Topic Explained Possible Test Questions

MENTAL STATUS EXAM QUESTIONS asked on STEP1,2,3

Akathesia Q: Due to What?

= Restless, moves around a lot A: Side Effect of Psyche
meds.

Q: How treat it?

A: Lower Dose, Beta-Blocker,
Benzos

Described Akathesia in case: Pt in ER, is combative. Put on

*Pt feels like there are ants in Meds. STAYS on
pants. meds"Weeks Later"get
*Constant moving restless/inability to sit still.
Q: Due to?
A: Medication

Q: Haloperidol (old) vs.

Risperidol (new)
A: Haloperidol - OLD
(OLD med caused it)

Q: 2 new meds given:

Risperidone vs. Olanzapine
A: Risperidone (bc structure
AE to Haloperidol...blocks D2)

Mood (how you feel today? - Look at face = can't tell what pt's
Subjective: Depressed, Anxious, affect is
Angry)
Blunted Affect= Less than
Affect: (how Express the Normal
emotions: Blunted, flat, labile) Flat Affect = No affect at all
Parkinson's FLAT Affect/no
emotions (Poker Face = Flat
Affect)

Speech Q: Pt talking really fast/Pressured Speech:

Q. "Pressured Speech" = Sb Speech = Think BIPOLAR!! *Relevant, Coherent, Fluent
talking really fast.
This is MANIA dx: Bipolar
Disorder

Depressed person - not

speaking a lot, speaking softly
Perceptual Disturbances:
*Hallucinations, Illusions
Auditory: Psychotic disorders
Visual: Drugs
Tactile: Drugs
Smell: SEIZURE disorders
See on EXAM:
1. Auditory/Hear a Voice:
-Schizophrenics,
Schizophreniform, Brief
Psychotic disorder
Most Questions seen on exam:
Auditory Hallucinations or
Visual Hallucinations
Tactile Hallucination - describes When:
Formication (Feels ants/insects *Alcohol Withdrawal
all over body)
Smell/Olfactory Hallucination
Hallucinations:
*False sensory perceptions
WITHOUT any sensory stimuli -
NO STIMULI
*Auditory: You think you HEAR a
voice -
*Visual: You think you SEE things
*Tactile: You FEEL things
*Olfactory: You SMELL things
Illusions:
*Cocain Intoxication
Type of SEIZURE gives Olfactory
Hallucination?
A: TEMPORAL LOBE (aka
COMPLEX-PARTIAL Seizures)
= Pt usually smells: (Burning
Rubber, Burning Tires, Burning
Coffee)something that alerts pt
they're gonna have seizure (aura)
You're in a Room By
yourself. you Hear things
when nothing is there/See
things/Feel things on you
when nothing is there/Smell
Things etc.
Q: Person HEARS Voices =
person has PSYCHOTIC
disorder
Q: Person SEEING Things = A:
DRUGS
Person gets admitted to
hospital. Next day, pt has
Tremors, pt tells you they SEE
bugs/insects.
Answer: Alcohol Withdrawal
(Pt stopped drinking) (Visual
Hallucination = Drug
Withdrawal Related
Questions)
Illusions: Sensory
misperception WITH A
STIMULUS
Means: There is a STIMULI
(something you
See/Hear/Smell/Touch-your
senses.but you Interpret as
Something else)
See dots on screen - you
see/think they are BUGS =
Illusion
Room by yourself -

(Everybody has Illusions, not

everyone has hallucinations)

Recognize Example in Question

Stem
Form of Thought: Way which
person thinks: Flight of ideas,
Loose associations, Tanget,
Circumstatial etc.
Content of Thought: What
person is ACTUALLY thinking
about: Delusions, Paranoia,
Suicidal Ideas

FORM OF THOUGHT: FORM OF THOUGHT: Tangential: Goes off topic,

Flight of Ideas: Rapid Shift Loose Associations: Rapid Shift Never reaches the Point
Topics WITH A CONNECTION Topics WITHOUT Connection
between thoughts, Mania ppl between thoughts, Circumstantial: Reaches a
Psychosis/Psychotic ppl Point (Get off topicbut then
Ex: I'm wearing black pants goes back to storytakes
right now, I need to buy Black Ex: It was very Sunny today, I may forever telling story)
shoes, you can never have have a sandwich later. Oh, what
enough Black shoes, my favorite time do you go to bed. I wish I Q: Did they reach the point??
shoes are the Red shoes, other had a Soda
day I'm trying to buy this red
purse, I have lots of purses, I'm
trying to change my closet to fit Loose Associations - Tend to see
my purses better. it in Psychotic People

Flight of Ideas - Tend to see in

Manic/Bipolar people (doesn't
define them)

CONTENT OF THOUGHT: I Believe I'm a Rockstar (= a

*What Person is ACTUALLY
THINKING About - Delusions,
Paranoia, Suicidal Ideas
Delusion) - Content of Thought
I Think Government is Following
me (=Parnoid) - Content of
Thought

Thinking of Killing myself, or

hurting others (=Suicidal -
Content of thought)
Delusion: (Content of Thought) Delusion - BIZARRE = Delusion - NOT BIZARRE =
= Fixed, False idea SCHIZOPHRENIA DELUSIONAL DISORDER

Delusion that is BIZARRE or Ex: I started working at the VA.
NOT BIZARRE They gave me a shot saying it's
the flu shot. But I think the the
government put a chip in my
Key: Look at the Content of the arm that traveled to my brain.
Delusion to help with Diagnosis And the government knows what
I'm thinking, what I'm doing, and
they're controlling my every
movement. So now in DC, they
know what I'm doing/saying.
Ex: I own Facebook.
I Bought Apple. I bought
AT&T
is this Possible? - Yes. They
are companies, they got
shares, can buy shares.

Sensorium & Cognition of KNOW SUBTLE DIFFERENCES -

Mental status Exam: MMSE delirum vs dementia (both listed)

Q: Will give you CASES.

