Dreary Drugs and Draughts
This drug was originally used to model psychosis in volunteers. It was then found to rapidly lift mood, leading to its use in treatment-resistant depression.
What is ketamine?
This plant-derived drug was used to induce prolonged coma states as a treatment for serious mental disorders.
What is belladonna-derived atropine?
This is the recommended first-line, least-restrictive intervention for the agitated but still-communicating patient before any medication or restraint is used overnight.
What is verbal de-escalation?
Clinical pearl: Across guidelines, the main goal is to calm the patient in the least restrictive manner- verbal de-escalation and environmental modification come before physical restraint or forced medication.
This Viennese neurologist made the dynamic unconscious the central object of psychiatric investigation and proposed a three-part structure of the mind.
Who is Sigmund Freud?
Clinical pearl: Freud did not discover the unconscious, but one of his greatest achievements was making it the main object of investigation- a dynamic reservoir of feelings, conflicts, memories, and desires kept out of consciousness by repression.
This 1975 Best Picture, set in a state psychiatric hospital, cemented the public image of ECTas a brutal punishment and the ward as a prison run by a tyrannical nurse.
What is "One Flew Over the Cuckoo's Nest"?
Clinical pearl: On-screen portrayals of mental illness are frequent and generally negative, and they have a cumulative effect on public perception and on the likelihood that people with mental illness will seek appropriate help. Patients with schizophrenia specifically cite films depicting psychiatric wards as prison-like environments as a source of fear and mistrust that delayed their own willingness to accept care.
This blood-thinning medication has been observed to improve schizophrenia symptoms.
What is warfarin?
100–200 mg daily of this antipsychotic was given for agitation well into the 1980s, now believed to have caused more harm than good (duh).
What is haloperidol?
(Please don't do this)
This is a famous regimen to help patients with severe agitation, utilizing 3 drugs.
What is B52? (haloperidol + lorazepam + benztropine (or diphenhydramine))
Clinical pearl: This is a classic regimen, though the components may be no more effective than individual agents, and minimizing polypharmacy/oversedation is preferred, especially in older adults.
These three Freudian structures of personality mediate between instinct, reality, and morality.
What are the id, the ego, and the superego?
Clinical pearl: The id is part of the unconscious that works on the pleasure principle; the ego deals with the demands of reality; and the superego supervises the ego to keep impulses within society's norms and ethics.
Whether it's Norman Bates, Hannibal Lecter, or a 'psycho killer,' this is the single most common negative stereotype attached to mentally ill characters on screen.
What is violence/dangerousness?
Clinical pearl: Dangerousness to others and violence are the most common negative depictions, appearing in up to 61.3% of media reports on mental illness, even though the real association between violence and conditions like schizophrenia is weak and unclear. In one analysis of primetime TV, 34% of characters portrayed as mentally disordered were shown committing murder, rape, or violent attacks, versus roughly 3% of mentally ill people in the real population showing conspicuously violent behavior.
This drug was synthesized in 1950 as an antihistamine and was being tested to supplement anesthesia, often referred to as the first antipsychotic!
What is chlorpromazine?
It failed as an anesthetic aid, but its calming effect in agitated psychotic patients launched the entire field of modern psychopharmacology.
This therapy consisted of wrapping wet sheets and continuous baths. This was applied to "excited" and "frenzied" patients and used on nearly all patients regardless of diagnosis
What is hydrotherapy?
(Physicians reframed it as therapeutic rather than as the physical restraint it functionally resembled.)
A mute, immobile, posturing patient on the unit dramatically improves within about 15 minutes of a test dose of this drug class, one of the fastest responses in behavioral medicine.
What are benzodiazepines?
Clinical pearl: A prompt benzodiazepine response (often within 15 minutes) validates acute catatonia. Avoid antipsychotics, which can worsen catatonia or precipitate NMS.
This Swiss psychiatrist and early Freud collaborator broke away to found 'analytical psychology,' introducing archetypes and the collective unconscious.
Who is Carl Jung?
