Stones Bones Groans Psychiatric Overtones
63 yo F with pphx treatment resistant MDD, PMH hypertension, R anatomic shoulder replacement, diabetes, migraine headache presents to your clinic after hearing about TMS and its efficacy
True or false this patient can undergo TMS
What is false?
Patients with metal implants, especially those in or near the head, are generally excluded from TMS treatment
23 yo med student gunning for plastic surgery reluctantly comes to university health department after urging by his roommates who found him in the library doing anki at 4am. During the interview, he states that he has gotten through a lot of reading, skipped the past 2 weeks of rotations bc he started 10 different research projects and invested 5k in a new pharma company. PE, labs, and UA are unremarkable. He has no history of drug use
What is bipolar 1 disorder
this antidepressant is a NE and dopamine reuptake blocker. it's commonly used for depression, smoking cessation, and Seasonal Affective Disorder
What is Wellbutrin (buproprion)?
Avoid in patients with anxiety (sometimes described as activating), eating disorders, and epilepsy (lowers seizure threshold)
Characterized by extreme confusion, loss of touch with reality, paranoia, delusions, disorganized thought process, and hallucinations occurring within first two weeks of childbirth
What is post partum psychosis
A psychiatric and obstetrical emergency!
Autism is characterized by impairment in social functioning, impaired communication, this.
What is stereotyped, repetitive behavior (including preoccupation with parts of objects)
70 yo male with pphx of schizophrenia refusing surgery after patella fracture. List at least 2 features of applebaum criteria for capacity
What is ability to communicate a choice, display appreciation, understanding and reasoning?
New patient to your clinic comes in after hearing voices for the past 6 months telling him he is worthless and to kill himself. His only medication is sertraline which he has taken for two years.
What is major depressive disorder with psychotic featuers?
SNRI to be avoided in patients with high or labile blood pressure
What is venlafaxine?
dose-dependent effect on diastolic BP usually observed in administration of the doses higher than 300 mg/d
This is the typical duration for postpartum depression to last if left untreated, though it can vary.
What is several months to a year
Pimozide is prescribed for this disorder in childhood
What is tic disorder
Perioperatively pt receiving regular high doses of metoclopramide, you notice pt has UE rigidity, vitals 103 F, tachycardia. Remote psych hx not currently on any psychotropic meds, what is your leading differential?
What is NMS?
Mr. S has been married for 10 years, and believes his wife has been trying to poison him to get his money. He frequently complains of stomach pains, which he believes are due to the poison in the food. His thoughts are logical and coherent. He denies hallucinations and does not believe that anyone else apart from his wife is out to get him
What is delusional disorder?
A patient recently taking NSAIDs is now experiencing tremors, nausea, increased urination, and mental confusion. What is the likely offending agent?
What is Lithium?
Acute lithium toxicity can be remembered with the acronym LMNOP (Lithium side effects: Movement (tremor), Nephrogenic diabetes insipidus, hypOthyroidism, Pregnancy problems)
Therapeutic level is 0.6 – 1.2 and you check a level 5 days (some resources say 4-7 days) after dose change
Mood stabilizer to most avoid during pregnancy
What is Valproic acid?
due to neural tube defects
Name a social skill developed as children engage in cooperative play.
What are emotion regulation, teamwork, and impulse control?
Form of hyperparathyroidism characterized by hypercalcemia and high PTH
What is primary hyperparathyroidism?
Primary: Benign tumors or enlargement of the parathyroid glands. Can get the characteristic stones bones groans psychiatric overtones (specifically mental confusion, delirium, psychosis)
Secondary: Vitamin D deficiency, chronic kidney disease, or certain intestinal surgeries or diseases.
Tertiary: Long-term secondary hyperparathyroidism
57 yo F presents to your clinic after multiple recent visits to dermatologist for persistent complaints of "bugs in my skin" excoriations and lesions 2/2 picking at skin are appreciated. Per chart review and derm notes no hx of intradermal bugs or mites are present
What is delusional parasitosis?
Mood stabilizers with risk of of SJS
What are carbamazepine and lamotrigine?
Abrupt discontinuation increases the risk of Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). Certain HLA alleles, particularly HLA-B*1502, have been identified as risk factors for lamotrigine-induced SJS/TEN
True or False ECT can be administered during pregnancy?
What is True!
Electroconvulsive therapy (ECT) is considered a safe and effective treatment option for severe psychiatric conditions during pregnancy, particularly when medication is not sufficient or poses risks to the fetus. It's used for conditions like severe depression, psychosis, catatonia, and mania
Eriksons psychosocial stage describing school aged children (6-12) behaviors practicing skills vs repeated failure of those tasks
What is industry vs inferiority?
(School Age, 6 to 12 years): Children develop a sense of competence and accomplishment through mastering skills and tasks, or feelings of inferiority if they experience repeated failure.
Percentage of elderly patients after a hip fracture found found to have symptoms of depression and anxiety, leading to a significant decrease in their quality of life
What is up to 35%
Orthopaedic surgeons, being integral to patient care, should be well-versed in available resources within their institution or community, facilitating appropriate referrals to specialists or therapists for comprehensive treatment. Early recognition and intervention for psychiatric symptoms have the potential to enhance patient recovery and significantly improve overall outcomes
43 y.o. woman in psych unit remains mute and does not answer questions on ward. In groups, she stares at the wall and does not change her position. She was hospitalized years ago for thinking others could read her mind and sending her messages.
What is schizophrenia, catatonic type?
Typical antipsychotics can worsen negative symptoms because of their effect on this pathway.
What is the mesocortical pathway?
Antipsychotic medications primarily affect four key dopamine pathways in the brain: the mesolimbic, mesocortical, nigrostriatal, and tuberoinfundibular pathways
The 2 SSRIs most utilized during breastfeeding
What are sertraline and paroxetine?
Most body of evidence for these two meds. While some SSRIs may pass into breast milk, the amount is typically low, and the benefits of breastfeeding for both mother and child generally outweigh the potential risks
Parasomnia consisting of screaming, autonomic hyperactivity, and retrograde amnesia considered normal in childhood, occurs during non rem sleep (stage N3/4 associated with delta waves)
What is sleep terror disorder?
Benzos decrease this stage. clonazepam may be considered on a short-term basis at bedtime if sleep terrors are frequent and severe or are associated with functional impairment, such as fatigue, daytime sleepiness, and distress
VS. Nightmare disorder. Occurs during REM sleep (the patient remembers)