Psychiatry Flashcards
4 P’s of the biopsychosocial model
- Predisposing
- Precipitating
- Perpetuating
- Protective
Suicide Risk Factors
SAD PERSONS
- Sex: male
- Age: >60
- Depression
- Previous attempts
- Ethanol abuse
- Rational thinking lost (i.e. Delusions, hallucinations, hopelessness)
- Suicide in family
- Organized plan
- No spouse
- Serious illness
(Think of the young 29y/o punk in PICU)
Important elements (4) to a safety plan
- Not harm themselves
- Avoid drugs, EtOH, and triggers
- Follow up at designated time
- Go to Emerg, call HCP, or call someone
Important elements (3) to a safety plan
- Not harm themselves
- Avoid drugs, EtOH, and triggers
- Follow up at designated time
- Go to Emerg, call HCP, or call someone
Time line for:
- Brief psychotic disorder
- Schizophreniform disorder
- Schizophrenia
- Brief psychotic disorder
- Schizophreniform disorder 1-6 months
- Schizophrenia > 6 months
Schizoaffective Disorder: DSM 5 Criteria
2 weeks or more with no mood symptoms
DSM 5 criteria for Schizophrenia
6 months of disturbanc, with at least 1 month of continuous symptoms (min 1 from each list) + _>_3 of the following:
Positive symptoms:
- Delusions
- Hallucinations
- Disorganized speech
- Disorganized or catatonic behaviors
Negative symptoms
- Anhedonia, avolition, alogia, affective blunting Think of ‘Robert’
Basic activities of daily living
DEATH
- Dressing
- Eating
- Ambulating
- Toileting
- Hygiene
Instrumental activities of daily living
SHAFT
- Shopping
- Housekeeping
- Accounting
- Food-preparation
- Transportation
Types of Dementia
- Alzheimer’s (60-70%)
- Vascualar (10-20%)
- Lewey body (10-20%)
- Frontatemporal/Pick’s (5-15%)
- Parkinson’s Disease
- Hungtington’s Disease
CAM
Confusion Assessment Method
Guideline taught to nurses to assess baseline cognition for every patient over 65 years of age.
Delerium Accronym
DIMS-O
- Drugs/Drug withdrawal
- Infection
- Metabolic
- Structural
- Organ System
PRISME
Identify and addresses factors contributing to delerium
- P: pain, poor nutrition
- R: retention, restraints
- I: infection, inmobility
- S: skin, sleep, sensory deficits
- M: mental status, metabollic, medications
- E: environment
4 Traditional Anti-Psychotics
- Haloperidol
- Loxapine
- Chlorpromazine
- Perphenazine
5 Atypical Antipsychotics
- Aripiprazole (AbilifyTM)
- Clozapine (ClozarilTM)
- Olanzapine (ZyprexaTM)
- Risperidone (ResperidolTM)
- Quitiapine (SeroquelTM)
Benzodiazapine list
- Lorazipam is Ativan
- Diazepam is Valium
- Oxazepam is Serax
- Clonazepam
Venlafazine (EffexorTM)
- Drug class
- SNRI
Extra Pyramidal Symptoms
TAP’D
- Tardive Dyskinesia - abnormal involuntary movement disorder (SSRI’s & antipsycotics)
- Akathesia
- Pseudoparkinsonianism
- Akinesia/Bradykinesia
- Rigidity
- Rabbit Tremor
Tardive Dyskinesia
- Involuntary muscle movement
- Starts months after meditcation
- Often permanent; non-treatable with benztropine
- Generally starts around mounth and tongues
- Can get grinding teeth (can lose teeth)
- Can spread to other parts of the body
- Tx: ween the patient off the offender
Akathisia
- The preception of restlessness
- Onset weeks after offender
- Tx: beta-blockers
General anti-psychotic side effects
- EPS (risperidone)
- Sedation (quitiapine)
- Dizziness/Orthostatic Hypotension (quitiapine)
- Anti-cholinergic effects (olanzapine)
- Metabollic syndrome (olanzapine!)
