EXAM 2: MARYVILLE UNIVERSITY: PSYCH
DIAGNOSIS & MANAGEMENT, QUESTIONS
AND CORRECT ANSWERS, WITH COMPLETE
SOLUTION, UPDATED 2024.
Percentage of patients who experience seizure when withdrawing from alcohol
roughly 3% experience status epilepticus
Percentage that experiences delirium tremens r/t alcohol withdraw
Roughly 5% of patients with alcohol use disorder experience DTs.
Mechanism of action of Disulfiram (Antabuse)
inhibits aldehyde dehydrogenase irreversibly.
Know which SSRI is most likely associated with symptoms withdrawal
Paroxetine
Withdrawal symptoms of paroxetine
akathisia, restlessness, GI upset, dizziness, and tingling.
Most common side effect r/t to the start of SSRI therapy
GI upset that generally decreases with time
What is the black box warning on SSRIs?
suicidal ideation (usually worse in the beginning of treatment). The rationale behind this
is likely due to already having a suicide plan, then having the energy from the initiation
of therapy.
What antidepressant is most associated with sexual dysfunction?
SSRI
What is the most common side effect of MAOIs?
hypertensive crisis
What causes hypertensive crisis with MAOIs?
inhibition of monoamine oxidase A, which leads to increased levels of norepinephrine.
This is only problematic when the patient is on another antidepressant without a wash
out period, or if the patient ingests a significant amount of tyramine.
other side effects of MAOIs
Dizziness, sexual side effects, sedation, headache, fatigue, weakness, tremor, blurred
vision, constipation, weight gain, change in appetite, nausea, orthostatic hypotension.
standard initial treatment of neuroleptic malignant syndrome
remove the causative agent first. Any contributory agents should be stopped as well.
Supportive care, including ICU support, may be necessary. Benzodiazepines should be
employed, but the treatment plan may vary based on symptom and presentation.
NMS symptoms
NMS presents with fever, rigidity, mental status change, and autonomic instability.
What symptoms differentiate NMS from Serotonin syndrome?
shivering, hyperreflexia, myoclonus, and ataxia
Classic triad of symptoms for NMS
, HOT, STIFF, and OUT OF IT
1. extreme instability/hyperthermia
2. extreme "lead pipe" muscle rigidity/dystonia
3. extreme mental status change/confusion
Treatment for NMS
discontinue neuroleptics, stabilize b/p, hydration, oxygen, cooling blanket, antipyretics
Medication treatment for NMS
dantrolene, amantadine (dopamine agonists), bromocriptine to relieve rigidity, conflicting
evidence regarding safety of restarting antipsychotics.
Serotonin syndrome mnemonic
ARMS mnemonic A--anxiety, R--restlessness, M--myoclonus, S--sweating. rare but
potentially fatal.
Treatment for serotonin syndrome:
antipyretics--stabilizing temp, benzodiazepine or dantrolene--muscle relaxation, beta-
blocker--tachycardia, and cyproheptadine -- binds to serotonin and histamine receptors
Schizophrenia and hallucinations
They are likely to fluctuate in the chronic residual phase
what symptoms of schizophrenia respond best to antipsychotic medications
Positive symptoms
What are the risk factors for suicide among those with schizophrenia?
Young, white, male, never married, previous functioning was high pre-schizophrenia,
history of past suicide attempts, history of alcohol or substance use.
Delusional disorder:
fixed false belief that is incongruent with culture or familial traditions; has never met
criteria for schizophrenia. If mood disorder exists, is relatively brief in duration compared
to the persistence of the delusion(s). Hallucinations may be present but must be
thematically related to the delusion(s).
Delusional disorder criteria:
Non-bizarre delusions of at least a month's duration
Other criteria for schizophrenia never met
Functioning not markedly impaired or obviously odd or bizarre in areas other than the
delusion
delusional disorder can be specified as:
Erotomanic
Grandiose
Jealous
Persecutory
Somatic
Mixed
Unspecified
Delusional disorder: Erotomanic-
patient believes another individual loves them
Delusional disorder: Grandiose-
patient has unrecognized talent/is on verge of incredible discovery
Delusional disorder: Jealous-
patient believes spouse/lover is unfaithful
DIAGNOSIS & MANAGEMENT, QUESTIONS
AND CORRECT ANSWERS, WITH COMPLETE
SOLUTION, UPDATED 2024.
