DEPRESSION

3 Question Warm-Up

4.

1.

W h a t is the empiric treatm ent for a brain abscess?

2.

W h a t is the treatm ent for an epidural hematoma or subdural hematoma?

3.

W h a t is the typical pseudotumor cerebri patient?

A t w ha t poin t does grief / bereavem ent b ecom e pathological?

G rief becomes pathological when any of the following are found:
Depression criteria met for at least 2 weeks after the first 2 months following the loss
Generalized feelings o f______________________________________________
O
Distressing feelings do not diminish in intensity by___________________
Inability to move on, trust others and reengage in life by___________________

5.

W h a t m edical conditions can cause severe depression?

6,

W h a t m ed ica tions are know n fo r causing sym p tom s o f depression?

Sedatives: alcohol, benzos, antihistamines
Stimulant withdrawal
o _______________________ (antihypertensive often used for hypertension in pregnancy)
First-generation antipsychotics (such as haloperidol)
Anti-nausea drugs including metoclopramide and prochlorperazine
O
Insufficient thyroid replacement - hypothyroidism
o ________________________(used in viral hepatitis treatment)

DEPRESSIO N

7.

W h a t are th e sym p t o m s o f m a jo r d e pression w ith a typ ic a l features? W h a t

m e d ica tio ns w o rk w ell for this?

8.

W h a t is the first-line tre a tm e n t for m ajor depression with seasonal pattern?

End o f Session Quiz

9.

A 36-year-old male smoker says he has been thinking a lot about quitting,
and wants to talk to you about ways to go about it. A t what stage o f change in
overcoming his smoking habit is this man?

10.

W h a t neurotransmitter derangements are seen in patients with depression?

II.

List the symptoms o f depression using the mnemonic SIG E CAPS:

12. Diagnosis of major depressive disorder (MDD) requires five of the above
symptoms, including depressed mood or anhedonia, that must last how long?

ANTIDEPRESSANTS

3 Question Warm-Up

4.

1.

A patient presents w ith hyperphagia, hyperorality and hypersexuality. W h at is

the diagnosis, and w hat brain lesion causes this?

2.

W h a t are the m ost com m on causes o f seizures in young adults (18-35 years)?

3.

W h a t is the treatm ent for cluster headaches?

Ca t egorize each of the following antidepressants:

nortriptyline, bupropion, mirtazapine,fluvoxamine, doxepin,phenelzine, fluoxetine,
imipramine, amitriptyline, milnacipran, sertraline, venlafaxine, paroxetine, tranylcypromine,
duloxetine, citalopram, trazodone, escitalopram, desvenlafaxine, nefazodone

SSRI -

TC A -

MAOI -

NDRI -

SNR.I -

Tetracyclic -

W h a t are th e sym p t o m s o f m a jo r d e pression w ith a typ ic a l features? W h a t

m e d ica tio ns w o rk w ell fo r this?

W h a t is the first-line tre a tm e n t for m ajor depression with seasonal pattern?

End o f Session Q uiz

9.

A 36-year-old male smoker says he has been thinking a lot about quitting,
and wants to talk to you about ways to go about it. A t what stage o f change in
overcoming his smoking habit is this man?

10.

W h a t neurotransmitter derangements are seen in patients with depression?

11.

List the symptoms o f depression using the mnemonic SIG E CAPS:

12. Diagnosis of major depressive disorder (MDD) requires five of the above
symptoms, including depressed mood or anhedonia, that must last how long?

ANTIDEPRESSANTS

S >
I z
I

a
m

3 Question Warm-Up

4.

1.

A patient presents w ith hyperphagia, hyperorality and hypersexuality. W h a t is

the diagnosis, and w hat brain lesion causes this?

2.

W h a t are the m ost common causes o f seizures in young adults (18-35 years)?

3.

W h a t is the treatm ent for cluster headaches?