Diagnose as DelirIum vs.
Dementia

Alertness & Conscious Level:
(Awake, Clouding of
Consciousness, etc.)
Orientation: Time, Place, and
Person (loss in that order)
Memory: Recent, Remote,
Immediate Retention & Recall
Concentration & Attention:
Serial 7's, Serial 3's, Ability to
Spell Backwards
DELIRIUM pt - has Fluctuating
conscious levelin and out..
DEMENTIA pt: - has
Disorientation to TIME
Ex: You ask pt What day is it?
Pt: I don't know,
ppl with DEMENTIAL Lose:
*Disorientation to TIME - 1st
*then to PLACE -2nd
*then to PERSON -3rd
TIME assessment:
Time, Day,
Date/Month/Year/Season?
Place: City, State, County,
Building, Floor they are In.
Progression of Dementia -
Time Place Person
What they lose
1st: TIME (date)
2nd: PLACE (where they're at)
3rd: PERSON (Don't recognize
Son, Family member)
DELIRIUM - FLUCTUATION
Time - Place - Person
Ex:
In morning, you know what
DATE it is (TIME)...but you don't
know WHERE you are (PLACE)
Maybe in Afternoon, you know (During Morning, pt knows
WHERE (PLACE) you arebut DATElater in dayDon't Know
you don't know what Day Date. Etc.)
(TIME)
Maybe Next Day, Don't
recognize a relative....but
EVENING YES Recognize a
relative
DEMENTIA
Yes PROGRESSION of loss: pt
doesn't know:
TIME PLACE PERSON-
(family/friends)
Doesn't have that progression of
loss (Time PlacePerson)
KEY:
DELIRIUM (has BACK & FORTH
Fluctuation of:
TIME-PLACE-PERSON)
Do you know the Time/Date?
DEMENTIA pt:
*will tell a LIE/Confabulate
*Tells you as STORY/reason
as to why they Don't need to
know the Time/Date
Ex: What day is it?
Pt: Listen, I'm retired. What
do I need to know the day of
the week for? Every day is the
same to me (An unbelieve
able answer/excuse to not
know day of the week)
Understand: ELDERLY is Very
GOOD at lying/Makes excuse
as to why not know day of
week.
Assess MEMORY: RECENT MEMORY: REMOTE MEMORY:
Recent memory, Remote, Dementia Patient: Something happened in the
Immediate Retention & Recall Q: What did you have for PAST
Breakfast? Q: What happened 5 years
*What did you have for A: Pt: I had bagel and juice. ago in your life?
Breakfast? (Dementia may not remember,
but has sense of what breakfast
items are) - Potientially MADE UP

Next Step: VERIFY with staff.

(What did this pt ACTUALLY EAT)

IMMEDIATE RETENTION: RECALL:

Say 3 things, Pt has to repeat it Pt has to say it 5 minutes
back to you later (WAIT 5 minutes)

CONCENTRATION & How to ASSESS Concentration & Ex: Serial 7's:

ATTENTION:
*Affected in DEPRESSED pt
Depression Pt Can't
Concentrate, Can't FOCUS
Attention:
*Serial 7's, Serial 3's
*Spell Backwards (Spell a word
backwards) - WORLD
Spell world backwards
Start from 100, minus 7
answer? (what's 93 minus 7)
do it for 5 trials
Pt will forget Question or
Answer

CAPACITY TO READ & WRITE Construction Aprasia - "Oh my Fund of Information &
*Ask pt to READ a sentence and math is horrible" Knowledge:
perform what it says. *Calculation
*Name past presidents
Visualspatiaal ability: Copy a
picture/figure

