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Psychiatry Basics:

A Shelf Review
Sonya Gabrielian
UCLA Psychiatry Clerkship

Agenda

Psychotic Disorders
Mood Disorders
Anxiety Disorders
Personality Disorders
Substance Use Disorders
Cognitive Disorders
Other Disorders
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Agenda
Psychotic Disorders

What is psychosis?
Delusions
False, fixed, and culturally inappropriate
beliefs that cannot be altered by rational
arguments

Perceptual disturbances
Hallucinations and illusions

Disordered thinking
Problems with thought content and
process
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Hallucinations
A perception WITHOUT external stimulus
Illusions are misinterpretations of TRUE STIMULI

Auditory hallucinations
Think schizophrenia or other psychotic disorder

Visual or tactile hallucinations


Think drug or alcohol intoxication/withdrawal

Olfactory hallucination
Think seizure disorder, e.g., temporal lobe
epilepsy

Differential Diagnosis

Brief psychotic disorder (1 day to 1 month)


Schizophreniform disorder (1-6 months)
Schizophrenia (>6 months)
Schizoaffective disorder
Delusional disorder
Depression or bipolar disorder with
psychosis
Substance-induced psychotic disorder
Delirium/Dementia
Psychosis secondary to general medical
condition
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Schizophrenia
Three key phases
Prodrome
Decline in function before initial psychosis.
Often socially withdrawn, irritable,
depressed

Psychosis
Residual
Episodes between psychotic exacerbations
Flat affect, social withdrawal, bizarre
behavior
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Schizophrenia Cont.
Positive symptoms
Hallucinations, delusions, disordered
thought, bizarre behavior

Negative symptoms
Less dramatic but may cause
significant decline in function
Includes diminished affect, apathy,
anhedonia, difficulties with attention
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Schizophrenia Cont.

Affects 1% of population
Men present earlier than women
Strong genetic predisposition
Chronic and debilitating
Various neurotransmitters are
implicated
Likely relationship with increased dopamine
Likely role of elevated serotonin and
norepinephrine
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Schizoaffective Disorder
Patients meet criteria for major depressive,
manic, or mixed episode during a time in
which they also meet criteria for
schizophrenia
Mood symptoms are present for substantial
portion of psychotic illness
Need to have delusions or hallucinations for
at least 2 weeks without mood symptoms
Do not confuse schizoaffective disorder with
mood disorder with psychotic features
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Delusional Disorder
Nonbizarre, fixed delusions for at least 1
month
Delusions may be erotomanic, somatic,
persecutory, grandiose

No significant functional impairment


Do not meet criteria for schizophrenia
Often occurs in patients after age 40
years
Antipsychotics are often less effective
than in other psychotic disorders
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Antipsychotics
Typical neuroleptics
Dopamine (mostly D2) antagonists
Treat positive symptoms > negative symptoms
Important side effects to memorize, with
greater incidence of EPS than in atypical agents

Atypical neuroleptics
Dopamine (D2) and serotonin (5-HT2)
antagonists
Better treatment of negative symptoms than
typical agents

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Typical Neuroleptics
Not as important to memorize each
individual typical agent
Remember that there are low and high
potency agents
Potency refers to action on dopamine
receptors
Low potency agents require bigger doses
High potency agents require small doses

High potency agents have more EPS than


low potency agents
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Antipsychotic Side
Effects
Extrapyramidal symptoms (EPS)
Dystonia (spasm) of face, neck, tongue
Parkinsonism
Akathisia (restlessness)

Anticholinergic symptoms
Dry mouth, constipation, visual blurring

Tardive dyskinesia
Darting/writhing movements of face, tongue
Condition can become permanent
Most common in older women
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Atypical Antipsychotics
Try to remember key side effects
Risperidone (Risperdal)
Hyperprolactinemia

Olanzapine (Zyprexa)
Hyperlipidemia, weight gain, glucose intolerance, liver
toxicity

Quetiapine (Seroquel)
Sedation, orthostatic hypotension

Clozapine (Clozaril)
Agranulocytosis, seizures

Ziprasidone (Geodon)
Some association with QTc changes
Need to take medication with food
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Neuroleptic Malignant
Syndrome
FALTER

Fever (high)
Altered mental status
Leukocytosis
Tachycardia/elevated blood pressure
Elevated CPK
Rigidity (lead pipe)

Can be lethal, but treatment is largely


supportive
Not an allergic reaction
Patient can later restart the same neuroleptic if
physician thinks it is appropriate
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Agenda
Mood Disorders