TJ
73
m
on
on
>

Ca t egorize each of the following antidepressants:

nortriptyline, bupropion, mirtazapine,fluvoxamine, doxepin, phenelzine, fluoxetine,
imipramine, amitriptyline, milnacipran, sertraline, venlafaxine, paroxetine, tranylcypromine,
duloxetine, citalopram, trazodone, escitalopram, desvenlafaxine, nefazodone
SSRI -

TC A -

M AOI -

N D RI -

SN RI -

Tetracyclic -

A typical -

[ 47 ]

SSRIs
5. W h ich drugs should not be taken with SSR Is because of the risk of serotonin
syndrome?

6.

W h a t are the charact eristic features of serotonin syndrome?

(anxiety, agitation, delirium, restlessness, disorientation)

o ' ___________________________(diaphoresis, tachycardia, hyperthermia, hypertension,
vomiting, diarrhea)
_____________________________ __ (tremor, muscle rigidity, myoclonus, hyperreflexia)
________________________ - slow, continuous, horizontal eye movements
Spontaneous or inducible clonus
Sabinski signs bilaterally

7.

W h a t is the tre a tm e n t for serotonin syndrome?

Discontinue all serotonergic agents * symptoms usually resolve in 24 hours
Supportive care to normalize vital signs
Oxygen, IV fluids,icardiac monitoring
If medical treatment for tachycardia or hypertension is needed, use short-acting agents
(e.g., esmolol or nitroprusside)

Sedation with - _________________________

If temp > 41.1 C >sedation, paralysis and ET tube > mechanical cooling (e.g., ice,
cooling blankets, misting fans)
Paralysis should relieve the hyperthermia which is caused by muscle activity
There is no benefit in using antipyretics in this scenario

If agitation despite benzodiazepine >__________________________

After resolution of symptoms, assess need to resume serotonergic agent

8.

W h a t are the symptoms of serotonin w ithdraw al syndrome? W h ich SSR Is are

well known for causing this when stopped abruptly?
SSRI discontinuation syndrome is characterized by dizziness, nausea, fatigue, muscle
aches, chills, anxiety and irritability that begins within days of abrupt discontinuation and
dissipates over 1-2 weeks.
Worst offenders:_____________ ____________________

TC A s
9.

W h a t evaluation should take place prior to the initiation o f T C A s in children?

Because TCA s can cause arrhythmias, the following should be performed:
Screen patients history for______________________________________________
0 Screen family history for sudden death prior to age 40, long Q T syndrome, arrhythmias
and hypertrophic cardiomyopathy
__________________________ prior to initiation and again when medication is
optimized

10.

W h a t are the symptoms of overdose with tricyc lic antidepressants (TC A s)?

: tachycardia, hypotension, conduction abnormalities

__________________________ : sedation, obtundation, coma, seizures
________________
:
mydriasis, xerostomia, ileus, urinary retention

H o w is T C A overdose managed?
ABCs - Airway, Breathing, Circulation
Activated charcoal lg/kg up to 50kg (unless ileus is present)
Continuous cardiac monitoring for at least 6 hours * if no problems, then clear for psych
eval
Frequent neuro checks
o Lab/Studies: TC A level, Chem 7, EKG

A N TIDEPRESSA N TS

II .

If ingestion < 2hrs ago * gastric lavage

If hypotension * IVF (LR or NS) * if ineffective, then norepinephrine
If QRS > 100 msec -trial__________________________ then infusion if effective
If seizures >_______
, barbiturates and/or propofol
(but n o t____________
. which is ineffective against toxin-induced seizures)

O t h e r A n tid e pressan ts
12. W h a t food substances should be avoided when ta king M A O Is in o rd e r to avoid
a tyra m in e-in d uc e d hypertensive crisis?
Foods that are spoiled, pickled, aged, smoked, fermented or marinated contain
tyramine. The following foods should be avoided because of sufficient quantities of
tyramine to be problematic while on MAOIs:
Fermented cheeses (cream cheese and cottage cheese are OK)
Smoked or aged meats (sausage, bologna, pepperoni, salami, smoked or pickled fish)
Chianti, most beers and wines (especially over 120mL)
Soy sauce, shrimp paste, miso soup
Sauerkraut, avocados, ripe bananas, Fava beans
Brewers yeast and yeast extracts (yeast used in baking is OK)

