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muscle rigidity
myoglobinuria
hyperpyrexia
excess muscle contraction = breakdown muscle tissue, myoglobin
goes out into blood, clogs up kidneys
- raises body temp
Tx: dantrolene (also treats malignant hyperthermia from inhaled
anesthetics), DA agonist (bromocriptine)
Atypical antipsychotics
- olanzapine, quetiapine, risperidone, aripriprazole, clozapine
block dopamine AND serotonin receptors (fewer SE)
but also block alpha (hypotension) and histamine (sedation, wt gain)
olanzapine = wt gain, diabetes (metabolic syndrome)
clozapine = strongest, most effective atypical
AGRANULOCYTOSIS (STOP MAKING GRANULOCYTES LIKE
NEUTROPHILS, EOSINOPHILS)
- monitor CBC 1x/wk
quetiapine = tx for psychosis from Parkinson meds (lowest risk EPS
side effects)
Virchow = left supraclavicular lymph node
Marked impairment in social/occupational functioning
Mania >/= 1 week
3 of 7 sx
Distractability
Irresponsibility
Grandiosity (inflated sense of self-esteem)
Flight of ideas (loose associations, cant slow down brain)
Activity & Agitation (energy to spare, productive or agitation/antsy,
over the top, larger than life)
Sleep decrease (less need)
Talkativeness (pressured speech, louder)
Hypomanic episode
Less severe sx, shorter duration (>/= 4 days)
No impairments in social or occupational functioning
Bipolar I
Sedation
Hypotension/sedation/dizziness (anti alpha)
Anticholinergic (hot as a hare, dry as a bone, mad as a hatter, etc)
HIGH DOSE = prolong QT interval
TCA OD (3 Cs of TCA ODs)
Cardiotoxicity (tachycardia, hypotension, conduction abnormalities,
arrhythmias)
CNS toxicity (sedated, obtunded, coma, seizure)
anticholinergic sx (mydriasis, dry mouth, ileus, urinary retention,
hyperpyrexia, confusion)
OR: convulsions, coma, cardiotoxicity
use sodium bicarbonate (TCA are weak acids)
MAOi (never used anymore)
Not breaking down serotonin, norepinephrine, dopamine, etc
Tranylcypromine, Phenelzine, Selegiline, Rasagiline
Selegiline, rasagiline selectively inhibit MAOi B inhibits dopamine
breakdown selectively (used for tx of Parkinson)
Serotonin syndrome
Hypertensive crisis with ingestion of tyramine (aging foods)
- these foods trigger migraines
brown bananas, wine, aged cheese, soy sauce, aged beef
- stimulates NE release
normally MAOi in gut will breakdown tyramine in foods
Atypical antidepressants
Bupropion NE/DA RI
Mirtazapine alpha 2 antagonist
Trazodone serotonin modulator
Nefazodone serotonin modulator
Bupropion works with SSRI (increases NE and DA, SSRI increases
serotonin)
- stimulant effect
smoking cessation
lowers seizure threshold
NO sexual dysfunction (unlike SSRI)
Mirtazapine
Remember, alpha 2 is on PRESYNAPTIC nerve terminal
Munchausen syndrome
- more self-harm
- multiple invasive procedures (long distances)
- risk to life
Munchausen by Proxy (factitious disorder imposed on another)
illness in child caused by caregiver
mental disorder in caregiver not child, they get to achieve sick role by
proxy
Somatization
Somatic Symptom disorder
(w predominant pain = pain disorder)
illness anxiety disorder = hypochondriasis
- no physical symptoms
- actually worried, not faking
conversion = stress converted to disorder
Immature defense mechanisms
isolation what we do as physicians to protect our emotions
rationalization convenient excuse (I didnt get that job but I didnt
really want it)
reaction formation overcompensating in the opposite direction
repression = unconscious forgetting of negative things
splitting = BPD
Mature defense mechanisms
Sublimation anxiety about an exam transformed into vigorous
exercise/study
Suppression conscious and deliberate attempt to stop thinking about
negative or stressful things
Personality Disorders
Trait vs disorder (cause problems, impaired functioning)
Disorder = stable by early adulthood
- educate people around them
- people dont recognize they have them