Psychiatry Flashcards
generalized anxiety disorder path
constant state of worry
generalized anxiety disorder pt
worry about most things on most days of most months (>/= 6mo)
>/= 3 somatic complaints
generalized anxiety disorder dx
clinical
generalized anxiety disorder tx
psychotherapy
SSRI or buspirone adjunct
social anxiety disorder path
irrational and exaggerated fear related to social performance
egodystonic
6mo+ duration
social anxiety disorder pt
anxiety and avoidance of stimulus
public speaking or public restrooms
social anxiety disorder dx
clinical
social anxiety disorder tx
CBT
ß blockers for public speaking
specific phobia path
irrational and exaggerated learned fear response to a specific trigger
egodystonic
6mo+ duration
specific phobia pt
anxiety and avoidance of stimulus
spiders, heights, clowns, etc
specific phobia dx
clinical
specific phobia tx
CBT
- desensitization: longer, better
- flooding: faster, not as good
control with SSRI during CBT
panic attack path
random and unprovoked bouts of intense anxiety without warning
panic attack pt
STUDENTS PANIC Shortness of breath Trembling Unsteadiness Depersonalization Excessive heart rate Numbness Tingling Sweating Palpations Abdominal distress Nausea Intense fear of losing control/dying Chest pain
panic attack dx
r/o medical disease:
- EKG + troponins
- asthma
- TSH, toxicology
panic attack tx
abort - benzo
CBT to abort without meds
control - SSRI
panic attack f/u
agoraphobia
intermittent explosive disorder path
trigger = anxiety
violent act = relief
response DISPROPORTIONATE to stressor (verbal, physical, etc)
intermittent explosive disorder pt
2x/wk in 3 mo without harm OR 3x in a year WITH harm males >> females decrease symptoms with increase age
intermittent explosive disorder dx
clx
intermittent explosive disorder tx
drugs (SSRI) = therapy (self-reflection) = drugs + therapy
pyromania path
setting fire = relief of pleasure
pyromania pt
more than 1 occasion
fire setting for decrease anxiety, increase sexual arousal, or increase pleasure
men»_space; women
pyromania dx
r/o arson
pyromania tx
none - incarceration
pyromania f/u
reaction formation
arson
monetary gain
to cause harm or to destroy
pyromania
decrease anxiety
sexual arousal
pleasure
kleptomania path
trigger = anxiety theft = relief
kleptomania pt
steals things
- little to no value
- pt can afford
- to decrease anxiety
- gifts/hides items
- and feels guilt/remorse
- impulsively, alone without external provocation
kleptomania dx
r/o pety theft
kleptomania tx
none
SSRI? Therapy?
theft vs. kleptomania
theft:
- desire, able to resist, HAS value, pt CAN’T afford, planned with help or provoked by external stimuli
- used or kept, NO remorse, NO guilt
kleptomania:
- decrease anxiety, unable to resist, has NO value, pt CAN afford, Unplanned, without help, and not proved by external stimuli
- stashed, gifted, or returned, remorse, guilt
obsessive compulsive path
obsessions = anxiety-PROVOKING thoughts, unwanted, and intrusive compulsions = anxiety-REDUCING actions, behaviors, or mental acts
obsessive compulsive pt
obsessions: contamination, symmetry, safety
compulsions: cleaning, washing, order, counting, lock checking
at least 1hr/d
causes impairment at school, work, socially
OCD dx
clx
OCD tx
CBT is best
SSIR or clomipramine (TCA)
hoarding path
OCD about throwing things away
hoarding pt
obsessions: ridding of possessions
compulsions: retaining useless items like trash or trinkets
unsafe or cluttered home
hoarding dx
clx
hoarding tx
CBT -> SSRI
body dysmorphic path
perceived flaws in physical appearance
body dysmorphic pt
obsessions: symmetry of body, hair, skin, nose, breasts, butt
compulsions: appearance, checking, approval-seeking
attempt to have multiple surgeries to correct what isn’t broken
body dysmorphic dx
clx
body dysmorphic tx
CBT -> SSRI
body dysmorphic f/u
DO NOT perform surgery as desired