13. In w ha t group o f pa tien ts is bupropion (W e llb u trin) con traindicated?

Because of an increased risk of lowering the seizure threshold, bupropion should be
avoided in patients with:

14. W h a t are th e indica tions fo r e lectroconvulsive th erapy (E C T )?

Severe debilitating depression refractory to antidepressants

Psychotic depression
Severe suicidality
Depression with catatonic stupor
Depression with food refusal leading to nutritional compromise
Situations where a rapid antidepressant response is required (e.g., pregnancy)

Previous good response to EC T

Medical condition preventing the use of antidepressants (e.g., elderly patients)
Bipolar disorder/mania
Schizophrenia/psychosis (esp. catatonic)

[ 49]

End o f Session Quiz

15.

H ow long must a patient expect to take an SSRI before they see improvement
in their depression?

16.

In T C A overdose, what can be used to correct the prolonged QRS interval and
possible seizures?

17. W hich antidepressant matches the following statements?

SE: priapism
Lowers the seizure threshold and can be used for smoking cessation
Appetite stimulant that is likely to result in weight gain
Works well with SSRIs and increases REM sleep
" Can be used for bedwetting in children
18. W h at are the symptoms of serotonin syndrome?

OTHER MOOD DISORDERS

3 Question Warm-Up
1.

C T scan o f the head shows a crescent-shaped lesion. W h a t event most likely

caused this lesion?

2.

W h a t is th e initial radiologic study in a patient w ith T IA /stroke symptoms?

W h a t radiologic studies need to be performed later to evaluate the underlying
cause o f the TIA /stroke?

3.

A 2-year-old develops lethargy, hypoglycemia and abnormal LFTs

approximately one week after being seen for a febrile U R I. W h a t is the most
likely diagnosis?

Bip o la r D iso rd e r
4.

H o w is depression m anaged in patien ts w ith bipolar disorder?

Mild depression >___________________________________
Moderate depression > add a second mood stabilizer (lamotrigine) or add an atypical
antipsychotic (olanzapine, quetiapine, risperidone)
Severe depression * consider________________

5.

W h a t are th e po ten tial side effects of lithium use in th e tre a tm e n t of bipolar

disorder?
CNS effects (depression, tremor, cognitive dulling)
o ________________________ _ (hyperthyroidism, hypothyroidism, euthyroid goiter)
o __________________________ (nausea, vomiting, diarrhea, metallic taste changes,
weight gain)
Nephrogenic diabetes insipidus (thirst, polydipsia, polyuria)

OTHER HOOD DISO RDERS

6.

W h a t is the tre a tm e n t for nephrogenic diabetes insipidus caused by lithium

toxicity?

A djustm en t Disorder
7. W h a t are the diagnostic crit e ria for adjustm ent disorder?
Clinically significant emotional or behavioral reaction causing marked distress or
impairment in social or occupational functioning
Symptoms develop in response to an identifiable psychosocial stressor (e.g., divorce, failure
at school, peer problems) other than bereavement
Symptoms begin within
of the stressor
Symptoms disappear within____________ of the disappearance of the stressor
If the stressor is chronic (e.g., ongoing parental conflict) then the disorder may last
longer than 6 months and is termed chronic

8.

W h a t is the difference between m ajor depressive disorder and adjustm ent

disorder with depressed mood?

End o f Session Quiz

9.

W h at is the drug o f choice in the treatment o f bipolar disorder in a patient with

renal failure?

10. W h at is the most problematic congenital malformation associated with maternal

lithium use?

11. How long must hypomania symptoms or depressive symptoms be present to

diagnose cyclothymia?

