Mental health Flashcards

Question

Follow up on clozapine use.

Answer 1

Weekly blood draws to ensure the white blood count is ≥ 3,500/mm3 and the absolute neutrophil count is ≥ 2,000/mm3. Patients who are on clozapine must be checked weekly during the first six months and then eventually once every four weeks. A mild leukopenia (WBC = 3,000-3,500), with or without clinical symptoms such as lethargy, fever, sore throat, or weakness, should cause the psychiatrist to monitor the patient closely and institute a minimum of TWICE-weekly CBC tests with differentials included. More serious leukopenia (WBC = 2,000 to 3,000) indicates DAYLY CBCs and stop the clozapine. It may be reinstituted after the WBCs normalize. With an uncomplicated agranulocytosis (no signs of infection), the patient should be placed in protective isolation, the clozapine should be discontinued, and a bone marrow specimen may need to be gotten to see if progenitor cells are being suppressed. Clozapine must not be restarted in this latter case. Additional side effects of clozapine include: hyperglycemia hypercholesterolemia. Increased potential for seizures.

Answer 2

A slit-lamp examination of the eye is used to detect different stages of corneal or lenticular pigmentation in patients

Answer 3

In addition to the psychotic symptoms, patients with schizoaffective disorder must meet these criteria: - A major mood episode (either major depression or mania) that lasts for an uninterrupted period of time - Delusions or hallucinations for two or more consecutive weeks without mood symptoms - Mood symptoms are present for the majority of the illness - Symptoms are not related to substance use

Answer 4

Tardive dyskinesia

Answer 5

Repetitive and involuntary series of oral-facial movements (primarily of the tongue and mouth The onset of tardive dyskinesia generally occurs over the course of several months of use. Tardive dyskinesia can be irreversible in many patients. The first step in treating tardive dyskinesia is to discontinue the antipsychotic or switch to a different, second-generation antipsychotic.

Answer 6

Both mental and physical restlessness that can result in anxiety. Affected patients may be unable to sit still. These types of extrapyramidal symptoms (EPS) generally occur over the course of several weeks on a first-generation antipsychotic and the symptoms are often reversible. Propranolol as a short term measure for management of akathisia. Diazepam if beta blockers are contraindicated (asthma, severe peripheral vascular disease). It is recommended to reduce the dose OR discontinue the antipsychotic switch to a different one, like thioridazine

Answer 7

Acute dystonia

Answer 8

Prolonged and painful muscle contractions and/or spasm Caused by excessive D2 dopaminergic receptor blockade. Often presents during the initiation of first-generation antipsychotics (within hours). Treatment with an anticholinergic (diphenhydramine or benztropine) can be used acutely, or even prophylactically. It is also recommended to discontinue the antipsychotic or to switch to a different one. Benztropne: intravenous injection, most people respond within 5 minutes, if no response the dose can be repeated after 10 minutes. Diphenhydramine: slow IV injection (not available in Australia as a parenteral preparation). Promethazine: IV or IM is readily available in most ED. It may be useful alternative for the patient who has both dysctonia and significant anticholinergic symptoms from antipsychotic drugs. Diazepam: IV or IM is used for the patients who don not respond to other treatment options.

Answer 9

Pseudoparkinsonism

Answer 10

It is classified as a type of EPS and is similar in presentation to Parkinson disease. Abnormal gait and/or cogwheel rigidity may be present. This EPS occurs over several days of initiating first-generation antipsychotic therapy and can be treated with an anticholinergic (benztropine or diphenhydramine - both of which are also antihistamines), a dopamine agonist (amantadine), by decreasing the dose of the offending agent, or by switching to a different antipsychotic.

Answer 11

Chlorpromazine

Answer 12

Nicotine (90%), cannabis (37%) alcohol (34%) cocaine (31%)

Answer 13

is a medium-potency antipsychotic agent used for the treatment of schizophrenia in addition to bipolar disorder, attention deficit hyperactivity disorder, and nausea. It can cause extrapyramidal and anticholinergic symptoms

Answer 14

is a high-potency antipsychotic agent that can cause extrapyramidal and anticholinergic adverse effects,

Answer 15

Is an atypical antipsychotic agent that commonly is used as a first-line treatment for schizophrenia. Adverse effects of olanzapine include weight gain, hyperglycemia, and orthostatic hypotension, but it typically does not cause agranulocytosis

Answer 16

An atypical antipsychotic agent that can cause hyperprolactinemia, which may lead to gynecomastia

Answer 17

Primarily presents mood symptoms but can be associated with psychosis during manic or depressive episodes.

Answer 18

DSM-V criteria for Anti-social personality disroder: The last 7 items are conduct disorders, of which ≥3 need to be evident before age 15: * Age (can be diagnosed only if ≥ age 18, with conduct disorder diagnosed ≤ age 15, with at least 3 of 7 conduct disorders diagnosed) * Criminality (DSM: “Disregards legal and social rules/norms”) * Impulsivity (DSM: “Impulsive”) * Disregard for safety (DSM: “Neglects safety [self/others”]) * Liar (DSM: Lies) * Irresponsibility (DSM: “Irresponsible”) * Aggression (DSM: “Irritable or Aggressive”) * Remorselessness (DSM: “No remorse”)

Answer 19

Borderline The immature defense mechanism of splitting, in which people are grouped into extreme categories. It occurs when an individual perceives their surroundings as good or bad, focusing on the far sides of the spectrum in all things

Answer 20

Borderline personality disorder is a pervasive pattern of instability in interpersonal relationships, self-image, and affects, along with marked impulsivity, as indicated, in the DSM-5 diagnostic criteria, by the presence of five (or more) of the following: 1. Frantic efforts to avoid real or imagined abandonment 2. A pattern of unstable and intense interpersonal relationships characterized by extremes 3. Identity disturbance 4. Impulsivity in at least 2 areas that are damaging (e.g., spending, sex, gambling, substance abuse) 5. Recurrent suicidal behavior 6. Instability in affect and/or mood 7. Chronic feelings of emptiness 8. Inappropriate or difficult-to-control anger 9. Transient, stress-related paranoid ideation or severe dissociative symptom

Answer 21

Diagnosis requires both obsessions and compulsions to be present. Obsessive-compulsive personality disorder (OCPD) is a condition where the patient is hyper-focused on order and control. However, in contrast to OCD, people with OCPD display ego-syntonic behavior. The recommended first-line treatment for OCD is cognitive-behavioral therapy combined with pharmacotherapy. Selective-serotonin reuptake inhibitors (SSRIs) are an effective choice for pharmacotherapy.