muscle dysmorphic disorder path
perceived flaws in physical appearance
muscle dysmorphic disorder pt
obsession: muscle size
compulsions: excessive exercise, anabolic steroids
roid rage, rhabdo (renal failure), testicular atrophy, ‘copper disorder’
muscle dysmorphic disorder dx
clx
muscle dysmorphic disorder tx
CBT -> SSRI
trichotillomania path
general anxiety with hair pulling
trichotillomania pt
obsessions: none in particular
compulsions: pulling out hair items like trash
alopecia with hair in different lengths
trichotillomania dx
r/o fungus (KOH prep)
r/o medical causes for alopecia
trichotillomania tx
CBT -> SSRI
trichotillomania f/u
small bowel obstruction (trichobezoar)
PTSD path
stressor
- actual death, threat death, combat, rape, abuse
exposure
- experienced (self), witnessed (strangers), learned (family), repeated exposure to effects
PTSD pt
disorder
- intrusion, neg mood, dissociation, avoidance, arousal
nightmares, flashbacks, memories
depression-like
depersonalization, amnesia
symbols, locations, memories
hypervigilence, irritability, easily startled, CHANGED concentration
PTSD dx
> 3d and <1 mo = acute stress
>1 mo = PTSD
PTSD tx
group therapy (best)
SSRI/SNRI (adjunct)
benzos (panic attack only)
CBT
PTSD f/u
mood disorder
substance abuse disorder
RAD/DESD path
stressor = neglect or abuse in infancy
RAD/DESD pt
disorder =
too much attachment (DSED)
too little attachment (RAD)
RAD
reactive attachment disorder
DESD
disinhibited attachment disorder
RAD/DESD dx
<5 y.o
r/o autism
RAD/DESD tx
caregiver - teach how to parent
RAD/DESD f/u
mood disorder
learning disabiliites
adjustment disorder path
stressor = non-life threatening event
- marital strife, loss of job, moving away
adjustment disorder pt
disorder = mood changes that don’t quite fit another mood disroder
adjustment disorder dx
begin <3mo from stressor
lasts <6mo from stressors
adjustment disorder tx
generally not needed
MDD path
decrease mood OR anhedonia and >/= 2wks AND 5 of SIGECAPS
MDD pt
Sleep incr/decr Interest decreased Guilt increased Energy decreased Concentration decreased Appetite incr/decr Psychomotor decreased Suicidal increased
MDD dxc
r/o SI
MDD tx
if + SI, + plan => hospital
if + SI, NO plan => safety contract
Combo»_space; SSRI/SNRI > Psycho therapy
ECT best (refractory only)
Bipolar I path
mania = “E” + 3
duration >/= 1wk
Bipolar 1 pt
DIG FASTER Distractibility Insomnia Grandiosity Flight of ideas Agitation Sexual exploits Talkative Elevated mood Racing thoughts
Bipolar 1 dx
r/o Bipolar II
r/o cyclothymia
Bipolar 1 tx
ED = benzos
mood stabilizers = lithium >
- valproate backup = lamotrigine, carbamazapine
anti-psychotics = quetiapine
Bipolar II path
hypomania AND major depression
Bipolar II pt
hypomania = mania, but less
bipolar II dx
r/o bipolar I (catatonia, psychotic)
bipolar II tx
bipolar I
bipolar II f/u
if major depression, start SSRI, then have mania -> reveals bipolar I
dysthymia pt
decreased mood >/= 2yrs
symptoms not absent 2+ months
dysthymia dx
r/o hypothyroid
dysthymia tx
SSRI/SNRI
cyclothymia pt
mild bipolar II
baby blues
baby #1, cares about baby onset and duration within 2wks dysthymic depression no psychosis no tx
post-partum depression
> #1, doesn't care about baby, may hurt baby onset within 1mo, ongoing depression MDE no psychosis tx antidepressants
post-partum psychosis
> #1, fears the baby, likely to kill it onset within 1 mo, ongoing depression MDE psychosis + tx mood stabilizers or antipsychotics
grief
onset: any
duration: <12mo
focus: focused on deceased
when mood symptoms: waxes, wanes, can imagine happy
behaviors: YES insight “psychotic”, talking TO deceased, doing things as if they were there
why suicide: to be with deceased
tx: time, counseling
PCBD
onset: >/= 6mo
duration: >/= 12mo
focus: on deceased
when mood symptoms: persistent +, cannot imagine being happy
behaviors: NO insight, psychotic features