Symptoms treated by Anti-Psychotics
- Delusions
- Hallucinations
- Physical/verbal aggression
- Manic-like
- Sexually inappropriate behaviour
Major Neurodegnerative
6 Common SSRI’s
- Sertraline (ZoloftTM)
- Escitalopram (CipralexTM)
- Citalopram (CelexaTM)
- Paroxetine (PaxilTM)
- Fluoxetine (ProzacTM)
- Fluvoxamine
Common Anti-cholinergic Side-effects
- Confusion
- Dry mouth
- Urinary retention
- Constipation
- Exacerbation of closed angle glaucoma
- Delirium
- Tachycardia
Define: Countertransference
The therapists emotional response to the patient
- Can be related to therapist’s past relationships
- Can be in response to unconscious pressure from patient to behave in a certain way
- Two types
- Concordant CT: therapist experiences patient’s emotions
- Complementary CT: therapist experiences the emotions of patient’s hisotircal caregiver
Three types of Defense Mechanisms
- Primitive (i.e. splitting, projection, denial)
- Neurotic (i.e. intellectualisation, repression)
- Mature (i.e. alturism, humour)
Explain Projection and Projective Identification
Patient will internalize aspects of absuer, but cannot accept the feelings and impulses and project them to others, making the others be abusive.
Define: Splitting
Splitting (also called black and white thinking or all-or-nothing thinking) is the failure in a person’s thinking to bring together both positive and negative qualities of the self and others into a cohesive, realistic whole. It is a common defense mechanism used by many people.
i.e. “You’re the best psychiatrist. The other ones were wrong about everything.”
Psychodynamic Psychotherapy Techniques
- Uncover unconscious thoughts
- Pay attention to Freudian slips/parapraxes
- Free associations
- Dreams
- Observe defense mechanisms as they happen
- Monitor transferDence/counter transference
Psychodynamic Psycotherapy Applications
Neurotic level disorders
- Anxiety disorders
- Conversion disorders
- Dysthymic disorder
- Mood disorders (mild-moderate)
- Personality disorders (mild-moderate)
The 4 Hateful Paitents
+ Solutions
- DEPENDENT CLINGERS: needy, seductive, grateful; early on say “I’m ony human” and set boundaries
- ENTITLED DEMANDERS: hostile, narsisstic; say “you are entitled to the very best medical care, but you must help us.”
- MANIPULATIVE HELP-REJECTERS: moms, needy; share pessimism/warn medications often fail
- SELF-DESTRUCTIVE DENIERS: help them anyway. That’s all.
Define: CBT
- Aaron Beck (father of CBT) - relautionship between thought, emotions, and behviours; emotions are hard to change, so target the other two
- Judith Beck (daughter) - focus on here and now (next week)
*
Dysfunctional Congntions
- Automatic thoughts (rapid responses
- Maladaptive schemas (i.e. “I will never succeed”)
10 Common Automatic Cognitive Distortions
Jammed Slop
- Jumping to conclusions
- All or nothing thinking
- Magnifying/minimising
- Mental filter
- Emotional reasoning
- Discounting the positive
- ‘Shoulds’
- Labeling
- Overgeneralization
- Personalisation
Formula for Anxiety
(Perceived probability of event X Perceieved severity of event) / Perceived ability to cope
DBT Skill Modultes
- Mindfulness
- Interpersonal effectiveness
- Distress tolerance
- Emotion regulation
IPT Uses
Adjunctive treatment in Bipolar disorder (combine with social rhythm therapy)
Treatment for MDD, bulimia, and dysthymia
Define: pseudocyesis
Patient who is not pregnant shows signs and symptoms of pregnancy, including abdominal distension, breast enlargement, pigmentation, cessation of menses, and morning sickness.