Answer 22

At least 4 out of the following 7 symptoms, all of which are all centered around the patient’s fear of not being accepted: Avoidance of activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection Unwillingness to get involved with people unless certain of being liked Showing restraint within intimate relationships because of the fear of being shamed or ridiculed Preoccupied with being criticized or rejected in social situations Inhibited in new interpersonal situations because of feelings of inadequacy Self-perception as socially inept, personally unappealing, or inferior to others Unusually reluctant to take personal risks or engage in any new activities because they may prove embarrassing Treatment: These patients can benefit from pharmacotherapy that suppresses the sympathetic nervous system, such as beta-blockers, and even selective serotonin reuptake inhibitors (SSRIs) if they have a comorbid major depressive disorder. However, patients with avoidant PD derive the most benefit from psychotherapy particularly assertiveness training

Answer 23

5 of the following being depressed mood everyday for 2 Weeks or sleep disturbances one of those SIGECAPS Sleep disturbances Interest being low such as anhedonia. Guilt Energy changes Concentration difficulties Appetite changes Psychomotor activity or retardation Suicidal Thinking

Answer 24

Mood symptoms during preganancy or within 4 weeks after childbirth 10-15% of women develop it Baby blues is associated with period of crying and sadness, but without meeting at least 5 of SIGECAPS symptoms

Answer 25

If high risk (mostly previous episode), initiate: - Antidepressants on the THIRD semester, if previously had good response in the later episode. Can also be initiated after delivery - If not: cognitive-behavioral therapy, interpersonal psychotherapy, or mindfulness based cognitive therapy

Answer 26

Angry and irritability

Answer 27

Depression It shall be considered in any elderly patient with poor concentration or focus or any changes in their cognition (Pseudodementia)

Answer 28

They block reuptake of nora and sero Use: Major depression; OCD; Enuresis; fibromyalgia SE: Anticholinergic: tachycardia; urinary retention Anti alpha adrenergic: sedation Lower seizure threshold Toxicity: 3 C Convulsions. COMA Cardiotoxicity (arrythmia)

Answer 29

Decrease MAO activity -> decrease amine degradation -> increased level of amine neutransmitters (importantly: tyramine) Use: Atypical depression Resistant depression Anxiety Hypochondriasis SE: Hypertensive crisis - might be deadly (Due to tyramine rich diet like wine, cheese, fava beans, cured meats) CNS stimulation - overexcitation Orthostatic hypotension Drowsiness Weight gain Dry mouth Sexual and sleep dysfunction Interaction with SNRI SSRI - Serotonin syndrome. Treated with cyproheptadine

Answer 30

Use: depression; OCD; PTSD; Panic; anxiety; bulimia; social phobia SI: Mild generally weight gain QTC prolongation GI distress Sexual dysfunction - bupropion or mirtazapine can treat Insomnia Serotonin syndrome SSRI discontinuation syndrome:

Answer 31

Venlafaxine and Duloxetine Use: depression; fibromyalgia; generalized anxiety; diabetic peripheral neuropathy SI: Mild generally Hypertension Sedation Nausea Anorexy, weight loss Insomnia SSRI discontinuation syndrome: flulike symptoms; electric-like shocks or zaps Serotonin Syndrome

Answer 32

Fever Agitation Increased reflexes Tremors Sweating Dilated Pupils Diarrhea MADAM'S TIPS: Mental status change Agitation Diarrhea Ataxia Myoclonus Shivering Tachycardia Increased reflexes Pyrexia Sweating

Answer 33

* Withdraw the offending agents. * Supportive therapy: ice packs and cold compresses. * Use Cyproheptadine ( antiserotonergic) orally if severe muscular excitation. * Chlorpromazine (5-HT receptor antagonist) IV infusion if oral intake impossible. * Consider benzodiazepines for sedation.

Answer 34

Family History Onset of mood disorder before the age of 20 Past History of depression Stressful lifestyle Substance abuse

Answer 35

First line: Atypical antipsychotics (Olanzapine or Risperidone) Second line: Haloperidol + Lithium carbonate, or Sodium valproate if renal failure, or Carbamazepine, Lamotrigine. If there is failure to respond: combined therapy second degree antipsychotics plus Lithium. If first episode of mania - continue treatment with mood stabilizer for 12 months after remission is achieved. Consider ECT if not responding to drugs.

Answer 36

BD I - at least one manic episode (for at least 7 days) and it's often accompanied by depressed or hypomanic periods. CAUSES SOCIAL, WORK AND LIFE IMPAIRMENT BDII - is marked by at least one hypomanic episode (for >=4 days) and at least one major depressive episode. DOESN'T CAUSE SOCIAL, WORK AND LIFE IMPAIRMENT Mixed - is when depressed mood coexists with manic symptoms. Rapid cycling - is the alternating periods of hypomanic periods with mild to moderate depressive symptoms intermixed over the course of two years. At least 4 mood episodes through a year Cyclothymic disorder - numerous periods of both hypomania and depression within 2 years without meeting the criteria for BD.

Answer 37

Continue treatment with Lithium through the pregnancy. * Monitor for Ebstein's anomaly (1: 1000) by high resolution US around 18-20 weeks. * The dose of Lithium is increased by 25% in third trimester. * Stop Lithium 24-48 hours before delivery. Restart after delivery. * Lithium is contraindicated in breastfeeding. If breastfeeding is desirable, consider atypical antipsychotic.

Answer 38

Many mood stabilizers (olanzapine, risperidone) have bimodal effect. They can be used for treatment of both depression and mania. If a patient, who has successfully been stable on prophylactic dose of a particular mood stabilizer, develops acute depression two approaches can be considered with about the same efficacy: Adding an antidepressant to the prophylactic mood stabilizer: the choices of the drug would be the same as for major depression. SSRls are first line options. Increasing the dose of prophylactic mood stabilizer . Cessation or dose reduction of a mood stabilizer can result in relapse of mania and is not appropriate.

Answer 39

Steroids, sympathomimetics; bronchodilators, levodopa, antidepressants, anything that increases dopamine Maand any kind of alpha agonists

Answer 40

DIGFAST distractibility, insomnia, grandiosity, flight of ideas, activity or agitation, such as increased goal-directed activity, pressured speech and also thoughtless disregard of others. If psychosis is present, shall be treated first, before mood symptoms.

Answer 41

NSAID, Tetracycline, metronidazole, ACE inhibitors, diuretics, theophylline, osmotic diuretics like mannitol and acetazolamide, Caffeine, high salt intake DECREASE lithium levels Therapeutic range: 0.7 to 1.2 (0,4-1,0 (>0,6)mmol) Toxic > 1,5 mmol/L Lethal > 2,0 mmol/l If above 3,0 -> dyalisis Risk factors: * Impaired kidney function * Dehydration * Age greater than 50 years * Drug interactions (NSAID, ARBs, ACEI, Diuretics) * Nephrogenic dial;,etes insipidus * Hypothyroidism

Answer 42

thirsty, weight gain, metallic taste, hair falling, tremor in their upper limbs (coarse tremor), weakness, dizzyness, nystagmus and it can eventually lead to stupor, coma, delirium, seizures, blurry vision and a heart arrhythmia. - CLASSIC: a fine tremor, sedation, ataxia, thirst or metallic taste in their mouth, polyuria, edema, and weight gain. GI problems, benign leukocytosis, thyroid enlargement. nephrogenic diabetes insipidus, coarse tremor and altered mental status. mild toxicity can be managed by correcting the electrolyte disturbance through IV hydration. Teratogenic effect: Ebstein’s anomaly (atrialization of the right ventricle, causing cyanosis and symptoms of heart failure) Check kidney and thyroid panels If >3 mmol/L - Do hemodialysis to protect the kidneys.