Percentage of patients who experience seizure when withdrawing from alcohol
roughly 3% experience status epilepticus
Percentage that experiences delirium tremens r/t alcohol withdraw
Roughly 5% of patients with alcohol use disorder experience DTs.
Mechanism of action of Disulfiram (Antabuse)
inhibits aldehyde dehydrogenase irreversibly.
Know which SSRI is most likely associated with symptoms withdrawal
Paroxetine
Withdrawal symptoms of paroxetine
akathisia, restlessness, GI upset, dizziness, and tingling.
Most common side effect r/t to the start of SSRI therapy
GI upset that generally decreases with time
What is the black box warning on SSRIs?
suicidal ideation (usually worse in the beginning of treatment). The rationale behind this
is likely due to already having a suicide plan, then having the energy from the initiation
of therapy.
What antidepressant is most associated with sexual dysfunction?
SSRI
What is the most common side effect of MAOIs?
hypertensive crisis
What causes hypertensive crisis with MAOIs?
inhibition of monoamine oxidase A, which leads to increased levels of norepinephrine.
This is only problematic when the patient is on another antidepressant without a wash
out period, or if the patient ingests a significant amount of tyramine.
other side effects of MAOIs
Dizziness, sexual side effects, sedation, headache, fatigue, weakness, tremor, blurred
vision, constipation, weight gain, change in appetite, nausea, orthostatic hypotension.
standard initial treatment of neuroleptic malignant syndrome
remove the causative agent first. Any contributory agents should be stopped as well.
Supportive care, including ICU support, may be necessary. Benzodiazepines should be
employed, but the treatment plan may vary based on symptom and presentation.
NMS symptoms
NMS presents with fever, rigidity, mental status change, and autonomic instability.
What symptoms differentiate NMS from Serotonin syndrome?
shivering, hyperreflexia, myoclonus, and ataxia
Classic triad of symptoms for NMS
, HOT, STIFF, and OUT OF IT
1. extreme instability/hyperthermia
2. extreme "lead pipe" muscle rigidity/dystonia
3. extreme mental status change/confusion
Treatment for NMS
discontinue neuroleptics, stabilize b/p, hydration, oxygen, cooling blanket, antipyretics
Medication treatment for NMS
dantrolene, amantadine (dopamine agonists), bromocriptine to relieve rigidity, conflicting
evidence regarding safety of restarting antipsychotics.
Serotonin syndrome mnemonic
ARMS mnemonic A--anxiety, R--restlessness, M--myoclonus, S--sweating. rare but
potentially fatal.
Treatment for serotonin syndrome:
antipyretics--stabilizing temp, benzodiazepine or dantrolene--muscle relaxation, beta-
blocker--tachycardia, and cyproheptadine -- binds to serotonin and histamine receptors
Schizophrenia and hallucinations
They are likely to fluctuate in the chronic residual phase
what symptoms of schizophrenia respond best to antipsychotic medications
Positive symptoms
What are the risk factors for suicide among those with schizophrenia?
Young, white, male, never married, previous functioning was high pre-schizophrenia,
history of past suicide attempts, history of alcohol or substance use.
Delusional disorder:
fixed false belief that is incongruent with culture or familial traditions; has never met
criteria for schizophrenia. If mood disorder exists, is relatively brief in duration compared
to the persistence of the delusion(s). Hallucinations may be present but must be
thematically related to the delusion(s).
Delusional disorder criteria:
Non-bizarre delusions of at least a month's duration
Other criteria for schizophrenia never met
Functioning not markedly impaired or obviously odd or bizarre in areas other than the
delusion
delusional disorder can be specified as:
Erotomanic
Grandiose
Jealous
Persecutory
Somatic
Mixed
Unspecified
Delusional disorder: Erotomanic-
patient believes another individual loves them
Delusional disorder: Grandiose-
patient has unrecognized talent/is on verge of incredible discovery
Delusional disorder: Jealous-
patient believes spouse/lover is unfaithful
