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Lithium toxicity- precip by NSAIDs better pain aspirin and sulindac.

Post partum psychosis are often a result of bipolar disorder and seldomly MDD

Schizophrenia- disorganized behavior, delusion, hallucinations, flat affect

Borderline personality disorder- rapid mood swings, efforts to avoid abandonment, chronic feelings

of emptiness, intense anger outburst, impulsivity, self mutilation/suicide; they utilize denial,

splitting, & projective identification.

Downdrift hypothesis suggests that people with mental illness cause them to go down social strata.

Bleur is known for 4 As of schizo- affect, altruism, ambivalence and association. Catatonic schizo- echolaia, hypomotorism negativism.

MAOIs are most effective in tx atypical depression but SSRI are 1st line.

To tx just akathsia use a BB rather than benztropine

Exacerbated tics, decreased falling asleep and !appetite are SE of stimulants

Tourettes is tx with dopamine antagonists and sometimes "2 agonist.

Clozapine is the only med know to improve DT

Think of borderline personality disorder when have suicide attempts and kid going with wrong

crowd and hating and loving some people. Tx w/ SSRI and antipsychotics

Schizoaffective- need to have hallucinations in absence of mood sx

Wernicke encephalopathy is characterized by VB1 deficiency and by bilat abducens nerve palsy,

horizontal nystagmus, ataxia and global confusion.

Folic acid deficiency px w/ diarrhea, chelosis, & glossitis

Tx akasthisia with propranolol

bipolar II 1st line tx is Li, lamotrigene or quetiapine. 2nd line is valproic acid

Cyproheptadine tx serototin synd while MAOI tx severe depression

Tx acute delirium with IV short acting lorazepam

Formication-tactile hallucinationof bugs

Haptic hallucination, touched by a phantom

Dereism is mental activity not in accordance with reality In schizophrenia the hippocampus and amygdala are smaller

Losseness of associations is characterized by lack of logical connection from sentence to sentence

N/V, aches fatigue flu like sx are signs of SSRI discontinuation syndrome

Fluoxitine has been reported to increase carbsmazapine levels while paroxitine has not

Li can invert T waves cause AV block and sinus node dysfunction

Clonidine can help with withdrawal from heroin by #sympathetic response

Clozapine inhibits D4 more than D2

Clonidine can be used for heroin withdrawal

Risperidone blocks da and alpha receptors causing hypotension, mild weight gain but no anti

cholinergic Ohimbine causes inc BP and Hr tx impotence

Sertraline is safe for pt with cardiac problem andhas fewest drug drug interactions

Neuroleptics are cleared by liver mainly

Lorazepam nd oxezepam is minimally metabolized by liver

Panic disorder can px with or without agoraphobia

Men have a better prognosis than men for schizophrenia

Panic disorder can be caused from endocrine cusing pheo angina pe

Mdd is often seen in people who have panic attacks

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Pimozide interacts with escitalopram

Clozapine can cause diabetes and sialorrhea which can be tx with anticholinergics propothiouracil

and req stopping med. clozapine can cause sinus tachy which if persists can tx with beta only

blocker

Paroxitine inc risk of suicide in children

Valproic acid inc risk of pancreatitis

Both carbamazepine and clozapine can cause agranulocytosis

Paroxetine as a short enough half-life they causes withdrawal symptoms Only haloperidol and risperidone have depot injections

Li can only be used in kids above age 12 valproic acid can be used before age 12

Benzo's can be an effective sleeping aid but avoid it in people who are alcoholics

Olanzapine can increase cholesterol levels

Clomipramine is the only one of the TCAs that causes sexual side effects due to the high affinity at

serotonin receptors

Propanolol tx akathsia while amantidine tx parkinsonian sx

Social phobia have inc activity in amygdala and insula

Dysarthria from muscle rigidity, numbness, nystagmus and violence indicate PCP intox, tx with

benzo first line perhaps antipsychotic if severe psychosis px but avoid due to antocholinergic effects

