Last Week Prep Flashcards
Are antipsychotics effective in treating or preventing delirium?
NO
It is an old habit that is dying hard. They don’t actually do anything to TREAT the delirium, just temporarily change the BEHAVIOR.
They are only indicated for agitation/aggression BEHAVIORS which are themselves secondary to delirium, usually haloperidol. In other words, the only use for antipsychotics in delirium is when you want to snow your patient.
Dexmedetomidine
A centrally acting alpha agonist
Effective in reducing incidence and actually treating delirium
What makes aripiprazole special among the antipsychotics?
It is FDA approved as a treatment for depression!
It is a partial dopamine agonist with HIGH AFFINITY. Thus, it displaces dopamine and treats psychosis, BUT it also helps with depression.
This makes it the perfect medication for depression with psychotic features or schizoaffective depressive type.
Aripiprazole is a favorite medication for ___
Aripiprazole is a favorite medication for personality disorders with micropsychotic episodes
Affective lability with anxiety that leads to psychosis. Think borderline.
Aripiprazole is rarely used as. . .
. . . monotherapy for psychosis
Due to its pharmacologic properties, it is a slightly weaker antipsychotic.
Clang associations
Describes an abnormal speech pattern in which words are used based on rhyme patterns instead of their meaning
Stimulants in the treatment of depression
Methylphenidate and other psychostimulants, despite adverse effects (e.g., anorexia, nausea, and weight loss), should be considered for terminally ill patients with severe acute depression and a very limited life expectancy (i.e., days to weeks) and/or those at risk of suicide because the drugs are fast-acting (response often within 1–2 days).
In many cases, psychostimulants are combined with SSRIs and phased out gradually over a period of weeks if the patient lives long enough to benefit from the effects of an SSRI.
Suppression
Defense mechanism in which someone actively chooses not to think about something.
Managing tardive dyskinesia
Try switching to a less potent neurleptic if possible (like haldol to aripiprazole)
Aripiprazole in particular is good for this because it is a partial dopamine agonist.
Group therapy and shared delusions
Group therapy is COUNTERproductive for shared delusions
It can serve simply to reinforce them.
Instead, separate CBT and antipsychotic therapy is indicated.
Pseudocyesis
A disorder in which the patient thinks (s)he is pregnant and has physical signs of pregnancy (e.g., breast tenderness, weight gain, amenorrhea, morning sickness), but confirmatory tests (e.g., ultrasound, β-hCG) are negative.
Classified under “Other Specified Somatic Symptoms and Related Disorder” in the DSM-V.
This condition is more common among women who want to get pregnant and have a history of several prior failed attempts. She should be gently informed that she is not pregnant and provided with counseling and therapy if needed.
Couvade syndrome
In Couvade syndrome, it is the partner or a close friend/relative of an expecting mother who experiences mild symptoms of pregnancy (e.g., weight gain, altered hormone levels, morning nausea) without believing that they are themselves pregnant.
Anticholinergics in tardive dyskinesia
Not only do they not help, they make things WORSE!!!
So don’t confused dyskinesia for the other neuroleptic-induced movement disorders (most of which are treated with anticholinergics)
When do we progress to ECT for nonmalignant catatonia?
When the patient fails one week of benzo therapy
When is ECT first line for catatonia?
- Malignant catatonia
- Nonmalignant catatonia due to mood disorder with psychotic features
