Case files psychiatry 4th edition pdf free download

Notify me of new posts by email. Been Medical Video Lectures Dr. Tuesday, November 23, Sign in. Forgot your password? Get help. Privacy Policy. Password recovery. Note: If Link for Any Book is not working then kindly tell us in the comment box of that post, please try to avoid sending email. It has been a great joy to work with Debra Klamen, a brilliant psychiatrist, educator, and lover of horses, and with all the excellent contributors.

I am greatly indebted to my editor, Catherine Johnson, whose exuberance, experience, and vision helped to shape this series. At the University of Illinois, I thank Dr. At Christus St. Without my esteemed colleagues, Drs. Most of all, I appreciate my loving wife, Terri, and my four wonderful children, Andy, Michael, Allison, and Christina, for their patience and understanding.

Eugene C. This page intentionally left blank. It requires the physician to understand the criteria and be able to sensitively elicit symptoms and signs from patients, many of whom have difficulty providing a clear history. The clinician must then put together the pieces of a puzzle in order to come up with the single best diagnosis for the patient. Finally, and almost unique to the field of psychiatry, in order to better diagnose and treat their patients, physicians must be alert to and aware of the unconscious conflicts, anxieties, and defenses put into play by these individuals.

Establishing rapport and a good therapeutic alliance with patients is critical to both their diagnosis and their treatment. Developing good rapport with patients is key to effective interviewing and thorough data gathering. Both the content what the patient says and does not say and the manner in which it is expressed body language, topic shifting are important.

History 1. Basic information: a. Identifying information includes name, age, marital status, gender, occupation, and language spoken other than English. Ethnic background and religion can also be included if they are pertinent.

It is helpful to include the circumstances of the interview because they provide information about potentially important patient characteristics that may be relevant to the diagnosis, the prognosis, or compliance.

Circumstances include where the interview was conducted emergency setting, outpatient office, in leather restraints and whether the episode reported was the first occurrence for the patient. Sources of the information obtained and their reliability should be mentioned at the beginning of the psychiatric history. Chief complaint: The chief complaint should be written exactly as the patient states it, no matter how bizarre. For example, if a patient comes in with a chief complaint about aliens, as noted above, one would immediately begin to consider diagnoses that have psychosis as a component and conduct the interview accordingly.

History of present illness HPI : This information is probably the most useful part of the history in terms of making a psychiatric diagnosis. It should contain a comprehensive, chronological picture of the circumstances leading up to the encounter with the physician. It is important to include details such as when symptoms first appeared, in what order, and at what level of severity, as this information is critical in making the correct diagnosis.

In addition, details of the history such as the use of drugs or alcohol, which are normally listed in the social history, should be put in the HPI if they are thought to make a significant contribution to the presenting symptoms.

Past psychiatric hospitalizations, the treatment received, and the length of stay should be recorded. Whether or not the patient has received psychotherapy, what kind, and for how long, are also important.

Any pharmacotherapy received by the patient should be recorded, and details such as dosage, response, and compliance with the medication should be included. Any treatments with electroconvulsive therapy ECT should be noted as well, including the number of sessions and the associated effects. Medical history: Any medical illnesses should be listed in this category along with the date of diagnosis.

Episodes of head trauma, seizures, neurologic illnesses or tumors, and positive assays for human immunodeficiency virus HIV are all pertinent to the psychiatric history. Medications: A list of medications including their doses and their duration of use should be obtained. All medications, including over-thecounter, herbal, and prescribed, are relevant and should be delineated. Allergies: A list of agents causing allergic reactions, including medications and environmental agents dust, henna, etc should be obtained.

For each, it is important to describe what reaction actually occurred, such as a skin rash or difficulty breathing. Many patients who have had a dystonic reaction to a medication consider it an allergy, although it is actually a side effect of the medication and not truly an allergy. Listing each family member, their age, and their medical or psychiatric disorders is generally the easiest, clearest way to do this.

Social history: a. The prenatal and perinatal history of the patient is probably relevant for all young children brought to a psychiatrist. A childhood history is important when evaluating a child and may be important in evaluating an adult if it involves episodes of trauma, long-standing personal patterns, or problems with education.

Occupational history, including military history. Marital and relationship history. Education history. Social history, including the nature of friendships and interests. Drug and alcohol history. Current living situation. Review of systems: A systematic review should be performed with emphasis on common side effects of medications and common symptoms that might be associated with the chief complaint.

Patients with presumed panic disorder might be questioned about cardiac symptoms such as palpitations and chest pain or neurologic symptoms such as numbness and tingling. Even a mute or uncooperative patient reveals a large amount of clinical information during the mental status examination. If a patient has thought about suicide for the past 3 weeks but during the interview says that he is not feeling suicidal while speaking with the psychiatrist, his history is considered positive for suicidal ideation although the thought content section of the mental status examination is said to be negative for current suicidal ideation.

General description a. Signs of anxiety should also noted, such as wringing of hands, tense posture, clenched fists, or a wrinkled forehead. Behavior and psychomotor activity: Any bizarre posturing, abnormal movements, agitation, rigidity, or other physical characteristics should be described.