Define: Adynamia
Weakness and fatigability
Define: acathexis
lack of feeling associated with an ordinarily emotionally charged subject
Define: alexithymia
Inability/difficulty describing or being aware of emotions/mood
Define: sundowning
Syndrome in older people, often at night, characterized by drowsiness, confusion, ataxia, and falling; overly sedated with medications
Define: coprophagia
eating of feces
Define: polyphagia
pathological overeating
Differentiate between:
- Circumstantiality
- Tangentiality
- Flight of Ideas
- Loosening of associations
- Pressure of speech
- Circumstantiality -indirect, but reaches the point
- Tangentiality - indirect, but never reaches point
- Flight of Ideas - constant shifting between ideas, sometimes able to follow
- Loosening of associations - unrelated shifting between ideas, can reach incoherence
- Pressure of speech - rapid speech and difficult to interrupt
Differentiate between:
- Tactile Hallucination
- Somatic Hallucination
- Tactile: False perception of touch or surface sensation (i.e. phantom limb, formication)
- Somatic: false sensation of thins in or to the body (usually visceral in origin)
Differentiate between:
- Depersonalization
- Derealization
- A person’s subjective sense of being unreal, strange, or unfamiliar
- A subjective sense that the environment is strange or unreal; a feeling of changed reality
Differentiate between:
- Thought broadcasting
- Throughs of inference
- Thought broadcasting:
- Throughs of inference
DSM 5 Criteria for Depressive Episode
5 of the following, including at least one of the first two, for at least 2 weeks and cause FUNCTIONAL IMPAIRMENT
- Depressed mood
- Anhedonia
- Sleep distrubances
- Feelings of guilt/worthlessness
- Energy low
- Poor concentration
- Increased/decreased appetite/weight
- Psychomotor slowing
- Suicide ideation
DSM 5 criteria for manic episode
At least 1 week of 3 the following, plus the first 1 (or 4 plus the first one, if mood is irritible); and cause FUNCTIONAL IMPAIRMENT:
- Abnormally persistent expansive, elevated or irritible mood
- Distractibility
- Insomnia
- Grandiose delusion
- Flight of ideas
- Activity focused/goal oriented
- Speech pressured
- Thoughtlessness (high risk activities with consequences)
DSM 5 criteria for mixed episode
Criteria is fully met for manic and depressive episode, minimum 1 week.
NOTE: like mania, a psychiatric emergency
Differences between Manic and Hypomanic Episodes
Mania
- _>_7 days
- Functional impairment
- Requires hospitalization
- Possible psychosis
Hypomania
- > 4 days
- No functional impairment
- Does not require hospitalization
- No psychosis
Medical causes of mania (5)
- MS
- Temporal lobe seizures
- Hyperthyroidism
- Neoplasms
- HIV Infections
MoNaSH - T
DSM IV diagnostic criteria for Major Depressive Disorder
_>_1 depressive episode and no history of manic or hypomanic episodes
Serotonin Syndrome Symptoms (3)
- autonomic instability
- hyperthermia
- seizures/confusion
- muscle rigidity
Too much serotonin… I think… fml.
SSRI Side Effect Profile
Mostly mild:
- Headache
- GI intolerance
- Sexual dysfunction
- Rebound anxiety
Psychotherapies
- CBT
- DBT
- IPT
- Dynamic psychotherarpy
- Family therapy
- Group therapy
What is ECT?
- A unilateral or bilateral induction of a generalized seizure lasting less than 1 minute
- Atropine, followed by a muscle relaxant
- About 8 treatments over 2-3 weeks, typical
- Retrograde amnesia, gone after 6 months
- Stimulants lower threshold for seizure, incase max dose given
DSM IV Bipolar 1 Criteria
One bipolar or mixed episode +/- depressive episodes, hypomanic episodes, etc.
