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Flashcards in Psych Deck (14):
1

Organic v. Functional Psychosis

MADFOCS - Organic // Functional
M - Memory Deficit - recent // remote
A - Activity - hyper, hypo, tremor, ataxia // repetitive activity, posturing, rocking
D - Distortions - visual // auditory
F - Feelings - labile // flat
O - Orientation - disoriented // oriented
C - Cognition - occasionally lucid // not lucid
S - Some Others ...

Organic - age > 40, sudden onset, abnormal PE or vitals, social immodesty, aphasia, AMS, confabulation.

Functional - age < 40, gradual onset, PE and vitals normal, social modesty, intelligible speech, alert/awake, ambivalence.

2

Reversible Psychosis

DEMENTIA
D - Drug Toxicity
E - Emotional
M - Metabolic
E - Endocrine
N - Nutritional
T - Tumors/Trauma
I - Infection
A - Arterosclerotic Complications

3

Life-Threatening Psychosis

WHHHIMP
W - Wernickes
H - Hypoxia/Hypoperfusion
H - Hypoglycemia
H - HTN Encephalopathy
I - Intracerebral Hemorrhage
M - Meningitis
P - Poisonings

4

Acute Psychosis Labs

CBC, electrolytes, toxicology, hCG, TSH, CT brain.

5

Causes of Secondary Depression

Hypothyroidism, diabetes, Cushing's, Brain tumor, parkinson's, seizures, dementia, cerebral vascular accidents, subdural hematoma, multiple sclerosis, lupus, pancreatic cancer. Rx - beta blockers, benzodiazepines, barbiturates, steroids, cimetidine/ranitidine.

6

MDD

Symptoms nearly every day for 2+ weeks:
Depressed mood or loss of interest + 5/8 SIGECAPS.

7

Hospitalize for SI?

SAD PERSONS - Sex (male), age (<19 or > 45), depression/hopelessness*, previous attempts/admissions, excessive EtOH/drug use, rational thinking loss*, separated/divorced/widowed, organized serious attempt*, no social support, stated future attempt*. (1 pt each, *2 pts)
< 5 - discharge
6+ - consult psych
9+ - admit

8

Common medical conditions that manifest as violent behavior.

Hypoxia, hypoglycemia, intracranial injury/bleed, hypo/hyper Na+, intoxication/withdrawal, rx side effects, meningoenchepalitis.

9

Violent Patients

1. verbal redirection
2. physical or chemical restraints

10

Chemical Restraints

1. BZDs
2. Typical Antipsychotics
3. Atypical Antipsychotics

11

BZDs

*Lorazepam, 1-2 mg IV/IM q1h prn
Diazepam, 5-10 mg PO/IV/IM/per rectum q1h prn
*Midazolam (+/– Haloperidol), 5 mg IM (rapid onset, short t1/2!!!)

12

Traditional Antipsychotics

*Haloperidol, 5-10 mg PO/IM q1h prn; MAX 30 mg/day.
Chlorpromazine

***Consider adding dyphenhydramine 50 mg PO/IM BID or benztropine to reduce risk of EPS.
***Consider adding lorazepam (i.e., B52, Benadryl + 5 mg halloo, 2 mg lorazepam) - also can use 4-5 mg midazolam.

13

Atypical Antipsychotics

Risperidone, 2-4 mg PO
*Olanzapine, 10-20 mg PO, 10 mg IM

***Do NOT combine IM olanzapine with a BZD due to risk of respiratory depression.

14

NMS

Rigidity, hypertension, hyperthermia, altered mental status. Tx -Supportive care and dantrolene.