Mood and affect a. For example, a person may rate his depression as 3 on a scale of 1 to 10 where 10 is the happiest he has ever felt. In addition to the affect noted, the range variation of the affect during the interview, as well as its congruency with consistency with the stated mood, should be noted. A constricted affect means that there is little variation in facial expression or use of hands; a blunted or flat affect is even further reduced in range.

Notations as to the rate, tone, volume, and rhythm should be made. Impairments of speech, such as stuttering, should also be noted. Perception: Hallucinations and illusions reported by the patient should be listed.

Thought process: Thought process refers to the form of thinking or how a patient thinks. It does not refer specifically to what a person thinks, which is more appropriate to the thought content.

Neologisms, punning, or thought blocking also should be mentioned here. Thought content: The actual thought content section should include delusions fixed, false beliefs , paranoia, preoccupations, obsessions and compulsions, phobias, ideas of reference, poverty of content, and suicidal and homicidal ideation. Patients with suicidal or homicidal ideation should be asked whether, in addition to the presence of the ideation, they have a plan for carrying out the suicidal or homicidal act as well as about their intent to do so.

Sensorium and cognition: This portion of the mental status examination assesses organic brain function, intelligence, capacity for abstract thought, and levels of insight and judgment. The basic tests of sensorium and cognition are performed on every patient. Those whom the clinician suspects are suffering from an organic brain disorder can be tested with further cognitive tests beyond the scope of the basic mental status examination. Any impairment usually occurs in this order as well ie, a sense of time is usually impaired before a sense of place or person.

Memory is divided into four areas: immediate, recent, recent past, and remote. Immediate memory is tested by asking a patient to repeat numbers after the examiner, in both forward and backward order. Recent past memory is tested by asking about news items publicized in the past several months, and remote memory is assessed by asking patients about their childhood. Note that information must be verified to be sure of its accuracy because confabulation making up false answers when memory is impaired may occur.

The patient can also be asked to name five words that begin with a given letter. Visuospatial ability: The patient is typically asked to copy the face of a clock and fill in the numbers and hands so that the clock shows the correct time.

Images with interlocking shapes or angles can also be used—the patient is asked to copy them. Abstract thought: Abstract thinking is the ability to deal with concepts. Can patients distinguish the similarities and differences between two given objects? Can patients understand and articulate the meaning of simple proverbs?

Be aware that patients who are immigrants and have learned English as a second language may have problems with proverbs for this reason rather than because of a mental status disturbance. Having the patient predict what they would do in an imaginary scenario can sometimes help with this assessment. For example, what would the patient do if they found a stamped envelope lying on the ground? Insight: Insight is the degree to which a patient understands the nature and extent of their own illness.

Patients may express a complete denial of their illness or progressive levels of insight into knowing that there is something wrong within them that needs to be addressed. Only a few questions need to be addressed to the patient directly, for example, those regarding the presence of suicidal ideation and specific cognitive examination questions.

Physical Examination The physical examination can be an important component of the assessment of a patient with a presumed psychiatric illness.

Many physical illnesses masquerade as psychiatric disorders, and vice versa. For example, a patient with pancreatic cancer may first present to a psychiatrist with symptoms of major depression.

Some patients may be too agitated or paranoid to undergo parts of the physical examination, but when possible, all elements should be completed. General appearance: Cachetic versus well-nourished, anxious versus calm, alert versus obtunded. Vital signs: Temperature, blood pressure, heart rate, respiratory rate, and weight. Head and neck examination: Evidence of trauma, tumors, facial edema, goiter indicating hyper- or hypothyroidism , and carotid bruits should be sought.

Cervical and supraclavicular nodes should be palpated. Breast examination: Inspection for symmetry, skin or nipple retraction 5. With the patient supine, the breasts should then be palpated systematically to assess for masses. The nipple should be examined for discharge, and the axillary and supraclavicular regions for adenopathy. Cardiac examination: The point of maximal impulse should be ascertained, and the heart auscultated at the apex of the heart as well as at the base.

Heart sounds, murmurs, and clicks should be characterized. Pulmonary examination: The lung fields should be examined systematically and thoroughly.

Wheezes, rales, rhonchi, and bronchial breath sounds should be recorded. Abdominal examination: The abdomen should be inspected for scars, distension, masses or organomegaly ie, spleen or liver , and discoloration. Auscultation of bowel sounds should be accomplished to identify normal versus high-pitched and hyperactive versus hypoactive sounds.

The abdomen should be percussed for the presence of shifting dullness indicating ascites. Back and spine examination: The back should be assessed for symmetry, tenderness, or masses. Pelvic examination: Although this examination is not often done in the emergent setting of psychiatric illness, it is important to realize that many patients with a psychiatric illness do not see their physician regularly and that this important preventive maintenance procedure is often neglected.

Patients should be reminded of the need for this examination. Extremities and skin: The presence of tenderness, skin edema, and cyanosis should be recorded.

Neurologic examination: Patients require a thorough assessment including evaluation of the cranial nerves, strength, sensation, and reflexes. There are no definitive tests for bipolar disorder, schizophrenia, or major depression.