ANXIETY DISORDERS

3 Question Warm-Up
1.

H ow does one differentiate between subarachnoid hemorrhage and a traumatic

lumbar puncture as a cause o f bloody cerebrospinal fluid?

2.

W h ich spinal tracts convey the following information?

Touch, vibration and pressure sensation
Voluntary motor command from motor cortex to body
Voluntary motor command from motor cortex to head/neck
Pain and temperature sensation
Important for postural adjustments and head movements

3.

A patient is recovering in the IC U after suffering a subdural hematoma that

occurred because o f a motor vehicle collision. The neurosurgery team performed
a craniotomy and drain placement to evaluate the clot. For the past few days the
drainage in the collection bulb was serous. Now, however, the drainage is thick
and yellow. A long w ith this, the patients neurological exam has deteriorated.
W h a t is the likely cause o f this clinical picture?

4. Ho w is acu te stress d isord e r differen t than p ost-traum a tic stress disord er

(P TSD )?

5.

W h a t are th e tre a tm e n t op tions for PTSD ?

Psychotherapy including behavioral (exposure) therapy and cognitive therapy

_______________ - first line
Other antidepressants - TCAs (imipramine, amitriptyline), MAOIs
Benzodiazepines should be avoided in PTSD due to lack of efficacy and potential for
abuse
a _______________ (carbamazepine or valproate) improve impulsive behavior, arousal and
flashbacks
o _______________ (prazosin) improves nightmares and sleep disturbance
Atypical antipsychotics if refractory to other therapies

End of Session Quiz

6.

How long must anxiety and worry symptoms be present to diagnose a patient
with generalized anxiety disorder?

7.

W h at are the treatment options for generalized anxiety disorder?

8.

How long must the symptoms o f P T S D be present to make the diagnosis?

9.

W h at are the treatment options for PTSD ?

PSYCHOTIC DISORDERS

3 Question Warm-Up
1.

W h a t complication may arise from perform ing L P in a patient w ith elevated

intracranial pressure?

2.

W h a t are the symptoms o f a basilar artery stroke?

3.

Bereavement and adjustment disorder share similar tim e tables in a patients

symptomatology. W h a t are the key differences between them?

n
x
O
H
n
g
on

o73
o

Sch izo p hre n ia

4.

W h a t are th e diagnostic crit e ria for schizophrenia?

At least 2 o f the following during a 1-month period (including at least 1 of the first 3):
Delusions (irrational belief that cannot be changed by rational argument)
Hallucinations (most common type is auditory)
Disorganized speech (e.g., frequent derailment or incoherence)
Grossly disorganized or catatonic behavior
- Negative symptoms (e.g., flat affect, poverty o f speech, lack o f emotional reactivity)
Social/occupational dysfunction
Duration of at least 6 months

5.

W h a t is th e difference be tw een each o f the follow ing disorders?

Schizotypal personality
disorder
Schizophrenia
Schizoaffective
Schizoid personality
disorder
Schizophreniform
Brief psychotic disorder

[ 55]

D IS O RDERS
PSYCHOTIC

6.

W h a t m igh t you see on n e uro im aging o f a p a tie n t w ith schizophre nia?

7.

W h a t drugs are known to cause psychosis in patients?

An tipsycho tic M edications

8. Ca t ego rize the following antipsychotics in the appropriate ca t egory as
neuroleptics (low- or high-potency) o r atypical antipsychotics:
olanzapine, thioridazine, quetiapine, chlorpromaxine, haloperidol, fluphenazine, loxapine,
risperidone, thiothixene, trifluoperazine, clozapine, aripiprazole
Low-potency neuroleptics -

High-potency neuroleptics -

Atypical antipsychotics -

9.

A patient previously diagnosed with schizophrenia arrives at the psych ER

w ith a severe neck spasm th a t forces his head to be m aintained in an unusual
position. W h a t is the treatm ent?
Acu te dystonia (torticollis in this case) due to antipsychotics

R x : ______________

10. W h a t features ch ara c t erize tardive dyskinesia th a t may develop from the use
of high-po tency typical neuroleptics?