Treatment for Bipolar Disorder
- Lithium
- Anti-convulsants (valporic acid, carbamazepine)
- Olanzapine (anti-psychotic)
DSM IV criteria for Bipolar 2
No manic episode ever, but at least one hypomanic episode PLUS _>_1 depressive episodes
Side effects of Lithium (13)
- Weight gain
- Tremor
- GI disturbances
- Fatigue
- Arrhythmias
- Seizures
- Goiter/hypothyroidism
- Leukocytosis (benign)
- Coma
- Polyuria
- Polydipsia
- Alopecia
- Metallic taste
Dysthimic Disorder Diagnosis
Dysthymic disorder (DD) = 2 Ds
- 2 years of depression
- 2 listed criteria:
- Sleep disturbances
- Hopelessness
- Energy low
- Concentration low/difficulty deciding
- Appetite high or low
- Self-esteem low
- Never asymptomatic for > 2 months
DSM IV criteria for Cyclothymic Disorder
- Numerous episodes of hypomania and/or mild-moderate depressive episodes over 2 years
- Never symptom free for >2 months in 2 years
- No reported manic or depressive episodes
General definition of a personality disorder
Pattern of behaviours that differ from one’s culture plus:
- Cognition
- Affect
- Personal Relations
- Impulse Control
(CAPRI)
Classify the clusters of personality disorders
-
Cluster A: Mad/Psychotic
- Schizoid
- Schizotypal
- Paranoid
-
Cluster B: Bad/Mood
- Borderline Personality
- Anti-social
- Histrionic
- Narcissitic
- Cluster C: Sad/Anxiety
- Avoidant
- Dependent
- Obsessive Compulsant
DSM IV Criteria for Paranoid Personality Disorder
A general distrust beginning by early adulthood
and present in different contexts + > 4 of the following:
1. Suspicion (without evidence) that others are exploiting or deceiving him or her
2. Preoccupation with doubts of loyalty or trustworthiness of acquaintances
3. Reluctance to confide in others
4. Interpretation of benign remarks as threatening or demeaning
5. Persistence of grudges
6. Perception of attacks on his or her character that are not apparent to others; quick to counterattack
7. Recurrence of suspicions regarding fidelity of spouse or lover
Differentiate between paranoid personality disorder and paranoid schizophrenia
PPD do not have fixed delusions and psychosis is only transient and under stress
DSM IV criteria for Schizoid Personality Disorder
Voluntary social withdrawal, restricted affect. + _>_4 of the following
- Not enjoying family or friend
- Solitary activities
- LIttle to no sex drive
- Anhedonia
- Few friends/if any
- Indifference to praise or criticism
- Emotional coldness, detachment, or flattened affect
Differentiate between schizoid and avoidant personality disorders.
Schizoid PREFERS to be alone.
DSM IV Schizotypal Personality Disorder
Social deficits related to magical thinking and eccentric behaviour + > 5 of the following:
- Ideas of reference (excluding delusions of reference)
- Odd beliefs or magical thinking, inconsistent with cultural norms
- Unusual perceptual experiences (such as bodily illusions)
- Suspiciousness
- Inappropriate or restricted affect
* *6. Odd or eccentric appearance or behavior**
* *7. Few close friends or confidants** - Odd thinking or speech (vague, stereotyped, etc.)
- Excessive social anxiety
Early signs of Anti-Social Personality Disorder
- Conduct disorder in childhood
- History of abuse (physical/sexual)
- History of hurting animals
- History of starting fires
- Violations of the law
DSM IV criteria for Antisocial Personality Disorder
- Disregard for others/rights since age 15, but diagnosis after age 18.