Answer 43

valproic acid, carbamazepine, and lamotrigine Best option when there's renal impairment - Valproic Acid Lamotrigine - depressive phase (isn't effective on mania) Fetal anomaly caused by valproic acid and carbamazepine? Spina bifida,

Answer 44

In bullimia, the symptoms are ego-dystonic. Also, they tend to have an average BMI Whereas in anorexia, patients find their symptoms ego-syntonic.

Answer 45

In bullimia, there is compensatory behavior influenced by guilt and a perception of appearance.

Answer 46

Recurrent episodes of binge eating, eating in a discrete period of time and a sense of lack of control. At least 2 episodes per week for 3 months Recurrent inappropriate compensatory behaviors to help prevent weight gain and the binge eating and inappropriate compensatory behaviors can both occur. Their self-evaluation that's unduly influenced by body, shape, and weight, and the disturbance does not occur exclusively during episodes of anorexia. The severity is assessed by the frequency of inappropriate compensating or purging behaviours

Answer 47

- Consuming an amount of food in a discrete period of time or so that is definitely larger than what most people would eat in a similar amount of time under similar circumstances is describing an episode of binge eating. - The episodes can occur, on average, at least once a week for about 3 months, and there's no regular use of inappropriate compensatory behaviors. - That patient also feels a sense of lack of control from overeating - Co-comorbities frequently seen: specific phobias, social phobias, depression, PTSD, and alcohol abuse or substance dependence. - Binge eating treatment includesRumination Disorder - overvier individual psychotherapy and also behavioral therapy, a strict diet program and exercise routine.

Answer 48

Rumination disorder is a behavioral disorder marked by repeated regurgitation of food, which may be re-chewed, re-swallowed, or spit out. This condition is not due to a medical disorder (GERD or pyloric stenosis) or other eating disorders (avoidant/restrictive food intake disorder, anorexia nervosa, binge eating disorder, or bulimia nervosa). Seen in all ages but emerges sometime between 3 and 12 months of age

Answer 49

Is an eating disorder characterized by self-imposed starvation and inappropriate dietary habits due to an intense fear of weight gain and disturbed perception of body shape and weight. Symptoms must be present for at least 3 months Subtypes: - Restricting type: characterized by excessive starvation (weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise) - Binge-eating/purging type: characterized by the use of drugs (laxatives, diuretics), induced vomiting, and excessive exercise as a means to reduce weight Severity Mild: BMI 17–18.49 kg/m2 Moderate: BMI 16–16.99 kg/m2 Severe: BMI 15–15.99 kg/m2 Extreme: BMI < 15 kg/m2

Answer 50

Constellation of metabolic disturbances that may occur due to refeeding of malnourished patients who are persistently starved. Sudden increase in caloric intake causes an increase in insulin production. Increase in insulin causes a sudden shifting of fluid and electrolytes into cells. Marked electrolyte disturbances (hypophosphatemia), seizures, delirium, cardiac complications (cardiopulmonary failure), rhabdomyolysis Aggressive nutrition without good monitoring can be fatal.

Answer 51

Myocardial atrophy Mitral valve prolapse Pericardial effusion Osteoporosis Gastroparesis Amenorrhea, infertility (functional hypothalamic amenorrhea due to low levels of LH and FSH) Growth disturbances Swelling of sallivary glands (purging subtype) Lanugo Cold intolerance (decreased thyroid hormones) Russel sign (calloused knucles) in the purgin type Hypercholesterolaemia Hypophosphataemia

Answer 52

Temperature < 36.0℃ (96.8°F) Pulse < 45/min 85% or less of expected weight Lack of any weight gain or refractory symptoms as outpatient Psychosis or suicidal ideations Significant edema Physiologic decompensation (e.g., serious cardiac arrhythmia, significant electrolyte disturbances, altered mental status, and orthostatic differential > 30 mm Hg) The strongest indication for inpatient hospitalization in this patient is her significant lower extremity edema, which is most likely due to a loss of oncotic pressure secondary to low plasma protein levels, which is a sign of severe malnutrition.

Answer 53

Factitious disorder, formerly called Munchausen syndrome, is the intentional falsification of symptoms in order to assume the role of a sick person. Purposeful misrepresentation of injury, impairment, or chronic sickness Obvious acts of deception with no clear motive of secondary gain More common in men than women

Answer 54

The presence of symptoms or deficits that affect voluntary motor or sensory function in a way that suggests a neurological condition but is not explained by medical findings. Diagnosis is clinical, and management includes psychological and physical therapy. Unlike factitious disorder, there is no evidence of actual disease or deliberate falsification of symptoms.

Answer 55

A disorder in which patients present with symptoms for secondary gain (e.g., avoiding the police, time off work, disability benefits). Determination of the external incentive distinguishes malingering from factitious disorder.

Answer 56

- Postpartum (PP) blues: mild depressive symptoms that are transient and self-limiting in the perinatal period (first 2 weeks) - PP depression: depressive symptoms beginning within the 1st 12 months following childbirth and lasting for at least 2 weeks - PP psychosis: a psychiatric manifestation with abrupt onset after delivery that is characterized by psychotic symptoms

Answer 57

Symptoms may include: Feeling guilty and/or overwhelmed (especially about being a mother) Crying, sadness Rapid changes in mood and irritability Anxiety Poor concentration Eating too much or too little Insomnia or frequent awakenings at night Symptoms are mild and do not interfere with activities of daily living. Duration of symptoms: Lasting up to and no more than 2 weeks Management: Resolves spontaneously Provide reassurance. Encourage self-care

Answer 58

Symptoms may include: Disinterest in self, in child, and in normal activities Feeling isolated, unwanted, or worthless Feeling a sense of shame or guilt about parenting skills FEARFULL OF CRITICISM and anxiety about the wellbeing of the baby ↑ Anger outbursts Suicidal ideation or frequent thoughts of death Symptoms are more severe and patients have an inability to cope. Duration of symptoms: > 2 weeks. Might initiate during pregnancy or up to 1 year after delivery. Selective serotonin reuptake inhibitors (SSRIs) are the 1st-line treatment; best studied Best options: paroxetine 10–50 mg/day, sertraline 50–200 mg/day (unlikely to have ↑ drug levels in breastfed infants) Most women recover within 6–12 months. Edinburgh Postnatal Depression Scale (EPDS) - to assess the suspected patient

Answer 59

Symptoms are similar to those of non-obstetric psychosis, which is a disturbance in an individual's perception of reality. Hallucination are usually BABY RELATED. Dellusions also presente Onset: few days to 1 year after delivery (most commonly 2 WEEKS AFTER delivery). BEGINS ABRUPTLY Severe physical anxiety (can't stay still) + insomnia Thoughts/plans of hurting themselvels or the baby Frequently associated with Bipolar disorder Admit to psychiatric mother-baby unit Best options (expert opinion): older 2nd-generation antipsychotics (start with the following initial doses, with a higher dose given for severe symptoms):[21] Quetiapine 50 mg once daily, up to 50 mg twice daily Risperidone 0.5–1 mg/day Olanzapine 2.5–5 mg/day If previous episode, prophilaxy with: olanzapine OR risperidone + Lithium. If lithium, don't breastfeed

Answer 60

Begins in the first 6 months Symptoms of PP Blues + anxiety and fear of criticism CBT; Psychodynamic therapy.

