Autism mnemonics:

'AUTISTIC PEOPLE'

A = Affect isolation
U = Unrelated to others
T = Twiddle
I = I/You confusion in speech
S = Self-mutilation
T = Temper tantrums
I = Inconsistent development
C = Concrete thinking

P = Perceptual difficulties
E = Echolalia
O = Orderly
P = Physical motor disorder
L = Lack language skills
E = Excessive activity

Tardive: the involuntary movements are tardive, meaning they have a slow or belated onset.
FACE: stiff & jerky movements =  smacking lips, chewing, blinking, grunting, puffing of cheeks
LIMBs: swaying from side to side, flapping arms, tapping feet, wiggling of fingers
 

Wiggling fingers

Smacking lips

Swaying from side to side

Epidemiology: Age 16-30 (High school age to the big 30s!)

The Phrase is HD N CD and it means "HD= High Definition ,N=& ,CD=Cd"

S/s:
Positive
H: hallucinations
D: delusions

N: Negative symptoms (flat affect, social withdrawal, poverty of speech)

C: catatonic or grossly disorganized behavior
D: Disorganized speech


Tx:
Neuroleptic drugs bind and block the Dopamine D2 receptors in the Dopaminergic pathways of the brain => This leads to Dopamines unable to exert effects on the pathway => less psychosis episodes (Decreased dopamine release in the prefrontal cortex, and excess dopamine release in other pathways, are associated with psychotic episodes in schizophrenia and bipolar disorder)

1st GENERATION
Mnemonics: A Scene (of psychosis! - what an old scene!) = Azine
Chloropromazine (Thorazine)
Trifluoperazine (Stelazine)
Fluphenazine (Prolixin)
Haloperidol (Haldol) - Halo parisol doll - old school doll

First-generation antipsychotics have a high rate of extrapyramidal side effects, including rigidity, bradykinesia, dystonias, tremor, and akathisia. Tardive dyskinesia (TD)—that is, involuntary movements in the face and extremities—is another adverse effect that can occur with first-generation antipsychotics. Neuroleptic malignant syndrome (NMS) can occur with these agents.


2nd GENERATION/ATYPICAL:
Aripiprazole (Arale ("even littler cracker") pretzel) - new!
Olanzapine (Olando Bloom in a pine forest) -
Risperidone
Invega Triza 4x/yr  

Second-generation (novel or atypical) antipsychotics, with the exception of aripiprazole, are dopamine D2 antagonists, but are associated with lower rates of extrapyramidal adverse effects and TD than the first-generation antipsychotics. However, they have higher rates of metabolic adverse effects and weight gain.



References:
http://emedicine.medscape.com/article/288259-medication#2
https://psychmnemonics.wordpress.com/category/schizophrenia/

Obsessive- repeated thoughts
Compulsive - repeated behavior 

1. ANXIETY (Types - generalized, panic, social; Epidemiology - female; Tx - Buspar, SSRI, SNRI, BZD for short-term, must taper, w/drawal & sz)
2. DEPRESSION (Types - psychotic, persistent>2yrs; Tx - Psychotherapy (CBT, IBT, Problem-solving); SSRI, SNRI, Wellbutrin, TCA; ECT/rTMS/VNS)
3.  BIPOLAR (Lithium - Side effects (skin, CV, Neuro; Women - Tetrarogenic, >12y/o ok , Elderly - decreased dose))
4.  OCD (O-thought; C-behavior)
5. SCHIZOPHRENIA (+: H&D; -:C&D; 1st generation: (Tardive Dyskinesia) -azine Chloropromazine (Thorazine), Trifluoperazine (Stelazine), Fluphenazine (Prolixin), Haloperidol (Haldol); 2nd generation (metabolic: weight gain, hyperglycemia, hyperlipidemia, hypertriglycerides, hypercholesterolemia) Aripiprazole, Olanzapine, Risperidone, Invega Triza 4x/yr
6.  AUTISM ( social issues, Epidemiology - more in males, 40% above avg. IQ, strong visual/auditory learners; ..)
7. ADHD
8. EATING DISORDERS (

Lithium
USE: for mania in bipolar

MECHANISM: modulates Na+ of nerve & muscle cells => reduces manic episodes. It's highly attracted to thyroid gland and thus causes hypothyroidism.

