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1
Q

Nocturnal enursis

A

Desmopressin and imipramine

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2
Q

RLS syndrome

A

Do Iron test

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3
Q

Antidepressant trial

A

> 6 weeks

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4
Q

MDD vs SAD

A
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5
Q

Bipolar I disorder

A

DIGFAST
distractible, irritable, grandiose, flight of ideas/racing thoughts, activity, decreased Sleep, talkative/pressured speech

Need 3 of the above and 1 week

Bipolar II is MDD plus hypomania (at least 4 days).

ANY manic episode, regardless of MDD episode is Bipolar I.

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6
Q

Cyclothymia

A

2 years of mild depression and hypomania (can’t meet criteria for MDD and mania)

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7
Q

Neuroleptic syndrome

A

MUSCLE RIGIDITY
Fever
Autonomic instability

Usually first gen APs like haloperidol. Can be all antipsychotics

Tx: Stop antipsychotics,
Bromocriptine (D2 agonist) or dantrolene (acts on RYR receptor and affects calcium) (but not with a CCB)

https://next.amboss.com/us/article/KH0Urh?utm_medium=chatgpt-plugin&utm_source=chatgpt

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8
Q

Dissociative Disorders

A
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9
Q

Antidepressant breast feeding

A

Sertraline

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10
Q

Malignant Hyperthemia

A
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11
Q

Postpartum period

A
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12
Q

Personality Types

A
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13
Q

Serotonin syndrome vs NMS

A

HYPERREFLEXIA distinguishes SS over NMS

Too many serotonin drugs or serotonin drug + MAOi (e.g., switching without a 2 week washout period.)

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14
Q

Malignant Catatonia

A

Slower, prodrome of motor agitation

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15
Q

Malignant Hyperthermia

A

RAPID, in setting of succinylcholine or other volatile anasthetics
hypercarbia, muscle rigidity, hyperthermia

Treatment Dantrolene

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16
Q

Acute Mania

A
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17
Q

Lamotrigine

A

Effective in bipolar DEPRESSION

Watch for Rash, SJS

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18
Q

Carbemezapine

A

Anticonvulsant, Bipolar, requires titration up so not for acute mania.

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19
Q

Physiologic tremor

A

TCAs, beta blockers, SSRIs can cause.

Fine, high frequency tremor, visible in high sympathetic moment (stress),

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20
Q

Acute dystonia

A

Painful spasms, grimacing, torticullis

Tx: anticholinergic benztropine

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21
Q

Akathesia

A

Restlessness
Tx: Propranolol

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22
Q

Tardive Dyskinesia

A

Switch to second generation AP: quetiapine, clozapine).

Risperidone is higher risk even though second generation.

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23
Q

Suicide risks

A

SAD PERSONS are at risk for suicide:

Sex (male), Age (> 45 years), Depression, Previous suicide attempt, Ethanol/substance use, Rational thinking loss (psychosis), Sick (chronic disease), Organized plan (acquisition of weapons/tools), No spouse or social support, Stated intent.

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24
Q

TCA + SGA can cause _____

A

Anticholinergic toxicity.

E.g., clozapine and Doxepin

Consider when hyperthermia, tachycardia, altered mental status. Do an EKG to evaluate for QTc prolongation.