why suicide:
tx: SSRI
depression
onset: any
duration: >/= 12mo
focus: pervasive, global
when mood symptoms: persistent +, cannot imagine being happy
behaviors: NO insight; psychotic (hallucinations, delusions), talking WITH deceased, believing they are there doing things with you
why suicide: to end suffering, despondent
tx: SSRI
delusions
fixed false belief without basis in reality
do NOT confront delusion; it is a glaring truth to the patient, and you will not get anywhere by challenging them
schizophrenia path
thought disorder with unknown cause though is certainly a genetic component
receptor pathology
- dopamine (too much) -> + sxs
- serotonin (too much) -> - sxs
schizophrenia pt
psychotic break = first break occurs in teenager with stressor (college) who then begins behaving bizarrely positive symptoms (must have 1+) - bizarre delusions - hallucinations, usually auditory (voices) - disorganized speech - disorganized state/catatonia Negative symptoms - anhedonia - flat affect - cognitive defects
schizophrenia dx
clinical
r/o drug abuse (cocaine)
schizophrenia tx
anti-psychotics
- typical controls positive symptoms
- atypical controls negative symptoms
- clozapine when all else fails
acute psychotic disorder
duration sxs: < 1 mo
duration tx: wait (or tx)
schizophreniform disorder
duration sxs: < 6 mo
duration tx: 3-6wks
schizophrenia disorder
duration sxs: >/= 6mo
duration tx: lifetime
schizoaffective disorder
duration sxs: any with mood sxs
duration tx: lifetime; tx delusions first
treatment options for psychotic disorders: positive symptoms
typical: haloperidol, thiazide, chlorpromazine
treatment options for psychotic disorders: negative symptoms
atypical: risperidone, quetiapine, olanzapine, ziprasidone, aripriprazole
treatment options for psychotic disorders: best
clozapine
anorexia nervosa path
anxiety induced by fear of being or becoming fat
patient is not fat, but fears fat; sees herself as fat
lacks recognition of how thin she is
anorexia nervosa pt
F:M 10:1, teens to 20s
severe:
- hypotension, bradycardia, leukopenia
- CMP abnormalities, electrolytes and albumin
- BMI < 16
non-severe:
- lanugo, cold intolerance, amenorrhea, emaciation
anorexia nervosa dx
clinical
anorexia nervosa tx
hospitalize if severe - IV nutrtion - correct electrolytes - forced feed outpatient - antipsychotics and CBT
anorexia nervosa f/u
if OCD or MDD, add SSRI/SNRI
relapse in 5yrs
death from medical or suicide
bulimia nervosa path
anxiety from the binge, then compensates
normal weight to overweight
bulimia nervosa pt
F:M 10:1; teens to 20s
normal appearance except purge signs
purge >/= 1x/wk x3mo
bulimia nervosa dx
clinical
bulimia nervosa tx
SSRI/SNRI = fluoxetine (best)
CBT
bulimia nervosa f.u
never use bupropion - causes seizures
binge-eating disorder path
anxiety from the binge - no compensation
overweight to obese
binge-eating disorder pt
F:M 10:1, teens to 20s
cannot control eating habits
binge >/= 1x/wk x3mo
binge eating disorder dx
clinical
binge eating disorder tx
topiramate
CBT
methods of eating disorders: restriction
decrease caloric intake (fasting, dieting)
increase caloric expenditure (exercise)
methods of eating disorders: binge purge emesis
eating/binging then induced emesis
dorsal hand scars (from emesis)
dental erosions (from emesis)
metabolic alkalosis, hypoK, hypoMg
methods of eating disorders: binge purge laxative
eating/binging then induced diarrhea
metabolic acidosis
diarrhea
personality cluster A disorders
paranoid
schizoid
schizotypal
paranoid personality disorder description
distrustful, suspicious
interpret others as malicious
paranoid PD examples
‘enemy of the state’ gene hackman
paranoid PD how to handle
clear, honest, nonthreatening
schizoid PD description
loners, have no relationships, but are also happy not having any relationships
schizoid PD examples
night-shift toll booth