Buspar is a 5ht1a agonist

Lamotrigene is effective if pt with bipolar and px with depression

Alproic acid causes spina bifida

OCD in children showed changes in dorsolateral prefrontal and parietal that normalized after tx

If see OCD in children think PANDAS and look for strep infection

Duloxitine tx depression and diabetic neuropathy

Medical students hace ocd traits not od as we still have social and occupational function

Thiamine deficiency leds to bilateral abducens nerve palsy, ataxia horizontal nystagmus, global

confusion with apathy. Folic acid deficiency px with chilosis, glossitis diarrhea

Normal pressure H is aw gait incontinence dementia

Acute stress disorder sx are px for less than 4 wks and ptsd if px for more

Nxiety disorder almost never result in uncomsciousness

Bulemia causes inc amylase bt normal thyroid function

Lorazepam and oxazepam are excreted renally

With alcohol withdrawal you see tremors in 6 to 8 hours, hallucinations at 8 to 12 hours and

seizures in 12 to 72 hours

Memantine is nmda antagonist that tx alzeimers

A diagnosis of hypochondriasis req sx for 6 months and impairment in function Lead intoxication can led to hyperactivity

Imulans can be aw development of tics except atomoxitinehich is a nonstimulant

Fluoxitine and sertraline are only two ssri approved for bulimia. Cbt is first line. Bulimia has a later

onset than anorexia nervosa

Hypercholesterolemia is common with anorexia nervosa

Patients with acute stress disorder experience anxiety and dissociative sx like feelings of

derealization, dec awareness of surroundings, dissociative amnesia, lack of emotional attachment as

well as avoidance behavior. There can be hypervigilence and insomnia. Asd must last atleast 2

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days. Treating ASD involves social supports while tx of PTSD involves osycho and pharmocology

and biofeedback

On iQ 20 to 34 is severe MR while 35 to50 is moderate and 50-70 is mild.

Opiod intox leds to psychomotor retardation, constricted pupils drowsiness, opiate withdrawal leds

to SLUDGE nausea vomiting, lacrimation, rhinorhhea, muscle aches sweats, photophobia,

urination, diarrhedilated pupils. Tx withdrwal sx with buprenorphine or methadone (long acting)

and clonide. Ibeuprofen can help relieve muscle cramps, loperamide for loose stools, promethazine

for NV. If see withdrawal sx with methadone, inc dose. Monitor BPs when on clonidine Benzo or alcohol withdrawal include sweats, tachy, htn, restless, irritable, insomnia, hyoerreflexia,

Nicotine withdrawal leds to headaches depression, anxiety htn tachy insomnia, dec concentration

***Opiod withdrawal will mot cause delerium seizures confusion.

TCAs and ssri are helpful for pain disorder while analgesics are not helpful. Biofeedback and

hypnosis can be helpful

Best way to deal with hypochondriasis is to schedule frequent appt with them as physician

Pimozide is an antipsychotic that tx tourettes and cause QT prolongation

Tourette add and ocd

Tourette can px with ocd behavior and has trouble sitting still moving around clearing throat

Neurosyphillis sx include tabes dorsalis-gait pos romberg argyl robertson pupil and general paresis Sle related neuro sx include sx of irritable insomnia headaches pain in hands and feet

Diaphoresis tremor and unstable vital signs along with ataxia point more to alcohol withdrawal than

toxication

PCP intox can be similar to schizophrenia sx sometimes

Oth marijuana and cocaine wijthdrawal inc appetiteocaine withdrawal also experience somnolence

and bad dreams

Mdma and ecstacsy use sx include trismus, hypervigilence, bruxism- grinding of teeth,

hyperthermia, tachy htn, pacifiers candy necklace and popsicles alleviate sx Particularly bruxism