Abstract Thinking: Similarities

and Proverb interpretation - (Ex:
how are an Apple & Orange are
alike? Concrete thinking =
They're both round. Abstract
Thinking = They're both FRUIT)
*How are Birds and Planes
alike? (Under 11yo...Concrete
thinking = They both have
wings) Abstract thinking: They
both can FLY (over 11yo)
Impulse Control:
Based on History, or they got up
and punched you in face. =
Impulse Control is Poor.
INTERVIEW QUESTIONS
Reassurance:
*We both know that what you words: 'Can you tell me about
have is serious (If truthful, can the voices?' (NOT YES OR NO)
lead to increased compliance) "Tell me about your breathing"
*Of Course, everything will be
all right (False, can lead to
decreased compliance)
CHAPTER 2 Defense
Mechanisms
Id: responsible for
Drives/Instincts: Sex &
Aggression - Present @birth
Ego: Defense Mechanisms,
Judgement, Relation to Reality,
Object Relationships -
Developed shortly after birth
Superego: Conscience - formed
during latency period
Judgement & Insight: RELIABILITY:
*Judgement: Ability to act *DOCTOR's impressions of
appropriately (do things in the patient's abilit to
reasonable way - Q: If you see an accurately assess his situation
envelop sealed with address.
What do you do to it? A: Put it in
mailbox)
*Insight: Ability to self-reflect
Ex: I'm not sleeping very well, I'm
suicidal, I'm hopeless - I have in
sight that I have depression, and
I need help
Open-Ended Questions: (START Facilitation: Helps pt
THE INTERVIEW) CONTINUE by providing
1. Allows pt to speak in his own verbal & nonverbal cues
1. Yes, please continue
2. Go on
3. That's interesting
4. (Silence)
Close-Ended Questions:
1. Are you hearing voices? (could Confrontation: (Point
be yes or no) something out to the patient)
1. You seem very upset today
Leading: Provides answer in
question
1. Are the voices telling you
to hurt yourself?
Goal: to DECREASE ANXIETY Given Scenario Pick correct
Defense Mechanism
Defense mechanisms: way Ego
wards off anxiety
*Unconscious (except
suppression), discrete,
irreversible
Projection: Attribute own
wishes, thoughts, feelings onto me. (Husband thinks/or is
someone else
Ito YOU
(What ever I am thinking it is
YOU who is doing it)
Introjection: External world
taken and made part of the self. Resident dresses and acts like
YOU to I
(What ever YOU are
thinking/doing. I WILL
DO/THINK)
Displacement:
Emotion shifted onto another
(that resembles the original in
some aspect)
Displacement vs. Projection
Displacement:
I'm angry AT YOU.and I Kick
the Dog (I channel my anger
into Something else)
Denial
I'm sure my wife is cheating on Q. What personality Disorder
do we have Projection the
cheating on his wife) most?
A: Paranoid Personality
You dont like me. (I don't like Disorder
you)
Projection & Paranoid starts
with "P"
Ex:
attending. (Unconscious)
I had to get rid of the dog since Attending yelled at Resident
my husband kicked it every time Resident goes to yell at
we had an argument Student
Take it out on Dad yells at Kid. Kid goes hits
Someone/Something Else teddy bear
Projection:
Something I do(ALWAYS goes
to YOU).but I say it's the other
way around. (MORE WITH
FEELINGS & EMOTIONS)
ONLY in that direction.
*WHAT I SAY. I am saying it's
YOU SAYING ABOUT ME
I know I do not have cancer People abuse substance, pt
says there's nothing wrong
Wife died, but still set up table with me. (Ex: Lindsay Lohan
for 2. Still cook for 2. in denial of their problems)
Splitting: ALL GOOD or ALL BAD "The morning staff is PERFECT,
Blocking: Temporary block in
thinking.
Regression = Return to earlier Ever since my divorce, my 5 year Child has new brother, Now
development stage (immature) old has bgun to wet the bed.
Stressor - makes you go
backwards. (happens to
children) - birth new
sibling/parents go through
divorce
SOMATIZATION: Psyche
derviatives get converted to
BODY symptoms.
Repression:
Idea/Feeling Withheld from
consciousness, unconscious
forgetting
Borderline Personality
the evening staff is TERRIBLE" Disorderuses SPLITTING
defense
Dr. A is a Miracle worker
Dr. B is totally Incompetent Terms:
Idealization (=Good)
Devaluation (=Bad)
Q. My BF is the best in the
world.
A: This is IDEALIZATION
I can't remember his name. It's
on the tip of my tongue.
I know that I'm forgeting
something.
he wets bed/sucks
thumb/has to be repotty
"Women - baby voicemy head trained = Regression
hurts, can you"
Just Thinking of the exam I get Somatization is main defense
Butterflies in my stomach in SOMATIFORM Disorders
*Hypochondriasis/Hypochon
*You have a STRESSOR. You're driacs
brain convinces you are *Conversion
Paralyzed, Blind, You got *Body Dysmorphic
Headache, Brain tumor, etc. *Pain
But on Physical Exam = get *Somatization
Nothing abnormal
Rx: Psychotherapy
I do not remember having had a
dog
Suppression:
Idea/Feeling Withheld -
Consciously Forget it.
BLOCKING = You KNOW you're
forgetting something.
Intellectualization:
*Excessive use of Intellect
process to AVOID affective
expression or experience
ISOLATION of affect
Separation of idea from the
affect that accompanies it.
Rationalization:
You make an EXCUSE to justify it was very difficult
behavior/beliefs/ behaviors
BLAME SOMEONE ELSE
*CONSCIOUS forgetting
Ex:
I would rather FORGET that my
dog was run over by a car
It's interesting to note the
specific skin lesions which seem
to arise as a consequence of my
end-stage disease
Goal: to REDUCE ANXIETY
As she arrived at the station to
identify the body, she appeared
to show no emotion
Face shows no emotions
whatsoever.
Ex: I didn't pass the test because
I didn't pass the test because it
wasn't covered in class/it's the
teaches fault.
Patient been diagnosed with
cancer he goes to buy
books to learn about cancer ,
then goes to cancer seminars,
then talk about it in an
INTELLECTUAL way.
Q stem: Man is outside is
planting some flowers. His 3
year old daughter playing
ball, runs into street, car hits
her, she dies. He doesn't cry.
Case:
Rationalization in SUBSTANCE
ABUSERS (Alcohols, drugs)
"I drink because I have a lot
of stress at work" -
Rationalization
Reaction Formation:
*an unacceptable
impulse/Behavior is
transformed into its OPPOSITE
results in formation of
character traits
1. Kill Babies (unacceptable)
You become: Pediatrician (to
save babies)
2. You want to set fires
You become: Firefighter (to
stop fires)
Ex: Q:
Listen to him tell his family he Long question stem see key
was not afraid, when I saw him word: OPPOSITE.
crying
A: Reaction Formation
You're brain wants to do
something, but it's
unacceptableso you're brain
does something acceptable.
You love porn, you're a porn
freak (Unacceptable) Your
BRAIN makes you do the
OPPOSITE:
*You become Preacher

3. You want to hit people (bad) Key word: OPPOSITE

police officer (so don't hit
people)

Sublimation: What you desire (Unacceptable) Easy to confuse:

= Impulse Gratification has been What you become Reaction Formation vs.
achieved but the aim has been (Acceptable) Sublimation
changed from UNACCEPTABLE
to ACCEPTABLE. (allows 1. Porn watcher Becomes
instincts to be channeled - Censor (watches movies/gives
Mature defense ratings = can watch and not be
judged)
*You want to hit people
(Unacceptable)you become 2. Killing babies Become
BOXER (acceptable) Abortionist (can do it legally/not
*Jack the Ripper becomes be judged)
Surgeon
3. Setting fires Special effects-
movies

4. Hitting People Be a Boxer

Undoing:
= Act out the REVERSE of an
Unacceptaable behavior
consists of an ACT.
Ex:
Getting dirty. (How to undo
getting dirty?)
= I need to wash my hands
whenever I have this
Obsessive Compulsive
Disorder OCD
*Reaction formation = the
OBSESSION.
*Undoing = the ACT

Undoing = the ACT Ex:

Spill salt on table (superstitious) BOARDS Love this Question
Reaction Formation = the How to undo this? = Throw salt for: OCD
BEHAVIOR over shoulder
Obsession (is the REACTION
Ex: Ex: (the undoing) FORMATIONthe Behavior)
*I'm the person who thinks left *Putting out the Fire Compulsive (is the
the stove on, and I'm going to *Preaching UNDOING)
burn. CHECKING THE STOVE *Washing Hands (= the ACT...the
(=UNDOING the Physical act) UNDOING)

Acting Out: Ex:

= Emotional OUTBURST Temper Tantrums
(Depends on AGE) (If it's a CHILD) (=Acting Out)

Ex: Older Person having Temper

Tantrums (= REGRESSION)

HUMOR:
= Protect self/feelings/thoughts
via Humor
20yo F. We have Med records in This question does not mention
front of us. We learn when she about MEMORY.
was 4-6yo, she was treated for Because memory was NOT
STD's (=sex abuse). When asked Mentioned Then the BETTER
if she ever was sexually abused? answer would be:
She says No. is that: DENIAL
A) Denial
B) Repression
C) Supression

QUESTION CHANGE ALITTLE: A: Repression

20yo F. We have Med records in (Repression & Suppression is
front of us. We learn when she MEMORY driven)
was 4-6yo, she was treated for
STD's (=sex abuse). WHICH of KEY: If question does NOT
the following would explain her MENTION MEMORY = answer
MEMORY LOSS? MUST BE: DENIAL
A) Denial
B) Repression
C) Supression