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What is mood?
Description of internal emotional
state
Generally, people have a wide range
of mood and feel that they have
some control over mood
Mood disorders are also known as
affective disorders

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Common Mood Disorders

Major depressive disorder


Bipolar disorder (I or II)
Dysthymic disorder
Cyclothymic disorder

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Major Depressive
Episode
Five symptoms, including depressed
mood or anhedonia, for at least 2 weeks
SIG E CAPS

Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor activity
Suicidal ideation
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Major Depressive
Disorder
At least one major depressive
episode
No history of mania/hypomania
Lifetime prevalence is around 15%
Depressive episodes are usually selflimited in the long term, but
antidepressant medications are quite
helpful
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Depression Secondary to a
General Medical Condition
Cerebrovascular disease
Endocrinological abnormalities
Cushings, Addisons, Hypoglycemia,
Hypothyroidism, Hyperthyroidism, Hypocalcemia,
Hypercalcemia

Parkinsons disease
Cancer, e.g., pancreatic malignancy,
lymphoma
Collagen vascular disease, e.g., lupus
Viral illness, e.g., mononucleosis
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Substance-Induced
Depression

Alcohol
Barbiturates
Benzodiazepines
Antihypertensives, e.g., beta-blockers
Corticosteroids
Stimulant, e.g., cocaine, amphetamine
withdrawal
Anticonvulsants
Many more
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Types of Antidepressants
Selective serotonin reuptake inhibitors
(SSRIs)
Atypical agents, e.g., dual-action
inhibitors
Tricyclic antidepressants (TCAs)
Monoamine oxidase inhibitors (MAOIs)
Adjuvant medications:
Stimulants, antipsychotics, lithium, thyroid
hormone
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SSRIs
Mechanism
Inhibit presynaptic serotonin pumps
Lead to increased availability of serotonin in
synaptic cleft

Advantages
Fairly safe in overdose
No food restrictions

Common side effects


Gastrointestinal disturbance
Insomnia
Sexual dysfunction
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SSRIs, cont.
Used for depressive and anxiety disorders
Remember a few key points about each agent
Fluoxetine (Prozac)
Longest half-life, somewhat activating

Sertraline (Zoloft)
Highest rate of GI upset
Useful for elderly, least wt gain

Paroxetine (Paxil)
Most activating agent, highest anticholinergic burden

Fluvoxamine (Luvox)
Very short half-life, approved for OCD only

Citalopram (Celexa)
Commonly used given minimal drug-drug interactions

Escitalopram (Lexapro)
L-enantiomer of citalopram, so use approximately half the dose
Significantly more expensive than Celexa
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Atypical Agents
Venlafaxine (Effexor)
Serotonin/norepinephrine reuptake inhibitor
Can increase blood pressure
Withdrawal phenomenon with electricshocks

Bupropion (Wellbutrin)
Norepinephrine/dopamine reuptake inhibitor
Minimal sexual side effects
Increased risk of seizures, do not use in
seizure disorder or eating disorder patients
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Atypical Agents, cont.


Trazodone (Desyrel)

Serotonin antagonist and reuptake inhibitor


Commonly used to aid with sleep
Rarely used as an antidepressant
Side effects to remember: sedation and priapism

Mirtazapine (Remeron)
Norepinephrine and serotonin antagonist
Often used in elderly patients
Side effects to remember: sedation and weight
gain
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Tricyclic Antidepressants
(TCAs)
Mechanism
Inhibit reuptake of norepinephrine and
serotonin
Increase availability of these neurotransmitters
in the synapse

Side effects to remember

Lethal in overdose, usually due to widened QRS


Convulsions, coma, cardiotoxicity
Orthostatic hypotention, tachycardia
Dry mouth, constipation, urinary retention
Sedation
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Monoamine Oxidase
Inhibitors (MAOIs)
Irreversibly inhibit MAO-A and MAO-B
Prevent inactivation of norepinephrine,
serotonin, dopamine, tyramine
Common side effects
Orthostatic hypotension
Drowsiness
Weight gain
Sexual dysfunction
Sleep dysfunction
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MAOI Side Effects to


Remember
Serotonin Syndrome
Lethargy, restlessness, confusion, flushing,
diaphoresis, tremor, myoclonus
Can lead to hyperthermia, rhabdomyolysis,
kidney injury, coma, death
Usually occurs with MAOI + SSRI