schizoid PD how to handle
you won’t see them
schizotypal description
magical thinking, borders on psychosis
bizarre thoughts, behavior, and dress
schizotypal example
lady gaga
schizotypal how to handle
brief psychotic episodes
clear, honest, nonthreatening
cluster B personality disorders
borderline
histrionic
narcissistic
anti-social
cluster C personality disorders
avoidant
dependent
obsessive-compulsive
borderline PD description
unstable, impulsive, promiscuous, emotional emptiness, unable to control rapid changes in mood, suicidal gestures
borderline PD examples
‘girl interrupted;
‘ fatal attraction’
borderline PD how to handle
suicidal gestures may be successful
splitting, dialectical behavioral therapy
histrionic PD description
theatrical, attention-seeking, hyper sexual, use of physical appearance, dramatic
exaggerated but superfluous emotions
histrionic examples
gone with the wind
Marilyn monroe
histrionic how to handle
set rules, insist they are followed
narcissistic description
inflated sense of self-worth or taken, self-centered, fragile ego, uses eccentric dress to draw attention, demands special treatment
narcissistic example
zoolander
ron burgundy
narcissistic how to handle
set rules, insist they are followed
anti-social description
criminal, no regards for rights of others, impulsive, lacks remorse, manipulative
must be >18y/o (conduct disorder)
anti-social examples
Tony soprano
the joker
anti-social how to handle
jail, set rules, insist they are followed
avoidant description
fears rejection and criticism, wants relationships but does not pursue them
passes on promotions
avoidant examples
Napoleon dynamite
shy hot librarian
avoidant how to handle
avoid power struggles, make patients choose
dependent description
unable to assume responsibility
submissive, clingy, fears being alone
dependent examples
stay at home mom in an abusive relationship
dependent how to handle
give clear advice, patient may try to sabotage their own treatment
obsessive compulsive description
rigid, orderly perfectionist
order, control
perfection at the expense of efficacy
obsessive compulsive example
monk
dissociative disorders path
severe + prolonged stressor causes separation of otherwise intact thought, memory, and identity
dissociative disorders pt
stressor proportional to disorder
dissociative disorders dx
amytal interview (truth serum)
r/o malingering
r/o substance abuse
dissociative disorder tx
psychotherapy
dissociative disorder f/u
non-severe = recovery severe = ?
dissociative identity disorder path
> /= 2 distinct identity states
most severe and prolonged trauma
dissociative identity disorder pt
self experiences - memory gaps (blackouts) - other dissociation symptoms others witness - paradoxical behaviors - appearance changes
dissociative identity disorder f/u
fight club, sybil
dissociative amnesia path
stressors include loss of memory
dissociative amnesia pt
memory loss of
- the event
- regular everyday occurrences/routine
- complete autobiographical self
dissociative amnesia f/u
law and order, SVU
dissociative amnesia with fugue path
stressors induce loss of memory WITH travel
dissociative amnesia with fugue pt
memory loss of
- the event
- regular everyday occurrences/routine
- complete autobiographical self
dissociative amnesia with fugue f/u
Jason Bourne, archer from FX
depersonalization derealization disorder path
adolescent with minor stressor (though stressor is relatively major for demographic)
depersonalization derealization disorder pt
seeing a video or dream of self, out of body experience (depersonalization)
detached from reality, as though in a dream
reality testing INTACT
catatonia path
not a disease state
modifier to another disease
psych - bipolar, depression»_space; schizophrenia
heart - autoimmune, paraneoplastic, nutritional
catatonia pt