QUESTION CHANGE ALITTLE: 1:36:00

20yo F. We have Med records in
front of us. We learn when she
was 4-6yo, she was treated for
STD's (=sex abuse). When asked
if she ever was sexually abused,
she said YES, but I don't want
to talk about it.
A) Denial
B) Repression
C) Supression
Topic, Term, Concept
Anxiety Disorders
Generalized Anxiety Disorder =
CONSTANT worrying about most
things
*Most Days
>6months
>3 somatic sx(Irritable, Wt
change, Sleep Change,
Concentration)
Phobia (irrational/exaggerated
fear - learned response)
Panic Attacks: sudden
sympathetic response attacks.
Palpitations/Paraesthesias
Abdominal pain/distress-
diarrhea,constipation,cramps
Nausea
Intense fear of death
Chest pain/tightness
Short breath -profound dyspnea
Explanation Presentation
Tx: Psychotherapy best > Drugs
Benzos to stop Pannick attacks
Benzos NOT FOR General Anxiety
Disorder
Rx: Control Sx by SSRI (to augment
their psychotherapy via SSRI)
Specific Phobias: Spiders, Height, Social Phobia:
Clowns *Urinate in PUBLIC restrooms
*PUBLIC speaking
Rx: Cognitive Behav. Therapy CBT
1. Flooding - put him in chamber Rx: Public Speaking = BETA-
and expose them to thing they're BLOCKER -olol/Propranolol -
extremely phobic to.dump USMLE Q
stimulus on them and control their
anxiety with meds = Break fear
response... Quick/less effective
2. Desensitation = Control the
anxiety. Then slowly escalate the
stimulus (weeks to months... more
effective)
Paresethesias: (breathe so fast-lose .
CO2get Symptoms of
Hypocalcemia)
When see symptomsdo first
1. ECG & Troponin (r/o MI)
2. R/O Asthma, TSH, Drugs
On Exam:
1. Female in 20s
Rx:
1. Short Benzos - takes her out of
pannick
2. Control Longterm/DOC = SSRI >
psychotherapy
Attack occurs anythime, Pt FEARS
having it...don't want to go in
Public...must (R/O Agorophobia-fear
of being in Public)
OCD OCPD
*pt KNOWS they're doing *pt does NOT KNOW they're doing
something riduculous. someing wrong

Obsession = Thoughts-
Intrusive/unwanted/ANXIETY
provoking - Contamination,
Safety - occurs throughout the
day

Compulsions = Actions-ANXIETY
reducing
- washing hands/cleaning (to
clean the contamination)
-checking windows/doors making
sure locked (for safety)

Rx:
1. SSRI (anxiety),
2. Desensitization to
obsessive/thoughts

Post-Traumatic Stress Disorder
1. Exposure/experienced or
witnessed a life-threatening
event.
2. 4 symptoms
*Anhedonia-interest in stuff
used to be interested in
*Hypervigilence -easily
startled/need to sit @back
restaurant to easily see windows
*Avoidance-can't go back/see
pictures of event...will provoke
anxiety
*Flashbacks - nightmares,
reexperience it
If Symptoms are LESS THAN 1 IF got Pannick attacks with the
Month = termed Acute Stress PTSD.
Disorder ASD = Rx:
(exact same as PTSD) 1. Psychotherpay
2. SSRI
Bottom Line: 3. Benzos to abort the attacks.
ASD = symtpoms <1month
(prognosis better).earlier start
therapy = recover better
PTSD = Symtpoms >1month
Rx:
1. Psychotherapy
2. SSRI (to augment psychotherapy)

Depressive Mood Disorders

Major Depressive Disorder: Typical everything slows DOWN Atypical
Time: 2 weeks (episode) Sleep: (insomnia) LESS Sleep: MORE
*Depressed mood + Loss of Interest: (lose interest in things Interest
function (Severe form) cared about) Guilt
Diagnose by: SIGECAPS (to Guilt: Energy
screen pt you think has MDD) Energy: Concentration
Typical vs. Atypical Depression Concentration: (can't concentrate) Appetite/weight: More
Appetite/weight: (don't want to Psychomotor
*If someone is Suicidal they eat) Suicidal
have Major Depressive Disorder Psychomotor: (don't move, don't
want to do anything)
*otherwise need FIVE of the 8 Suicidal:
Sx..to have MDD

Major Depressive Disorder: Dx: 5/8 or more. Or SI For Exam: look for
SI+Plan = Hospitalization PLAN vs NO plan
SI+ NO Plan = Safety Contract Tx: Complicated. Are they Impaired
they need to be hospitalized?
Rx: 1. IF have SI+ & a Plan = Hospitalize R/O: Hypothyroid, Rheumatoid,
Typical Depression: SSRI him. (do Physician's Emergency Anemia Chronic Fatigue Sd
Atypical Depression: SNRI Commital -ED take away pt's (mimics depression)
ability to decide for self, and
Most effective/fasted way to cure hospitalize them)
depression:
ECT - electric convulsive therapy 2. IF SI+ & NO PLAN = Safety
get amnesia Contract

Dysthymia: (Not severe form) Rx: SSRI

Chronic: 2 years
Mild form of MDD
(Depressed mood but WITHOUT
'Loss of Function'. CHRONIC 2
years!
(always sad)
1. R/O MDE major depressive
episode, SI

Manic Disorders
Bipolar: (Severe)
Type 1: Mania
Type 2: Hypomania + MDE (major
depressive episodes = LOSS OF
FUNCTION)
Screen by: DIGFAST
Clinical clues:
*You can't keep up with their
conversations - goes from topic to
topic
*Speech so pressured
On Exam: Look for DIGFAST clues
Cyclothymia - (Not Severe)
Sx:
1. Hypomania, Episodes of
Dysthymia, but NO Loss of
Function
Q: Pt has Major Depressive
Disorder vs. Bipolar
Give pt with all SIGECAPS, treated Episode.next will see MANIC
by SSRIthen Reveals a MANIC episode
episode.
Delusional Disorders (Psychotic)
Distracted easily-jump topics More of the DIGFAST he has
Insomnia then more likely has bipolar
Grandiosity: think master of
everything they're doing, start a Rx: Mood Stabilizers:
bunch of projects 1. Lithium (Nephrotoxic-
Flight of ideas Diabetes Insipidus)
Agitated 2. Lamotrigine, Valproate (back
Sexual exploits-multiple partners in up to lithium)
same week 3. Benzo (Acute Sxcalms them
Talkative-extremely down)
Ex: these are the guys in medschool Treat: Mood Stabilizer
you don't want to be around bc they
could sit down, read 3 textbooks in a
weekend, recover everything. They
remember it all. They have no loss
of function.
During hypomanic phase-they may
be very productive (can start a
bunch of projects and accomplish
them). every once in a while, you
may not see them. bc entered
dysthymic phase-depressed...then
switch to hypomanic again.
R/O: Bipolar
Why: Bipolar Type 2
Treated the Depressive
Tx:
1. Stop SSRI.switch to
2. Mood Stabilizer