13.

DISO RDERS

12. In w ha t t im e fra m e would you exp e c t to see Parkinsonian sym p tom side
effects in a pa tien t taking antipsychotics?

PSYCHOTIC

11. W h a t is t h e t r e a t m e n t f o r t a rd iv e dyskinesia?

W h a t is the tre a t m e n t fo r Parkinsonian sym p toms th a t have developed from

n e uro le p tic adm inistration?

14. W h a t are th e signs and sym p tom s of n eurolep tic m align an t syndrome?
Mental status change initial symptom in most patients (agitated delirium with confusion
rather than psychosis)
Muscular rigidity +/- tremor
Hyperthermia greater than 38-40 C
Rhabdomyolysis appearing over 1-3 days
Autonomic instability - tachycardia, high/labile blood pressure, tachypnea, diaphoresis

15. W h a t is th e tre a tm e n t fo r neurole p tic m align an t syndrome?

Stop the offending medication
Supportive care in the ICU
- IVF
- Low er fever with cooling blankets, ice packs in the axilla, Tylenol
- Reduce hypertension with clonidine and/or nitroprusside ( cutaneous vasodilation can
facilitate cooling)
- D V T prevention with heparin or enoxaparin
- For agitation, use benzos (clonazepam, lorazepam)
o ______ prevents rigidity and hyperpyrexia by inhibiting
calcium release
Other possible therapies:________________________

[57]

End of Session Quiz

16.

Give examples o f negative symptoms of schizophrenia.

17. W hich neuroleptics are known for their extrapyramidal side effects?

18.

19.

20.

W h a t are the different treatments for acute dystonia, tardive dyskinesia and
neuroleptic malignant syndrome?
Acute dystonia
Tardive dyskinesia
Neuroleptic malignant syndrome

W h a t is the most common side effect o f olanzapine?

W h at is the drug category o f choice for the treatment o f the negative symptoms
o f schizophrenia?

PERSONALITY DISORDERS

3 Question Warm-Up
1.

A wom an who witnessed a murder is able to calmly describe every gory detail.
W h ich defense mechanism is she displaying?

2.

W h ich defense m echanism is a person displaying when she subconsciously

pushes memories o f past abuse out o f her conscious mind?

3.

A m other w ho is frustrated w ith her child yells at her husband. W h a t defense

mechanism is she displaying?

PERSONALITY DISO RDERS

End of Session Quiz

4.

A 40-year-old woman comes to your office after becoming dissatisfied with

her former physician. She explains that her former physician was the most evil
creature with absolutely no redeeming qualities. She finishes her story and
remarks that she can tell you are so smart and will cure her of everything.
W hat personality disorder might this patient have?

5.

A 32-year-old woman tells you during one of her office visits that you are the best
doctor shes ever had but that your nurse is very disrespectful. O n a subsequent
visit, she threatens to change doctors because you do not feel a particular lab test
is necessary. Additionally, you notice several symmetrical cuts on her left forearm
which she attributes to cat scratches. W h at personality disorder does this person
have?

6.

A 55-year-old woman comes to your office wearing all black including a black
miniskirt and black feather boa. She is also wearing an excessive amount of
lipstick, and you notice her having conversations w ith many o f the other patients
in the waiting room. W h at personality disorder do you suspect in this patient?

7.

A person demands only the best and most educated doctor in town. W h at
personality disorder does this person have?

SUBSTANCE ABUSE PART I

3 Question Warm-Up

4.

1.

W h a t is the m ost serious side effect o f clozapine?

2.

W h a t is T odds paralysis?

3.

W h a t is the first-line treatm ent for acute otitis media?

W h a t tre a tm e n ts are effective in helping preven t relapse in recovering

alcoholics?
_________________________ is the tried-and-true best relapse prevention
O
O
o

Acamprosate (Campral) tid

End of Session Quiz

5.

