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
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
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
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
amines
Tourettes- damage to dopamine pathways in caudate nucleus tx w/ risperidone or clondine
Simbutrimine tx binge eating by inhibiting dopamine, seronotin NE. Fluoxitine only approved SSRI
for binge eating
Somatization disorder px prior to age 30
Borderline personality disorder px with transient stress related psychosis, tx w/ DBT
Histrioninc personality use regression and reaction formation (like OCPD)
Fluorodeoxyglucose PET imaging distinguishes alzeimers from other dementias, which shows
characteristic temporal and parietal hypometabolism
Clonazepam tx REM sleep behavior disorder a/w lewy dementia
Crutzfeldt jakob diseasehas myoclonus and triphasic complexes
Methadone and oxycodone will not be detected on standard drug screen
Vicodin: hydrocodone/acetaminophen; Percocet: oxycodone/acetaminophen






Regurgitation disorder is when chil regurgitates food and chews it following a month of normalcy
Children with mdd have more psychomotor agitation and anxious than adolesants with mdd
Substance ingestion is the most common way kids attempt suicide
Ddavp ts enuresis se include hyponatremia headache nausea
CaEDTA chelates lead
Rett disorder normal head circumference until 5 to 48 months when it slows, hand wringing, seen in
girls, poor gait and expressive language
Childhood disintegrative disorder develop normally uptil age 3 or 4
Tourette age of onset is 7 yr req tics to be px for a year
If child with ADHD has tics or family hx of tics avoid stimulants and still choose stimulant,
TCA is 2nd line
A developmentally normal child can copy a circle at the age of 2. She can tell her age and gender
and ride a tricycle at age 3. She can copy a square and can identify her left hand at age 5.
At age of 4 the idea of reward and punishment is useless but model behavior is great
Toxocara canis is a/w pica sx
Bed wetting is normal uptil age 7, can tx with imiprimine or DDAVP
ADHD patients have a 25% chance of developing antisocial personality