Clinical pearl: Jung's approach is developmental and deals with theories about existentially. He worked with Freud but did not agree with many of his theories, particularly rejecting Freud's emphasis on infantile sexual trauma and sexual libido. The final breaking point for the two was when they analyzed each other's dreams en route to a conference.
Heavier TV coverage for this disorder is linked to LESS knowledge about the disorder.
What is schizophrenia?
Clinical pearl: This is also true for OCD! Interestingly, knowledge of major depressive disorder is independent of TV coverage.
The first antidepressant, derived from antihistamines and originally tested as an antipsychotic. It failed against psychosis—but patients' mood improved, revealing it was an antidepressant.
What is imipramine?
Psychiatrists deliberately infected patients with this to induce high fevers as a treatment for neurosyphilis ("general paresis of the insane") and psychosis well into the 20th century. Craziest thing? It worked!
What is malaria?
It actually worked for neurosyphilis (the fever killed the heat-sensitive spirochete), and Julius Wagner-Jauregg won the 1927 Nobel Prize for it.
The overnight resident is called because a schizophrenic patient on scheduled haloperidol now has rigidity, fever, autonomic instability, and confusion. This is the name of the syndrome and the single most important first step.
What is neuroleptic malignant syndrome?
What is stop all dopamine-blocking agents?
Clinical pearl: The most important factor improving survival is discontinuing dopamine antagonists (and anticholinergics); add supportive care, benzodiazepines for milder cases, dantrolene for extreme hyperthermia (>40°C), and ECT if refractory.
This American psychoanalyst widened Freud's psychosexual stages into a lifespan 'psychosocial' theory of eight stages, each defined by a central conflict.
Who was Erik Erikson?
Clinical pearl: His epigenetic principle holds that development is a predictable, sequential process through eight stages, each with opposing tendencies whose balanced resolution yields a specific virtue (e.g., trust vs. mistrust yields hope).
The '13 Reasons Why' controversy centers on this phenomenon- the imitative rise in suicides after a sensational or graphic portrayal.
What is suicide contagion (the Werther effect)?
Clinical pearl: Exposure to certain depictions of suicide can influence vulnerable individuals to attempt or die by suicide; after reporting of celebrity suicides, rates tend to rise about 13% in the following one to two months. Risk is highest when coverage is extensive, prominent, sensational, and explicitly describes the method. WHO media guidelines specifically advise never depicting the method or location and never using sensational framing.
This class of antidepressants came from a tuberculosis drug- iproniazid was an anti-TB agent, and doctors noticed TB patients became euphoric even though their lungs didn't improve.
What are monoamine oxidase inhibitors?
Described in laymen terms as "boring holes into the head", this procedure dated back to Neolithic times "to permit the noxious material to exhale" and release demons, used for mania and melancholy.
What is trepanation?
(They should have had some...trepidation about this one)
This paradoxical overnight scenario- a catatonic patient whose clozapine was abruptly held- is treated not by adding a benzodiazepine alone but by doing THIS.
What is restarting the clozapine?
Clinical pearl: Withdrawal catatonia is managed by reinstating the offending withdrawn agent- restart clozapine (or benzodiazepine for benzodiazepine-withdrawal catatonia).
This humanistic psychologist proposed in 1943 a five-level pyramid of human motivation, from physiological needs up to self-actualization.
Who is Abraham Maslow?
Clinical pearl:
Maslow's hierarchy holds that lower-level needs (physiological, then safety) must be relatively satisfied before higher needs (belonging, esteem, self-actualization) emerge. Notably, some argue safety needs are actually more fundamental than physiological ones, and adverse childhood experiences (ACEs) disrupt fulfillment across all levels.
In contrast to the above answer, this phenomenon describes the protective, suicide-reducing impact of stories about coping and recovery.
What is the Papageno effect?
Clinical pearl: The strongest evidence for beneficial media effects involves stories of hope and recovery from psychosocial crises; a meta-analysis of RCTs found that narratives featuring people who coped with adversity and suicidal thoughts produced a small reduction in suicidal ideation. This is why responsible-portrayal guidance emphasizes modeling help-seeking and providing crisis resources rather than only avoiding harm.