Delusion.
Decide if it is Bizzare/crazy or
Non-bizzare/logical potentially
true
Schizophrenia
Patho: Thought disorder with
delusionsGenetic Component,
Dopamine: Too much = Positive
Sx
Seratonin: Too much = Negative
Sx
= Have BIZZARE Delusions
Favorite BQ:
College kid + presentation of
Schizophrenia. They want you to
rule out cocaine
Delusion: Fixed, False Belief-that's
true to the ptbut to rest of the
world, there's no sound basis
Delirium: Acute
Dementia: Progressing
Case: Positive Sx:
YOUNG Teenager, after a -STRESSOR *Delusions-Bizzare (Ex: King of
(College kid yo go to college for first
france and JFK are sitting with
time.acting bizzare = 1st break) him at hospital, wearing tin foil
Bizzare (Positive Sx) hat so aliens won't steal his
brain)
Teen/college age kid with Psychosis *AH (talking to the delusions)
symptoms:
1. r/o drugs: Cocaine Negative Sx:
*Flat Affect-No emotions
*Speech
*Anhedonia-don't want to do
anything
*Cognitive defect-can't think
Cocaine Binge: Psychosis
Resolves
Cocaine Addiction/Drug Abuse:
Functioning
But if pt has weeks to months with
Auditory Hallucinations and Bizzare
behavior = NOT DRUGS
But has Schizophrenia
Types of Schizophrenia
1. Paranoid Schizophrenia: Most
common-DELUSION (Grandure or
Persecution)
2. Catatonic Schizophrenia:
Immobile, waxy flexibility....move
to any position and let go-they'll
stay in that position.
3. Disorganized (worse): No
contact with reality-lost in their
delusions, POOR prognosis.
(Usually: Homeless pt, on Meds
but still Cannot function in
Society. Talk to self/Disheveled)
Rx:
1. Typical Anti-psyche Tx
Positive Sx
2. Atypical Anti-psyche Tx:
Neg. Sx
2. (For ACUTE Catatonic-BENZO)
Acute Psychotic Disorder
Schizo like Sx <1month
Schizophreniform
>1month -to- <6 months sx
Schizophrenia
>6 months sx
Schizoaffective
Schizo Sx (Psychotic)
+ANY MOOD Sx
*Mania
*Depression
*Bipolar
*Cyclothymic Etc.
Delusion of Grandure: Ghost of JFK Duration Treatment: = is BASED
is telling him to go talk to the on Duration Symptoms
president, and solve all of the
worlds problems 1. Acute Psychotic Disorder
Schizo-like sx LESS than 1 month
Delusion of Persecution: Queen of Tx: Wait&Watch
England from 1973 is talking to him
to make sure he is staying away 2. Schizophreniform:
from the US government bc they are Sx LESS than 6 months
trying to take all of his money,
brains, loins. 3. Schizophrenia
Sx MORE than 6 months
4. Schizoaffective
Sx Schizophrenia w. MOOD Sx
BQ: Given all sx of Schizo...sx has
been present for number of
weeks. Diagnosis?
Rx:
1. Wait&watchuntil symptoms
persists more than 1 month
2. (If sx lasts more than 1 month =
Schizophreniform)
Rx:
Treat for 3-6 weeks
(to see if Sx go away on own or if
persists until >6months =
Schizophrenia)
Rx:
Treated Lifelong
Rx:
1. Lifelong
2. Treat DELUSIONS 1st
3. THEN Treat Mood Sx
NON-Bizzare Delusions
(Logical/possible)
*Believable/Logical (but false)
*NO LOSS of function
Dx:
1. r/o Truth (make sure it's not
true)
Tx:
1. Gentle Confrontation-tell the
patient over long period of time
to break the delusion/Remove pt
from person or environment
associated with the delusion
2. No medication available
BQ:
1. r/o Drugs/Alcohol - in a teen
who's having his first psychotic
episode
2. Differentiate Types of
Schizophrenia:
Paranoid/Catatonic/Disorganized
3. Schizophrenic-LIKE disease
based on TIMING
Eating Disorders
Hard to identify. Bc Pt presents with
Believable/Logical.. (it's totally
false)but believable.
Rational Thoughts Process/False
Fixed belief
Cx: Guy complains government is
coming for him because he owes
money. (Possible-maybe bc of back
taxes)
Cx: Maybe the guy's wife is trying to
kill him for his money.
Acute Psychotic Disorder: <1month
Schizophreniform 1-6months
Schizophrenia >6months
Schizoaffective: ANY Schizo+Mood
Sx
Anorexia: Bulimia: Question Compares BOTH.
= Girls think they are fat (when = Bulimic Girls ARE FAT, (don't like
they aren't), FEAR WEIGHT GAIN that they are fat), don't like what
they do because they ARE FAT
Anorexia: a Body Dysmorphic
Disorder. Though she is NOT FAT, Bulimia: Her body image is correct
SHE THINKS she's fatFEARS she DOESN'T like being fat. So
weight gain = (Anxiety) method: Binge/Purge
TO prevent wt gain= do Weight
loss/Method: Restriction She thinks she is fatbc SHE IS FAT.
BINGE/PURGE
BMI <85% of Ideal Body Wt *BMI N or Elevated Body Weight
Sx:
1. Bradycardia Presents by METHOD of
2. Lethargy BINGE/Purge
3. Cold Intolerance 1. Laxative
4. Hypotension (severe) 2. Vomiting (induce vomiting)
Look like pt with HYPOTHYROID *Parotid Swelling
Sx...BUT SHE IS THIN/Low Body *Dental Erosions
Weight. *Dorsal Hand Scars
(egodystonic...they know they're fat,
Tx: Hospitalize** they want your help)
1. Force Feeds
2. Nutrional Status Tx: No hospitalization needed
3. Anti-depressants: SSRI 1. Anti-Depressants: SSRI
4. Psychotherapy 2. Psychotherapy
3. NEVER Give BUPROPRION (BQ
TESTED)-Risk seizure