Answer 61

Fear or anxiety in a situation that would be difficult to leave or to obtain help in the event that one develops panic-like symptoms. >> It's needed at least 2 social situations (open spaces, enclosed spaces, etc). Situations include being in public or open spaces, lines, crowds, or public transport. If severe, the condition results in significant social and occupational disability in which patients actively avoid the situation, and in certain cases, refuse to leave their homes alone. Diagnosis is clinical, based on the presenting symptoms. Agoraphobia occurs frequently with panic disorder. Management is best approached with CBT and medications (selective serotonin reuptake inhibitors (SSRIs)).

Answer 62

Paroxetine, fluoxetine, MAOI

Answer 63

Characterized by spontaneous and recurrent panic attacks. The number of attacks can vary from patient to patient. The episodes are short but leave lasting anticipatory anxiety. For diagnosis of PD, patients must also have significant concerns and worries for at least 1 month about future panic attacks or their consequences. - Symptomatology: 'PANICS': Palpitations Abdominal distress Nausea Intense fear Chest pain, choking Sweating, short of breath The single best treatment is CBT + selective serotonin reuptake inhibitors (SSRIs)

Answer 64

Is a transient period of sympathomimetic symptoms. These symptoms can include chest pain, shortness of breath, palpitations, diaphoresis, and sensations of choking. They usually peak after 10 minutes and typically last approximately 30 minutes

Answer 65

A persistent fear of one or more social or performance situations in which they are exposed to unfamiliar people or to possible scrutiny by others. These symptoms have to persist for at least 6 months. They often suffer from panic attacks in these situations and fear they will act in a way that will be embarrassing and humiliating. The SSRI class and beta-blockers (off-label use) have proven effective in treating performance anxiety, including public speaking. Other medications include monoamine oxidase inhibitors such as phenelzine. Psychotherapy is also a mainstay of treatment.

Answer 66

Fear of inescapable situations, such as open spaces or public spaces. Diagnosis with ≥ 6 months of symptoms Treatment: 1st-line: SSRI or CBT

Answer 67

DT is a severe form of alcohol withdrawal which usually presents 3–5 days following the last alcoholic drink. Some important clinical features of DT include psychomotor agitation, severe global confusion, disorientation, hallucinations, tremors, fever, and excessive perspiration. Signs of autonomic hyperactivity, such as tachycardia, hypertension, and tachypnea, are often present. Positional nystagmus and mydriasis are important ocular signs of DT. In addition, hallucinations frequently occur in DT and visual and tactile hallucinations are common.

Answer 68

Is classically characterized by the triad of confusion, nystagmus, and ataxia. Wernicke’s encephalopathy is an acute, reversible condition caused by thiamine deficiency, which is characterized by ataxia, confusion, and ocular abnormalities. Korsakoff’s syndrome is a chronic amnestic syndrome characterized by anterograde amnesia and confabulation. The earliest biochemical change seen in thiamine deficiency in the central nervous system is decreased α-ketoglutarate-dehydrogenase activity in the astrocytes, especially in those areas of the brain high in thiamine content. Acute thiamine deficiency is also associated with mitochondrial dysfunction in areas of the brain with the highest metabolic activity. Other pathophysiologic changes associated with thiamine deficiency include increased astrocyte lactate levels, swelling of the astrocytes, increased extracellular concentration of glutamate, increased nitric oxide (from endothelial cell dysfunction), increased fragmentation of deoxyribonucleic acid (DNA) in the neurons, increased production of free radicals, increased cytokines, and breakdown of the blood-brain barrier.

Answer 69

Wernicke’s encephalopathy is an acute, reversible condition caused by thiamine deficiency, which is characterized by ataxia, confusion, and ocular abnormalities.

Answer 70

Korsakoff’s syndrome is a chronic amnestic syndrome characterized by anterograde amnesia and confabulation.

Answer 71

It begins within 12 to 24 hours of abstinence, can even start while drinking heavily, and resolves within 48 hours. Thee hallucinations are not associated with confusion—patients are aware that they are hallucinating. Vital signs are usually normal.

Answer 72

Classic clinical features include anorexia, fever, jaundice, and tender hepatomegaly. Laboratory testing reveals moderately elevated transaminases (typically < 300 IU/mL), with an AST/ALT ratio of ≥ 2. Patients may also present with right upper quadrant/epigastric pain, hepatic encephalopathy, and signs of malnutrition. Decompensated cirrhosis can occur concurrently with acute alcoholic hepatitis. Histologic findings in liver biopsies from patients with alcoholic hepatitis include steatosis, hepatocellular ballooning, infiltration by neutrophils and lymphocytes, Mallory-Denk bodies, fibrosis, cholestasis, and bile duct proliferation. Mallory-Denk bodies are eosinophilic intracytoplasmic inclusions representing damaged intermediate filaments within the hepatocytes. They can also be seen in nonalcoholic steatohepatitis and are not specific for alcoholic hepatitis.

Answer 73

Intermittent explosive disorder (IED) is an impulse control disorder characterized by recurrent episodes of violent aggressive outbursts, either verbal or physical, out of proportion to the provoking events and immediately followed by a sense of regret. Psychotherapy: CBT Family therapy recommended for children/adolescents, and group therapy for older patients Medication: Antidepressants: 1st line: selective serotonin reuptake inhibitors (e.g., fluoxetine) Mood stabilizers/anticonvulsants: 2nd-line treatment Anticonvulsant medications (e.g., valproate, phenytoin, carbamazepine)

Answer 74

Characterized by an angry or irritable mood, argumentative or defiant behavior, and/or vindictiveness over at least 6 months. The behavior is typically directed to at least one individual who is not a sibling - a authority figure. Does not involve aggressive behavior toward people/animals, destruction of property, or theft

Answer 75

Patient is mainly angry all the time (most of the day and every day), with frequent outbursts, for at least > 12 months Outbursts occur at least 3x per week in 2 different settings. The child is always angry or irritable between outbursts. Onset: 6–10 years of age

Answer 76

Depersonalization/derealization disorder (DDD) is a type of dissociative disorder characterized by a persistent experience of depersonalization (the feeling of being detached from oneself, like watching oneself from an external viewpoint) and derealization (the feeling of being detached from the real world, like the world is distant or hazy). Crisis intervention therapy during the acute episodes, combined with psychotherapy during the asymptomatic period, is 1st-line treatment for this disorder.

Answer 77

In ASD, symptoms doesn't last more than 1 month

Answer 78

Onset of Symptoms - Insidious Cognitive symptoms - Decline in memory and executive function Motor symptoms - Usually rare The main pathologic features are neuritic plaques, extracellular deposits of amyloid peptides, and neurofibrillary tangles. Treatments for Alzheimer disease dementia: - Acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine) Increase the amount of available neurotransmitters and thus transmission of signals. Long-term use modestly stabilizes cognitive decline for 6–12 months longer than no treatment.

Answer 79

Onset of Symptoms - Stepwise progression Cognitive symptoms - Decline in executive function Motor symptoms - Depending on location of lesion Reduction in cerebral perfusion → disruption of brain connectivity, cerebral atrophy

Answer 80

Onset of Symptoms - Pre-senile onset (the late 5os or early 60s) Cognitive symptoms - Decline in executive function Motor symptoms - Parkinsonian symptoms in certain cases Changes in personality and social behavior or language, progressing over time to a more global dementia. Other features include impaired initiation and planning, disinhibited behavior and social disgrace and mild abnormalities on cognitive testing. Apathy and memory deficits develop later in the course of the disease. A subset of patients may also exhibit symptoms of extrapyramidal or motor neuron involvement at some point in the disease process.