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25
Medications that can cause anticholinergic toxicity
26
Bupronion
First line for MDD Mild stimulant effects Helps smoking cessation Helps with weight loss Does not cause sexual side effects Contraindicated in seizures and eating disorders.
27
Atomoxetine
SNRI Can treat ADHD if someone has stimulant abuse or SUD history
28
Mirtazapine
AD, can increase appetite
29
Modafinal
Promotes WAKEFULNESS Treats Narcolepsy
30
Phenelzine
Atypical depression Hyperphagia, hypersomnia, leaden paralysis, rejection sensitivity. Only treatment resistant cases because MAOi risks
31
Lamotrigine
Use as mood stabilizer in pregnancy Quetiapine and risperidone can also be used.
32
Medications in pregnancy
All antidepressants EXCEPT paroxetine
33
Bipolar II
Lurasidone, quetiapine, lithium or anticonvulsants like lamotrigine
34
Extrapyramidal symptoms
35
Substance use management
36
Substance use management 2
37
Schizoaffective disorder
38
Antidepressant medications
39
Serotonin Syndrome
40
Functional tremor
Involuntary movement, better with action. Shifting tremor frequency
41
Opioid use disorder treatment
42
Pediatric antidepressants
Fluoxetine
43
Intellectual disability
44
Delusional Disorder
45
Ropinirole
Dopamine agonist used for RLS. May cause bipolar like behaviors
46
Venlafaxine
Associated with increased blood pressure
47
Huntington Disease
Gaba neurons Caudate nucleus and putamen
48
Parkinson's disease
Dopamine neurons Substantia Nigra
49
Phenelzine
MAOi Treatment resistant depression
50
Fragile X Syndrome
51
Tramodol + sertraline
Can develop serotonin syndrome
52
Bipolar II
Quetiapine or Lurasidone
53
Defense mechanisms
54
Neuroleptic malignant syndrome
55
Prazosin
PTSD nightmares Alpha 1 adrenergic antagonist
56
Eating disorders
57
Lithium Toxicity
58
Bipolar I disorder
59
Tourette's syndrome
60
Depression + psychosis
61
Schizophrenia diagnosis criteria
62
Dementia
63
Avoid SSRI Citalopram in recent MI patients
QT prolongation
64
Venlafaxine side effects
Tachycardia High blood pressure
65
Withdrawal
66
Acute Dystonia
67
Partial response to MDD
Augment with other mechanism (e..g, add bupronion) Add antipsychotic (second gen like ariprizole or lithium) ECT
68
Buspirone
Antianxiety Generalized Anxiety
69
Neuroleptic Malignant Syndrome and Serotonin Syndrome
70
Catatonia
71
Antipsychotics EPS
72
Depression
73
Opioid withdrawal
74
Enlarged ventricles
Schizophrenia
75
Atrophy of caudate
Huntington's disease
76
Decreased hippocampus
Schizophrenia
77
Citalopram
QT prolongation
78
Motivational Interviewing
79
Catatonia
Benzos like Lorazepam ECT
80
Severe serotonin syndrome
Cryheptadine
81
Bipolar
Lithium and Valproate, then quetiapine and lamotrigine
82
Diabetic + Neuropathy + MDD
Duloxetine (or venlafaxine) Can do TCA, prefer SNRI Then gabapentinoids
83
Second generation AP
Quetiapine, Clozapine
84
Mirtazapine
Great first line antidepressant for poor sleep, appetite loss. e.g., MDD due to grief with insomnia and weight loss
85
TCA
Not usually first line Anticholinergic effects, Cardiotoxicity, orthostatic hypotension
86
Therapeutic approaches
87
Second generation AP
Serotonin and dopamine D2 effect is antipsychotic
88
Buproprion
NE and dopamine reuptake inhibition
89
Antidepressant side effects
90
Bipolar disorder
91
TCA
Serotonin and NE
92
Narcolepsy
93
Psychotic disorders
94
Lithium
Hyperparathyroidism and hypercalcemia Can cause nephrogenic diabetes inspidus, CKD, hypothyroidism,
95
Second generation antipsychotics
Hyperlipidemia and diabetes
96
Carbamezapine and lamotrigine
Steven Johnson syndrome rash
97
Valproate
Fetal neural tube defects
98
Delusional disorder vs paranoid personality type
99
Acute drug intoxication symptoms
100
Alprazolam
Can cause seizure from sudden discontinuation
101
Bipolar disease
Monotherapy: Lithium, valproate, lamotrigine, quetiapine. Combination therapy: Lithium or valproate PLUS SGA (quetiapine).
102
Tourette syndrome
OCD and ADHD most likely to develop
103
Dementia vs Normal aging
104
Developmental Milestones
105
Brief psychotic disorder
Related to an acute stress. e.g, patient's father dies in car accident and a week later he is disorganized, bizarre behavior and hallucinations.
106
Adjustment disorder
Can't be beyond 6 months from the stressor
107
Cathinone aka bath salts
prolonged duration of effect
108
Histrionic personality disorder
109
Wilson disease
110
Neuroleptic Malignant syndrome
111
Clomipramine
TCA, second line OCD
112
Hoarding disorder
CBT Don't use SGA (e.g., quetiapine) not indicated SSRI not useful unless with OCD, then helpful
113
Conditions that seem like ADHD
114
Serotonin syndrome
Treated with cryoheptadine (seratonin antagonist) Hyperreflexia, NMS has lead-pipe rigidity
115
Antipsychotic medication EPS
Benztropine Dystonia
116
Alcohol use
Acamprosate, Naltrexone NOT buprenorphine
117
Naltrexone in AUD
contraindicated with liver failure or any liver issues
118
Acamprosate AUD
Don't use in renal impairment
119
Smoking cessation
Bupropion (not in eating disorder) Varenicine
120
ADHD medications
121
Clonidine in ADHD
Children/adolescents
122
Antipsychotic medication effects
123
Increased dopamine activity in mesolimbic
drug use decrease is why antipsychotic medications work
124
Nigrostriatal pathway
Substantia nigra to basal ganglia Coordination of movement
125
Venlafaxine
Dose-dependent hypertension NOREPINEPHRINE
126
BDD
Preoccupation with a body part > repetitive behaviors like checking. DISTRESS, not high functioning
127
Schizophrenia
At least 2 of the 5 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Disorganized behavior 5. Negative symptoms (flat affect, apathy, alogia/poverty of speech).
128
GAD
Requires 6 months or more
129
Narcolepsy
Daytime sleepiness Cataplexy Hypnagogic hallucinations (hearing music as falling asleep) Sleep paralysis Tx: Modafinil Pathophysiology: Decreased orexins in hypothalamus
130
REM sleep disorder
Acting out during REM sleep because of loss of paralysis
131
PCP intoxication
Aggression Rotary nystagmus Ataxia
132
Anticholinergic toxicity
Delerium, sedation, hallucinations Smooth muscle dysfunction (dry) Supportive care Treat with pyridostigmine in severe cases TCA can cause severe anticholinergic effects Sleep aid toxicity too, diphenhydramine causes this
133
Lithium toxicity
GI symptoms Cardiac symptoms Neuro symptoms Relies on kidney to be excreted, so if you take HCTZ then can affect lithium.
134
Pseudodementia
cognitive impairment due to MDD need depressive symptoms
135
Alprazolam
GABA, increase Cl Can cause rebound anxiety Can switch to clonazepam which is a longer acting benzodiazepine
136
Prazosin Clonodine
Alpha 1 adrenergic antagonists can cause orthostatic hypotension
137
Valproic acid
Can cause acute pancreatitis Hepatotoxic - DO NOT USE IN LF Bone marrow toxicity Alopecia
138
Lithium
DO NOT USE IN RF
139
Chronic alcohol use
gynecomastia palmar erythema
140
Lithium
can induce nephrogenic diabetes inspidus Thyroid dysfunction
141
Toluene inhalation
Violent behavior Redness around mouth Hallucination, disorientation, agitation
142
MDD
2 or more weeks of 5: 1. Depressed mood 2. anhedonia 3. guild or worthlessness 4. difficulty concentrating 5. psychomotor slowing 6. suicidal thoughts decreased energy, sleep disturbance, appetite disturbance SIGECAPS
143

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