Psychiatry in the Movies
A man gets transferred from prison to a psychiatric ward where he has a battle of wills with the nurse in charge.
One Flew Over the Cuckoo's Nest
Name 4 out of the 8 symptoms represented by SIGECAPS (e.g. diagnosing depression)
Sleep disturbances, Interest loss, Guilt, Energy deficit, Concentration difficulties, Appetite changes, Psychomotor agitation or retardation, and Suicide ideation
Antidepressants come in many forms! Name at least 2 pharmacological categories.
SSRIs, SNRIs, DNRIs, TCAs, MAOIs
This antipsychotic is a partial dopamine agonist. It is less likely to cause EPS and often used to help treat hyperprolactinemia for that reason.
Abilify
This mood stabilizer should be avoided in people with uteruses of reproductive age. If it cannot be avoided, birth control is strongly recommended.
Depakote (teratogenic)
Split
Name 3 out of the 7 symptoms represented by DIG FAST (e.g. diagnosing mania)
Distractibility, Impulsivity, Grandiosity, Flight of Ideas, Activity increase, Sleep deficit, Talkativeness
This antidepressant can be used to assist in discontinuation of other antidepressants due to its long half life.
Prozac
Name 4 short acting IM antipsychotics.
Haldol, Zyprexa, Thorazine, Geodon, Prolixin, Abilify (just learned this one!)
This mood stabilizer needs to be titrated slowly in order to avoid risk of skin rash.
Lamictal
An FBI agent enlists the help of an incarcerated, cannibalistic serial killer to catch another serial killer who captures and skins his victims.
The Silence of the Lambs
Name 5 out of the 5 symptoms represented by I FEVER (e.g. diagnosing neuroleptic malignant syndrome)
Fever, Encephalopathy, Vital sign instability, Elevated WBC/CPK, Rigidity
This antidepressant has a lower likelihood of causing a manic switch if given to a patient with bipolar disorder.
Wellbutrin
Why should you avoid giving IM Zyprexa and IM Ativan within 1 hour of each other?
Risk of respiratory depression (though there is some research being done to determine how likely this is to happen, however, continue to avoid!)
This mood stabilizer has strong evidence to support reduction in suicidal ideation.
Lithium
A family becomes isolated in a haunted hotel and the father descends into madness and violence.
The Shining
Name 3 out of the 7 symptoms represented by Worry WARTS (e.g. diagnosing anxiety)
Wound up, Worn-out, Absentminded, Restless, Touchy, Sleepless
This now uncommonly used antidepressant is effective for treating OCD, though is not often a first choice due to side effect profile.
Clomipramine
Why does Clozapine need to be titrated slowly, particularly during initiation of treatment for the first time?
Strong risk of orthostatic hypotension
This infrequently used mood stabilizer is most likely to have significant drug-drug interactions
Carbamazepine
Newlyweds are terrorized by demonic forces after moving into a large house that was the site of a grisly mass murder a year before.
The Amityville Horror
Name 5 out of the 11 symptoms represented by I WATCH DEATH (e.g. diagnosing the cause of delirium)
Infection, Withdrawal, Acute metabolic, Trauma, CNS pathology, Hypoxia, Deficiencies, Endocrinopathies, Acute vascular, Toxins or drugs, Heavy metals
What is the unique pharmacological mechanism of Mirtazapine?
Tetracyclic. Alpha2 antagonist. Stimulates the release of norepinephrine and serotonin. 5HT2, 5HT3, and histamine antagonist.
Which antipsychotic is least likely and which is most likely to cause QTc prolongation?
Least likely - Haldol
Most likely - Thioridazine (Mellaril), close second is Geodon
This infrequently used mood stabilizer has a risk of causing significant hyponatremia
Oxcarbazepine (induces SIADH is a result of an increase in ADH, which increases sensitivity of the aquaporin 2 channels in the renal tubules, resulting in hyponatremia)