Answer 81

Onset of Symptoms - Insidious Cognitive symptoms - Decline in executive and visuospatial function and Hallucinations (Recent onset forgetfulness and peculiar behavior and importantly visual hallucinations suggested by seeing people that do not exist) Motor symptoms - Parkinsonian symptoms follow cognitive symptoms Abnormal aggregation of protein (α-synuclein) within nerve cells is the chief component of Lewy bodies. Presence of Lewy bodies alters the level of neurotransmitters and neuromodulators in the brain, principally dopamine.

Answer 82

Attention deficit hyperactivity disorder is a neurodevelopmental disorder characterized by a pattern of inattention and/or hyperactivity-impulsivity that occurs in at least 2 different settings for more than 6 months. Although the patient has normal intelligence, the disease causes functional decline. The onset usually occurs before 12 years of age and often persists into adulthood. The 1st line of treatment is stimulant medications but may include non-stimulant medications and behavioral therapy. Atomoxetine (Non-stimulant medications): Usually 2nd-line therapy Mechanism of action via norepinephrine reuptake inhibitor Indicated with comorbid anxiety, tic disorder, or insomnia Side effects: increased suicidal ideation in children

Answer 83

Psychogenic polydipsia Self-induced water intoxication should always be considered in the differential diagnosis of confusional states and seizures in schizophrenic patients. As many as 20% of patients with a diagnosis of schizophrenia drink excessive amounts of water. At least 4% of these patients suffer from chronic hyponatremia and recurrent acute water intoxication. In psychogenic polydipsia, urine osmolality is < 100 mOsm/kg (100 mmol/kg). Decreasing water intake gradually will lead to decreasing urine output, increasing plasma and urine osmolality and serum sodium concentration. Medications that cause excessive water retention, such as lithium and carbamazepine, can aggravate the symptomatology.

Answer 84

In complicated grief reaction, we find: Intense feeling of guilt and blame Functional impairment Might occur psychotic thoughts or suicidal SYMPTOMS LAST MORE THAN A YEAR Ttx: antidepressants, antipsychotics, ECT

Answer 85

Assess the patient in 2 WEEKS: - If responding well, continue treatment - If partial response, increase the dose further - If no initial response, switch to different drug - If not possible, switch to different drug - If inadequate responde AFTER 6 WEEKS, change to different drug (can be of the same class).

Answer 86

* Taper the drug by halving the dose each week to avoid discontinuation syndrome. * Washout period: 2 - 4 days; 1 week (Fluoxetine ); 2 weeks (MAOI). * The new drug should be started at a low dose. * Monitor closely for serotonin toxicity.

Answer 87

SNRIs SSIRs like: paroxetine, reboxetine TCA MAOI Bupropion

Answer 88

Less implicated: Desvenlafaxine, mirtazapine, escitalopram Methylphenidate can be added to SSRI to boost the antidepressant action and it can reduce SSRI-induced sexual effect.

Answer 89

FINISH: * Flu-lÍke symptoms (headache, myalgia, arthralgia) * Insomnia (vivid dreams, nightmares) * Nausea * Instability of gait ( ataxia ), tremor * Sensory disturbances ( electric shock-lik:e sensation) * Hyperarousal (anxiety, irritability, anger, panic, low mood) Management: restart the drug in the original dose before beginning to taper slowly: reduce the dose by 25 - 50%, wait 2 - 4 weeks, repeat. Liquid medication may be required.

Answer 90

Drugs to avoid in pregnancy: Paroxetine, Fluoxetine, MAOI. * Paroxetine can increase the risk of withdrawal syndrome in newbom baby due to rapid absorption. - First trimester: cardiovascular malformation. - Third trimester: pulmonary hypertension in fetus.

Answer 91

It can cause nausea, vomiting, cold and clammy extremities, bradycardia and a fall in the BP, disorientation, restlessness and incoherence of speech. Most patients recover with conservative management and require little intervention. Deaths involving paroxetine toxicity have generally been a result of ingestion of multiple drugs, and not from paroxetine alone ------>>> Evaluate for coingestants is the MOST important thing to be done

Answer 92

* Cardiotoxicity with cardiovascular collapse: * Reduced cardiac contractility. * Hypotension. * Broad complex dysrhythmias (abnormal conduction). * ECG: sinus tachycardia, wide QRS tall R wave in a VR prolonged QTc. prominent S wave in lead I CNS depression: drowsiness, sedation, coma, convulsions, ataxia.

Answer 93

Escaping the school and going to games and parlours on the one hand and being tearful and withdrawn on the other hand does not fit into the diagnosis of depression. Truancy is any intentional unauthorised or illegal absence from compulsory schooling.Children who run away from school to do other things (truancy) rather than stay home usually have different problems from those who do not want to go to school. They may be wanting to get attention, trying to impress their friends or they may be angry because of school or home problems.Truancy may happen when there are learning problems.Children who truant a lot sometimes go on to break the law as they get older. Children who truant usually try not to let their parents find out.Truancy sometimes happens when parents are not very interested in the child getting a good education, and perhaps don’t get on very well with the school themselves. Children with depressive disorders feel sad, lack interest in activities they previously enjoyed, criticise themselves, and are pessimistic or hopeless about the future.Thinking that life is not worth living, they may contemplate suicide. They may also be irritable and aggressive. They may be indecisive and have problems concentrating. They tend to lack energy and to have problems sleeping

Answer 94

Clinical features (some evidenced <5 years) Insufficient care (eg, neglect, abuse, inconsistent caregiving, prolonged institutionalization) Does not seek or respond to comfort Poor social responsiveness, limited positive affect Unexplained irritability/fear/sadness even during safe encounters Associated features Toileting & sleep difficulties Anxiety, aggression, hyperactivity/impulsivity Differential diagnosis Adjustment disorder, posttraumatic stress disorder Global developmental delay, intellectual disability Autism spectrum disorder Anxiety disorders (eg, social anxiety disorder, selective mutism) Depressive disorders Management Early intervention promoting: safe, stable & enriching environment consistent, responsive caregiving Psychological services (eg, parenting skills, individual/family counseling)

Answer 95

Late onset eschizophrenia

Answer 96

symptoms and signs of paranoid psychosis appear for the first time in elderly (female): paranoid persecutory delusions; accusative, abusive auditory hallucinations. Thoughts disorder and negative symptoms are rare. Good response to medications. Spontaneous remissions are less likely Cognitive deficit but intact recall and visuospatial ability, intact orientation

Answer 97

Typical antipsychotics: High potent: Haloperidol (Haldol), Trifluoperazine ( Stelazine ), Fluphenazine ( Madecate ), High risk of extrapyramidal side effects, hyperprolactinemia. Less potent: Chlorpromazine ( Largactil ), Thioridazine (Aldazine), Pericyazine Neulactil Less risk of EP side effects, but more anticholinergic effect. Depot forms: Haloperidol Decanoate IM every 4 weeks. Fluphenazine decanoate IM every 4 weeks.