Hypertensive crisis
Can occur if tyramine is ingested when on
an MAOI
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Manic Episode
Abnormally and persistently elevated,
expansive, or irritable mood, for at least
one week
DIG FAST (need three of the following, or
four if mood is irritable)

Distractability
Insomnia
Grandiosity
Flight of ideas
Activity/agitation
Speech (pressured)
Thoughtlessness
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Mania vs. Hypomania


Mania

Hypomania

Lasts 7 days

Lasts at least 4 days

Causes severe impairment

No marked functional impairment

May require hospitalization

Does not require hospitalization

May have psychotic features

No psychosis

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Mania Secondary to a
General Medical Condition

Hyperthyroidism
Multiple sclerosis
Neoplasm
HIV-related
Stroke
Epilepsy, e.g., temporal lobe seizures

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Substance-Induced
Mania

Corticosteroids
Sympathomimetics
Dopamine agonists
Bronchodilators
Antidepressants (controversial)

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Mood Stabilizers

Lithium
Carbamazepine (Tegretol)
Valproic Acid (Depakote)
Lamotrigine (Lamictal)
Antipsychotics

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Lithium

Exact mechanism is unknown


Narrow therapeutic range (0.7 1.2)
Need to monitor TSH and Creatinine
Watch out when also using diuretics, ACEI,
NSAIDs
Side effects

Hypothyroidism
Nephrogenic diabetes insipidus
Tremor/ataxia
Polyuria, thirst
Weight gain
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Other mood stabilizers

Carbamazepine (Tegretol)
Anticonvulsant
Numerous side effects, including leukopenia, hyponatremia,
aplastic anemia, agranulocytosis, transaminitis
Monitor CBC and LFTs

Valproic Acid
Anticonvulsant
Numerous side effects, including alopecia, weight gain,
hepatotoxicity, thrombocytopenia
Aim for level of ~100 in treatment of acute mania

Lamotrigine

Anticonvulsant
Must follow a careful titration schedule
Famous side effect is Steven Johnson Syndrome
Used for depression predominant bipolar disorder

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Agenda

Anxiety Disorders

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What is anxiety?
Subjective experience
of fear and its
resultant physical
manifestations
Normal and common
response to perceived
threat

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Common Anxiety
Disorders

Generalized anxiety disorder


Obsessive-compulsive disorder
Panic disorder
Agoraphobia
Posttraumatic stress disorder
Acute stress disorder
Specific and social phobias
Substance-induced anxiety disorder
Anxiety disorder secondary to general
medical condition
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Generalized Anxiety
Disorder (GAD)
Persistent, excessive anxiety and
hyperarousal for at least six months
Anxiety surrounds daily events and
activities
Very common in general population,
especially in women
Associated with restlessness, fatigue,
difficulty concentrating, irritability,
muscle tension, sleep disturbance
SSRIs and behavioral therapy are useful
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Obsessive Compulsive
Disorder
Obsession
Recurrent and intrusive thought that
causes marked anxiety
Person attempts to suppress thought
Person realizes that the thought is a
product of his or her own mind

Compulsion
Repetitive behavior that person performs to
respond to his or her obsession
An unrealistic attempt to alleviate distress
caused by obsession
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Obsessive Compulsive
Disorder, cont.
Several common patterns of obsessions
and compulsions
Patterns include contamination, symmetry,
doubt and subsequent checking, intrusions of a
sexual or violent nature

SSRIs are first line treatment


Often need higher-than-normal doses

Behavioral treatment is also very important


Exposure and response prevention
Relaxation techniques

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Panic Disorder
A panic attack is a brief (usually less
than 30 minutes) sudden rush of fear
and anxiety
PANICS
Palpitations
Abdominal distress
Numbness/Nausea
Intense fear of death
Choking, chills, chest pain
Shortness of breath, sweating
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Panic Disorder, cont.


To meet criteria for the actual disorder,
one must have spontaneous recurrent
panic attacks without precipitant
At least one attack must cause worry
about additional attacks, or behavioral
change (avoidance)
Usually a chronic illness, but variable
severity
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Panic Disorder, cont.


Consider differential diagnosis
Drugs
Stimulants, caffeine, nicotine, hallucinogens
Alcohol, opiate, benzodiazepine withdrawal

Psychiatric illness
Depression, other anxiety disorders

Medical illness
Nearly any cardiac, pulmonary, neurological,
endocrinological abnormality may be
confused as panic
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Panic Disorder, cont.