GAD is dx by having sx for 6 months

BeCk's triad for depression include neg thoughts to self worl and future

Wernicke encephalopathy sx ataxia confusion nystagmus

Subacute combined degeneration results from b12 deficiency

Meniere dz sx vertigo tinitis and hearing loss

Bipolar disorder has a 80-90% rsk in monozygotic twins

Cataplexsy is part of narcolepsy

With hypochondriais have preocupation with disease wile somatoform has preocupation with sx

Schizoaffective can px with depression or mania with gradiosisty

Repression and dissociation is a common defense mechanism fir histrionic oersonality

Grandiosity is seen in antisocial and narcicisstic personalities If depressive sx of asd or anxious if kids do not resolve after stressor is resolved dx mdd

Sedation is SE of clonidine that goes away with time

Nihilistic delusion is classic for coward syndrome

Capgras- people replaced by impostors

PTSD is only diagnosed after a month of sx and the stressor is life threatening otherwise MDD

Adjustment disorder vs acute stress disorder (both require psychotherapy)

Boderline personality disorder is common with factitious disorder

First degree relative of bipolar 1 have a 25% chance of any mood disorder

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Psychiatric sx with abdominal pain suggest porphyria as cause

Kluver bucy- hyperphagia, hypersexuality, lack of fear; bilateral damage to amygdala

Arnold chiari malformation is hydrocephalus and cerebellar anatomic dysfunctio

Punchdrunk syn- drome describes an acquired movement disor- der associated with traumatic

damage to the substantial nigra

Mbius syndrome is congen- ital absence of the facial nerves and nuclei with resulting

bilateral facial paralysis.

Superior temporal gyro involved in hearing Anorexia nervosa is less than 85% of ideal body weight

Only 50% of patients with depression have dexamethasone suppression and 30 % do not show !

TSH with TRH

The alcohol dependence criteria can be met with a without psyiologic dependence criteria therefore

the patient's inability to quit drinking regardless of desire or knowledge differentiates dependence

from abuse

Adjustment disorder is dx instead of ASD only if stressor was non traumatic

Feelings and attitudes originating from the treater, evoked by the patient, are called coun-

tertransference. Transference denotes feelings and attitudes about the treater coming from the

patient. ECT for psychosis req 20 tx while for mdd req 6-12 and for catatonic states 2-4

FAS vs Downs

Infcts of left frontal hemisphere $depression vs left prefrontal $mania, euphoria

12% risk i one parent has schizophrenia and 40% if both parents affected

Schizophrenics also have soft neurologic signs such as short-term memory deficits, unstable

smooth-pursuit eye movements, and decreased ability to habituate to repeated sensory stimuli

Selective amnesia- can't remem her certain parts of an event while localized amnesia is can't

remember a certain period of time

Pseudoseizure is a psychogenic induced behavior that resembles epilepsy however it carries a

normal EEG

Doppelganger is the belief in the existence of an identical counterpart. Cacodemonomania is the

delusion of being poisoned by an evil spirit.

Fregoli syndrome is the delusion that a person is taking the form of a number of people or creatures

Mirtazapine is a "2 antagonist and antagonist at 5ht2 and 3 & H receptors

Eventhough TCA can cause heart block and coma they can be used in people with hx of cerebral

infarcts

Haloperidol is least likely to caue orthostatic hypotension because it does not have activity at "1

receptors while atypical and other typicals do

To tx acute delirium choose haloperidol, olanzapine is not used because it lacks paraenteral form Perphenazine is a low dose antipsychotic

Detox centers from heroin can be managed with clonidine, some centers avoid methadone because

of success with clonidine

SSRIs can treat pain just as well as TCAs in addition to depression 55

If you suspect adjustment disorder, you can't have sx for more than 6months from the stressor.

True seizures cause !in prolactin w/i 1 hour

Gabapentin and topiramate are 2nd line for bipolar disorder

Tertiary amines TCAs (nortriptiline, desiprimine) inhibit serotonin more strongly that secondary

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