Psych

Question 1

Organic v. Functional Psychosis

Answer 1

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.

Question 2

Reversible Psychosis

Answer 2

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

Question 3

Life-Threatening Psychosis

Answer 3

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

Question 4

Acute Psychosis Labs

Answer 4

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

Question 5

Causes of Secondary Depression

Answer 5

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.

Question 6

MDD

Answer 6

Symptoms nearly every day for 2+ weeks:

Depressed mood or loss of interest + 5/8 SIGECAPS.

Question 7

Hospitalize for SI?

Answer 7

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

Question 8

Common medical conditions that manifest as violent behavior.

Answer 8

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

Question 9

Violent Patients

Answer 9

1. verbal redirection

2. physical or chemical restraints

Question 10

Chemical Restraints

Answer 10

1. BZDs
2. Typical Antipsychotics
3. Atypical Antipsychotics

Question 11

BZDs

Answer 11

*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!!!)

Question 12

Traditional Antipsychotics

Answer 12

*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.

Question 13

Atypical Antipsychotics

Answer 13

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.

Question 14

NMS

Answer 14

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