Acute treatment
Benzodiazepines
Propranolol can be used for performance
anxiety, but is not as good for true panic

Maintenance treatment
SSRIs start low and increase slowly,
watching for activation
Relaxation training
Cognitive therapy
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Agoraphobia
Definition
Fear of open places
Often, but not always, develops secondary
to panic disorder

Need to specify if panic disorder is with


or without agoraphobia
If you treat the panic disorder,
agoraphobia often resolves
Agoraphobia not associated with panic
is much more difficult to conquer
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PTSD vs. Acute Stress


Disorder
PTSD

Acute Stress
Disorder

Event occurred any time in past

Event occurred less than 1


month ago

Symptoms last more than one


month

Symptoms last less than one


month

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PTSD vs. Acute Stress


Disorder, cont.
Criteria for both disorders are the same
Witness traumatic event
Persistent re-experiencing of event
Nightmares
Flashbacks

Avoidance of stimuli associated with


trauma
Persistent hypervigilence/increased arousal

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PTSD vs. Acute Stress


Disorder, cont.
Treatment
Medication management
SSRIs are first-line
Alpha-1 adrenergic receptor antagonists,
e.g., Prazosin

Behavioral therapy
Psychotherapy numerous techniques
Relaxation training

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Phobias
Most common psychiatric disorder
Specific phobia
Exaggerated fear of specific object or situation
Heights, animals, flying, etc.

Treat with systemic desensitization

Social phobia
Exaggerated fear of social situations in which
humiliation could occur
Treat with SSRIs and cognitive therapy

Phobias are ego-dystonic, i.e., the person


knows that fear is exaggerated
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Substance-Induced Anxiety
Disorders

Caffeine
Amphetamines
Alcohol and sedative withdrawal
Other illicit drug withdrawal
Antidepressants
Carbon dioxide inhalation
Many more
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Anxiety Disorder Secondary

to General Medical
Condition
Endocrinological
abnormalities
Hyperthyroidism
Hypoglycemia
Pheochromocytoma

Neurological disorders
Seizure disorders
Brain tumors
Multiple sclerosis

Cardiovascular disease
Pulmonary disease
Hypoxia is anxiety provoking
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How to Treat Anxiety?


Regardless of precise disorder, usually use
short-term treatment with benzodiazepines,
and maintenance treatment with SSRIs
Be familiar with the types of
benzodiazepines and their time to
onset/duration of action
Recognize abuse potential of
benzodiazepines
Beta-blockers are useful for akathisia and
autonomic effects of panic/performance
anxiety
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Agenda

Personality Disorders

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What is a personality
disorder?
Inflexible pattern of interaction that
impairs social functioning
Patients do not have insight into their
problematic interaction style
Onset in adolescence/early adulthood

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Test Worthy Material


Be familiar with the three clusters of
personality disorders
Know which specific disorders fall
into each cluster
Memorize a few key facts about each
disorder, but specific diagnostic
criteria will be difficult to test

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Cluster A: Weird
Eccentric, withdrawn, border on
psychosis
Schizoid
Quiet and reclusive
Do not desire close relationships

Schizotypal
Magical thinking
Bizarre fantasies

Paranoid
No frank psychosis
Pervasive suspiciousness
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Cluster B: Wild
Emotional, dramatic, often with mood
disorders
Antisocial
Disregard for safety of others
Manipulate for personal gain
Often violate the law

Borderline

Desperate attempts to avoid abandonment


Unstable and intense relationships
Recurrent suicidal thoughts, self-mutilation
May border on psychosis
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Cluster B: Wild, cont.


Histrionic
Attention-seeking behavior
Flamboyant and extroverted
Often sexually inappropriate

Narcissistic
Exaggerated self-importance
Require admiration from others
May exploit others for self-gain
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Cluster C: Worried
Anxious, fearful, shy
Avoidant
Avoid interpersonal contact due to fear of rejection
Desire companionship

Dependent
Low self esteem
Excessive need to be cared for by others

Obsessive-Compulsive
Do not confuse with OCD
Big distinction is ego-syntonic (personality disorder) vs.
ego-dystonic (anxiety disorder)

Preoccupation with orderliness, perfectionism,


control
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Personality Disorder
Treatment
Often, patients have co-existing
mood and anxiety disorders
Treat co-occurring disorders with
medication and therapy as appropriate

Personality disorders are difficult to


treat
Psychotherapy is the mainstay of
treatment
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Agenda

Substance Use Disorders

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Substance Abuse vs.


