia. A full medical work-up is done and no cause is found. The patient's father has HTN and dyslipidemia and the patient's mother has T1DM and asthma.
What is Munchausen syndrome by proxy?
200
This drug is contraindicated in patients with an active eating disorder
What is Buproprion (Wellbutrin)? Buproprion also has no sexual side effects, is helpful in ADHD/smoking cessation, and is an NDRI.
300
This medication has a unique mechanism of action because it acts on the alpha 2 adrenoreceptor antagonist
What is mirtazapine (Remeron)? Blocking the presynaptic alpha 2 adrenoreceptor causes neurons to release more NE and serotonin into the synaptic cleft. This medication is useful in cancer patients as it also can cause weight gain.
300
An 18 yo college freshman is brought to the ED by his friends. They say he is normally happy and good-natured, but became unsually withdrawn and aloof a few hours after a football game. He complains of dry mouth and PE shows injected conjunctivae and tachycardia. He used this substance.
What is cannabis (marijuana)?
300
Parents are awoken by their 4-year-old screaming. They rush into his room and find him in his bed, thrashing wildly, his eyes wide open. He pushes them away when they try to comfort him. After two minutes, the boy suddenly falls asleep and the next day he has no memory of the episode. This disorder is associated with what stage of sleep.
What is stage 3-4.The child in the vignette is experiencing an episode of sleep terror disorder, a dyssomnia characterized by sudden partial arousal accompanied by piercing screams, motor agita- tion, disorientation, and autonomic arousal. The episodes take place dur- ing the transition from deep sleep to REM sleep. Children do not report nightmares (which would be associated with REM sleep) and do not have any memory of the episodes the next day. Sleep terrors occur in 3% of chil- dren and 1% of adults.
300
Patients with this syndrome will often complain of seeing a familiar person as a stranger who is posing as the familar person
What is Capgras’ syndrome? (delusion of doubles). Delusional conviction that other persons in environment are not their real selves but are their own doubles.
There are 4 types
1. Typical Capgras’ syndrome(illusion des sosies)- pt sees a familiar person as a stranger who is imposing as the familiar person.
2. Illusion de Fregoli pt falsely identifies strangers as familiar persons.
3. Syndrome of subjective doubles pt’s own self is perceived as being replaced by a double.
4. Intermetamorphosis pt’s misidentification is complete including both external appearance & personality.
300
Both of these medications are effective in patients with chronic pain and depression?
What is duloxetine (Cymbalta) and venlafaxine (Effexor)? Both are SNRIs.
400
This medication works as a partial agonist on the D2 receptors. What is the SE associated with this medication.
What is aripiprazole (Abilify), Akathisia.
400
A 37 yo M presents to ED complaining that “it hurts so bad all over, I think I’m dying.” He also reports diffuse muscle aches for the last couple of hours, abdominal cramps which started last night and have gradually increased in intensity, and persistent nausea. T 97.8F BP 144/102 P 88/min RR 16/min. PE shows sweating, thin man, clear nasal discharge, and dilated pupils.
What is heroin withdrawal?
400
Britney is a 10-year-old girl without significant medical history brought to the pediatrician by her father for evaluation. Over the past school year, she has been having increasing difficulties going to sleep. Although she has “always had bedtime rituals,” they have extended in complexity and length. Most of her time in the evening is now spent going around the house numerous times, locking and unlocking the doors and windows. While she knows the chances of a burglary are slim, she is extremely anxious about her safety, and she “can’t stop” the urges to perform these behaviors. As a result, she only obtains 5 hours of sleep, and she has been falling asleep in class with dimin- ishing grades. Infection with which of the following organisms might have contributed to her current illness?
What is Group A Strep. This patient is suffering from OCD. Prior infection with Group-A beta-hemolytic Streptococcus has been associated with several psychiatric illnesses, such as OCD and Tourette disorder.
400
Finger agnosia, agraphia, right-left disorientation and dyscalculia associated with dominant parietal lobe lesions.
What is Gerstman Syndrome.
400
These medications received a black box warning for "Increased Mortality in Elderly Patients With Dementia-Related Psychosis"
What are Antipsychotics?
500
These medications can potently inhibit sodium channels causing cardiotoxicity
What are TCAs?
500
The criteria that make up the definition for substance abuse.
What is use of a substance leading to impairment or distress for at least 1 year with one or more of the following manifestations: 1) failure to fulfill obligations at work, school, home 2) use in dangerous situations 3) recurrent substance-related legal problems 4) continued use despite social or interpersonal problems due to substance use?
500
An anxious mother brings her 4 year old son to clinic for a new patient visit. She say that her son was progressing well and meeting all milestones until three months ago. Since then, she and her husband have noticed a marked restriction in the boy’s activities. He keeps o himself, refuses to play with his siblings, speaks only when spoken to, and appears indifferent to the presence of others. Attempts to engage the child in conversation are unsuccessful. He seems disinterested and refuses to make eye contact. While in the examination room, he starts banging his head against the wall, Given his clinical presentation, which of the following is the most likely diagnoses?
What is Childhood disintegrative d/o. Childhood disintegrative disorder is a rare pervasive developmental disorder that occurs more commonly in males. It is characterized by a period of normal development for at least 2 years, followed by a loss of previously acquired skills in at least 2 areas: language, social skills, bowel and bladder control, or play and motor skills.
500
DAILY DOUBLE
DAILY DOUBLE
500
A 27 yo F complains of abdominal pain that persists for the last 2 years. The pain is constant and unrelated to menses. She also complains of nausea and a sense of bloating. She has seen numerous physicians and undergone many endoscopies/colonoscopies to no avail. On ROS, she states she has severe headaches, dyspareunia, weakness in her lower extremities, lower back pain, and irregular menses.
What is somatization disorder? Somatization D/o includes at least 4 pain symptoms involving multiple sites, 2 GI symptoms, sexual or reproductive symptoms other than pain, and one pseudoneurologic complaint.