Psychopharm Pearls
This is the minimum duration SSRIs should be continued after remission of a first major depressive episode to prevent relapse.
What is 4-9 months (or 6-12 months)?
This diagnosis requires at least one month of delusions, hallucinations, or disorganized speech, plus at least this total duration of illness including prodromal and residual periods.
What is schizophrenia (6 months total duration)?
This medication is FDA-approved for alcohol use disorder and works by blocking opioid receptors, reducing the rewarding effects of alcohol.
What is naltrexone?
These three factors constitute the most immediate risk assessment for suicide: ideation, plan, and this third critical element.
What is intent?
Postpartum psychosis typically presents within this timeframe after delivery and is a psychiatric emergency requiring immediate hospitalization.
What is 2 weeks (or first 4 weeks)?
This tricyclic antidepressant has the strongest evidence for neuropathic pain management and is typically dosed at this much lower range compared to antidepressant dosing.
What is amitriptyline (10-75mg vs. 150-300mg for depression)?
Persistent depressive disorder (dysthymia) requires depressed mood for most of the day, more days than not, for at least this duration in adults.
What is 2 years?
Opioid withdrawal syndrome typically begins within this timeframe after last use of short-acting opioids like heroin, presenting with lacrimation, rhinorrhea, piloerection, and myalgias.
What is 6-12 hours?
This evidence-based intervention involves collaborative development of a written plan identifying warning signs, coping strategies, and emergency contacts, and has been shown to reduce suicide attempts.
What is a safety plan?
This screening tool specifically designed for perinatal depression asks 10 questions and uses a cutoff score of 10 or greater to indicate probable depression.
What is the Edinburgh Postnatal Depression Scale (EPDS)?
Bupropion is contraindicated in patients with this condition due to dose-dependent seizure risk, which occurs in approximately 0.4% of patients at standard doses.
What is a seizure disorder (or eating disorder with purging)?
This condition is characterized by at least 3 symptoms of mania lasting at least 4 consecutive days, but unlike full mania, does not cause marked impairment or require hospitalization.
What is a hypomanic episode?
This medication used for opioid use disorder is a partial mu-opioid receptor agonist with a ceiling effect, making it safer than methadone for office-based treatment.
What is buprenorphine?
Following psychiatric hospitalization for suicidal ideation or attempt, patients have this fold-increase in suicide risk in the first week after discharge compared to the general population.
What is 100-200 times (or approximately 200-fold)?
Delirium is distinguished from dementia by this key feature
What is acute onset with fluctuating level of consciousness (or inattention)?
This extrapyramidal side effect presents with sustained muscle contractions causing twisting movements and abnormal postures, typically occurring within days of antipsychotic initiation.
What is acute dystonia?
Adjustment disorder requires the development of emotional or behavioral symptoms in response to an identifiable stressor within this timeframe, and symptoms must resolve within 6 months after the stressor ends.
What is 3 months?
Benzodiazepine withdrawal can be life-threatening and typically manifests with peak symptoms at this timeframe for short-acting agents like alprazolam.
What is 1-2 days? (vs 5-7 days for long-acting agents)
This population has a suicide rate 4-9 times higher than the general population, with highest risk in the first year after diagnosis and during disease exacerbations.
What are patients with schizophrenia (or psychotic disorders)?
This atypical antipsychotic is FDA-approved for treatment-resistant depression as an augmentation strategy and carries lower risk of metabolic syndrome than quetiapine or olanzapine.
What is aripiprazole?
When switching from an SSRI to an MAOI, this minimum washout period is required for most SSRIs, but fluoxetine requires 5-6 weeks due to its long half-life.
What is 2 weeks?
This dissociative disorder requires the presence of two or more distinct personality states with recurrent gaps in recall of everyday events, not attributable to ordinary forgetting.
What is dissociative identity disorder (DID)?
This syndrome presents with confusion, ataxia, and ophthalmoplegia in patients with chronic alcohol use disorder and thiamine deficiency, and requires immediate IV thiamine administration.
What is Wernicke encephalopathy (or Wernicke-Korsakoff syndrome)?
Following a suicide attempt, the highest risk period for a subsequent attempt is within this timeframe, with risk remaining elevated for at least 1 year.
What is the first 3 months?
Electroconvulsive therapy (ECT) is considered first-line treatment for severe depression in this specific population due to the safety profile compared to medications.
What are pregnant women (or patients with catatonia/severe depression with psychotic features)?