Shelf EXAM High Yield Points

1. If you are a psychiatrist who has a therapist and psychologist working for you
and they get sued, ultimate responsibility lies with you called Captain of the
Ship Doctrine.
2. Linezolid (antibiotic) +SSRI can cause Serotonin syndrome
3. Meperidine (Demerol) + SSRI can cause Serotonin syndrome
4. Serotonin syndrome = Neuromuscular excitation, sweating, diaphoresis,
altered mental status
5. Serotonin syndrome treated with cyproheptadine (Serotonin blocker) or Benzo
6. Intermittent explosive disorder is found to have low serotonin in the CSF or 5HIAA
7. Most common hallucination in schizophrenia is Auditory
8. 1 in 100 people get schizophrenia, often born in winter
9. Psychosis for <1 month called Brief psychotic disorder; 1 month 6months
Schizophreniform
10.Good prognosis schizophrenia, Paranoid type, if later in life, abrupt onset,
married, family involved
11.Poor prognosis of Schizophrenia, disorganized type, insidious onset, get it at
early age
12.Schizo-affective disoreder: the base word Schizo appears first, so they must
have only psychotic symptoms for at least two weeks, then they become
manic or depressed
13.Bipolar disorder; 4% lifetime risk, 10-15% commit suicide, suicide usually
during the depressed phase
14.Cycolthymia; at least 2 years of being hypomanic or slightly depressed, but
not full blown manic or full blow depression.
15.Rapid cycling: 4 mood switches per 12 months, can be combination of
mania, main, depression, mania; 4 of them in 12 months
16.Major depressive disorder: at least 2 weeks symptoms in Adults; 1 week in
kids, 1 week in kids, remember that point
17.Dysthymia, 2 years in adults; 1 year in kids to be dysthmia
18.High Suicide risk factors: <19 YO, >45 yo white male, intoxicated
19.Guys kill themselves more often, girls attempt suicide more often
20.Pt was on Haldol for10 years then one day develops a dystonic reaction,
because he quit smoking and smoking causes P450 to metabolize drugs
faster, when someone quits smoking the metabolism slows down.
21.Dystonic reactions like torticolis, oculogyric crisis happen when pt takes high
potency antipsychotic notoriously Risperdal. Treat it with Benztropine
(Cogentin) or Diphenhydramine (Benadryl)
22.Parkinsonism more likely with Typical antipsychotics
23.Akathisia: restlessness varies, Common with Aripiprazole
24.Treat Akathisia with Beta Blocker

25.Tardive dyskinesia: risk from being on older antipsychotics, on it long time,

older age, abrupt onset
26.Treat Tardive dyskinesia with Benzos
27.Neuroleptic Malignant syndrome: Increase CK, Rigidity, fever, autonomic
instability, delirium
28.Treat Neuroleptic malignant syndrome with Dopamine agonist like
Bromocriptine Amantadine, or Dantrolene
29.Valproic acid during pregnancy, risk Neural tube defect like spina bifida
30.Lithium during prego can cause Ebsteins anomaly
31.Benzodiazepines: similar to fetal alcohol syndrome can cause cleft palate
32.Alzheimers dementia: insidious, slower onset
33.Vascular dementia: step wise drop, once the decline, they dont get better,
then can drop again in cognitive symptoms, HX Diabetes, hx HTN, Strokes
34.Delirium, happens short, suddenly, treat the cause, infections, post op causes
35.Difference between Autism and Aspergers syndrome: Aspergers has no
delay in cognitive or language development
36.Retts syndrome: a child that is developing normally and then regresses, then
dies
37.ADHD kids must show some symptoms before age 7 years
38.Conduct disorder happens before age 13
39.Wernikes syndrome: CAN- Confusion Ataxia Nystagmus are symptoms
40.Treat Wernickes with Thiamine
41.Korsakoffs- confabulations
42.CN 6 palsy in Werickes
43. Reverse Opioids with Naloxone
44.Cocaine: person comes in high with coronary spasm, agitation- treat it with a
Benzo\
45.Person High on PCP will have Vertical Nystagmus
46.Picks disease, Frontal lobe damage, person will be foul obscene, sexual
47.Creutzfeldt- Jacob disease- Neurosurgery infected equipment, Prion disease,
will have 14-3-3 tau protein n CSF
48.Temporal lobe seizures can cause manic type symptoms
49. NPH, Normal pressure hydrocephalus: Weird wet wobbly
50.Huntingtons syndrome: CAG repeats
51.Hepatic encephalopathy: increase ammonia, treat with Lactulose and/or
Neomycin
52.Psychotic person with Hepatitis C or cirrhosis, use Paliperidone (Invega), its
easy on the liver
53.Pellegra: Diarrhea, delirium, dementia, 3 Ds, Vegan patients
54.B12 deficiency in geriatric can cause depression
55.Long term Beta Blocker use can cause depression
56.MRI of Herpes encephalitis, shows bi temporal lobes lit up
57.Myocardial infarction pts get depressed
58.Mitral valve prolapsed patients will often have panic or anxiety
59.Hyperthyroidism patients will have anxiety, panic disorder
60.Hypothyroidism, overweight, weight gain, depression

61.Clozapine: only Antipsychotic shown to decrease persons risk of suicide, risk

causing seizures, right sided obstipation, Agranulocytosis, seizures, weight
gain; check with biweekly CBC with differential
62.Olanzapine causes weight gain
63.Risperidone: increase in Prolactin, #1 dystonic reaction
64.Ziprasidone (Geodon): must take with food, has little weight gain
65.Aripiprazole: seen as the no weight gain antipsychotic
66.Lithium: Decrease risk of suicide, do dialysis if level >4,
67.After being on Lithium for a long time will eventually cause hypothyroidism,
Diabetes insipidus, skin problems, if person has HTN may want to use
Calcium channel blocker or Beta blockers to treat it
68.Lithium may cause Psoriasis, worsen acne in teens
69.NSAIDS, HCTZ can all increase levels of Lithium
70.Carbamazepine is an autoinducer of its own metabolism
71.Dont use Depakote(Valproic acid) with Lamictal (Lamotrigine) , Depakote
(Valproic acid) will increase the Lamictal(Lamotrigine) level too much.
72.Lamotrigine can cause Stevens Johnsons syndrome
73.Topiramate (Topamax) side effects, Kidney stones, lower weight
74.Fluoxetine: once stopped wait 4-5 weeks before you start
75.Fluvoxamine: SSRI of Choice for OCD
76.Venlafaxine SNRI, causes increase in blood pressure
77.Duloxetine, treats chronic pain
78.Bupropion: Dont use in Bulemics (suppresses appetite), lowers the seizure
threshold; use in people to stop smoking, Helps treat ADHD
79. Use Bupropion if someone is having sexual side effects from SSRI
80.Trazadone: PRIAPISM huge
81.TCAs: Great for Neuropathic pain, anxiety, fetal limb defects
82.MAOIs: avoid Tyramines, like cheeses wines
83.OTL, outside the liver, Benzos metabolized outside the liver include
Oxazepam, Temazepam, Lorazepam
84.Buspar: good drug for Generalized anxiety disorder
85.Salycilates overdose will cause metabolic acidosis, tinnitus
86.Overdose on anticholinergic, tx Physostigmine