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Question 1

What plot/chart to check in event of OD on Tylenol?

Answer 1

Rumack Matthew Normogram

Question 2

Activating SSRI

Answer 2

prozac, buproprion, venlefaxine, duloxetine (GOOD FOR CHRONIC PAIN!)

Question 3

common psych meds used to help with sleep

Answer 3

trazodone (+melatonin), mirtazapine, quetiapine, doxepin (TCA), Benadryl maybe (watch out for side fx)

Question 4

general safety plan for all patients?

Answer 4

1. take meds
2. sleep 8 hours
3. exercise
   4 45 minutes of social activity
4. therapy

do 3/5 of these EVERYDAY or you will decomp

Question 5

What to do after make a general safety plan?

Answer 5

Weekly review (have you been keeping up with general safety plan?)
see if you need accountability
need to reach out
call doctor if you can’t keep up

Question 6

three weight neutral antipsychotics

Answer 6

abilify, Geodon, haldol

Question 7

another way to view depression aside from just SIG E CAPS symptoms

Answer 7

think of a person’s schedule throughout the day…there is a decline in all those activities

Question 8

2nd gens with most anticholinergic side effects

Answer 8

THE -PINES!

olanzapine
quetiapine
clozapine

Question 9

what to talk about when starting SSRI

Answer 9

• sexual side effects (delayed ejaculation which can be positive)…these go away when med dc’d or switched
• GI side effects; go away in a week, take with food
• headache
• black box warning: increased suicidal thoughts in children/adolescents…question validity of study, if you stop SSRIs, huge spike in reported suicides

Question 10

cardiac side effect venlefaxine

Answer 10

increases DBP

Question 11

TCA for OCD

Answer 11

clomipramine

Question 12

TCA vs venlefaxine?

Answer 12

TCA more sedating, can increase hungry (use anticholinergic effects)…but make sure they don’t have medical contraindications

Question 13

duloxetine vs venlefaxine

Answer 13

dulox- more expensive but with small doses, already get good noadrenergic reuptake
venlefaxine - less expensive but need to use higher doses to get good noradrenergic reuptake…at low doses this is essentially just an SSRI

Question 14

If patient feels emotionally more “blunted” on SSRI, what can you do?

Answer 14

add on more doparminergic antidepressant like wellbutrin

Question 15

why is h/o gastric bypasses relevant in social hx? (particularly roux en y)

Answer 15

problems with absorption -> chronic brain resorption -> can resemble TBI

someone who is depressed who has history of gastric bypass is at risk for treatment refractory depression requiring ECT!

Question 16

parts of affect

Answer 16

1. perceived emotion that is observable by you in patient (patient looks dysphoric, euphoric, )
2. range (flat, constricted, labile, reactive, blunted)
3. appropriateness with stated mood
4. appropriateness relative to content of interview/context of their situation

Question 17

how to ask for hx bipolar disorder

Answer 17

1. has there been a period where you were completely sober off all drugs/substances?
2. during that time, was there ever a period where you didn’t sleep for a week at a time, where you felt like you were on a special mission, had special powers?, where you didn’t feel tired even though you didn’t sleep

Question 18

why are escitalopram and citalopram better used for patients with multiple medical comorbidities?

Answer 18

Lexapro and celexa both have renal metabolism which means less competition for hepatically cleared medications…also something to do with cytochrome p450 metabolism

Question 19

criteria to be cleared to go to inpatient psych

Answer 19

1. patient able to ambulate
2. patient able to tolerate food PO
3. if event of recent OD, make sure patient has had BM

for casts, hard materials, ACE bandaging…usually by case by case basis depending on how agitated patient has been or risk for using these materials in violence towards self/others