Answer 98

Sedation: High risk: Olanzapine, Clozapine , Quetiapine, Low risk: Aripiprazole, Amisulpride , Risperidone, Management: Reassure the patient that the degree of sedation is likely to decline over 1 to 2 weeks. If this does not occur and the degree of sedation is unacceptable to the patient, reduce the dose or change the medication.

Answer 99

Risperidone: Common side effects: Weight gain is one of the most common side effects (4.6 pounds after 10 weeks of treatment) due to increased appetite. Drowsiness Dizziness Nausea Other side effects: Parkinsonism Gynaecomastia (late term side effect). Galactorrhoea. Absence of periods in females. Delay in growth. Sexual dysfunction. Risperidone (Risperdal) initial dose 1 mg maximum dose 6 mg Risperdal Consta IM every two weeks Indications: positive and negative symptoms.

Answer 100

High risk: Amisulpride , Paliperidone, Risperidone, Ziprazidone , all typical antipsychotics. Low risk: Olanzapine, Quetiapine, Clozapine, Aripiprazole. Hyperprolactinemia: Monitor prolactin concentration. Reduce the dose. Switch to antipsychotic with low risk. Or add small dose of Aripiprazole. Consider Sildenafil (Viagra), Tadalafil.

Answer 101

Aripiprazole atypical antipsychotic causes weight loss and significant reduction in total and low density lipoprotein cholesterol. Aripiprazole can be added to clozapine. It has beneficial effects. Alternative option for weight reduction is Metformin. This medication can be used in combination with Clozapine. Clozapine is used for drug resistant schizophrenia and should not be stopped or changed for other medication unless there are severe side effects such as neutropenia, myocarditis. Olanzapine is associated with weight gain and metabolic syndrome. Quetiapine is associated with weight gain.

Answer 102

When switching between oral antipsychotics a crossover phase of at least 1 to 2 weeks is recommended, during which the dose of the drug being ceased is reduced and the dose of the new drug is gradually increased

Answer 103

Cognitive behavioural therapy and motivational enhancement therapy (aimed at reducing the chances of reexposure and establishing coping mechanisms to resist further use). There is no evidence to use pharmacotherapy in the management of cannabis abuse disorder.

Answer 104

Dysthymic disorder is characterized by mild to moderate symptoms of depression lasting for at least 2 years.

Answer 105

Projection is misattribution of undesired thoughts, feelings, or impulses onto another person 🔄 Used when thoughts are unacceptable to express 😡 Lack of insight and acknowledgment of one's own motivations and feelings 🧠 Example scenario: blaming government for financial problems to protect ego 🏛️💰 Disliking your manager but accusing them of having a grudge against you Accusing your spouse of being in a bad mood when you are Blaming your child for weight issues instead of addressing your own self-confidence 🙅‍♂️🔀

Answer 106

Denial is refusing to experience a situation or fact 🚫 Coping by not accepting reality to avoid unpleasant consequences and pain 😖 Examples include denying health consequences of smoking or refusing to acknowledge a failing business 🚭📉

Answer 107

Displacement is repressing emotions or impulses and redirecting them toward another person or object 🎯 Often due to irrational or socially unacceptable feelings 🙅‍♀️ Examples involve getting mad at a family member for issues unrelated to the true source of frustration 🤬🎯

Answer 108

Rationalization involves explaining or creating excuses for events or actions 📜 Used to avoid accepting the true cause or reason 🚫 Examples include justifying being late for dinner or cheating on a test 🍽️📝

Answer 109

Regression is reverting to behaviors from an earlier age in response to stress or anxiety 🧒🔄 Seeking comfort in familiar, secure actions or habits 🍼📺 Examples involve thumb-sucking in the hospital or resorting to temper tantrums instead of mature parenting 🚼🪣

Answer 110

Typically 6 to 12 months of antidepressant therapy for most patients with depression 📆💊 Extend therapy to 3 to 5 years in the following situations: Two episodes of major depression in 5 years Three previous episodes of major depression Depression with psychotic features Depression with a serious suicidal attempt 🧠💉 Reassess after 3-5 years, and some patients may require lifelong therapy 🔄🩺

Answer 111

Symptoms include disruption of daily routine, weight loss, decreased sleep, and appetite 💔 Typically, patients return to normal social functioning within 2 months, but symptoms may last up to one year with waxing and waning 🕰️ Key features: sadness, despair, tearfulness, decreased sleep, decreased appetite, and decreased interest in life and the world 🙁

Answer 112

Prescribe a short course of benzodiazepines (< 7 days) for insomnia 🌙💊 Refer the patient to grief counseling to help cope with the loss 🩺🧡 SSRIs are not indicated for depressive symptoms or sleep issues unless a diagnosis of moderate to severe depression is present 🚫 Referral to a psychiatrist is not necessary at this stage 🙅‍♂️ Antipsychotics are not indicated for grief-related auditory and visual hallucinations unless there are psychotic features necessitating treatment 🚫👻

Answer 113

T-score of -2.5 or less indicates osteoporosis 🦴 T-scores between -1 to -2.5 suggest osteopenia 🦴 T-score of -1 or above is considered normal bone density 🟩 For prevention, maintain a high-calcium diet with a total daily calcium intake of 1300 mg, with diet being the preferred source of calcium 🍽️💊 Encourage patients with low dietary calcium intake to increase their intake of calcium-rich foods instead of supplements 🥛🧀 Limit the dose from a supplement to 500 to 600 mg of elemental calcium daily, ideally achieved from dietary sources 🚫 Bisphosphonates are used for treatment of established osteoporosis or osteopenia, not for prevention 🚫 Calcium supplementation is used when adequate calcium intake cannot be ensured through diet 🚫 Exercise has additional benefits but is not the primary preventive measure 🏋️‍♀️ Exposure to sunlight is necessary for vitamin D production, which aids calcium absorption but is not the primary preventive measure ☀️ Maintain a serum 25-hydroxyvitamin D concentration above 50 nanomol/L in patients taking drug therapy for osteoporosis 🌞

Answer 114

To monitor osteoporosis treatment, use actual BMD values; T-scores and Z-scores are not appropriate 🦴 Measure BMD at the lumbar spine and hip: 2 years after starting treatment 1 to 2 years after a significant change in treatment 📊 Consider more frequent BMD measurement (but not more often than once a year) in patients with severe osteoporosis or high risk of bone loss, including those taking high-dose glucocorticoid therapy ⏳ If BMD is stable or improving, subsequent measurement is not required for at least 2 years; an interval of up to 5 years may be reasonable 📈 If BMD decreases by more than 5% or 0.05 grams/cm2 at any major site, or if a fracture occurs, consider investigation for new or unrecognised risk factors, and check adherence to therapy. A change of therapy may be appropriate. 🚑

Answer 115

Measure bone mineral density (BMD) in patients with significant risk factors for fracture, and in patients 70 years and older. Calculate absolute fracture risk using online calculators (eg Fracture Risk Assessment Tool [FRAX]) Start osteoporosis drug therapy for patients aged 70 and older with T-scores of –2.5 or less. Consider treatment for younger patients with declining BMD or high fracture risk; seek specialist advice when needed. Ensure sufficient calcium and vitamin D intake and advise on fracture prevention. After a minimal-trauma fracture, assess BMD, and treat if T-score is osteopenic or osteoporotic. For normal T-scores, investigate other causes of fracture and consider treatment based on fracture site and risk factors. If BMD measurement isn't possible, start drug therapy for hip or vertebral fractures, and consider follow-up BMD when available.

