Miscellaneous
A screening assessment for cognitive impairment
MMSE (or MoCA)
SIGECAPS stands for these symptoms
(depressed mood) + sleep, anhedonia, guilt/hopelessness/worthlessness, energy, concentration, appetite, psychomotor restardation, suicidality
Drug given in opioid overdose emergency
Narcan (naloxone)
Antidepressant that lowers the seizure threshold & is a smoking cessation aid
Bupropion
Class of drugs with FDA black box warning for children, adolescents and young adults
SSRIs
Name 5 (or more!) components of the mental status exam
Appearance, Activity, Attitude, Speech, Mood/Affect, Thought Process/Content, Perception, Orientation/Memory, Attention/Concentration, Insight/Judgment
This disorder can cause "pseudodementia"
Major depressive disorder
The most serious form of alcohol withdrawal (medical emergency), often begins within 72 hours of cessation of drinking. Symptoms include confusion, visual or tactile hallucinations, tremor, autonomic instability, and fluctuating levels of psychomotor activity
~15-20% mortality rate if left untreated
Delirium tremens (DTs)
Atypical antipsychotic most likely to prolong QTc
Ziprasidone (Geodon)
Medication most commonly given for alcohol withdrawal
Lorazepam (Ativan)
Patients often placed on the "CIWA"
X percent of patients with dementia have a treatable and potentially reversible condition
15%
Work up for potentially reversible causes can include: CBC, electrolytes, TSH, B12, folate, RPR, ceruloplasmin (Wilson's disease), Brain CT/MRI (eg normal pressure hydrocephalus)
This combined treatment is most effective for treating generalized anxiety disorder
SSRI + CBT
Opioid overdose causes pupils to constrict/dilate
Constrict (miosis)
Atypical antipsychotic most likely to cause hyperprolactinemia
Risperidone (Risperdal)
Switching over to aripiprazole (Abilify) or adjunctive aripiprazole has been advocated for optimal management of antipsychotic-induced hyperprolactinemia
These two drugs typically reduce suicidality in patients
Lithium & Clozapine
Most effective long term treatment for chronic insomnia
CBT for insomnia (behavioral strategies including sleep restriction and stimulus control)
Benzos, may require very high doses
If not responding --> ECT
Treatment for benzo overdose (on your test...)
Flumazenil
The 4 major movement side effects that can develop secondary to antipsychotic medications
Acute dystonia, akathisia, parkinsonism, tardive dyskinesia
The dopaminergic pathway that antipsychotics act on to target the "positive symptoms" of schizophrenia
mesolimbic
This disorder has the highest mortality rate of any psychiatric condition
Anorexia nervosa
Most likely diagnosis in the following vignette:
A 24-year-old woman presented to the hospital with an insidious onset of stupor, catalepsy, and mutism that began with depression, anhedonia, and suicidal thoughts 4 months prior. Recently, she had reportedly become mute, stopped eating, and lost weight. This dysfunction prompted a hospital admission.
The initial history from her parents revealed no psychiatric, medical, or substance use problems and no medicinal allergies. Later, her mother reported that after failing a high school final examination, her daughter evidenced a period of suspiciousness. Her father provided further details about an episode at age 12 years of elated mood and hypersexuality. Despite no intervention, she returned to normal function. In later years, she became a teacher, doing well with no psychiatric concerns. The physical examination was unremarkable except for generalized weakness. The patient exhibited psychomotor retardation, mutism, posturing, and waxy flexibility. The workup included a complete blood count, comprehensive metabolic panel, thyroid function tests, serum muscle enzyme studies, syphilis serology, a pregnancy test, toxicology screens, and a CT head scan without contrast. All assessment results were within normal limits.
Catatonia (secondary to untreated bipolar disorder)
Intoxication with this drug causes recklessness, impulsiveness, impaired judgment, violence, rotatory nystagmus, ataxia, hypertension, tachycardia, muscle rigidity, and high tolerance to pain. Overdose can cause seizures or coma.
Phencyclidine (PCP) - an NMDA receptor antagonist
The dopaminergic pathway responsible for extrapyramidal side effects of antipsychotic drugs
Nigrostriatal pathway
(Other pathways: Mesolimbic - pos sxs, Mesocortical- neg sxs, Tuberoinfundibular- hyperprolactinemia)
It is best to avoid giving this common medication for akathisia if a patient has asthma
Propranolol (beta blocker, constricts airways)