Neuro-Psych Flashcards
Bipolar spectrum
BPDI = mania +/- depression BDII = hypomania + MDD Cyclothymia = (mild hypomania + dep) * 2yrs
How do antipsychotics affect HPO axis?
Anti-psychs are anti-DA
Halting DA means no inhibition of Prl, which then …
*Risperidone is the worst
DA agonists
Bromocriptine
Cabergoline
Pramipexole
Ropinirole
Pronator drift
- sensitive and specific for UMN lesion, or pyramidal/corticospinal tract disease
- UMN lesions cause disproportionate weakness in the supinator muscles, so the pronator muscles dominate
Treatment for BPD
1st line: monotherapy with Li, VPA, quetiapine, lamotrigine
2nd line: combo therapy with Li or VPA, plus 2nd gen AP
*Don’t use SSRI –> it will destabilize mood
First and second generation anti-psychotics
FGA: (-azine)
High potency = Haloperidol, Trifluoperazine, Fluphenazine
Low Potency = Chlorpromazine, Thioridazine
SGA: Quetiapine, Olanzapine, Risperidone, Aripiprazole, Clozapine, Ziprasidone,
Major side effects of FGAs
- NMS
- Anti-muscarinic
- Anti-histamine (sedation)
- EPS
- lower sz threshold
- Hyperprolactinemia
- Torsade
*Thioridazine–retinal deposits; Chlorpromazine–corneal deposits
Major side effects of SGAs
- NMS
- SOME anti-muscarinic (worst with Clozapine)
- Anti-histamine (sedation; worst with Quetiapine and Clozapine)
- EPS (worst with risperidone, least with clozapine and quetiapine)
- Metabolic syndrome: dyslipidemia, DM, weight gain (worst with Clozapine & Olanzapine, least with Ziprasidone & Aripiprazole) AZOC
- Hyperprolactinemia (worst with Risperidone)
- Torsade
*Clozapine–lower sz threshold, agranulocytosis, myocarditis/CM; most anti-muscarinic and metabolic side effects
Uses for FGAs and SGAs
FGAs: psychosis, schizophrenia, acute agitation/aggression, Tourette’s
SGAs: acute agitation, bipolar mania, treatment-resistant depression, 2nd line OCD, risperidone for Tourette’s, clozapine for treatment-resistant schizophrenia
Risperidone is the worst at… (side effects)
EPS
hyperprolactinemia
Treatment for catatonia
BZDs
When should BZDs not be used because of AEs?
in the elderly - makes them more likely to experience confusion and falls; also they can cause paradoxical agitation which occurs within an hour of taking dose (so DO NOT increase the dose in this case it will make it worse)
Serotonin syndrome vs NMS
NMS = autonomic instability like fever, along with AMS/delirium, rhabdo, lead pipe rigidity; can treat with dantrolene or DA agonist (bromocriptine)
SS = neuromuscular instability like myoclonus, hyperreflexia, and tremor (no rigidity), fever, GI sx like V/D; can treat with BZDs for agitation and cyproheptadine
Borderline vs Histrionic PD
Borderline = labile mood, chaotic relationships, self-harm, splitting; also associated with mood d/o Histrionic = dramatic, superficial, attention-seeking, regression; also associated with somatic disorders
BZD antagonist
EtOH antagonists
Opiate antagonists
Flumazenil
Fomepizole, Disulfiram
Naloxone, Naltrexone, Methylnaltrexone