must have 3 or more: - retarded catatonia -- stupor -- cata-LEPSY -- waxy flexibility -- mutism -- negativism - excited catatonia -- stereotypy -- agitation or grimace -- echolalia -- echopraxia retarded and excited symptoms may occur together
catatonia dx
clinical
lorazepam
catatonia tx
lorazepam (diagnostic and therapeutic)
malignant catatonia meds/hx
no meds, lorazepam corrects
malignant catatonia sxs
rigidity autonomic dysfunction (increase BP, HR, temp) muscle breakdown (increase CK)
neuroleptic malignant hyperthermia meds/hx
atypical antipsychotics/ lead-pipe rigidity
neuroleptic malignant hyperthermia sxs
rigidity autonomic dysfunction (increase BP, HR, temp) muscle breakdown (increase CK)
serotonin syndrome meds/hx
SSRI’s and hypertonicity/hyperreflexia
serotonin syndrome sxs
rigidity autonomic dysfunction (increase BP, HR, temp) muscle breakdown (increase CK)
malignant hyperthermia meds/hx
halothane anesthesia, family history
malignant hyperthermia sxs
rigidity autonomic dysfunction (increase BP, HR, temp) muscle breakdown (increase CK)
intellectual disability disorder path - chromosomal
down syndrome
fragile x
cri-du-chat
intellectual disability disorder path - maternal acquired
EtOH in utero
hypothyroid in utero
intellectual disability disorder path - child acquired
lead poisoning
head trauma
intellectual disability disorder pt
decrease cognitive skill
decrease adaptive functioning
+/- syndromic physical features
intellectual disability disorder dx
clx; severity on adaptive functioning
intellectual disability disorder tx
assess social, conceptual (speak, read, write), and practical (self mgmt)
special education, supervision
50-70 = group home, work and ADLs alone
25-49 = group home, ADLs alone
20-34 = institutionalized, supervised ADLs
<20 = institutionalized, total care
tic disorder (Tourette’s) path
essentially OCD
tic disorder (Tourette’s) pt
onset < 18 "obsession" = impulse to perform tic "compulsion" = the tic itself hidden: hair flicks, blinking, rubbing vocal: grunt, cough, yell NEVER a swear word
tic disorder (Tourette’s) dx
clx
tic disorder (Tourette’s) tx
dopamine antagonists
- fluphenazine, tetrabenazine
tic disorder (Tourette’s) f/u
ADHD on stimulants who gets worse is Tic disorder
autism spectrum path
impaired social communication - social reciprocity - social relationships - nonverbal communication - joint attending restrictive/repetitive behavior - stereotypy - sameness - restricted interests - change in perception
autism spectrum pt
young child, 1-4y/o
no social smile or eye contact
repetitive useless behaviors
insistence on consistency
autism spectrum dx
clx; severity based on progress
autism spectrum tx
supportive
ADHD path - impulsivity
blurts out answers
interrupts
fidgets a lot
cannot wait turn
ADHD path - inattention
talks fast
easily distracted
fails to complete tasks
ADHD path - timing and situation
> /= 2 settings
onset 7-12
duration >/= 6mo
ADHD pt
the 'ad kid' who is male, disrupts class and moves all over the place, fails to wait his turn, whose parents have a tough time controlling behaviorally, and whose like this in every setting ensure there are no absence seizures
ADHD dx
clx
ADHD tx
stimulants (avoid at night d/t insomnia)
- methylphenidate
- dextroamphetamine
ADHD f/u
special ed classes, parent education
if absence seizures, carbamazepine (ethosuximide)
learning disabilities path
performing substantially below expected for age and grade
learning disabilities pt
medical conditions
- deaf, blind, non-native speaker
poor education to date
- low socioeconomic class, home schooled
learning disabilities dx
audiology test
vision testing
language assessment
learning disabilities tx
remediate, fix the medical problem (glasses, hearing aids), fix the teacher to student ratio
conduct disorder path
antisocial personality disorder but <18
conduct disorder pt
bullying - hurts animals/people, uses torture/cruelty, forced sex
