Neuroleptic Malignant Syndrome (slow onset 1-3 days),
Lead pipe rigidity
Fever HTN, tachycardia
mild form of bipolar alternating hypomania and dysthymia (mild depression) for at least 2 yrs (symptom free for 2 mo. max)
Tx: Lithium, Quetiapine
4 day minimum, no social/occupational impairment, no psychotic features, no hospitalization required
Dysthymia, Time frame
depressed for at least 2 yrs (symptom free for 2 mo. max), poor concentration, hopeless, low self esteem, fatigue, insomnia, poor/excessive appetite
Serotonin Syndrome (fast onset)
d/t when MAOIs are taken with SSRIs/Serotonergic opioids; e.g. Trancypromise + Meperidine/Dextromethorphan/Tramadol
myoclonic jerks/ clonus
confusion, rhabdo, renal failure, coma
Tx: Supportive care then Cyproheptadine (serotonin antagonist)
↓ Frontal Lobe mass
impaired DA regulation in caudate
Tx. for Extrapyramidal SE of antipsychotics
How do NSAIDs affect Lithium levels?
NSAIDs ↓ Lithium levels
What is Lithium used for? Adverse effects?
Bipolar disorder and Refractory depression
AE: metal taste, hypothyroidism, polyuria
getting sick to assume sick role (1º gain)
excessive emotionality, attention seeking
acting out false/grossly exaggerated signs and symptoms for 2º gain (unemployment benefits, narcotics, money)
Extrapyramidal Symptoms (d/t typicals/atypicals i.e. Risperdal or Haldol) Rule of 4's
Rule of After 4's:
4 hrs: acute dystonia
4 days: akathisia (restlessness)
4 wks: bradykinesia
4 mo: tardive dyskinesia
Dysthymia (Persistent depressive disorder)
chronic low grade depression at least 2 yrs
Avoidant personality disorder, Tx
feels a "void" and wants to be friends, fear intimate relationships/friendships, Tx: SSRIs
Cluster A ODD personality disorders "PASS",
PAranoid: mistrust others
Schizoid: no desire for close relationships
Schizotypal: "magical thinking" and distorted cognitions/perceptions
Cluster B DRAMATIC personality disorders "BAHN"
Borderline: unstable relationships, mood swings. Tx: Dialectical behavioral (DBT)
Antisocial: violate rights of others, steals, kills with no guilt. Tx: DBT
Histrionic: attention seeking but functional. Tx: psychotherapy
Narcissistic: grandiose, need for admiration Tx: psychotherapy
Cluster C ANXIOUS personality disorders "CADO"
Avoidant: desires companionship. Tx: SSRI
Dependent: afraid of separation. Tx: psychotherapy
OCPD: rigid rules so tight they exclude friendships. Tx: psychotherapy
mature way of channeling impulses into socially acceptable behavior
When treating a single episode of Major Depression, how long should you continue antidepressants to follow a pt.'s response?
What a.a. should you avoid while on MAOIs?
Tyramine (age cheese, anchovies, red wine, cured meats, etc.)
psychosis + major Depression/Manic S&S lasting 2+ wks
i.e. Schizophrenia + either depression or bipolar disorder. That's why it has two subtypes (depression type, bipolar type)
Why can't you abruptly stop benzodiazepines like Xanax?
Hoarding is treated with?
Major Depressive Disorder, S&S, d/t?
2+ wks of 5 of 9 CISEGAPS, d/t ↓ 5HT
What would you see on PET Scan of MDD?
↓ frontal lobe blood flow
SSRIs, TCAs, MAOIs, ECT if pregnant
DIGFAST of Bipolar I
Talkative Manic Episodes last 1 wk, may have depressive episodes
Tx. Bipolar I
Lithium (mood stabilizer), Carbamazepine or Valproic Acid, Atypicals
Bipolar II (Hypomanic)
less severe DIGFAST, more prevalent, 1+ major depressive episode is required