NBME Study Tips Flashcards
What is neuroleptic malignant syndrome (NMS)?
Potential complication resulting from antipsychotic medication. Characterized by fever, muscular rigidity, autonomic instability, altered mental status and elevated levels of creatine phosphokinase.
What causes the muscular symptoms associated with NMS?
Muscular sx result from the DA blockade induced by antipsychotic medication, which leads to Parkinson’s-like sx.
What is Serotonin Syndrome?
Potential complication that can result from combining selective serotonin reuptake inhibitors (SSRIs) with monoamine oxidase inhibitors (MAOIs).
How do SSRIs and MAOIs lead to serotonin syndrome?
SSRIs increase amt of serotonin in circulation and MAOIs inhibit the degradation of serotonin. When these medications are simultaneously used, they result in excess amounts of serotonin.
What are the symptoms of serotonin syndrome?
Combination of cognitive, autonomic and somatic symptoms. Including flushing, tachycardia, altered mental status, myoclonus and hyperreflexia. Of note, hyperreflexia helps distinguish serotonin syndrome from NMS, in which patients develop hyporeflexia.
How do antipsychotics work?
Inhibiting the release of DA from the basal ganglia. While the inhibition of dopamine helps control hallucination and other psychotic symptoms, it can also lead to tardive dyskinesia and other extrapyramidal symptoms.
What is the main differences between atypical and typical antipsychotics?
Atypical also inhibit the release of DA but are less likely than typical to cause EPS. However, atypical have other risks like weight gain, metabolic syndrome and agranulocytosis.
How do you diagnose MDD?
5 or more of SIGECAPS (changes in sleep, interest, guilt, energy, concentration, appetite, psychomotor symptoms, suicidality) during the same two week period, difference in functioning. At least one symptom is depressed mood or loss of interest or pleasure.
What is bipolar disorder characterized by?
Episodes of mania and episodes of depression. Know that mania consists of abnormally elevated energy levels.
What are SSRIs the treatment of choice for?
MDD, but also many psychiatric disorders, including obsessive compulsive disorder and chronic treatment for anxiety disorders.
What is lithium the treatment of choice for?
Bipolar disorder
What can lithium lead to?
Lithium levels must be closely monitored as lithium toxicity can lead to nephrogenic diabetes insipidus. Lithium is also contraindicated in pregnancy as it can lead to Ebstein’s anomaly in the fetus.
What is the duration of schizophrenia?
Patients with schizophrenia have delusions and/or hallucinations affecting their lives for at least 6 months.
What is the duration of schizophreniform disorder?
Patients have psychotic symptoms for more than 1 month but less than 6 months.
What is the duration of a brief psychotic disorder?
Patients have psychotic symptoms for less than 1 month.
