What drugs should be avoided with Kava Kava? - Alprazolam CNS depressants (e.g., phenobarbital, zolpidem) Cultural Formulation Interview perform what 3 functions? - Clarify meaning of illness Empower the patient Validate symptoms within cultural context What does a cultural formulation interview do? - cultural assessment What is the normal range for TSH? - 0.5 - 5.0 mu/L What are lab values in Hyperthyroidism - Decreased TSH Increased T4 and T3 What are labs in Hypothyroidism? - Increased TSH Decreased T4 and T3 What are 5 primary symptoms of Hyperthyroidism? - Heat intolerance Agitation, Anxiety, Irritability Tachycardia Mood swings Weight loss What are 4 primary symptoms of Hypothyroidism? - Cold intolerance Lethargy Weight gain Decreased libido Hypothyroidism mimics symptoms of what psychiatric disorder? - Depression Hyperthyroidism mimics symptoms of what psychiatric disorder? - Mania Valproic acid produces what teratogenic effect? - Spina bifida (neural tube defect) What is the primary organ where valproic acid is toxic? - Liver (hepatoxicity) What are 4 signs of hepatoxicity? - Abdominal pain in the URQ Reddish-brown urine Yellowing of the skin and sclera Fatigue Abdominal pain in the URQ, Reddish-brown urine, Yellowing of the skin and sclera, and Fatigue are signs of - Hepatoxicity What is the therapeutic range for valproic acid? - 50-125 mcg/ml What is a toxic level of valproic acid? - >150 mcg/ml What are 4 signs of valproic acid toxicity? - Disorientation Lethargy Respiratory depression Nausea/vomiting Disorientation, Lethargy, Respiratory depression, and Nausea/vomiting are symptoms of toxicity with what drug? - Valproic acid With suspected toxicity with valproic acid, what labs should be drawn? - DC drug Check drug level Obtain LFTs Obtain ammonia level What is the major side effect with Kava Kava? - Liver damage What herbal supplement is sued for anxiety, stress, and insomnia? - Kava Kava What are 5 symptoms of Stephen's Johnson Syndrome? - Fever Body aches Severe red rash Peeling skin Facial and tongue swelling Severe red rash, Fever, Body aches, Peeling skin, and Facial and tongue swelling are symptoms of - Stephen's Johnson Syndrome Which mood stabilizer causes the least weight gain? - Lamotrigine (Lamictal) Which 3 SGAs cause the least weight gain? - Lurasidone (Latuda) Aripiprazole (Abilify) Ziprasidone (Geodon) Which SGA is the least sedating? - Aripiprazole (Abilify) What are 3 hallmark symptoms of delirium? - Acute disturbance of LOC impaired cognition inattention Acute disturbance of LOC, cognition, and inattention are hallmark symptoms of - Delirium How are agitation and psychotic symptoms treated in delirium? - Low dose Haldol What 4 drugs can cause mania? - Steroids Disulfiram (Antabuse) Isoniazid (INH) Antidepressants (in BPD) Steroids, Disulfiram (Antabuse), and Isoniazid (INH) can induce - Mania What 6 drugs can induce depression? - Steroids Beta blockers Interferon, Isotretinoin (Accutane) Retroviral drugs, Antineoplastic drugs Benzodiazepines Progesterone Steroids can induce what 3 psychiatric states? - Mania Depression Psychosis What medication to treat acne cause cause birth defects? - Isotretinoin (Accutane) What is the therapeutic range for lithium? - 0.6-1.2 mEq/L What medication has a neuroprotective effect for bipolar disorder? - Lithium What is the gold standard for treating manic episodes - Lithium What mood stabilizer has anti-suicidal effects? - Lithium What 5 labs should be drawn with lithium? - Thyroid panel (TSH) Serum creatinine BUN Urinalysis HCG What is a normal SCr range? - 0.6-1.2 mg/dL What is the normal range for BUN? - 10-20 mg/dL When should you suspect kidney disease with a urinalysis? - 4+ protein 4+ protein in the kidney suggests - Kidney disease What are 7 side effects of lithium? - Hypothyroidism Fine hand tremors Maculopapular rash GI upset (N/V/D, cramps, anorexia) Polyuria, polydipsia, diabetes insipidus T-wave inversions Leucocytosis What are 7 signs of lithium toxicity? - Severe nausea, vomiting, diarrhea Confusion Drowsiness Muscle weakness Heart palpitations Coarse hand tremor Unsteadiness while standing or walking Which 3 drugs can increase lithium levels by decreasing renal clearance? - NSAIDs (ibuprofen, indomethacin) Thiazides ACEI What is a toxic level of lithium? - 1.5 mEq/L or higher At what level do you monitor lithium closely (but not discontinue)? - 1.3 mEq/L or higher With suspected lithium toxicity, what do you do first? - Lithium level (not VS) What is the appropriate action if lithium level is 1.5 mEq/L? - DC lithium Check lithium level What 2 conditions can increase lithium levels? - Dehydration Hyponatremia What birth defect can lithium cause? - Ebstein anomaly (congenital heart defect) What 3 neurotransmitters are associated with ADHD? - DNS What 3 parts of the brain are affected with ADHD? - Frontal cortex Basal ganglia Reticular Activating System The Frontal cortex, Basal ganglia, Reticular Activating System are associated with which psychiatric disorder? - ADHD Inattentive Type ADHD demonstrates abnormalities in which part of the brain? - Prefrontal cortex What should be done before placing a patient on stimulants for ADHD (priority)? - Cardiac history Excessive worry, apprehension, or anxiety about events or activities that occurs more days than not for a period of at least 6 months is - GAD If a patient is receiving Haldol 5 mg PO bid, how much Haldol Decanoate should they receive? - 20 x 10 mg = 200 mg (q month) What is the formula for converting oral Haldol to depot form? - 20 x daily dose What does thought process assess? - thoughts and ideas The way a patient organizes his thoughts and ideas is called - Thought process A normal thought process is described as - Logical Linear Coherent Goal-oriented Moving from thought to thought and never getting to the point is called - Tangentiality ("goes on tangent") Providing unnecessary detail but eventually getting to the point is called - Circumstantiality ("goes in circles") Themes that occupy a patient's thoughts and perceptual disturbances is called - Thought content Thought content includes 3 items - Suicidal ideation