Behavioral Medicine – General

A new mother presents with sadness, tearfulness, without negative
feelings towards her baby. She is diagnosed with postpartum blues
and treated with self-limited support only.
The onset of postpartum blues is:

a) Birth up to one month
b) Birth up to two months
c) Birth up to two weeks


A new mother is diagnosed with post partum depression, and treated with
antidepressant medications. Her symptoms are: depressed mood, weight changes,
sleep disturbances, and excessive anxiety. She has some negative feelings toward
her baby.
You may diagnose her with postpartum depression:

a) 4-6 months after birth
b) 2-3 weeks after birth
c) 1-3 months after birth

A new mother is diagnosed with post partum psychosis. Her symptoms
are: depression, delusions, and thoughts of harm (self and baby).
She is treated with antipsychotic medications, LITHIUM, and
possibly antidepressants.
The onset of these symptoms will be:

a) 1 week after birth
b) I month after birth
c) within 2-3 weeks after birth


Major depression can be diagnosed after:

a) 2 weeks
b) 4 weeks
c) 1 month

True or false:
In order to diagnose major depression, the patient must show
a depressed mood or anhedonia (inability to experience pleasure from
activities they usually found enjoyable) and FOUR out of the following:

 – Depresssed mood most of the day
– Weight changes
– Sleep changes
– Psychomotor disturbances
– Fatigue
– Poor concentration
– Thoughts of death and worthlessness

a) True
b) False


Before diagnosing major depression, you must first rule out:

a) Hypothyroidism
b) Congestive heart failure
c) Pancreatitis


The most common neurological associations with major depression are:

a) Schizophrenia
b) Conversion disorder
c) Parkinson’s disease and dementia

The first-line treatments for major depression are: Fluoxetine, Paroxetine,
Sertraline, Citalopram, Escitalopram.  
These are:

a) SNRIs
b) SSRIs
c) Phenothiazines


Why shouldn’t you take SSRIs with
MAO (Monoamine oxidase) inhibitors?

a) They will cause a dramatic decrease in serotonin
b) They will cause a dramatic increase in serotonin
c) They will cause a dramatic increase in norepinephrine

What medication is an alternative to SSRIs, and is
approved for both depression and neuropathy?

a) Penicillin
b) Aspirin
c) Desvenlafaxine


Why do some patients choose BUPRPION an alternative to
SSRIs?

a) Some studies have show that improves concentration
b) It has fewer side effects and less weight gain
c) It is much less expensive


Bipolar disorder is diagnosed after manic symptoms persist for
at least:

a) one year
b) six months
c) one week


Before diagnosing bipolar disorder, rule out:

a) Cocaine / Amphetamine use
b) SNRI use


Bipolar disorder type 1 is:

a) Depression and psychotic behavior
b) Mania and depression
c) Mania only


Bipolar disorder type 2 is:

a) Hypermania and depression
b) Hypomania and depression


In general, bipolar disorder is treated with
Lithium / Lamotrigene. But do not use Lithium if
______ are damaged:

a) Liver
b) Kidneys
c) Lungs


For acute mania, first-line treatment is Lithium / 
Valproic acid / Atypical antipsychotic. However, for
severe symptoms, consider using:

a) Atypical antipsychotics
b) SSRIs


These medications, aripipraZOLE, 
ziprasiDONE, risperiDONE,
quetiaPINE, or olanzaPINE are examples
of:

a) Typical antipsychotics
b) Atypical antipsychotics


The following medications, ChlorpromaZINE, FluphenaZINE,
HaloperiDOL, PerphenaZINE, ThioridaZINE, TrifluoperaZINE are:

a) Typical antipsychotics
b) Atypical antipsychotics


For a diagnosis of Cyclothymia OR Dysthymia, symptoms must
be present for:

a) one year
b) two years
c) 6 months


Cyclothymia is characterized by HYOmanic episodes and:

a) mild depression
b) severe depression


Treatment for Dysthymia is antidepressant medications and psychotherapy
while treatment for Cyclothymia is:

a) Lithium valproic acid AND Carbamazepine, psychotherapy
b) Lithium valproic acid OR Carbamazepine, psychotherapy


