NU 664 COMPREHENSIVE EXAM UPDATED QUESTIONS
AND SOLUTIONS RATED A+
✔✔Neurotransmitter Disturbances Acetylcholine (ACh) Abnormal levels of choline,
which is a precursor to ACh, have been found at - ✔✔autopsy in the brains of some
depressed patients, perhaps reflecting abnormalities in cell phospholipid composition
✔✔Reductions of GABA have been observed in - ✔✔CSF, and brain GABA levels in
depression. Animal studies have also found that chronic stress can reduce and
eventually can deplete GABA levels. By contrast, GABA receptors are upregulated by
antidepressants, and some GABAergic medications have weak antidepressant effects
✔✔Serotonin syndrome - ✔✔Concurrent administration of an SSRI with an MAOI,
Ltryptophan, or lithium (Eskalith) can raise plasma serotonin concentrations to toxic
levels, producing a constellation of symptoms called serotonin syndrome.
✔✔This serious and possibly fatal syndrome of serotonin overstimulation comprises, in
order of appearance as the condition worsens - ✔✔(1) diarrhea; (2) restlessness; (3)
extreme agitation, hyperreflexia, and autonomic instability with possible rapid
fluctuations in vital signs; (4) myoclonus, seizures, hyperthermia, uncontrollable
shivering, and rigidity; and (5) delirium, coma, status epilepticus, cardiovascular
collapse, and death.
✔✔Treatment of serotonin syndrome consists of removing the offending agents and
promptly instituting comprehensive supportive care with - ✔✔nitroglycerine,
cyproheptadine (Periactin), methysergide (Sansert), cooling blankets, chlorpromazine
(Thorazine), dantrolene (Dantrium), benzodiazepines, anticonvulsants, mechanical
ventilation, and paralyzing agents.
✔✔The use of specific pharmacotherapy - ✔✔approximately doubles the chances that a
depressed patient will recover in 1 month.
✔✔All currently available antidepressants may take up to - ✔✔to 3 to 4 weeks to exert
significant therapeutic effects, although they may begin to show their effects earlier.
✔✔Choice of antidepressants is determined by the side effect profile least objectionable
to a given patient's - ✔✔physical status, temperament, and lifestyle.
✔✔Numerous classes of antidepressants are available, many with different
mechanisms - ✔✔of action, represents indirect evidence for heterogeneity of putative
biochemical lesions
, ✔✔Although the first antidepressant drugs, the monoamine oxidase inhibitors (MAOIs)
and tricyclic antidepressants (TCAs), are still in use - ✔✔newer compounds have made
the treatment of depression more "clinician and patient friendly."
✔✔Psychosocial Therapy Three types of short-term psychotherapies - ✔✔cognitive
therapy, interpersonal therapy, and behavior therapy—have been studied to determine
their efficacy in the treatment of major depressive disorder
✔✔Although its efficacy in treating major depressive disorder is not as well researched
as these three therapies, psychoanalytically oriented psychotherapy - ✔✔has long been
used for depressive disorders, and many clinicians use the technique as their primary
method.
✔✔What differentiates the three short-term psychotherapy methods from the
psychoanalytically oriented approach are the - ✔✔active and directive roles of the
therapist, the directly recognizable goals, and the end points for short-term therapy.
✔✔·Obsessive and compulsive/Anxiety/trauma and stress related disorders
Diagnostic criteria - ✔✔Obsessions (thoughts) or Compulsions (behaviors) or both
The thoughts are often intrusive and unwanted and cause distress; not usually involving
real-world worries
The behaviors are repetitive and an attempt to suppress / cope with / eliminate the
thoughts
Time consuming
Common obsessions include: worries about contamination, repeated doubts, need to
have things in a specific order, aggressive or horrific thoughts, may occur during
pregnancy as intrusive thoughts about baby that are ego-dystonic and sexual imagery
✔✔· Obsessive and compulsive/Anxiety/trauma and stress related disorders screening
tools, assessment acronyms - ✔✔Yale-Brown Obsessive-Compulsive Scale (YBOCS)
10-items
10-15 mins completion time
Standard instrument used in virtually every drug trial and can be used to monitor
treatment
✔✔Obsessive and compulsive/Anxiety/trauma and stress related disorders - ✔✔Body
Dysmorphic Disorder
ED
Trichotilomania
Hypochondriasis
OC Personality D/O
Tic or ST movement disorder
AND SOLUTIONS RATED A+
✔✔Neurotransmitter Disturbances Acetylcholine (ACh) Abnormal levels of choline,
which is a precursor to ACh, have been found at - ✔✔autopsy in the brains of some
depressed patients, perhaps reflecting abnormalities in cell phospholipid composition
✔✔Reductions of GABA have been observed in - ✔✔CSF, and brain GABA levels in
depression. Animal studies have also found that chronic stress can reduce and
eventually can deplete GABA levels. By contrast, GABA receptors are upregulated by
antidepressants, and some GABAergic medications have weak antidepressant effects
✔✔Serotonin syndrome - ✔✔Concurrent administration of an SSRI with an MAOI,
Ltryptophan, or lithium (Eskalith) can raise plasma serotonin concentrations to toxic
levels, producing a constellation of symptoms called serotonin syndrome.
