Inpatient Psych Rotation - Mania/hypomania

Front 1

What are the DSM criteria for hypomania? Include duration, necessary moods and seven symptoms.

Back 1

Duration: 4 days or more
Necessary Moods: Euphoria or Irritability
7 Symptoms: Distractability, Hyposomnia,Grandiosity,
Subjective Racing thoughts (or objective Flight of Ideas/Loose associations), Hyperactivity (Goal-Oriented), Impulsivity (for Pleasurable Activity), Talkativity.
stinky mnemonic: DiHG SH IT

Front 2

Of the seven symptoms how many are needed to make a dx?

Back 2

If euphoria, need 3.
if irritability, need 4.

Front 3

Lithium: general side effects?

Back 3

Weight gain (less than depakote).
Less sedation.

Front 4

Lithium: Respiratory/CVS/GI side effects?

Back 4

Respiratory: None.
CVS: Arrhythmias.
GI: None.

Front 5

Lithium: GU/CNS/Endocrine side effects?

Back 5

GU: Renal dysfunction, polyuria.
CNS: Tremor, Seizure, Cognitive Dysfunction, if ataxia present, consider toxicity.
Endocrine: Hypothyroidism.

Front 6

Lithium: Metabolic/Skin/Blood/Other side effects?

Back 6

Metabolic: Hypernatremia from polyuria, High Ca (PTH activity)
Skin: Alopecia, Rash, Acne, worsening of psoriatic rash
Blood: Benign increased WBC (due to marginalization)
Other: none.

Front 7

Depakote: general side effects?

Back 7

Weight gain.

Front 8

Depakote: Respiratory/CVS/GI side effects?

Back 8

Respiratory: None.
CVS: None.
GI: Hepatic damage (high LFTs), Pancreatitis.

Front 9

Depakote: GU/CNS/Endocrine side effects?

Back 9

GU: Polycystic Ovarian Disease.
CNS: Tremor, Cognitive Dysfunction from NH3
Endocrine: None.

Front 10

Depakote: Metabolic/Skin/Blood/Other side effects?

Back 10

Metabolic: Increased NH3 can cause confusion (mechanism= mitochondrial dysfunction).
Skin: Alopecia, Maculopapular Rash, Antiepileptic Syndrome: severe rash (TENS), fever
Blood: Bone marrow suppression (check CBC)
Other: none.

Front 11

Tegretol: general side effects?

Back 11

Sedation.

Front 12

Tegretol: Respiratory/CVS/GI side effects?

Back 12

Respiratory: None.
CVS: Arrhythmias, CHF (uncommon)
GI: Hepatic damage/Cholestatic jaundice (check LFTs).

Front 13

Tegretol: GU/CNS/Endocrine side effects?

Back 13

GU: Interacts with BCP - USE BARRIER PROTECTION if female.
CNS: Tremor, Cognitive Dysfunction, Dizziness, ataxia, diplopia.
Endocrine: None.

Front 14

Tegretol: Metabolic/Skin/Blood/Other side effects?

Back 14

Metabolic: Hyponatremia.
Skin: Antiepileptic Syndrome: severe rash (TENS), fever
Blood: Bone marrow suppression (check CBC)
Other: mild anti-cholinergic symptoms.

Front 15

Which of the above mood stabilizers is NOT appropriate as monotherapy for bipolar mania?

Back 15

Topiramate, Neurontin, Lamotrigine

Front 16

Of lithium, valproic acid, carbamazepine and lamotrigine, which is associated with a life-threatening rash?

Back 16

All but lithium is associated with toxic epidermal necrolysis syndrome.

Front 17

List the mood stabilizers WHICH PREVENT AND TREAT BIPOLAR MANIA on the basis of weight gain (most to least).

Back 17

Valproic acid > Lithium > Carbamazepine

Front 18

This mood stabilizer worsens psoriasis.

Back 18

Lithium.

Front 19

This mood stabilizer causes polycystic ovarian disease.

Back 19

Valproic acid.

Front 20

This mood stabilizer interferes with the birth control pill – Advise fertile females to use barrier protection!

Back 20

Carbamazepine.

Front 21

This mood stabilizer causes hyponatremia.

Back 21

Carbamazepine.

Front 22

This mood stabilizer can cause hypernatremia.

Back 22

Lithium.

Front 23

True/False: Valproic acid exposure in utero considerably increases the risk of mental retardation in the fetus?

Back 23

True.

Front 24

True/False: Lithium fetal exposure in utero considerably increases the risk of smaller neonate head circumference?

Back 24

False.

Front 25

True/False: Carbamazepine rarely causes severe weight gain?

Back 25

True.

Front 26

This mood stabilizer reduces the risk of osteoporosis.

Back 26

Lithium.

Front 27

This mood stabilizer increases the action of PTH.

Back 27

Lithium.

Front 28

What is the target plasma level for lithium (range)?

Back 28

0.8 - 1.2

Front 29

What are 6 neurological symptoms of lithium toxicity?

Back 29

cerebellar symptoms: Coarse tremor, Ataxia, Nystagmus
Hyperreflexia
Altered MSE
Muscle fasciculations/seizures

stinky mnemonic: CAN(ned) HAM

Front 30

Name two other life-threatening consequence of lithium toxicity.

Back 30

arrhythmias, renal failure.

Front 31

In combination with valproic acid, lamotrigine dose should be adjusted up or down?

Back 31

Down.

Front 32

In combination with carbamazepine, lamotrigine dose should be adjusted up or down?

Back 32

Up.

Front 33

What blood tests do you order when following patients on Valproic acid?

Back 33

Valproic acid level, CBC, LFTs.

Front 34

What blood tests do you order when following patients on Carbamazepine?

Back 34

Carbamazepine level, CBC, LFTs, consider BMP to check for low Na.

Front 35

What blood tests do you order when following patients on Oxcarbamazepine?

Back 35

CBC, LFTs, BMP to check for low Na.

Front 36

What is the prediction error?

Back 36

Actual reward – expected reward

Front 37

How does prediction error explain secondary negative symptoms in schizophrenia?

Back 37

Dopamine antagonism reduces dopamine release from positive prediction error, causing less motivation.

Front 38

How does prediction error relate to mania?

Back 38

There is much less negative prediction error in mania than there should be when actual reward < expected reward.
Thus manic patients don’t learn from mistakes, but continue to take risks.

Front 39

How does prediction error explain pathological gambling in Parkinsons?

Back 39

Dopamine agonists result in more positive prediction errors.
Thus, even when prediction error should be negative from gambling loss (actual reward< expected reward), dopamine release is not decreased, and motivation does not decrease either.