SIDE EFFECTS:

• Vulnerable population:
•  Women: effective birth controls => D category for pregnancy & lactating
• Elderly: lower dosage
• Adolescents: FDA approved for >12 y/o
• Organs:
• Heart - arrhythmias & hypotension
• Neuro - impaired thought process & drowsiness
• Skin - hives, acne, alopecia, eruption of psoriasis

MONITORING:

1. Renal (BUN, Cr, GFR q3 mo.)-----Need to drink lots of water due to risk of nephrogenic diabetes insipidus
2. Thyroid (TSH) ----Similar to Iodine, Lithium as a chemical element is also attracted to thyroid
3. Monitor blood level ---- Narrow therapeutic index, Toxicity is closely related to serum lithium concentrations and may occur at dosages close to therapeutic levels; monitor therapy by measuring serum lithium

Lithium:
Metabolism: Not metabolized (Therefore, not worried about Liver function).----it cannot be further broken down, kinda similar to Sodium
Elimination: Renal (Check renal function)

Generic	Brand	Dosage
Duloxetine	Cymbalta	30-60mg 20mgBID 30mgBID
Venlafaxine* (Incr BP)	Effexor	37.5mgBID 25mgTID
Desvenlafaxine* (Incr BP)	Pristiq	50mgqd same time
Levomilnacipran	Fetzima	40-120mgQD Start 20mgqd x2-3d Then 40mg

*Check Liver & Renal functions
*Do not combine with MAOI (causes erotonin syndrome)

Generic	Brand	Dosage	Elderly***
Citalopram	Celexa	20-40mg qd*	20mg max (QTc)**
Escitalopram***	Lexapro	10mg qd
Fluoxetine	Prozac	20-60mg 90mgqweek Extended Release AM 20mg PM20mg	10mg initial
Paroxetine	Paxil	20-50mg	10mg initial
Sertraline	Zoloft	25-50mg
Vilazodone	Viibryd	20-40mg Start @ 10mg initial

Mnemonics:
Parrot               savors the       ecstatic               citrus            fruit in the       village
Paroxetine        Sertraline       Escitalopram      Citalopram   Fluoxetine      Vilazodone




Citalopram

* The SSRIs are not thought to be as worrisome in patients with cardiac disease, as they do not appear to exert any effect on blood pressure, heart rate, cardiac conduction, or cardiac rhythm; however, dose-dependent QT prolongation has been reported with citalopram. Because of the risk for QT prolongation, citalopram is contraindicated in individuals with congenital long QT syndrome.
**The FDA advises that the dose of citalopram not exceed 40 mg/day because of the risk of potentially fatal QT prolongation. Furthermore, higher doses have not been shown to be more effective in treating depression.


***Escitalopram is an SSRI and S-enantiomer of citalopram

**** Elderly is always half the dosage

3 brain chemicals:

1. serotonin
2. dopamine
3. norepinephrine

A - Reuptake inhibitors: SSRIs, SNRIs, NDRIs
Premise: Serotonin, Dopamine, Norepinephrine are feel-good chemical in the brain. Therefore, blocking the reuptake (brain cells take those neurotransmitting chemicals back in the brain) will help more of them available for you to feel good.

1. SSRI - Selective Serotonin Reuptake Inhibitor
2. SNRI - Serotonin Norepinephrine Reuptake Inhibitor  
3. NDRI - Norepinephrine Dopamine Reuptake Inhibitor - Wellbutrin (Zyban) 
4. SARIs - Serotonin antagonist reuptake inhibitors -Nefazodone & Trazodone

B - Older:  MAOIs & TCAs

1.  TCAs
2. MAOIs - Monoamine oxidase is a natural enzyme that breaks down serotonin, epinephrine, and dopamine. MAOIs block the effects of this enzyme. As a result, the levels of those neurotransmitters might get a boost.The downside is that MAOIs also prevent the body's ability to break down other medicines metabolized by this enzyme (such as Sudafed, or stimulants) -- raising the risk for high blood pressure -- as well as an amino acid called tyrosine, which is found in certain foods like aged meats and cheeses. MAOIs also shouldn't be combined with other medicines that can raise serotonin (such as certain migraine medicines, or other antidepressants), because that can cause a buildup of excessive serotonin (called "serotonin syndrome"), which could be life threatening.

References:
http://www.webmd.com/depression/how-different-antidepressants-work#1

tattoos may contain iron (think red dye and the rusted iron bar). Magnetic fields can heat up these tattoos pigments leading to 1st or 2nd degree burns. Therefore, ppl with facial tattoos is contraindicative for MRIs or rTMS.

also, no stents in brain or neck or aneurysm clips

In this educational presentation, Dr. Cady completely explains the process of "TMS", or Transcranial Magnetic Stimulation. TMS is a state of the art, FDA approved treatment for depression, which treats this condition by shooting pulses of magnetic waves into a certain section of the brain - the left dorsolateral prefrontal cortex. Unlike the "shock treatments" made infamous in such movies as "One Flew Over the Cookoo's Nest," TMS is a remarkably well tolerated treatment, which involves NO anesthesia, NO seizure, NO loss of consciousness, and NO medications. Patients are completely awake throughout the procedure, and actual psychotherapy (or "talk therapy") can be accomplished right during the appointment.

