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Psychiatry - Rosh Review exam test guide with complete solution
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Psychiatry - Rosh Review exam test guide with complete solution
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Psychiatry - Rosh Review exam test guidewith complete solution
What is generalized anxiety disorder? - ANS having uncontrollable anxiety and worry that
interfere with daily activities for at least 6 months
What are the first line medications for generalized anxiety disorder? - ANS SSRIs and SNRIs
in addition to psychotherapy
What are the ADRs of SSRIs and SNRIs? - ANS nausea, diarrhea, insomnia/agitation,
somnolence, impaired sexual function, and hyponatremia
What are the characteristics of citalopram? - ANS - lower risk of insomnia/agitation
- few drug interactions
- can prolong the QT interval with increasing blood levels
What are the characteristics of escitalopram? - ANS - lower risk of insomnia/agitation
- few drug interactions
What are the characteristics of sertraline? - ANS - greater risk of insomnia/agitation
- more frequent diarrhea and other gastrointestinal concerns
What are the characteristics of paroxetine? - ANS - mildly sedating
- weakly anticholinergic
- lower risk of insomnia/agitation
- withdrawal symptoms if not tapered
What are the characteristics of fluoxetine? - ANS - greater risk of insomnia/agitation
- no withdrawal symptoms if not tapered
- takes weeks to reach steady blood levels due to long half-life
What are the characteristics of fluvoxamine? - ANS - lower risk of insomnia/agitation
- withdrawal symptoms if not tapered
- significant drug interactions
What are the characteristics of duloxetine? - ANS - greater risk of insomnia/agitation
- useful for treatment of comorbid painful conditions
- withdrawal symptoms if not tapered
What are the characteristics of venlafaxine? - ANS - greater risk of insomnia/agitation
- increased blood pressure (primarily diastolic) and heart rate with increasing doses
,- useful for treatment of comorbid painful conditions
- few drug interactions
- withdrawal symptoms if not tapered
What are the characteristics of buspirone? - ANS - a nonbenzodiazepine anxiolytic
- augmentation choice for partial response to antidepressant
- slow onset and modest efficacy
- lacks tolerance, dependence, and withdrawal
- ineffective for comorbid major depression
What are the characteristics of pregablin? - ANS - a GABA analog calcium-channel modulator
anticonvulsant
- onset within days of starting treatment
- approved for treatment of anxiety in some countries (not United States)
- sedation and dizziness
- tolerance, dependence, and withdrawal possible
- schedule V controlled substance in the United States
- many patients require >150 mg/day, up to 300 mg/day
What are the characteristics of mirtazapine? - ANS - an atypical antidepressant
- alternate or augmentation choice for anxiety with insomnia
- sedating, and notably increases appetite
What are the characteristics of quetiapine? - ANS - a second-generation antipsychotic
- potential augmentation choice for partial response to antidepressant or alternate as
monotherapy
- sedation, extrapyramidal effects, weight gain, and metabolic side effects
- rarely tardive dyskinesia
What are the characteristics of hydroxyzine? - ANS - a sedating antihistamine with anxiolytic
properties
- augmentation option for treatment of insomnia
- anticholinergic side effects with increasing doses
What are the characteristics of imipramine? - ANS - a tricyclic antidepressant
- anticholinergic side effects
- cardiotoxic in overdose
- may be poorly tolerated relative to SSRI and SNRI antidepressants
What is the MOA of buspirone? - ANS partial serotonin agonist that has been shown to have
similar effects to benzodiazepines without the risk of dependence
When is buspirone indicated in the treatment of generalized anxiety disorder? - ANS
treatment augmentation in addition to cognitive behavioral therapy in patients with generalized
, anxiety disorder who have a partial response to treatment with an SSRI or an SNRI - generally
not indicated as monotherapy
How long should treatment with a selective serotonin reuptake inhibitor continue in patients with
generalized anxiety disorder? - ANS at least 12 months
What is bulimia nervosa? - ANS episodic and uncontrolled ingestion of large quantities of
food followed by recurrent, inappropriate, compensatory behavior to prevent weight gain, such
as self-induced vomiting, diuretic or cathartic use, strict dieting, or vigorous exercise
What are the physical signs and symptoms of bulimia nervosa? - ANS body weight classified
as normal or near normal, mouth sores, dental caries, swollen salivary glands, Mallory-Weiss
esophageal tears, gastroesophageal reflux, hair loss, intolerance to cold, menstrual
irregularities, and cardiac abnormalities
What are the most common methods of purging seen in patients with bulimia nervosa? - ANS
laxative misuse and vomiting
Which electrolyte abnormalities are associated with bulimia nervosa? - ANS hypokalemia and
metabolic alkalosis
What can hypokalemia due to bulimia nervosa lead to? - ANS cardiac dysrhythmias,
rhabdomyolysis, muscle weakness, hypokalemic cardiomyopathy, and tetany
How is bulimia nervosa treated? - ANS nutritional rehabilitation, psychotherapy (CBT),
pharmacotherapy (SSRIs)
Why is metabolic alkalosis seen in patients with bulimia nervosa? - ANS secondary to
dehydration and volume depletion from vomiting
What clinical sign in patients with bulimia is associated with callosities, scarring, and abrasions
on the knuckles secondary to repeated self-induced vomiting? - ANS Russell sign
What will the EKG of a patient with bulimia nervosa with hypokalemia show? - ANS U waves,
T wave flattening, ST depression, QT prolongation
What is the treatment for patients with bulimia nervosa who have hypokalemia? - ANS
potassium replacement along with magnesium
What are risk factors for suicide? - ANS psychiatric illness, history of previous suicide
attempts, never having been married, previous or active military service, childhood abuse, family
history of suicide, and access to weapons
Are men or women more likely to attempt suicide? - ANS women
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