Answer 116

Alendronate: Oral dosing 🩸, Low cost 💰, Can cause or exacerbate upper gastrointestinal tract irritation 😫, Absorption reduced by food, antacids, calcium, magnesium, and iron 🚫, Requires more frequent dosing than intravenous options 📅, Not recommended in severe kidney disease 🚑. Risedronate: Oral dosing 🩸, Low cost 💰, Enteric-coated formulation available (may have a lower incidence of gastrointestinal adverse effects, and absorption less affected by food, antacids, calcium, magnesium, and iron) 🍽️, Can cause or exacerbate upper gastrointestinal tract irritation 😫, Absorption reduced by food, antacids, calcium, magnesium, and iron 🚫, Requires more frequent dosing than intravenous options 📅, Not recommended in severe kidney disease 🚑, Enteric-coated formulation only available as a weekly dose (non–enteric-coated formulation available as a monthly dose) 🗓️. Zoledronic Acid: Intravenous administration avoids gastrointestinal adverse effects 💉, Yearly dosing can improve adherence 🗓️, Intravenous administration not acceptable to some patients 🚫, Not recommended in severe kidney disease 🚑, Can cause transient influenza-like symptoms 🤒, Can cause uveitis (uncommon) 👁️, Can cause hypocalcaemia (particularly in patients with impaired kidney function, vitamin D deficiency, or a malabsorption disorder) 🚑. Denosumab: Subcutaneous administration avoids gastrointestinal adverse effects 💉, Dose adjustment not required in kidney disease 🚑, 6-monthly dosing can improve compliance 🗓️, Subcutaneous dosing not acceptable to some patients 🚫, Adherence to 6-monthly dosing regimen is essential to prevent loss of bone mineral density between doses 📅, Therapy must be either indefinite or replaced by a bisphosphonate if stopped 🔄, Withdrawal or interruption of treatment (dose delayed by more than 4 weeks) is associated with an increased risk of multiple spontaneous vertebral fracture 🦴, Can cause hypocalcaemia (particularly in patients with impaired kidney function, vitamin D deficiency, or a malabsorption disorder) 🚑.

Answer 117

Alendronate: 70 mg orally, once weekly on an empty stomach 💊🍽️, Low cost 💰, Limited by upper gastrointestinal irritation 😫, Absorption affected by food, antacids, calcium, magnesium, and iron 🚫, Frequent dosing required 📅, Caution in severe kidney disease 🚑. Risedronate: 35 mg orally, once weekly on an empty stomach 💊🍽️, Low cost 💰, Enteric-coated formulation available for reduced gastrointestinal adverse effects 🍽️, Can cause or exacerbate upper gastrointestinal tract irritation 😫, Absorption affected by food, antacids, calcium, magnesium, and iron 🚫, Frequent dosing required 📅, Caution in severe kidney disease 🚑, Monthly dosing option available 🗓️. Zoledronic Acid: 5 mg intravenous infusion once a year 💉, Avoids gastrointestinal adverse effects 💊🍽️, Improves adherence with yearly dosing 📅, Risk of transient influenza-like symptoms 🤒, Risk of uveitis (uncommon) 👁️, Risk of hypocalcaemia, especially with risk factors 🚑. Denosumab: 60 mg subcutaneously every 6 months 💉🗓️, Increases BMD and reduces fractures 🦴, Need for patient adherence to 6-month regimen 🔄, Considerations upon therapy cessation leading to rapid bone turnover and loss of BMD 📈🦴, Risk of hypocalcaemia, especially with risk factors 🚑, Requires calcium and vitamin D sufficiency 🍽️🌞, Discussion with patients on the importance of adherence and therapy continuation or replacement 🗣️.

Answer 118

Effects of Glucocorticoids on BMD: Reduce bone formation, increase bone resorption, affect osteoblast function, hinder intestinal calcium absorption, cause osteocyte dysfunction, lead to hypercalciuria, and suppress gonadal function 🦴📉. Fracture Risk with Glucocorticoids: Increased fracture risk regardless of BMD, higher risk compared to non-users with similar BMD 🦴📈. Factors Affecting Bone Loss: Highest bone loss rate in the initial 3 to 6 months, dose and duration-dependent bone loss, prednis(ol)one dose ≥ 7.5 mg/day or equivalent associated with highest risk, increased risk even with low doses (≥ 2.5 mg/day) 📆. Prevention and Management: Assess fracture risk, measure BMD, ensure sufficient calcium and vitamin D intake, optimize other fracture risk factors, advise on minimal-trauma fracture prevention 📊🍽️🌞. Treatment Options: Bisphosphonates (first-line), Denosumab, Teriparatide (strict eligibility criteria), Estrogen therapy (for postmenopausal women) 💊🦴. Monitoring: Consider BMD measurement every 12 to 24 months initially, with less frequent monitoring if stable and acceptable results 📏🔄.

Answer 119

Definition: Rare demineralizing condition, primarily affecting the hip, but can impact other joints. Mechanism unknown 🤰🦴. Distinguishing Factors: Differentiate from physiological bone mass loss during pregnancy and lactation. Presents in the third trimester with severe atraumatic anterolateral groin pain, anterior thigh radiation, acute or insidious onset 🚼🤕. Bone Mineral Density: Hip BMD significantly reduced compared to lumbar spine 📏. Resolution: Self-limiting, typically resolves 2 to 6 months postpartum 🔄. Management: Requires specialist assessment and management 👩‍⚕️.

Answer 120

Decreased Libido Psychosis

Answer 121

Mental Health Tribunal authorizes ECT for involuntary patients, forensic patients, those under supervision, or with a community treatment order. Approval requires patient's incapacity to give informed consent and the opinion of two medical practitioners (at least one being a psychiatrist). The medical practitioners must consider the patient's clinical condition, treatment history, and alternative treatments. ECT approval aims to prevent serious mental or physical deterioration. ⚖️🧠🏥

Answer 122

Authorized psychiatrists can perform ECT without tribunal approval in life-saving emergencies for involuntary patients, those under supervision, or forensic patients. ECT is administered when necessary to save a person's life or prevent irreparable harm. Following emergency ECT, authorized psychiatrists must report the procedure to the tribunal. 🆘⚡🏨

Answer 123

Emergency ECT should be avoided when possible and not administered without a second opinion. Practical discussions with the chief psychiatrist or their representative are encouraged. Unlike other medical procedures, consent from relatives, administrators, colleagues, or seniors is not required for involuntary patients. 🚫👥💬

Answer 124

An MMSE score of 21-24 suggests mild dementia, and a patient with this score may have mild functional dependence. 🧠📊👴 An MMSE score between 10 and 20 is associated with moderate Alzheimer's disease and indicates more immediate dependency on daily activities. Patients may have difficulty with tasks like driving, hygiene, and shopping. 🧠📊🚗🧼🛒 Severe dementia, with MMSE scores under 10, is associated with total dependence and the need for constant supervision. It's marked by motor impairments (like gait and balance issues), incontinence, and myoclonus. 🧠📊👴🚶‍♀️🚽🙅‍♀️