Dissociative Disorders LOW YIELD- on step/shelf

Things happen to us without us
knowing/aware of it. (zoning
out)
Taking it to extremes: - BQ
1. Multiple Personality Disorders
- created in response to extreme
stressors (Pt not aware of each
personality)
*Blackout, Membory Gap
complaints
*Behavior changes-Sex/drugs
*Appearance-Facial Expressions
Rx: Hypnosis/Psychotherapy
Dissociative Amnesia - Dissociative Fugue - long term Depersonalization:
1. Severe Stressor before Amnesia dissociative amnesia + Travel *Out of body experience
of event/person (she forgets the 1. StressorAmnesia of OLD LIFE. *dj vu
event) 2. Arrive at New Place Teenager.due to Minor
Dx: do Amital Interview (r/0 3. New Identitiy Stressor
Malingering) Months to Years
Tx: Psychotherapy Dx: do Amital Interview (r/0 Diagnosis: via Clinical
Malingering) Rx: Psychotherapy
Tx: Psychotherapy
(This choice is DISTRACTOR
(Dude loss his job/house, going thru unless Teen+MINOR stressor)
divorce...moves to a new state, can't
remember his old life.)
= Must RULE OUT MALINGERING

Sleep Physiology very few Qs on boards.

REM sleep is Restful sleep. Sleep Latency: Time it put head BQ:
Stage 1 & 2 = Easy to arouse down on BED Asleep. Stage 1: Theta waves, NO alpha
Insomnia: (inability to fall Stage 2: K-Komplex, Sleep
Serotonin SLEEP asleep) = awake Spindles
Acetylcholine DREAMS Stage 3: Delta
Norepi Wakefulness Deprivation = sleep latency Stage 4: Delta
Dopamine Wakefulness REM: Awake pattern, rapid eye
REM LATENCY: Asleep get to REM movements, lose all tone,
GABA-receptors = Sleep (40minutes) men/women get erections
LATENCY, Stage (Rx: BZD1) Decreased in Narcolepsy (Get
straight to REM)
Alcohol = Sleep Latency, REM. Decreased in Sleep Deprivation
(If stop alcoholget to sleep = (Alcoholic/sleep apnea...
REM REBOUND)

Nightmares = dreams gone bad Night Terror: product of Stage 3 or 4

DREAMSis in REM Sleep. *Child 4-10yo 'wakes up'.sit up in
*Pt awakes, Remembers dream bed/eyes open/screams.
*Any age *Kid is actually NOT AWAKE
Dx: Clinical dx
Rx: Decrease nightmare by Rx: it's stage 3/4 so:
decreasing REM (Alcohol/TCA REASSURANCE
but can't do this)
sooo. Should STRESSOR in life

Impulse Control ANXIETY DISORDERS (socially

unacceptable
Anxiety disorders.ego-syntonic
They do the ACT because it feels
good (but not normal)so they
don't think it's wrong, so won't
seek help

Intermittent-Explosive Disorder: Male early 20sas age, it decreases Likely Men

*Normal person has SUDDEN
INAPPROPRIATE Violent Act, out
of proportion to a stressor
*Menolder they get, the smaller
the symptoms.
(Think road rage)follows guy home
to beat the crap out of him
(inappropriate)

Rx: SSRI Mood Stabilizers

Best: Group Therapy

Pyromania: Set Fires Likely Men

Reason set fire = for
PLEASURE/Anxiety/Sexual
Arousal

Dx: r/o Arson (Set fire to business

to get money) Sets fire to house
to get revenge = Intermittent
Explosive Disorder

Rx: SSRI ineffective

So likely get JAIL

Kleptomania: Likely Women

1. Steal to reduce anxiety
When Pt sees object: (anxiety)
Pt STEALS object: (Anxiety)
HAS TO BE THE SAME OBJECT
over and over again.

Dx: r/o petty theft

Rx:
1. SSRI (to control anxiety)
2. CBT (to control compulsion)
Trichotillomania:
Girl 20s Pulls out Hair
*(Different lengths of hair in
different placesHair still grows)
20xvarying hair lengths Likely Women
Dx: r/o fungus (do KOH)
r/o Allopecia (Patchy hair loss,
WITHOUT hair regrowth)

RX: SSRI (for Anxiety)

f/u: Bezoar (make sure pt don't EAT
own airBEZOAR = HAIR BALL) = GI
abdominal Pain, Small bowl
obstruction = Get KUB (see Bezoar
on xray)

Mood Life & Death MOOD Disorders II

Grief Depression USMLE Q. Fav
(Recovers on own) (Requires treatment, doesn't get TIMING.determines Treatment
Rx: Wait/Watch better on its own)can lead to SI
BQ the most: Recap!
+SIGECAPS +SIGECAPS *Impaired function?
-SI +SI *Insight in psychotic features
*How long have the symptoms
Sx: Comes & Goes Sx: Persistent Sx been present?
Lasts < 1 year Lasts >1year! - BQ *Suicidal Ideations =
Rx: Reassure/Supportive Care - Psychotic features+ = NOT ok Depression!
BQ *Lacks Insight
Psychotic features+ = is Okay *Still has conversation with loved
(Hearing loved ones call name. ones at night before they sleep
Look in crowd see her. = Normal) *Asks live pt to join them in heaven
Pt Knows it is illogical = SI

Resolves <2months (Spontaneous Never Goes Away - Needs Meds

Resolves)-no impaired function Rx: SSRI (bc has impaired
function/can't pay bills etc.)

DABDA Pt with terminal cancer

Denial
Anger They cycle in any order of the
Bargaining stagesdo deal/talk with pt or
Depression survivors
Acceptance

Post-Partum Will get BQ

Baby-Blues Post-partum Depression Post-Partum Psychosis
Baby: happens w/ 1st Baby
mom CARES
Timing/Onset/Duration
Within 2 weeks post-birth
occurs AFTER 1st Baby
mom does NOT CARE
(neglects itnot harm itit might
get hurt, mom doesn't intend to)
Onset: w/in 1st month
Duration: Ongoing
occurs AFTER 1st Baby
Mom Fears of babyfeels she
needs to Protect herself by
harming baby. She thinks it's
evil. Mom can kill baby.
Onset: w/in 1st month
Duration: Ongoing (if no tx)