In this very complete presentation, Dr. Cady demonstrates the operation of the equipment, the positioning of the patient, how effective TMS is, the way it works, and its excellent tolerability. He also reviews the process at CWI of "hot-rodding" our TMS machine in creative ways to get maximum amounts of improvement in minimum time (which translates into minimizing the patient's total out of pocket cost).



https://www.youtube.com/watch?v=0QwCuglKjME

Last-line therapy for pts with Severe Depression unresponsive to antidepressants
It causes seizure
Therefore, after seizure, pt will have typical post-seizure s/s: disoriented, memory loss, & temporary confusion

Types:

• Psychotic depression
• Persistent depression: 2 years (mnemonics: think nursing school!)
• PMDD: dysthymia, erratic mood swings before menstruation

Etiology: genetics + biological + environmental + psychological
Epidemiology:

• Women: attempt more suicides (keep trying again and again, unable to complete the suicide like men)
• Men: choose ETOH & Drugs
• Elderly: usually mistaken grief for depression

Timing:

• Postpartum blues: 1 fortnight 

S/s:

Test: PHQ9
Tx:

  Psychotherapy:

	Goal	Population	Caution
Cognitive Behavioral Therapy (CBT)	Change behavior
InterPersonal Therapy (IPT)	relationship issues
Problem Solving Therapy (PST)	realistic solutions	Good for elderly
Internet-Computer based therapy	CBT + IBT	Homebounds, teens, LGBTQ, rural	Viz-a-viz still preferable

Meds:

• Adolescents: suicidal thoughts
• Onset: 1-2 fortnights (2-4 weeks) or up to 1/2 year (6 mo.) to work
• SSRIs, SNRIs, TCAs should NOT be used with MAOI
• Common antidepressant side effects: 
• Monitor Liver/Renal function (cleared thru hepatic and renal chanels)
• Decreased libido
• St John Wort: bleeding side effects (due to being an anticoagulant)
• Need to wean before stopping antidepressant

•  SSRI - Serotonin:
• 
  

• Generic	Brand	Dosage	Elderly***
  Citalopram	Celexa	20-40mg qd*	20mg max (QTc)**
  Escitalopram***	Lexapro	10mg qd
  Fluoxetine	Prozac	20-60mg 90mgqweek Extended Release AM 20mg PM20mg	10mg initial
  Paroxetine	Paxil	20-50mg	10mg initial
  Sertraline	Zoloft	25-50mg
  Vilazodone	Viibryd	20-40mg Start @ 10mg initial

   

Others: ECT, rTMS, VNS

Beta blockers

•  Propanolol (Inderal); Atenolol (Tenormin); Nadelol (Corgard) 
• Pre-treatment EKG for baseline
• Side effects:
• Fatigue, dizziness, weakness, decreased BP or HR (think: beta blocker is like a damping break on the machine of the heart = the heart can't increase BP or HR => leading to fatigue & weakness. Of course, the heart can't work as fast leading to weakness
• Tx: 
• always start with lowest dose
• elder caution!

Types - Generalized, social, panic

	Timing
Generalized	Months/years (trait temperament)
Social	Stressor precedent
Panic	Minutes

Epidemiology - females mostly
Etiology - genetics

Tx - Social (CBT); Meds(most common)-BZD (withdrawal/sz - needs taper!), Antidepressants (Adolescent caution!), BB (elderly caution!); Meds (most helpful for long term)-BuSpar


Meds:
Common side effects:

• Blurred vision, nausea (rest & digest)
• Fatigue (Beta blocker)
• HA (Buspirone)
• Confusion (cloudy thinking - rest &digest)
• Nightmares (Buspirone)

Severe side effects:

• It's like Rest & Digest (relaxation mechanism) going too much (severe/adverse Side effects): drowsy (rest!), dizzy (rest!), increased saliva (digest!), blurred vision (dim light sleepiness!), difficult with cognition (!!!), decreased libido (rest!), unsteady gait
• Anaphylaxis: swelling of face, sob, rash
• Psych (antidepressants in youth): suicidal thoughts
• Metabolic issue: jaundice

1.     BB

•  Propanolol (Inderal); Atenolol (Tenormin); Nadelol (Corgard) 
• Pre-treatment EKG for baseline
• Side effects:
• Fatigue, dizziness, weakness, decreased BP or HR (think: beta blocker is like a damping break on the machine of the heart = the heart can't increase BP or HR => leading to fatigue & weakness. Of course, the heart can't work as fast leading to weakness
• Tx: 
• always start with lowest dose
• elder caution!