- History consistent with conduct disorder
- + _>_3 of the following:
- Unlawful non-conforming acts
- Deceitfulness/repeated lying/manipulating others for personal gain
- Impulsivity/failure to plan ahead
- Irritability and aggressiveness/repeated fights or assaults
- Recklessness and disregard for safety of self or others
- Irresponsibility/failure to sustain work or honor financial obligations
- Lack of remorse for actions
DSM IV criteria for Borderline Personality Disorder
- Impulsive or unstable relastionships/affect/self-image/behaviours
- + _>_5 of the following:
(IMPULSIVE)
- I - impulsive x 2
- M- moody
- P - paranoid under stress
- U - unstable self image
- L - Labile relationships
- S - suicidal/self harm
- I - inappropriate anger
- V - vulnerable to abandonment
- E - emptiness
DSM IV criteria for Histrionic
- *Excessive emotionality and attention seeking + _>_5 of the following**
1. Uncomfortable w/o attention
2. Inappropriately seductive or provocative behavior
3. Uses physical appearance to draw attention to self
4. Has speech that is impressionistic and lacking in detail
5. Theatrical and exaggerated expression of emotion
6. Easily influenced by others or situation
7. Perceives relationships as more intimate than they actually are
More functional and less depressed than BPD
DSM IV criteria for Narcissistic Personality Disorder
_>_5 of the following
- Grandiosity
- Grandiose fantasies
- Can only associate with high-status individuals
- Needs excessive admiration
- Has sense of entitlement
- Takes advantage of others for self-gain
- Lack Empathy
- Envious or believes others are envious
- Arrogant or haughty
DSM IV criteria for avoidant personality disorder
- Avoidant, but desires relationships, absolute fear of rejection
- Avoids work with interpersonal contact
- Avoid uncertain interactions
- Cautious of intrapersonal relationships
- Preoccupied with social rejection
- Inhibited in new social situations
- Believes they are socially inferior/inept
- Reluctant in new activities due to embarrassment
DSM 5 criteria for Delerium
- Change from baseline
- Short time line +/- prodromal
- Disturbance in cognitive
- Not from pre-existing neurocognitive disorder
- Not due to other medical
INCLUDE SPECIFIERS: hyperactive (agiation) or hypoactive
Vascular Dimentia features
- stepwise decline in cognition (multpile infarcts) or more gradual (small vessel ischemia)
- Frontal lobe = emotional lability
2 variants of Fronto-Temporal Dementia & features
- Behavioural variant
- Language variants
- i.e. Difficulty remebering words, but remember function
The most affected neurotransmitter deficiency in Alzheimer’s Disease
Acetylcholine
If patient is not oriented, which is better: MMSE or MOCA?
MMSE
The MOCA is more complicated, but the MMSE does not test executive function (have them do a clock)
Give me the profile for one atypical anti-psychotic
Risperidone
- Initial dose 1-2 mg PO daily
- Titrate up 1-2 mg PO per day
- Maximum dose 6 mg PO daily
- Thereapeutic dose
Treatment for Alzhimer’s
- Rivastigmine
- Donepezil
- Galantamine (contraindicated with asthma, bradycardia, active ulcers)
DSM 5 criteria for Dependent Personality Disorder
- Submissive, clingy, desperately relationship seeking
- 5 of the following:
- Difficulty deciding without reassurance
- Needs others to take responsibility for Pt
- Fear prevents disagreement
- Difficulty initiating projects, because of lack of confidence
- Excessively seeks support
- Helpless when alone
- Serial approach to relationships
- Fear of taking care of self
DSM 5 criteria for OCPD
- Patient is inflexible, focused, and detail oriented, preventing task performance in time
- FOUR or more of the following
- Detail/rule focused
- Detrimental perfectionism
- Excessive devotion to work
- Excessive attention to ethics
- Inability to delegate
- Unable to discard worthless objects
- Miserly (selfish with objects)
- Rigid and stubborn
Lambert
Types of Anxiety Disorders
- Generalized Anxiety Disorder
- Social Anxiety Disorder
- Separation Anxiety Disorder
- Selective Mutism
- Post Traumatic Stress Disorder
- Specific Phobia
- Panic Disorder
- Agoraphobia
9.
Define: Panic Attack
Intense fear & discomfort + _>_4 of the following:
- Palpitations
- Abdominal distress
- Numbness, nausea
- Intense fear of death
- Choking, chills, chest pain,
- Sweating, shaking, shortness of breath
DSM IV criteria for Panic Disorder
- Attack with no obvious trigger + minimum 1 month of _>_1 of the following
- Persistent concern of next attack
- Worry about the implications of attacks (“Am I out of control?”)
