Psychiatry

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Missed Concepts

  • Varenicline can be combined with NRT without additional adverse effects, and is possibly more effective than either method alone.
  • Adjustment disorder is characterized by emotional symptoms causing clear impairment in social and occupational function developing within 3 months of an identifiable stressor.
  • Opioid withdrawal: mydriasis, irritability, anxiety, tachycardia, hypertension, nausea, vomiting, cramping, myalgias, arthralgias, lacrimation
  • Stimulant toxicity: mydriasis, irritability, anxiety, tachycardia, hypertension, loss of appetite, diaphoresis
  • Stimulant prescriptions for ADHD are not associated with increased risk of substance use disorder.
  • Histrionic personality disorder diagnosis
  • The difference between illness anxiety disorder and somatic symptom disorder is that in the former they are not complaining of having symptoms, just preoccupied with concern that they might have a serious undiagnosed disease (e.g. brain tumor).
  • Bupropion is not first line in pediatrics for depression
  • Always rule out secondary causes of dementia (e.g. depression) before jumping the gun.
  • Late onset MDD is associated with increased risk of Alzheimer's
  • Akathisia (inability to sit still), is a side effect of FGA > SGA, treat with propranolol.

Tourettes

  • H&P: Comordid psychiatric disorders include OCD/ADHD > MDD/anxiety
  • Dx: Motor and vocal tics for more than 1 year, onset before 18.
  • Tx: Management is with behavioral training, antiDA agents (risperidone), or alpha-2 receptor antagonists (clonidine)