Dependence
Abuse

Dependence

Pattern of use leading to


impairment for at least one year

Pattern of use leading to


impairment for at least one year

Need one or more of following:

Need three or more of


following:

Failure to fulfill obligations at


work, school, home
Use in dangerous situations
Recurrent legal problems due to
substance use
Continued use despite social
problems due to use

Failure to fulfill obligations work,


school, home
Tolerance
Withdrawal
Actual use exceeds extended use
Continued use despite medical
or psychological problems
due to use
Persistent desire or
unsuccessful efforts to cut
down on use
Significant time spent using,
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getting, recovering from

Patient CANNOT meet criteria


for dependence, as such
supersedes a diagnosis of
abuse.

Key Terms
Intoxication
Signs and symptoms differ by drug of
choice
Often confused with withdrawal

Withdrawal
Substance-specific syndrome due to
cessation of prolonged substance use

Tolerance
Need for increased amount of substance
to achieve desired effect
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Alcohol
Most commonly abused substance
Alcohol

Alcohol dehydrogenase

Acetaldehyd
e
Aldehyde dehydrogenase

Acetic acid

Disulfiram
(Antabuse)
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Alcohol Intoxication

Ensure ABCs
Monitor electrolytes
Check finger stick glucose
Consider breathalyzer or blood
alcohol level

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Alcohol Withdrawal
Can be life threatening
Mild
Irritability
Insomnia
Mild tremor

Moderate
Disorientation
Fever

Severe
Autonomic instability
Seizures
Delirium Tremens
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Delirium Tremens
Begins within 2-3 days of alcohol
cessation
High mortality rate if untreated
Delirium is the key characteristic
Patients have altered, waxing and waning
sensorium

May also have hallucinations (visual or


tactile), psychomotor changes,
autonomic instability
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Treatment of Alcohol
Withdrawal
Frequent vital sign checks vs.
telemetry
Taper doses of benzodiazepines
Chlordiazepoxide (Librium)
Lorazepam (Ativan)
Diazepam (Valium)

Seizure precautions
Multivitamin, thiamine, folate
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Wernickes
Encephalopathy
Three key characteristics
Ataxia
Confusion
Ocular problems

An acute problem that can be


reversed with thiamine
Always give thiamine before glucose

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Korsakoffs Syndrome

Chronic and often irreversible


Impaired recent memory
Anterograde amnesia
Confabulation often present

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Opiates
Stimulate opiate (mu, kappa, delta)
receptors
Involved in analgesia, sedation, dependence

Examples:
Heroin
Codeine
Morphine
Methadone
Meperidine
Dextromethorphan
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Opiate Intoxication

Drowsiness/altered mental status


Respiratory depression
Constipation
Constricted pupils
Can progress to coma or death in
overdose
Treatment
Ensure ABCs
Can use naloxone or naltrexone if there is
respiratory compromise
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Opiate Withdrawal

Craving/Anxiety
Lacrimation
Rhinorrhea
Diaphoresis
Abdominal discomfort
Mydriasis
Myalgias
Irritability
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Treatment of Opiate
Withdrawal
Symptomatic relief for nausea,
vomiting, myalgias, anxiety, and
insomnia
Clonidine
Reduces catecholamine release from
sympathetic nervous system

Methadone or buprenorphine may be


considered for withdrawal and/or
maintenance treatment
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Sedative-Hypnotics
Benzodiazepines
Potentiate GABA by increasing
frequency of chloride channel opening

Barbiturates
Potentiate GABA by increasing duration
of chloride channel opening

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Sedative-Hypnotic
Intoxication

Drowsiness/altered mental status


Lack of coordination/ataxia
Respiratory depression
Nystagmus
Death or coma in overdose,
especially in combination with
alcohol
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Sedative-Hypnotic
Withdrawal
Maintain ABCs
Flumazenil
Short-acting benzodiazepine antagonist
that can be used in overdose treatment
May precipitate seizures

Basic principle is same as alcohol


Taper benzodiazepines, maintain seizure
precautions, watch for autonomic
instability
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Other Substances
We see patients who abuse or meet
dependence criteria for a host of other
substances
In a test situation, just recognize if the
substance is an upper or a downer
Withdrawal phenomenon is generally
the opposite of symptoms of
intoxication
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Agenda

Cognitive Disorders

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What is a cognitive
disorder?
Problem with memory, orientation,
attention, and/or judgment
Three major categories
Dementia
Delirium
Amnestic disorder

