one can stop valproate right away, no taper is needed.
"much easier to use none than one" - heard on addiction rounds in reference to making a case for abstinence over controlled use
brain reward system prefers immediate gratification- overweighting the immediate reward is called delayed discounting.
Age of onset of schizophrenia in habitual marijuana users is 3 years earlier.
"imagination is more important than knowledge" - einstein
"conscious mind is but the neck of the bottle" -psychoanalyst making his case for his practice
"neocortex is the thin condom covering the limbic system" - heard in seminar
Semmelweis who single-handedly did more to reduce hospital mortality than anyone or thing since the modern era died in an asylum a madman.
"marriage is diagnostic, not therapeutic" - heard in seminar
4 major side effects of the typical antipsychotics
1. EPS
2. anti-cholinergic
3. sedation
4. orthostatic hypotension
-be sure to ask yourself, is it potent or not?
think of the high and low potency typical antipsychotics in this way
the high potency- turn you into a walking zombie, drooling because less anticholinergic
the low potency - put you out cold because they're very sedating, completely knocks you out very sedating and anticholinergic so no drooling, nurses love giving the low potency antipsychotics
the first antipsychotic was chlorpromazine in the 50's, aka Thorazine. it takes about 300-350mg of thorazine to put someone out cold. this was a low potency antipsychotic and all other antipsychotics from that day have been measured in thorazine equivalents. the other low potency antipsychotics are 1:1 with thorazine (thioridazine etc...)
there are middle of the road antipsychotics that are somewhere between high and low potency-
perphenazine - 12:1 thorazine equivalents
thiothixene and stelazine: 20:1 thorazine equivalents
big dog haldol (haloperidol) is high potency antipsychotic with 50:1 thorazine equivalents (300mg thorazine = 6 mg haloperidol)
calm someone down with this: 5:2:1, 5mg haldol, 2mg ativan (lorazepam), 1mg cogentin (benztropine)
difference between psychiatry and medicine - in medicine dropping in on your patients on the weekend makes them feel cared for and they may think you're a good doctor. "drop in" on your psych patients on the weekend and you risk confusing them by blurring boundaries, ESPECIALLY with borderline persons
nortriptyline is a "window" drug- meaning there is a plasma concentration range that is its therapeutic window if you are too high or low the drug looses its efficacy, nortriptyline has low ortho/low anticholinergic side effects good for geriatric
45 minutes is most time you want to spend in family meetings, after that there is no payoff and only risk
"these are new year's resolutions" -in regard to the promises heard on the wards about future adherence
the narcissistic injury leads to suicidality
4 types of emotional attachment in this life
1. secure
2. avoidant
3. anxious
4. chaotic
"he who has never read the greeks is bound to make a lot of discoveries" - heard in seminar
Notes on Freud:
masculine protest- striving to be a real man, genesis behind narcissism
neurotics - will trade everything for safety
oral phase - wish for dependency/gratification
anal - time dirt money (anal trilogy), compliance v defiance, autonomy v doubt
phallic/oedipal - exhibition/woo the world
genital phase- typified by cougar in top gun - turn in your wings
anal phase - comply until resent, defy until guilty and go around in neurotic circle, men become dependent on mothers, passive aggressive
misc notes...
borderlines have affective storms
don't know where to go in an interview? hunt for the affect, follow the affect.
patient's advice on marriage:
"respect and believe what they are saying. believe the other person if they say you hurt them, feel the genuine of your heart, and do things together, work on being buddies from the start"
when someone has has axis i disorder its impossible to diagnose an axis ii b/c coping with diseases regresses our defenses
and the final pearl for the psychiatry rotation-
"why have a tantrum about taking your medication? isn't that cutting your nose off to spite your face?" - heard in rounds
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