destruction - fire starting, lies, cheats, steals, breaks into property
rules violation - truancy, run away at least twice, staying gout at night before 13
conduct disorder dx
clx
conduct disorder tx
juvenile detention
conduct disorder f/u
fights authority
HARMS peers
oppositional defiant disorder path
incongruent parenting
teen acting out
oppositional defiant disorder pt
NO bullying - does NOT hurt animals/people, does NOT use torture/cruelty, no forced sex
destruction - lies, cheats, steals, breaks into property
rules violation - truancy, run away at least twice, staying out at night before 13
ODD dx
clx
ODD tx
improved parenting
ODD f/u
fights authority
COOPERATES with peers
enuresis - never been dry path
normal toilet training takes up to 7 years old
enuresis never been dry pt
if < 7 and still wets bed, NORMAL
enuresis never been dry dx
clx
enuresis never been dry tx
POSITIVE reinforcement
alarm blankets
water restriction before bed
DDAVP as last resort
enuresis never been dry f/u
TCAs may also be used
enuresis - was once dry path
regression, abuse, infection, anatomic
enuresis - was once dry pt
was once dry, now is not
enuresis - was once dry dx
u/a, u/s, clx
enuresis - was once dry tx
infection (abx); if STI then abuse
anatomic (resection)
regression (identify stressor)
abuse
encopresis and enuresis path
encopresis (stool) or enuresis (urine) repeatedly on clothes or bed
- intentional (acting out)
- incontinent (cognitive impairment)
- medication side effect
- anatomic (fistula)
- regression (abuse, stressor)
encopresis and enuresis pt
dependent on patients. look for new sibling, new step parent, or new house
antidepressants
SSRIs SNRIs atypical SM TCAs MAOIs
SSRIs
escitalopram citalopram fluoxetine paroxetine sertraline
SSRI side effects
decrease libido
delayed ejaculation
serotonin syndrome
GI, insomnia
SNRI side effects
cleaner, better version of SSRI, more expensive
SNRIs
venlafaxine
duloxetine
bupropion
smoking cessation
no weight gain
NEVER in bulimia (increase seizures)
mirtazapine, trazodone
appetite stimulant
sleep aid, caution priapism
TCAs
‘-tryptylines’
- imipramine
- desipramine
- doxepin
TCAs extra info
used for enuresis (anti-ash)
1st line use is neuropathic pain
can be lethal because of CCC (convulsions, coma, cardiac) so get EKG
has anti-ash properties (Dry mouth, sedation, urinary retention, constipation)
MAOIs
phenelzine
tranylcypromine
selegiline
MAOIs info
HTN crisis when mixed together, lack of washout, or eating of tyramine (red wine/cheese)
distinguish from other hypertensive-hyperthermia disorders in psych by the ABSENCE of lead-pipe rigidity and fever
mood stabilizers
lithium valproate quetiapine lamotrigine carbamazepine
lithium indications
first line, drug of choice for bipolar
bipolar, acute mania, depression augmentation
lithium side effects
teratogen
nephrotoxic > 1.5 - causes neph DI
narrow TI
valproate indications
first line in bipolar if Li cannot be used
also tx seizures
valproate side effects
teratogen (spina bifida)
thrombocytopenia
agranulocytosis
pancreatitis
quetiapine indications
second line bipolar
all phases of treatment
quetiapine side effects
weight gain, QTc prolongation
lamotrigine indications
second line bipolar
newer anticonvulsant
lamotrigine side effects
blurred vision
SJS
carbamazepine indications
third line bipolar
trigeminal neuralgia
absence seizures
carbamazepine side effects
teratogen (cleft palate)
rash, SJS
AV block
anti anxiety
benzos
SSRIs
ß blockers
benzos indications
abort panic attack, treats EtOH withdrawal
benzos side effects
dependence
withdrawal seizures
SSRIs indications
first line long term medication for tx of chronic anxiety; OCD, PTSD, GAD
SSRI side effects
not useful in acute attack
ß blockers indications
performance anxiety
ß blockers side effects
bradycardia, asthma
typical antipsychotics
haloperidol
fluphenazine
thioridazine
chlorpromazine
typical antipsychotics action