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Dementia vs. Delirium


Dementia

Delirium

Memory impairment

Sensorium impairment

Slow onset (generally)

Acute onset

Symptoms are stable throughout


the day

Waxing and waning course

Usually not reversible

Usually reversible if identify cause

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Dementia
Memory impairment without change in level of
consciousness
May have behavioral disturbance and/or
psychosis
Watch out for pseudodementia, i.e., depressed
mood that masquerades as dementia
Need to rule out reversible causes of dementia

B12/folate deficiency
VDRL/RPR
Thyroid abnormalities
Electrolyte abnormalities

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Alzheimers Disease
Most common type of dementia
Progressive and linear course
Often have personality and mood
changes
Pathology:
Neurofibrillary tangles (Tau protein)
Senile plaques (Amyloid protein)

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Alzheimers Disease,
cont.
Need memory problems plus one of
the following:
Aphasia: Language difficulty
Apraxia: Purposeful movement
(practiced) activity difficulty
Agnosia: Recognition difficulty
Executive functioning deficits: Planning,
organizing, abstracting difficulty

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Alzheimers Disease,
cont.
Assess cognition at regular intervals
Use antidepressants if patient has true
depression
Consider low-dose antipsychotics to treat
associated behavioral disturbance
Some medications may slow rate of decline:
NMDA receptor antagonists (Memantine)
Cholinesterase inhibitors (Donepezil,
Rivastigmine)

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Vascular Dementia
Cognitive deficit secondary to infarct
burden
Clinical criteria are identical to that of
Alzheimers disease
Etiology and progression are different

Step-wise course
Neurological deficits are common
Same limited treatments as with
Alzheimers disease, but must also
control vascular risk factors
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Delirium
Fluctuating clinical course
Waxing and waning

May be agitated or stuporous


Hallucinations are common
Etiology includes nearly any medical
condition:

Drug-induced
Liver/renal/endocrinological dysfunction
Electrolyte abnormality
Infection
Many more
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Delirium, cont.
First and foremost, try to identify the
underlying cause of delirium
Until the etiology is identified, can
only provide symptomatic treatment
Frequent re-orientation
Low-dose antipsychotic to treat agitation
Avoid benzodiazepines and
anticholinergic agents, as these can
cause paradoxical disinhibition
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Amnestic Disorders
Memory impairment without other cognitive
problems associated with dementia
No alteration in consciousness
Always occur secondary to medical
condition
Seizures
Hypoxia
Head trauma
Substance use
Many more
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Agenda

Other Disorders
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Mental Retardation
Significant deficits in intellectual functioning
and age-appropriate adaptive skills
IQ is 70 or below
Onset in childhood, before age 18 years
Most mental retardation has no clear cause
Some genetic syndromes are implicated, e.g.,
Downs Syndrome, Fragile X, Prader Willi,
Angelmans
Prenatal and perinatal exposures can play
significant roles
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Pervasive Developmental
Disorders
Deficits in social skills, language, behavior
Impairment is apparent in early childhood
Autism
Difficulties with social interaction
Communication impairment (non-verbal or
delayed speech)
Repetitive and stereotyped behavior

Aspergers Disorder
Similar to autism, but higher functioning
because cognitive development and language
skills are normal
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Disruptive Behavioral
Disorders
Conduct disorder
Pattern of behavior that violates rights of
others and defies social norms
Aggression toward people, animals, property
Serious rule violation
Think: precursor to antisocial personality
disorder

Oppositional defiant disorder (ODD)


Hostile and defiant behavior
Big difference from conduct disorder is that
ODD patients do not violate the rights of others
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Attention Deficit
Hyperactivity Disorder
Onset before age seven years
Behavior is inconsistent with age and
development
Symptoms involve inattentiveness,
hyperactivity, or both for 6 months
Mainstay of treatment is CNS stimulants,
e.g., methylphenadate,
dextroamphatamine
Some role for behavioral modification
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Eating Disorders
Anorexia nervosa
Body weight is 15% below normal
Intense and distorted body image preoccupation
Amenorrhea

Bulimia nervosa
Recurrent binge eating and attempts to
compensate (vomiting, laxatives, diuretics,
and/or excess exercise)
Intense and distorted body image preoccupation

Behavioral therapy and individual


psychotherapy is mainstay, as well as
control of medical comorbidities
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The End
GOOD LUCK!

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