SIGECAPS & Beyond
This screening questionnaire is commonly used in primary care to assess depression severity.
What is the PHQ-9? (PHQ-2 is initial screening).
First-line medication class for generalized anxiety disorder (GAD)?
What are SSRIs/SNRIs?
This mood stabilizer commonly causes nephrogenic diabetes insipidus and hypothyroidism.
What is lithium?
This medication is first-line treatment for opioid overdose with respiratory depression.
What is naloxone (Narcan)?
A hospitalized elderly patient develops acute fluctuating confusion, inattention, and visual hallucinations overnight. This is the diagnosis.
What is delirium?
This anti-depressant medication is commonly avoided in patients with seizure disorders and/or eating disorders.
What is bupropion (Wellbutrin)?
This psychotherapy is highly effective for generalized anxiety disorder (GAD) and panic disorder.
What is cognitive behavioral therapy (CBT)?
Fever, rigidity, autonomic instability, and elevated CK after antipsychotic exposure describe this life-threatening syndrome.
What is neuroleptic malignant syndrome (NMS)?
This medication for alcohol use disorder is contraindicated in patients taking chronic opioid therapy.
What is naltrexone?
A patient with catatonia becomes mute, immobile, and refuses PO intake. This medication is considered first-line treatment.
What is lorazepam (Ativan)?
A patient with depression also has severe insomnia and weight loss. This antidepressant medication may help address all three symptoms.
What is mirtazapine (Remeron)?
A patient with "refractory panic attacks" despite multiple anxiety medications develops episodic headaches, diaphoresis, palpitations, and severe paroxysmal hypertension.
What is pheochromocytoma?
A patient started on haloperidol develops painful neck spasms and sustained upward eye deviation several hours after administration. This is the first-line treatment.
What is diphenhydramine (Benadryl) or benztropine (Cogentin)?
This medication for alcohol use disorder is often preferred in patients with significant liver disease because it is primarily renally cleared.
What is acamprosate (Campral)?
A patient develops fever, rigidity, autonomic instability, and markedly elevated CK several days after initation of haloperidol. This medication is commonly used in treatment.
What is dantrolene (Ryanodex)?
This SSRI's long half-life makes discontinuation symptoms less likely and often eliminates the need for a prolonged taper.
What is fluoxetine (Prozac)?
After initiation of this antibiotic, a patient taking fluoxetine develops inducible clonus, agitation, diaphoresis, hyperthermia, and hyperreflexia.
What is linezolid?
This atypical antipsychotic requires routine CBC monitoring due to risk of agranulocytosis.
What is clozapine (Clozaril)?
A patient with chronic alcohol use disorder develops refractory lactic acidosis despite adequate perfusion/oxygenation. Deficiency of this cofactor is contributing to impaired pyruvate dehydrogenase activity.
What is thiamine (vitamin B1)?
A patient with Parkinson disease develops rigidity, autonomic instability, and elevated CK after abrupt withdrawal of dopaminergic therapy. This syndrome closely mimics neuroleptic malignant syndrome.
What is parkinsonism-hyperpyrexia syndrome?
A patient with severe depression, psychomotor retardation, and persistent suicidal ideation has failed multiple antidepressants. This treatment has the fastest onset and strongest evidence for severe, refractory depression.
Electroconvulsive Therapy (ECT).
A patient with depression presents with anxiety, tachycardia, urinary retention, dry mucous membranes, and widened QRS complexes after a suspected overdose on amitryptaline. This is the first-line treatment in the ED.
What is sodium bicarbonate? (IV bolus 1-2 mEq/kg, repeat as needed, target serum pH 7.45-7.55, max cumulative dose 6 mEq/kg)
A patient taking valproic acid develops progressive confusion, lethargy, and vomiting, despite otherwise unremarkable laboratory evaluation including LFTs. This is the diagnosis.
What is valproate-induced hyperammonemic encephalopathy?
A patient with severe salicylate poisoning rapidly deteriorates after intubation due to inability to maintain this primary acid-base disturbance.
What is respiratory alkalosis?
A young woman presents with rapidly progressive psychosis, seizures, dyskinesias, autonomic instability, and decreased consciousness. Imaging later reveals an ovarian teratoma. CSF analysis reveals antibodies against this receptor.
What is NMDA receptor?