✔✔This serious and possibly fatal syndrome of serotonin overstimulation comprises, in
order of appearance as the condition worsens - ✔✔(1) diarrhea; (2) restlessness; (3)
extreme agitation, hyperreflexia, and autonomic instability with possible rapid
fluctuations in vital signs; (4) myoclonus, seizures, hyperthermia, uncontrollable
shivering, and rigidity; and (5) delirium, coma, status epilepticus, cardiovascular
collapse, and death.
✔✔Treatment of serotonin syndrome consists of removing the offending agents and
promptly instituting comprehensive supportive care with - ✔✔nitroglycerine,
cyproheptadine (Periactin), methysergide (Sansert), cooling blankets, chlorpromazine
(Thorazine), dantrolene (Dantrium), benzodiazepines, anticonvulsants, mechanical
ventilation, and paralyzing agents.
✔✔The use of specific pharmacotherapy - ✔✔approximately doubles the chances that a
depressed patient will recover in 1 month.
✔✔All currently available antidepressants may take up to - ✔✔to 3 to 4 weeks to exert
significant therapeutic effects, although they may begin to show their effects earlier.
✔✔Choice of antidepressants is determined by the side effect profile least objectionable
to a given patient's - ✔✔physical status, temperament, and lifestyle.
✔✔Numerous classes of antidepressants are available, many with different
mechanisms - ✔✔of action, represents indirect evidence for heterogeneity of putative
biochemical lesions
, ✔✔Although the first antidepressant drugs, the monoamine oxidase inhibitors (MAOIs)
and tricyclic antidepressants (TCAs), are still in use - ✔✔newer compounds have made
the treatment of depression more "clinician and patient friendly."
✔✔Psychosocial Therapy Three types of short-term psychotherapies - ✔✔cognitive
therapy, interpersonal therapy, and behavior therapy—have been studied to determine
their efficacy in the treatment of major depressive disorder
✔✔Although its efficacy in treating major depressive disorder is not as well researched
as these three therapies, psychoanalytically oriented psychotherapy - ✔✔has long been
used for depressive disorders, and many clinicians use the technique as their primary
method.
✔✔What differentiates the three short-term psychotherapy methods from the
psychoanalytically oriented approach are the - ✔✔active and directive roles of the
therapist, the directly recognizable goals, and the end points for short-term therapy.
✔✔·Obsessive and compulsive/Anxiety/trauma and stress related disorders
Diagnostic criteria - ✔✔Obsessions (thoughts) or Compulsions (behaviors) or both
The thoughts are often intrusive and unwanted and cause distress; not usually involving
real-world worries
The behaviors are repetitive and an attempt to suppress / cope with / eliminate the
thoughts
Time consuming
Common obsessions include: worries about contamination, repeated doubts, need to
have things in a specific order, aggressive or horrific thoughts, may occur during
pregnancy as intrusive thoughts about baby that are ego-dystonic and sexual imagery
✔✔· Obsessive and compulsive/Anxiety/trauma and stress related disorders screening
tools, assessment acronyms - ✔✔Yale-Brown Obsessive-Compulsive Scale (YBOCS)
10-items
10-15 mins completion time
Standard instrument used in virtually every drug trial and can be used to monitor
treatment
✔✔Obsessive and compulsive/Anxiety/trauma and stress related disorders - ✔✔Body
Dysmorphic Disorder
ED
Trichotilomania
Hypochondriasis
OC Personality D/O
Tic or ST movement disorder