Answer 125

"Hot as a hare" 🌡️ Mechanism: ↑ Body temperature due to reduced sweating. "Dry as a bone" 💧 Mechanism: Reduced secretions from mucous membranes and sweat glands. "Red as a beet" 🍅 Mechanism: Flushed skin due to superficial vasodilation from increased body heat. "Blind as a bat" 🦇 Mechanism: Cycloplegia and mydriasis caused by the paralysis of the ciliary muscle and iris sphincter. "Mad as a hatter" 🎩 Mechanism: Altered mental status due to the drug permeating the blood-brain barrier and affecting CNS pathways. "Full as a flask" 🧳 Mechanism: Constipation and urinary retention from decreased intestinal smooth muscle contraction, detrusor contraction, and internal urethral sphincter relaxation. "Fast as a fiddle" 🏃 Mechanism: Tachycardia resulting from decreased vagal tone at the sinoatrial node. Mechanism: "Widespread, competitive blockade of muscarinic acetylcholine receptors" 🧪 Common Causes: "Overdose of medications with anticholinergic properties (e.g., diphenhydramine)" 💊

Answer 126

Serotoninergic has often GI symptoms (nausea) + neuromuscular hyperactivity. It is characterized by a triad of mental status changes, autonomic dysregulation, and neuromuscular hyperactivity. Anticholinergic toxicity is characterized by hyperthermia, delirium, dilated pupils, dry mucous membranes, urinary Neuroleptic malignant syndrome is characterized by hyperactive vital signs (eg, hyperthermia, tachycardia), altered mental status, and rigidity that develops in the context of antipsychotic use. The absence of an inciting medication, this patient's hyperreflexia, and the overall clinical picture make serotonin syndrome more likely Acute toxicity from lithium (used to treat bipolar disorder) can cause neurologic findings, including confusion and ataxia. However, acute toxicity typically also causes gastrointestinal symptoms (eg, nausea/vomiting, diarrhea), and hyperthermia and urinary retention are not expected.

Answer 127

The first-line treatment for cognitive symptoms of AD is a cholinesterase inhibitor. These drugs can improve the quality of life and cognitive function, including memory, language, thought, and reasoning. 🧠📖 However, it's important to note that cholinesterase inhibitors do not alter the disease course in any type of dementia. They primarily provide symptomatic relief. 📊

Answer 128

Cholinesterase inhibitors effective in patients with mild to moderate AD include donepezil, galantamine, and rivastigmine. 🩹 These medications function by increasing the availability of acetylcholine, a neurotransmitter, in the brain. This can help enhance cognitive function in AD patients. 🧪

Answer 129

Memantine is an NMDA receptor antagonist approved for moderate to severe dementia, specifically in AD. 🧪 It functions by modulating glutamate activity in the brain, which can be beneficial in advanced stages of the disease. 🧠

Answer 130

Amantadine is thought to possess dopaminergic and NMDA receptor antagonist properties and is frequently used in the treatment of Parkinson's disease. 🦠🧠 However, the evidence of its benefit in the treatment of AD is limited, and it is not considered a first-line treatment in this patient. 📉🚫

Answer 131

Recommended monotherapy drugs for bipolar depression: Lamotrigine, lithium, lurasidone, olanzapine, and quetiapine 💊 Antidepressant monotherapy should be avoided as it can induce mania or rapid cycling ⚠️

Answer 132

Monotherapy alone is often ineffective or only partially effective for bipolar depression, necessitating combination therapy 📉 Combination therapy involves using an antidepressant along with one of the following drugs to prevent manic switch: lithium, lurasidone, olanzapine, quetiapine, or sodium valproate. >Before adding an andidepressant, its possible to attempt an increase the dose of the antipsychotic firslt

Answer 133

When using an antidepressant in bipolar depression, closely monitor patients for signs of emerging hypomania or mania, which is more common in young people 👀 Response to treatment is typically noticeable after at least 1 week, with full benefits taking 4 to 6 weeks or longer ⏳ If an acceptable response is achieved, continue combination therapy for 1 to 2 months after recovery from the depressive episode, followed by gradual reduction and discontinuation of the antidepressant. Continue with the other drug as monotherapy for at least 6 to 12 months to prevent relapse. Assess the need for bipolar disorder prophylaxis after this period ⚙️ Note that discontinuing the antidepressant may not always be possible if the patient is prone to recurrent depressive episodes 🔄

Answer 134

Avoid paroxetine in young people due to an increased risk of suicidal thoughts, behaviors, and other serious adverse events associated with its use ❌

Answer 135

Prophylaxis should be evaluated on a case-by-case basis, involving shared decision-making with the patient and the treating psychiatrist 🧑‍⚕️🤝 Consider prophylaxis if the patient has had either: 2 or more episodes of mania or depression 🔄 Mood episodes that significantly impaired their function, with or without psychotic features 📉🧠 Benefits and harms of treatment should be discussed with the patient to make an informed decision 🗣️

Answer 136

f there was a sufficient response to the drug used for acute therapy, use the same drug for prophylaxis 🔄 The effective dose or target blood concentration may be lower than when the drug was used for acute treatment 🎯

Answer 137

First-line therapy for prophylaxis: Lithium 💊 Third-line therapy options for prophylaxis: Carbamazepine, Olanzapine 💡

Answer 138

Prophylaxis may be time-limited (3 to 5 years) or indefinite, depending on factors such as the patient's history of recurrences, response to treatment, patient age, and treatment tolerability 📅🤔

Answer 139

Anorexia nervosa may be associated with a family history of leanness or athleticism 🏃‍♂️🧬 Bulimic eating disorders are associated with a personal or family history of obesity 🍔🧬 Sexual abuse is a significant risk factor for the development of eating disorders and various other psychiatric disturbances 🚫🤕

Answer 140

The scenario describes a typical example of ‘tangentiality'. Tangentiality occurs when one idea connects to the next with one word or phrase, but the thoughts become confusing because they go off on a tangent and end in a different subject. In the above example the word ‘food’ ends in another comment about food unrelated to the previous sentence. The word ‘food’ is the only connection. Loosening of association (derailment), on the other hand, happens when one idea does not connect to the next at all. Following are sentences told by patients in real situations. The first two are examples of derailment (loosening of association), while the third is 'tangentiality': The next day when I’d be going out you know, I took control. Like uh, I put bleach on my hair … The traffic is rumbling along the main road. They are going to the north. Why do girls always play pantomime heroes? I think someone has infiltrated my copies of the cases. We’ve got to case the joint. I don’t believe in joints, but they do hold your body together.

Answer 141

Beta blockers should not be used in the treatment of cocaine-induced cardiovascular symptoms and complications owing to the fact that beta blockers may result in unopposed alpha-adrenergic stimulation, resulting in coronary vasoconstriction and end-organ ischemia.

Answer 142

Without treatment, an episode of major depressive disorder in adults lasts from 6 months to 18 months (average 8 months). The course of the disease in adolescents appears to be different from that of adults. Although there is no solid evidence, it is suggested that major depression in adolescents may last from 2 weeks to many years.