- Change in behaviour because of attacks
DSM IV criteria for Agoraphobia
- Anxiety for situations difficult to escape or will be without help for a panic attack
- Avoid, endure with severe distress, or bring a companion to these situations
- Not better explained by another mental disorder
DSM IV criteria for Specific Phobias
- Persistent excessive fear of specific
- Anxiety with exposure
- Patient recognizes that the fear is excessive
- Avoidance or tolerance with intense anxiety
- Under 18, duration must be at least 6 months
DSM IV criteria for PTSD
1 month or more of all of the following:
- Trauma (potentially harmful + intense fear)
- Persistent reexperiencing of the event
- Avoidance of triggers or difficulting recalling event
- Decreased affect/feeling detached
- Persistent increased arousal
DSM IV criteria for GAD
Persisten worry about normal daily stuff, for more than 6 months, plus _>_3 of the following:
- Concentration poor
- Restlessness
- Irritable mood
- Muscle tension
- Energy low
- Insomnia
DSM IV criteria for Adjustment Disorder
- Sx’s within 3 months of stress and resolved within 6 months of resolution of stressor
- Either excess distress or significant loss of function
- Sx’s are not bereavement
DSM IV criteria for substance abuse
(using substances badly) A pattern leading to impairment or distress for _>_1 year with _>_1 of the following:
- Unmet obligations
- Dangerous use
- Related legal problems
- Continued use despite problems
DSM IV criteria for dependence
- Impairment or distress manifested for _>_1 year with _>_3 of the following:
- Tolerance
- Withdrawal
- Using more than intended
- Desire or unsuccess to cut back
- Time spent using/recovering
- Use despite problems
CAGE Questions
- Have you ever felt the need to cut back your drinking?
- Have you ever felt annoyed by criticism about your drinking?
- Have you ever felt guilty about your drinking?
- Have you ever had a drink as an ‘eye opener’?
Blood Alcohol of a drunk person
>150mg/dL or 0.15mg% causes obvious signs of intoxication in 50% of adults
What does Thiamine prevent?
Wernickles’
Time line of Alcohol withdrawal
- Onset 6-24 hours
- Lasts 2-7 days
*
Severity of Alcohol Withdrawal
- Mild: Irritability, tremor, insomnia
- Moderate: Diaphoresis, fever, disorientation
- Severe: Grand mal seizures, DTs
Wernickle’s Encephalopathy
- Ataxia
- Confusion
- Ocular abnormalities (nystagmus, gaze palsies)
Korsakoff’s Syndrome
- Impaired recent memory
- Anterograde amnesia
- +/− Confabulation
Effects of Cocaine Intoxication
- Death (2nd to arrhythmia, seizure, or respiratory depression)
- Euphoria
- Hallucinations (tactile)
- Hyper or hypotension
- Brady or tachycardia
- Nausea
- Dilated pupils
- Weight loss
- Agitation/Depression
- Chills/sweating
Cocaine Intoxication & Dependence & Withdrawal Treatment
Intoxication
1. Mild-Mod: Benzodiazepines
2. Severe: Haliperidol
+ Symptomatic support
- *Dependence:**
1. Psychotherapy, group therapy
2. Tricyclic antidepressants (TCAs)
3. Dopamine agonists (amantadine, bromocriptine)
Withdrawal
… just let them sleep it off, since they’re crashing…
PCP intoxication symtoms
- Rotary nystagmus
- Impulsivity
- Hypertension/tachycardia
- Muscle rigidity
- Pain tolerance
Gamma-hydroxybutyrate
(GHB, “Grievous Bodily Harm”)
- Dose specific CNS depressant
- Memory loss
- Respiratory distress
- Coma
Treat with activated charcol (prvent more GI absorption)
Opioid Overdose
- Respiratory depression
- Altered mental status
- Miosis
“Rebels Admire Morphine”
Opiate Withdrawal Symptoms
- Dysphoria
- Insomnia,
- Lacrimation, rhinorrhea
- Yawning
- Weakness
- Sweating, piloerection,
- Nausea/vomiting
- Fever
- Dilated pupils
- Muscle pain
DSM IV criteria for Binge Eating Disorder
- Excessive eating within a 2 hour time at least 2/week for at least 6 months
- Done without compensatory behaviour (i.e. purge)
- Severe stress with over-eating
- Must have 3 of the following:
- Eating very rapidly
- Eating to be uncomfortable full
- Eat when not hungry
- Eating in insolation out of embarassment
- Guilt, depressed, or disgusted about overeating
6.