2.     BuSpar = Boost Spa = relaxing for Anxiety

BuSpar = Boost Spa
Side effects:

• Dizziness, HA (if tapered too quickly); Nausea -----Mnemonics: if get up to leave from boost spa (BuSpar) too quickly, it will cause you to have orthostatic low blood pressure & middle ear vertigo (dizziness, HA, nausea)
• Nervousness/Excitement/Insomnia ----Mnemonics: if you leave Boost Spa (BuSpar), you may get nervous rebound, thus insomnia - can't sleep, at times get paradoxical excitement

~By Qt

Benzodiazepines for anxiety mnemonics:
LA-AX-Clo =LAX Clorox eases ur zepam anxiety = Lorazepam (Ativan); Alprazolam (Xanax); Clonazepam (Klonopin)

Note: withdrawal/sz - needs taper! = Mnemonics: just think of BZD like alcohol = can cause seizure and w/drawal - needs taper Viz: pt on ETOH cold turkey = needs to be given BZD bc they will be having sz and w/drawal)


~by Qt

•  Antidepressants [DOC]
• BuSpar (antianxiety 
•  not related to BZD or barbituates = minimal side effect; 
• a novel antianxiety agent with no other members in its class;  
• Unlike the immediate relief of symptoms that occurs with benzodiazepine therapy, buspirone's onset of action takes two to three weeks = 2-3 wk for full efficacy)

• BZD (Oral, IV - early onset but high abuse potential)
• Immediate onset & short half life: IV Lorazepam (Ativan)
• Drugs: Lorazepam (Ativan); Alprazolam (Xanax); Clonazepam (Klonopin)
• Mnemonics: LA-AX-Clo =LAX Clorox eases ur zepam anxiety = Lorazepam (Ativan); Alprazolam (Xanax); Clonazepam (Klonopin)
• lead to dependence; that is, withdrawal symptoms occur once the medications are discontinued. Withdrawal symptoms include anxiety, irritability and insomnia, and it can be difficult to differentiate between withdrawal symptoms and the recurrence of anxiety. Seizures occur rarely during withdrawal.28 Withdrawal symptoms tend to be more severe with higher dosages, with agents that have short half-lives, with rapidly tapered dosages, and in patients with current tobacco use or with a history of illegal drug use.15 The risk of dependence increases as the dosage and the duration of treatment increases, but it can occur even when appropriate dosages are used continuously for three months.4,27 Withdrawal symptoms begin six to 12 hours after the last dose of an agent with a short half-life and 24 to 48 hours after the last dose of an agent with a longer half-life.27 In patients who have taken a benzodiazepine for more than six weeks, the dosage should be decreased by 25 percent or less per week to prevent withdrawal symptoms.4 Patients may experience rebound anxiety (akin to the rebound hypertension that occurs when some antihypertensives are discontinued) once the tapering process is completed, but this is transient and ends within 48 to 72 hours.28 Once the rebound anxiety ends, a patient may re-experience the original symptoms of anxiety, referred to as recurrent anxiety.

• Beta blockers - Propanolol (Inderal); Atenolol (Tenormin); Nadelol (Corgard) (Pre-treatment EKG for baseline, Tx: always start with lowest dose, elder caution!)

BuSpar = Best Spa = relaxing for Anxiety
BuSpar = Boost Spa
Side effects:

• Dizziness, HA (if tapered too quickly); Nausea -----Mnemonics: if get up to leave from boost spa (BuSpar) too quickly, it will cause you to have orthostatic low blood pressure & middle ear vertigo (dizziness, HA, nausea)
• Nervousness/Excitement/Insomnia ----Mnemonics: if you leave Boost Spa (BuSpar), you may get nervous rebound, thus insomnia - can't sleep, at times get paradoxical excitement

Buspar = Push bar = Push the bar = trying to exercise to get the edge off. (by Qt).

Buspar is used for long-term management of anxiety. (Viz: long term exercise = long-term feel good)

 

 

What do most people go to when they need to quell some anxiety? They need Booze(pirone).

Both booze and boozpirone will take the edge off. We can even get fancy and use its trade name, Buspar. No better place to get that booze than down at the BoozeBar….
Go get smart! (Source: https://www.medschooltutors.com/blog/mastering-mnemonics-for-the-usmle-neuro-psych-drugs)