Who am I?
Olanzapine!! A commonly used antipsychotic that is commercially known as Zyprexa. This compound can eliminate psychotic symptoms by competitively blocking overactive serotonin receptors in the basal forebrain in psychotic individuals. However significant side effects to this medication are metabolic derangements, obesity, and edema. Instances of extrapyramidal symptoms are rare with Zyprexa because it is not a strong blocker of dopamine.
Here is my mnemonic for the DSM criteria for diagnosing substance dependence"
L U/R Ng Q W T Time
aka "learning quit time"
L- longer/larger periods using substance than originally planned
U/R - use despite repercussions
Ng - neglect of obligations, work, relationships...
Q - unsuccessful attempts at quitting
W - withdrawal
T - tolerance
Time - inordinate amount of time/energy/expense used to acquire substance
in psychotherapy here are three things to say when you don't know what to say next-
1. that must have been hard
2. tell me more
3. how are you feeling?
The full-proof parenting algorithm:
1. Hungry? Feed em
2. Wet? Change em
3. Upset? Soothe em
When inquiring about history of trauma or abuse during an interview one way to ask is, "Do you have any history of trauma or abuse?"
The signs and symptoms of PTSD revolve around three primary clusters:
1. Reliving the experience in some way
2. Hyperarousal/hypervigilance
3. Avoidance, numbing, shutting out/down/off
Substance abuse clinical points-
ethanol disinhibits the behavior regulating prefrontal cortex- it inhibits the inhibitor, most drugs don't do this. -"Have you ever heard of a crack house brawl?"
Heard in rounds- "when the going gets tough, the borderlines get using"
-substance abusers are ambivalent about change, remember- ITS DOING SOMETHING GOOD FOR THEM!!! - so don't finger wag, it will get you nowhere, instead try asking about their goals? do they want to control their using, cut down, switch whatever but find out- this can reveal flawed thinking and assumptions. And if you feel as though whatever reasons are not in line with treatment, reality or your own moral compass simply state - , "I can't join you in that goal"
Think a person in a hospital for detox is lying about use? Ask him/her what are their goals? What are you hoping to get out of this hospital visit?
Heard in rounds regarding borderline personality - "They love beyond measure whom they will soon hate without reason."
"what is learned with pleasure is learned full measure"
the key to motivational interviewing is get the patient to tell you why they should quit
Food for thought:
During a discharge plan one day we were discussing the private psychiatrist fees for an office in a suburb of Washington, DC. The office does not take insurance and the following rates are out-of-pocket.
Initial consult - $350
20 minute med check - $135
1 hour psychotherapy - $270
Child psychiatry pearls
Kids deal with trauma by either internalizing or externalizing.
IF they internalize there are two chief symptoms: depression and anxiety. This is ego-dystonic, i.e. - it causes conflict with the child's sense of self or ego.
IF they externalize then you get conduct disorder, oppositional defiant disorder, disruptive behavior disorder. Conduct disorder presents with two chief behaviors - fire setting and animal harming. It is oftentimes a prelude to antisocial personality disorder as an adult.
The 4 P's for diagnosing and understanding psychological illness
Predisposing factors - family history, genetics, environment
Precipitating events - trauma, deaths, life events
Perpetuating circumstances - psychosocial issues, persons, places, things
Protective factors - supportive family, financial stability, treatment
Atypical antipsychotic receptor blockade profiles:
here is another source comparing first generation antipsychotic and atypical - notice the reduction in dopamine blockade
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