DSM IV criteria for Bulimia Nervosa
- Over eating with compensation (i.e. purge, exercise, laxatives)
- 2/week for at least 3 months
- Perception of self-worth is heavily influenced by body weight
DSM IV criteria for Anorexia Nervosa
Acutally requires low body weight. Criteria:
- 15% below average body weight
- Amenorrhea
- Intnese fear of gaining weight/fat
- Disturbed body image
What are the major risks of Clozapine?
- 2-3% risk of seizures
- 0.5-2% risk of agranulocytosis
When should blood work be taken for a patient taking clozapine?
CBC diff
- 1/week for 6 stable months
- 1/2 weeks for 6 stable months
- Monthly therafter
Bio-psycho-social considerations for Schizophrenia
- Bio
- Continue antipsychotic for 1-2 years
- Monitor AIMS (EPS symptoms)
- Monitor Metabollic sypmtoms
- Monitor CBC-Diff
- Plan G
- Family Doctor
- Psycho
- CBT when not acute
- Family education, support, and involvement
- Social
- Housing
- Independent living strategies (OT)
- Substance avoidance
Drugs for Opiate Withdrawal
- Clonidine
- and/or Buprenorphine
- Severe cases: taper with methadone 7 days
Lithium Toxicity
4 days of nausea, vomiting, and diarrhea. On examination she is tremulous and weak. She seems somewhat confused and cannot recall what medication she is on.
Activated charcol not helpful.
L
Lithium has a narrow therapeutic range with a target serum concentration between __ and __. GI side effects and tremor start at __, while seizure, coma, and death can occur with concentrations greater than __.
0.6 and 1.2; 1.5; 2.5.
Which of the atypical antipsychotics has the lowest associated risk of inducing EPS?
clozapine
What percentage of patients with schizophreniform disorder go on to develop schizophrenia or schizoaffective disorder?
66%
Depressive symptoms are present in what percentage of the older adult community?
15%
A patient with dementia who presents with memory impairment, executive dysfunction, visual hallucinations and Parkinsonian symptoms is most likely to have which type of dementia?
Lewey body dimentia
Some TCA side effects
Blurred vision, dry mouth and sedation
Some SNRI side effects
Increased blood pressure, increased heart rate, irritability
The amino acid, L-tryptophan, is the precursor to which neurotransmitters?
Serotonin
A 19 year old male is brought to the emergency by his distraught parents for vomiting and profuse diarrhea. On arrival, his pupils are dilated. He has cold and sweaty extremities with goose flesh. His BP is 175/ 105 and his muscles are twitching. His parents report that these symptoms started 2 hours earlier. For the past two days, he has been house bound due to a fractured ankle. He has become increasingly anxious and agitated during the period. He is constantly yawning and has a runny nose. What is the most likely drug that this man is withdrawing from?
Heroine
A 25 year old male is brought to the emergency by his distraught parents because they found their son on the floor with an assortment of pills and bottles around him. The patient is stuporous and his eyes are constricted. His breathing is slow, shallow and infrequent. While on the way to the emergency, he had a grand mal seizure. What drug did he most likely overdosed on?
An opiate (merpidine..?)
A 13-year-old girl was brought into the emergency department for bizarre behaviour by the police. She complains of “hearing colours and seeing sounds.” She feels that she is going “crazy.” On examination she has tachycardia, hypertension and has mydriasis. She thinks it might be due to the white tabs her boyfriend gave her 1 hour ago at a rave party. Which of the following substances did she most likely consume?
LSD
Peaks at 4 hours, clears in 12 hours