Depression: Dysthmic Major Depressive Episode MDE: Major Depressive Episode

Rx: Reassurance
(Mom had Hx post-partum
psychiatric dz/worried about post- depression. Make sure someone can * Anti-psychotics (if more
partum depression You can
Counsel hersay if Sx doesn't
resolve in a week call me.)
Rx: SSRI Rx:
* Mood Stabilizers (if more MDE
No psychotic features/only mainly)
care for baby. She intellectually psychotic features mainly)
knows need to take care baby, but
psychologically low energy...can't (YES Psychotic Features. Mom
take care has delusions that baby is
evil...to protect herself, she
harms it)

Personality Disorders GOAL: MEMORIZE table & do Qs

Cluster A: Weird (Paranoid, Cluster B: Wild (Borderline, Cluster C: Whimpy (Avoidant,
Schizoid, Schizotypal) Histrionic, Narcissistic, Anti-social) - Dependent, Obseessive
Bad Boys Compulsive)

You won't change thembut

Pt will try to change the rules being
manipulative and demanding.
Rx: Set the rules, Follow the rules,
do not deviate, be firm, but
nonaccusatory

Paranoid: Suspicious, Distrustful, Borderline: Unstable, impulsive, Avoidant:

interpret others a malicious.
THINKS everyone else is out to
get them.
Defense: Projection -what they
feel, will THINK OTHERS are
feeling (If they are sad, will THINK
YOU are sad. If they're angry, will Defense: Splitting
THINK Sb else is angry)
Rx: Clear, Honest, Nonthreaten
Promiscous, unable to control rapid
changes in mood emotions
emptiness, suicidal gestures "I'm
gonna kill myself, you need to come
homethen drink pill/slit wrist).
- WOMEN
(You're AWESOME, or TERRIBLE)
Fears rejection and criticism,
WANTS relationships but does
not pursue them, WANT
friends. Is ALONE, but doesn't
want to be ALONE.
(vs. Schizoid is opposite)
Really shy, but hot librarian
Rx: Avoid Power, Struggles make
patients Choose (They fear
making any decision)
Schizoid: Loners, have no
relationships, happy alone, Don't
want to see people
Clue: Works jobs don't have to
interact with people - Night shift
Toll booth
Schizotypal: Magical thinking,
Bizzare Thoughts, Behavior, and
dress. Charm bracelets keeps
them safe from disease and harm.
(NO AH, No internal stimuli)
Lady Gaga
Rx: Clear, Honest, Nonthreaten
Pediatric Psychiatry
Histrionic: Theatrical, Attention-
seeking, Superficial emotions,
hypersexual also
-WOMEN (no deep meaningful
relationshipsdepends on looks to
get by)
(Marilyn Monroe, Gone with the
wind)
Narcissistic: Self-Centered, Inflated
self worth sense, Explosive,
Demands the best, Entitled.
Thinks He is important
MALE
Example: Zoolander
Anti-Social Personality Disorders
*Criminals, No regards for other's
rights, Impulsive, Lacks Remorse
Rx: JAIL
Dependent: Clingy, Submissive
Need to be taken cared of.
(Also Fears rejection)
*Stay at home Mom in abuse
relationship.refuses to leave
her husband.
*She needs other people to
make decisions for her.
BQ: Pt comes in with her
husband. Husband makes all
decisions, she just sits there.
Rx: Give Clear Advice, pt try to
sabotage their treatment so
comes in to see you more.
Obsessive Compulse
PERSONALITY disorder:
Orderly, Control, Perfectionist at
expense of efficacy. Ego-
syntonic
*Obsessed with orderliness.
(NOT OCD..)
Student has to redraw her notes
70x bc notes isn't quite exact
color of blue, so does everything
again.
Mental Retardation: (Intellectual Rx: Elective Abortion to prevent
Disability)
Path: IQ <70
Genetic: Down's, Fragile X, Cri-du
Chat
Acquired: Mom exposed to
Substances when baby in utero
(alcohol/drugs), Lead poisoning
Onset: Before 18yo
Impaired function
Diagnosis: by Prenatal Screen
BQ: Differentiate types of MR
based on Severity based on IQ,
LIVE, WORK, Education
Severity: Mild
IQ: 50-69
Live: Group Home
Work: Independent (Janitornot
require a lot of skills to do)
Education: 6th grade
birth.
Prevent Substance use
Severity: MODERATE
IQ: 35-49
Live: Group Home
Work: Supervised (Need sb there to
make sure they do it right)
Education: 3rd Grade
These are MENTAL FUNCTION
Disorders
Severity: SEVERE MR
IQ: 20-34
Live: Institutionalized
Work: DAILY fxn NEEDS FULL
HELP
Education: NONE. Mental like
a toddler
Severity: PROFOUND
IQ: <20
Live: Institutionalized
Work: Dependant on others
mental like a neonate.Will die
bc of infxn/bc can't take care of
self
AUTISM: disorder of SPEECH &
Social Interaction
Pt diagnosed: ~3yo
Clue: Fails to Meet MILESTONE
*No social smile
*No bonding with parents
Lots of BQ: Compare
Autism: Speech impaired & Social
impaired (mental ok)
Aspergers: Social impaired,
(Speech/mental ok)
These are SPEECH & Social
interaction. MENTAL FUNCTION
ok/preserved.but
communication is affected

BQ clues Mental Retardation: Mental

*Hand Flapping function problem
*Lining up Objects
*Rocking Back&Forth Rett's: different from others
= AUTISM!!

DDX:
1. Asperger's (12yos in college). your job to differentiate these
Is Autism, but Speech is
preserved...Mental function
preserved...don't form emotional
connections with other humans
2. Rett's: Girls...develop normally
until 5months...regresses to
death-parents need genetic
counselling
ADHD: Attention Deficit
HYPERACTIVE Disorder
Patho: don't know cause
Pt is a Troublemaker. Kid cannot
focus/concentration
Clue: Pt disruptive, can't focus on
teacher/can't learn.get bad
grades

(Q: is he a bad student?)

Dx:
1. Timing: >6mo - 7yo,
occur @>2 settings (at school &
somewhere else)
2. AD: Attention, inability to
complete tasks, easily
distracted....
3. HD - inability to wait in line,
(hyperactive), can't wait turn,
interrupting constantly/fidgits in
seat

Rx: Stimulants
1. IN morning ("on way to school"
- Methylphenyldate,
Dextromorphen
2.Parents need education how to
deal with kid after school
3. Special Ed.