Atypical depression is characterized by:

a) reverse vegetative changes (increase in sleep, weight, appetite/hyperphagia),
mood worsens in the evening, extremities feel heavy
b) reverse vegetative changes (decrease in sleep, weight, appetite),
mood worsens in the evening, extremities feel heavy


Atypical depression is treated with SSRI OR MAO inhibitor, but
if you have the option to choose either, choose:

a) MAO because of strong increase in serotonin
b) SSRI because less side effects


Seasonal affective disorder affects some people’s mood in
fall and winter, and is characterized by weight gain, increase in sleep
and lethargy. It is treated with:

a) Phototherapy and Bupropion
b) Psychotherapy and Bupropion

One major difference between Bereavement and Major Depression
is the duration of symptoms. Major depression continues for
more than 2 months and adversely affects functioning while
Bereavement is usually less than:

a) three months
b) six months


With Schizophrenia, males and females are equally effected, but
FEMALES generally exhibit more chronic symptoms.

a) True
b) False


With Schizophrenia, 75% of patients develop their first psychotic episode
between the ages of 15 and 35.

a) True
b) False


Regarding the epidemiology of schizophrenia, the lifetime prevalence
is  _____ and the percent of the total population
treated for schizophrenia is ____ :

a) 10%, 0.10%
b) 1%, 0.05%
c) 5%, 0.10%


Prevalence:
———————————————————————

General population – 1-1.5%
First-degree relative – 10-12%
Second-degree relative – 5-6%
Child of two schizophrenic parents – 40%
Dizygotic twins – 12-15%
Monozygotic twins – 45-50%
———————————————————————


The NEGATIVE symptoms of schizophrenia involver which receptors?

a) D1
b) D2


Dopamine is thought to be the major factor with schizophrenia
based on:

a) effects of drugs that increase dopamine levels
b) the antipsychotic effect of dopamine receptor antagonists
c) Both


Schizophrenia may result from:
—————————————————————————
– increase in LIMBIC dopamine activity (POSITIVE Sx)
– decrease in FRONTAL dopamine activity (NEGATIVE Sx)
—————————————————————————-


With schizophrenia, also consider the biological findings
—————————————————————————
– Norepinephrine hypothesis
– GABA hypothesis
– Serotonin hypothesis
– Glutamate hypothesis
– Evidence of abnormal neuronal migration during
the 2nd trimester
—————————————————————————

Regarding patients with Schizophrenia, which patients will have
a better prognosis?

a) Those with positive symptoms
b) Those with negative symptoms (associated with muscarinic receptors)


For schizoaffective disorder, how long must delusions or hallucinations
be present for – in the absence of prominent mood Sx during some
phase of the illness?

a) 1 week
b) 2 weeks


For delusional disorder, how long must there be Sx (nonbizzare, systemized delusions
relatively well-functioning personality, no prominent hallucinations, onset
middle to late adult life)

a) 1 month
b) 6 months

Schizophrenia – First generation antipsychotics (dopamine receptor
antagonists) are effective in treating:

a) Positive symptoms
b) Negative symptoms

Typical antipsychotics
——————————————————————————–
Cause tardive dyskinesia at a rate of roughly 5% per year of
exposure
——————————————————————————–



Temporal Lobe:
——————————————————————————-
DOMINANT LOBE = Happy Psychotic (Euphoria, auditory
hallucinations, delusions, thought disorders, poor verbal 
communication – Wernicke encephalopathy), Broca’s aphasia
(in dominant)

NON-DOMINANT LOBE = Dysphoria, Irritability, decreased
visual and musical ability
——————————————————————————–

Bilateral lesion – dementia
Rostral temporal – dominant side: No name memory


Parietal Lobe – Intellectual processing of sensory information,
LEFT (dominant): verbal processing, RIGHT: Visual-special
processing
——————————————————————————-
DOMINANT LOBE = Agraphia, Acalcula, Finger agnosia,
right-left disorientation, Count for part of learning disabilities,
(Grestmann Syndrome)

NON-DOMINANT LOBE = denial of illness (anosognosia),
Construction apraxia (difficulty outlining obejects), Negelect
of opposite side (not washing or dressing opposite side)
——————————————————————————

——————————————————————————
2nd generation antipsychotics
– aka: atypical, novel or serotonin-dopamine antagonists
– will take care of both positive AND negative symptoms
– D2 receptors
– dyskinesia less likely
——————————————————————————

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