Side FX
Patients on antipsychotics can develop tachycardia, what is the cause/management/treatment?
Antipsychotics - Alpha 2 Antagonist - Consider EKG/Medicine/Cardiology/Propranol/CCB for tachycardia and lower doses.
Provides advice, sympathy, and support while reinforcing the patient’s strengths. Patient may be undergoing a life crisis, poor reality testing, low level of frustration tolerance, impaired object relations, poor impulse control, may have ego deficits. These patients are generally less functional that patient participating in the other above types of therapy.
Supportive Psychotherapy
An untreated manic episode can last what length of time?
15 days, 30 days, 3 months, 6 months
3 months
This medication has recently obtained FDA-aproval for the management of ADHD. It is a non-stimulant, that is a norepinephrine reuptake inhibitor.
Qelbree (Viloxazine)
Patients on antidepressants can develop bruxism, what is the management?
Serotonergic action on mesocortical neurons arising from the ventral tegmental area leading to dopaminergic deficit which in turn causes akathisia like movement of jaw muscles leading to bruxism. Alleviated by buspar which has 5HT1 agonism and D2 blockade(mild).
Mouth Guard. Dentist. Buspar.
Reduce doses.
Treats BPD using combination of supportive/cognitive/behavioral techniques. Works to improve interpersonal skills, and decrease self-destructive behaviors. Addresses ambivalence, increases motivation, seeks to not reinforce maladaptive behaviors, learn new skills, and restructure the patient’s environment. Uses homework, advice, and confrontation.
Dialectical Behavioral Therapy - Marsha Linehan
A patient with a hx of psychosis in remission has been managed on abilify, a new mood stabilizer is started to treat on going mood symptoms. Over the span of a few days he becomes disorganized in speech/thought/behavior, and has a relapse of psychotic symptoms. What mood stabilizer has added to the regimen?
Tegretol.
This drug is now FDA approved for treatment resistant depression, and shown to rapidly decrease suicidality.
Esketamine(Spravato)
Milk-like discharge is present in your patient who has just started Risperdal, what phenomena is taking place?
D2 Antagonism - Dopamine blockade - Dopamine is unable to block prolactin - galactorrhea.
Abilify?
Focuses on the interplay of maladaptive thoughts, feelings, and behaviors that cause mental disorders. The goal is to teach the patient to become their own therapist through a series of assignments, homework, and close interaction between therapist and patient.
Cognitive Behavioral Therapy - Dr. Aaron Beck, RIP.
What antidepressant can you add to lithium for tx resistant bipolar depression and is least likely to induce rapid cycling/mixed state?
Wellbutrin
Approved for twice yearly injection for management of Schizophrenia.
Invega Hafyera - 6-month paliperidone palmitate, First and Only Twice-Yearly Treatment for Adults with Schizophrenia.
Most common reason for discontinuation of ssri?
GI distress
Actively suicidal, manic, psychotic, and emotionally sadomasochistic individuals are contraindicated in this type of therapy.
Group Therapy - IOP - Joseph Pratt
20 y/o F w/hx of endometriosis, seizures, and bipolar 1 , has had stable mood on lamictal 100mg, however they have a seizure. The Neurologist is worried about a rash deeloping from titrating lamictal, so they start depakote. A week later, your patient develops Steven Johnson and admitted to the burn unit, what has likely occurred?
Valproate decreases the clearance of lamictal, and can double the elimination half-life. Lamictal has been potentiated, and she has now developed a rash from it.
FDA approved for irritability in Autism.
Risperdal. Abilify.
SSRI of choice to treat the discontinuation syndrome associated w/stopping other antidepressants.
Prozac - Half life
Work on present/past life situations, focus on interpreting unconscious conflict to challenge defenses and reduce shame. Allow for catharsis, reality testing, examine transference.
Psychodynamic Psychotherapy - Freud
The same 20 y/o F w/hx of endometriosis, seizures, and bipolar 1, has now been stopped on depakote, because of the rash. Her OBGYN elects to start OCP's for her endometriosis. Subsequently, the patient suffers a manic episode. What has happened now?
OCP's containing estrogen decrease serum levels of lamotrigine.
FDA Approved for the management of Panic Disorder?
3 ssri
2 benzo
1 snri
Prozac, Paxil, Zoloft
Effexor (XR only!)
Xanax, Klonopin