Conduct Disorder: Kid<18yo Opposition Defiant Disorder (will

(Anti-social personality disorder
>18yo)
(Disregard for others/lie, cheat,
steals)
=Bullying, Start fights, hurt
others, will break law
Clue on BQ:
*Killing Animals
= Conduct Disorder
Rx: Rehabilitation: Big Brother-Big
Sister program, Juvenile
Detention (not prison for kids...JD
is rehab for kids)
not be criminal)
*Pt disregard for AUTHORITY-
actively oppose people in charge:
Parent/Teacher
*Clue: NO Bullying, NO fighting, NO
Hurting of others.
*(Distractors: can Lie/cheat/steal
bc defiant of authority)
Rx:
*Parental Education (This disorder
has nothing to do with the
kid....everything to do with
Inconsistent Parenting....especially
in divorced parent)
Learning Disability:
*When child SCORES POORLY-
standard test
Assess medical reasons why he's
doing poorly. So CHECK:
1. Hearing, Vision, English
language, MR
CORRECTION:
Rx: Glasses, Hearing Aids
If NOT THESE.then
REMEDIATION
1. ADHD?, Absence?
= Repeat Grade, Special Ed
Eneuresis-bed wetting
*Age, Been Dry?
>4yo & Dry previously = Step
Back in development. So must in development. So must Assess
Assess for medical disease:
1. Urinalysis
2. Ultrasound
. Mass/hematuria..Cancer: Rx: . NO mass/No Hematuria.
Biopsy, Resect
Tourette's
Path: (Associated with OCD)
Anxiety, ADHD
Pt has onset <18yo
Impuse = Anxiety
Action = Reduces Anxiety
Tourette's: 2 types of impulses, 2
actions
Vocal Tics: GRUNTS, COUGHS-
SOUNDS that can't be contained
Actions: Hair Flicks, Blinks, Tongue
Pertrusions
Rx: Dopamine Antagonists!!!
Eneuresis-bed wetting Eneuresis-bed wetting
*Age, Been Dry? *Age, Been Dry?
>4yo & Dry previously = Step Back >4yo & Dry previously = Step
Back in development. So must
for medical disease: Assess for medical disease:
1. Urinalysis: WBC+ 1. Urinalysis: Neg.
2. Ultrasound: Neg. 2. Ultrasound: Neg.
UTI = Regression
Rx: Antibiotics, Education. (have to r/o abuse)
Eneuresis-bed wetting
*Age, Been Dry?

<7yo Never been dry. = NORMAL

VARIANT (Child not learned to
potty train by 6.5yo=NORMAL)

(Child not learned to potty train

by 7 years old = ABNORMAL)

<7yo = NORMAL VARIANT

>7yo = ABNORMAL

Rx:
1. Potty Train
NEVER use NEGATIVE
Reinforcement (don't yell at
him/make him feel bad)
2. Bed Alarms
3. Fluid Restrict (to get him thru
the night)
4. if all fails....give DDAVP-
VASOPRESSIN

ADDICTION Identify Acute Intoxication &

Withdrawal - BQ
Abuse: Dependence:
Using a NEEDING MORE to feel the same
drug/medication/alcoholin any thing (Body is used to it, so needs
other way it should be used more of it)
Ex: *Tolerance
*Legal problems *Withdraw.sx when drug leaves Angry
*Risky situations-bad body.
neighborhoods, sex for drugs, fails *Isolation/only want to be around
to fulfill responsibilities people that use or byself.
*Continues to use despite these *Risk overdose
problems. Can't sustain family college party)
bc of use WITHDRAWAL Sx:
1. HTN, Tachycardia, Diaphoretic,
Anxious-crawling skin, Delirium,
Seizure
Rx:
1. Benzo Taper
2. PRN Benzo
Wernicke. = Reversible Cerebellar
Dysfunction.
Korsakoff =
Irreversible/Confabulation
Addict. Alcoholic Alcoholic Anonymosus
Has a genetic predisposition to group therapy.
the disease Rx: Antibuse (disulfiram)
Memorize Close to Test Date
Alcohol: Acute Intoxication: Benzo: Acute Intoxication sx
Slurred speech, disinhibition, 1. Delirium in Elderly
Ataxia, Blackout-forget some of 2. Resp. , Coma, Amnesia depressed
the night, Impaired Judgement
Withdrawal Sx: Withdrawal Sx: - same
1. HTN 1. HTN
2. Tachycardia, Seizures, 2. Tachycardia, Seizures, Psychosis
Psychosis = Benzo Taper
Rx: Rx: OVERDOSE Benzo
1. Benzo Taper 1. Flumazenil
Alcohol Withdrawal can kill you
Alcohol intoxication can kill you
Screen by: CAGE
Cut down
Guilty
Eye opener
Dx: INTOXICATION (guy at
*slurred speech.
*ataxic gait
*Cerebellar Dysfunction
BAC>0.08 (Blood Alcohol Conc.)
Tx: IVfluids, Monitor,
"Found Down" =
1. Naloxone,
2. Thiamine next,
3. D50-reverses hypoglycemia
(Dextros)
Opiates acute intoxication Sx
1. Pupil constricts, respiratory
2. Track Marks (penis, toes),
Euphoria
= Rx: NALOXONE
Withdrawal Sx:
1. Yawning, lacrimation,
sweating, itching, pain all over
Rx: METHADONE - takes 'the
edge' off w/o pt getting high
Cocaine intoxication:
1. Psychomotor Agitation
2. HTN, Tachycardia, Psychosis
3. Dilated Pupils, Angina/HTN
Crisis
Withdrawal:
*Depression, Cocaine "Bugs"
Rx: a-block 1st, then b-block
Amphetamines:
1. Dilated pupils, Psychosis,
Overheating (Fever, Tachy)
2. Water intoxication-over drink
Withdrawal:
*Crash, Depression
Rx: Supportive

PCP Intoxication: LSD intoxication: Marijuana THC

1. Aggressive psychosis/agry 1. Hallucinations, Flashbacks, 1. Tired, Slowed Reflexes
2. Vertical & Horizontal Senses 2. Conjunctivitis, Munchies,
Nystagmus Paranoia
3. Impossible strength, blunted Withdrawal Sx:
senses 1. Flashbacks Withdrawal Sx:
1. Non
Withdrawal sx: Rx: Supportive
1. Severe Random Violence Rx: Supportive

Rx: Haldol to subdue, Acidify

urine to Excretion

Barbituates Nicotine
1. Safety margin, Resp , Coma 1. Nonejittery, stimulated, V.tach

Withdrawal Sx: Withdrawal:

Redistribute into Fat Cravings

Rx: LOW YIELD Rx: Patch, Gum, Welbutrin