W h a t are the components o f th e C A G E questionnaire?

6.

In w hich vitamins are alcoholics typically deficient?

7.

W h a t is the m ost successful treatm ent for alcoholism?

8.

List the symptoms associated w ith the life-threatening condition delirium

tremens (D T ).

9.

W h a t is the drug o f choice for alcohol withdrawal?

SUBSTANCE ABUSE PART 2

3 Question Warm-Up
1.

W hat medical conditions can cause severe depression?

2.

A 25-year-old man is seen in the E R w ith severe headache. H e tells you that the
headaches always occur at around the same time, and that the pain is localized
around the right eye. O n exam his pupils are unequal and his right eye is
tearing. W hile he waits for the C T scan o f the head, w hat treatment should he
receive?

3.

W h a t are the major symptoms o f H untington disease?

End of Session Quiz

4.

A 19-year-old slender woman presenting w ith recent weight loss is found to have
erythem a o f her turbinates and nasal septum. W h at is the cause o f her weight
loss?

5.

A patient is brought to the E R by police, restrained and exhibiting violent

behavior. W h a t O D is likely? W h a t is the Rx?

6.

W h a t features are unique to P C P intoxication that allow you to distinguish it

from LSD intoxication?

7.

W h a t drugs can be used in the case o f hypertension in a patient with cocaine or

amphetamine intoxication?

OTHER PSYCH DISORDERS

3 Question Warm-Up
1.

W h at is the treatment for benign paroxysmal positional vertigo (BPPV)?

2.

W hat disorder classically presents w ith the triad o f cognitive impairment,

urinary incontinence and abnormal gait?

3.

A patient with a history o f lithium use presents with copious amounts o f dilute
urine. W h at condition is this?

. Conversion D isord er
Sensory or motor neurological symptoms with no recognized neurological or medical cause
Motor symptoms:
Weakness/paralysis
0 Tremor
Dystonia/myoclonus
Gait disorder
Dysphagia
Dysphonia
Sensory symptoms:
Numbness/paresthesias
Blindness
Deafness
May or may not be related to specific psychological stressor

So m a t ic Sym p tom D iso rd e r

One or more somatic symptoms that are distressing or significantly disruptive, e.g.:
Pain symptoms
Sexual symptoms (erectile dysfunction, decreased libido)
Neurological symptoms (motor or sensory deficits, gait disorder, tremor)
- Gastrointestinal symptoms (vomiting, diarrhea)
Symptoms may or may not be due to a recognized medical condition
Individual experiences disproportionate and persistent thoughts about the seriousness
of his/her symptoms, and/or a persistently high level of anxiety about his/her health or
symptoms.

Illness A n xie t y D iso rd e r

Preoccupation with having or acquiring a serious illness
High level of anxiety about health
Individual performs excessive health-related behaviors, such as repeatedly checking his/
her body for signs o f illness
Somatic symptoms are not present

End of Session Quiz

7.

W h a t serum lab abnormalities may be seen in a patient with prolonged excessive

vomiting/purging?

8.

W h a t somatoform disorder matches each o f the following descriptions?

Patient w ith normal anatomy is convinced a part of
his/her anatomy is abnormal.
Unexplained loss o f sensory or motor function.
Normal exam/tests
Overwhelming worry about having a particular
disease, w ithout any signs/symptoms
Unexplained complaints in multiple organ systems

9.

10.

W h a t is a major difference between factitious disorder and malingering?

W h ich eating disorder can be treated effectively w ith SSRIs?

\ND DE

DELIRIUM AND DEMENTIA

3 Question Warm-Up
1.

Albuminocytologic dissociation (increased protein in the CSF, with only

modest increase in cell count) indicates what condition?

2.

A violent patient w ith vertical and/or horizontal nystagmus has been exposed to
what substance?

3.