mesolimbic D2C-R-i
- treats + symptoms
nigrostriatal antagonism -> EPS side effects
tuberoinfundibulnar antagonism causes increase prolactin, gynecomastia
typical antipsychotics side effects
potency of drug proportional to EPS
potency inversely proportional to anti-ACh
atypical antipsychotics
risperidone quetiapine olanzapine aripiprazole ziprasidone
atypical antipsychotics mechanism
both D2c and 5HT1 so work on + and - sx
more selective to lower risk of EPS
currently ‘first line’ for psychosis
atypical antipsychotics side effects
QTc prolongation
EPS, gynecomastia, sedation, anti-ACh (small risk)
DM and weight gain
clozapine
best antipsychotic
most selective for D2c and 5HT1
drug of last resort
clozapine side effects
agranulocytosis
requiring CBC q week
extrapyramidal side effects
akathisia
acute dystonia
dyskinesia
tardive dyskinesia
akathisia
feeling of restlessness
decrease dose, ß blockers, anti-ACh (benztropine)
acute dystonia
involuntary muscle contractions, hand wringing, torticollis, and oculogyric crisis
anti-ACh (benztropine)
dyskinesia
parkinsonism - dyskinesia = bradykinesia
anti-ACh (benztropine)
tardive dyskinesia
irreversible hypersensitization of dopamine-R = suppressible oral-facial movements
stop drug, sxs initially worsen
choosing a medication: compliant young adult without complications
any atypical po
decreased SE profile
choosing a medication: combative ER pt
haloperidol depot
dedating
choosing a medication: noncompliant psychotic
olanzapine depot, risperidone depot, haloperidol dept
q 1wk
choosing a medication: dysphagia or IM not availabl
olanzapine ODT, risperidone ODT
oral dissolving tablet
choosing a medication: everything else has failed
clozapine
best, most dangerous
choosing a medication: hospitalized and off their meds
atypical, increase dose q day until maxed, then try another
EtOH intox
slurred speech, disinhibition, ataxia, blackouts, memory loss, impaired judgment
EtOH withdrawal
tachycardia and HTN, tremor, perspiration, hallucinations, and eventual seizures
EtOH drug/antidote
benzo taper (withdrawal) disulfiram (long term)
benzos intox
delirium in elderly
respiratory depression and coma (with increase dose), amnesia
benzos withdrawal
tremor, tachycardia, HTN, seizures, psychosis
benzos drug/antidote
flumazenil
opiate intox
euphoria, pupil constriction, respiratory depression, and potential track marks
opiate withdrawal
yawning, lacrimation, n/v, hurts everywhere, sweating
opiate drug/antidote
naloxone methadone (long term)
cocaine intox
psychomotor agitation, HTN, tachycardia, dilated pupils, psychosis
angina, HTN crisis
cocaine withdrawal
depression, suicidality, irritability, ‘cocaine bugs’
cocaine drug/antitode
supportive care
benzos/antipsychotics for agitation
HTN treated with α, then ß blockade
MDMA intox
overheat (fever, tachycardia), water intoxication, pupillary dilation, psychosis
MDMA withdrawal
crash
MDMA drug/antidote
supportive
PCP intox
aggressive psychosis, vertical, lateral, or rotary nystagmus, impossible strength, blunted senses
PCP withdrawal
severe random violence
PCP drug/antidote
haloperidol to subdue
acidify urine to enhance excretion (sodium bicarb)
LSD intox
hallucinations, flashbacks, heightened senses, dissociative symptoms
LSD withdrawal
flashbacks
LSD drug/antidote
supportive
THC intox
tiredness, slowed reflexes, conjunctivitis, munchies, OD brings paranoia
THC withdrawal
none
THC antidote/drug
supportive (often nothing required)
barbs intox
low safety margins, benzos safer
barbs withdrawal
redistribute into fat
barbs drugs/antidote
none
nicotine intox
none - just jittery and stimulated
pt has to overdose a lot -> VFib
nicotine withdrawal
cravings
nicotine drug/antidote
bupropion chant (varencicline)
amphetamines intox
tachycardia, HTN, pressured speech, flight of ideas
amphetamines withdrawal
crash
amphetamines drug/antidote
none