Categorize each o f the following antidepressants:

duloxetine, nefazodone, bupropion, mirtazapine, desvenlafaxine,fluvoxamine,
doxepin,fluoxetine, imipramine, escitalopram, amitriptyline, phenelzine,
milnacipran, sertraline, venlafaxine, paroxetine, tranylcypromine, citalopram,
trazodone, nortriptyline
SSR1

TCA -

M AOI -

N D RI -

SN RI -

Tetracyclic -

Atypical -

End of Session Quiz

4.

W h a t are key features o f delirium that differentiates it from dementia?

5.

W h a t are the two most common causes o f dementia, and how do you
differentiate between them when m aking a diagnosis?

6.

A nurse pages you, saying that one o f your elderly patients has been sleeping
most o f the two days hes been on the unit, but is very agitated and aggressive
w ith the nurses while awake. She asks you to write for a benzodiazepine to
sedate the patient. W h a t do you propose instead and why?

7.

W h a t disease th a t causes dem entia is also associated w ith visual

hallucinations and frequent falls?

8.

W h a t disease that causes dementia is also associated w ith unpleasant behavioral

and personality changes?

PEDI PSYCH

PEDI PSYCH

3 Question Warm-Up
1.

After a minor car accident, a woman wears a neck brace and requests permanent
disability. W h a ts the most likely diagnosis?

2.

In which disease would you find atrophy o f the mammillary bodies?

3.

W h a t is the most common cause o f sensorineural hearing loss? W h at is the

most common cause o f conductive hearing loss?

A t t e n tio n-D e ficit Hyp eractivity D isord e r (A D H D )

4.

W h a t o ther m edications can be used in the tre a tm e n t of A D H D in children

who fail to respond to stim ulants or atomoxetine?

5.

W h a t are the com m on com plica tions of A D H D stim ulan t m edications, and
how are these com plica tions managed?
Stim ulan ts
Insomnia ~> address sleep hygiene, take meds earlier in the day, change to shorter duration
formulation, clonidine at night
0 Appetite suppression and weight loss administer meds after meals rather than before
Tics > usually transient, choose low-moderate dose methylphenidate which does not
worsen tics
Psychosis or mania >discontinue (no need to taper)
Decreased growth velocity -> reassure parents that adult height is not affected, drugholidays may help with catch-up growth

A tom oxe tin e

[ 68 ] I

Increased risk of suicidality * close observation and usually discontinuation

Liver injury discontinue

To ure t t e Syn drom e

6.

W h a t th erap e u tic options are available for To ure t t e syndrome?

Counseling/psychotherapy for social adjustment and coping
If interfering with necessary functions of life > anti-dopamine agents: fluphenazine,
pimozide or tetrabenazine (which are all tolerated better than haloperidol in these patients)
If only focal motor or vocal tics Botox injections into affected muscles
If impulse control problems > clonidine or SSRIs
If refractory to medical management * consider deep brain stimulation of globus pallidus,
thalamus or other subcortical target (undergoing clinical trials)

A u t ism Sp e c tru m D iso rd e r

7.

W h a t are som e o f the c h ara c t e rist ic fe a tures of autism sp e c trum disorder?

Living in his own world
Symptoms evident prior to age 3
Lack of responsiveness to others, poor eye contact, absence of social smile
Impairments in communication, language delay, repetitive phrases
Peculiar repetitive, ritualistic habits (e.g., spinning around, hand flapping)
Fascination with specific, seemingly mundane objects (vacuum cleaners, sprinklers)
Usually below-normal intelligence

PEDI PSYCH

End of Session Quiz

8.

How is A D H D diagnosed?

9.

W hich childhood psychiatric disorder matches each of the following statements?

Females only. Loss of previously acquired
purposeful hand skills between 6-30 months
Impairments in social interactions,
communications, play. Repetitive behaviors
Characterized by hostility, annoyance,
vindictiveness, disobedience and resentfulness
Multiple motor and vocal tics
Impulsive and inattentive

10.

W hen treating a child suspected of having a learning disorder, what must first be
investigated?