Laboratory tests are also useful in long-term monitoring of medications such as lithium and valproic acid. Screening tests A. Tests related to psychotropic drugs A. Lithium: A CBC, a serum electrolyte determination, kidney function tests, a fasting blood glucose determination, a pregnancy test, and an electrocardiogram ECG are recommended before treatment and yearly thereafter.

Lithium levels should also be monitored. Clozapine: Because of the risk of developing agranulocytosis, patients taking this medication should have their white blood cell WBC count and differential count measured at the onset of treatment, weekly during treatment, and weekly for 4 weeks after discontinuation of treatment.

Tricyclic and tetracyclic antidepressants: An ECG should be obtained before a patient begins treatment with these medications. Carbamazepine: A pretreatment CBC including a platelet count should be obtained to assess for agranulocytosis. Reticulocyte and serum iron levels should also be determined and all these tests performed monthly thereafter. Liver function tests should be performed every 3 to 6 months, and carbamazepine levels should be monitored this often as well.

Valproate: Valproate levels should be monitored every 6 to12 months, along with liver function tests. Psychometric testing A. Structured clinical diagnostic assessments 1. Tests based on structured or semistructured interviews designed to produce numerical scores. Psychological testing of intelligence and personality 1.

Tests generally administered by psychologists trained to administer and interpret them. Such tests play a relatively small role in the diagnosis of psychiatric illness: The psychiatric interview and other observable signs and symptoms play a much larger role.

These tests are therefore reserved for special situations. Objective tests generally consisting of pencil-and-paper examinations based on specific questions. They yield numerical scores and are statistically analyzed.

Minnesota Multiphasic Personality Inventory: This self-report inventory is widely used and has been thoroughly researched. It assesses personality using an objective approach. Projective Tests: These tests present stimuli that are not immediately obvious.

The ambiguity of the situation forces patients to project their own needs into the test situation. Therefore, there are no right or wrong answers.

Rorschach test: This projective test is used to assess personality. In skilled hands, it is helpful in bringing out defense mechanisms, subtle thought disorders, and pertinent patient psychodynamics. This test also assesses personality but does so by presenting patients with selections from 30 pictures and 1 blank card.

The patient is required to create a story about each picture presented. Generally, the TAT is most useful for investigating personal motivation eg, why a patient does what he or she does than it is in making a diagnosis.

Sentence completion test: A projective test in which the patient is given part of a sentence and asked to complete it. Intelligence tests: These tests are used to establish the degree of mental retardation in situations where this is the question. The Wechsler Adult Intelligence Scale is the test most widely used in clinical practice today. They are used to identify cognitive deficits, assess the toxic effects of substances, evaluate the effects of treatment, and identify learning disorders.

Wisconsin Card Sorting Test: This test assesses abstract reasoning and flexibility in problem solving by asking the patient to sort a variety of cards according to principles established by the rater but not known to the sorter.

Abnormal responses are seen in patients with damaged frontal lobes and in some patients with schizophrenia. Wechsler Memory Scale: This is the most widely used battery of tests for adults. It tests rote memory, visual memory, orientation, and counting backward, among other dimensions. It is sensitive to amnestic conditions such as Korsakoff syndrome. Patients are asked to copy nine separate designs onto unlined paper.

They are then asked to reproduce the designs from memory. This test is used as a screening device for signs of organic dysfunction. Further diagnostic tests A. Interviews conducted by a social worker with family members, friends, or neighbors C. Psychological testing, including projective testing to help with the assessment of personality structure, psychosis, or depression D.

Electroencephalogram to rule in or rule out a seizure disorder E. Computed tomography scan to assess intracranial masses F.

Magnetic resonance imaging to assess intracranial masses or any other neurologic abnormality G. Tests to confirm other medical conditions. Making a diagnosis 2. Rendering treatment based on the disease 4. Making a Diagnosis A diagnosis is made by careful evaluation of the database, analysis of the information, assessment of the risk factors, and development of a list of possibilities the differential diagnosis.

The process involves knowing which pieces of information are meaningful and which can be discarded. A good clinician also knows how to ask the same question in several different ways and to use different terminology.

For example, patients at times may deny having been treated for bipolar disorder but answer affirmatively when asked if they have been hospitalized for mania. A diagnosis can be reached by systematically reading about each possible disease. Usually, a long list of possible diagnoses can be pared down to the two or three most likely ones based on a careful delineation of the signs and symptoms displayed by the patient, as well as on the time course of the illness.

For example, a patient with a history of depressive symptoms, including problems with concentration, sleep, and appetite and symptoms of psychosis that started after the mood disturbances may have major depression with psychotic features, whereas a patient with a psychosis that started before the mood symptoms may have schizoaffective disorder. With a malignancy, this is done formally by staging the cancer.

Some major mental illnesses, such as schizophrenia, can be characterized as acute, chronic, or residual, whereas the same clinical picture, occurring with less than a 6-month duration, is termed schizophreniform disorder. This categorization usually has prognostic or treatment significance. Treating Based on Stage Many illnesses are stratified according to severity because prognosis and treatment often vary based on these factors.

If neither the prognosis nor the treatment is influenced by the stage of the disease process, there is no reason to subcategorize a disease as mild or severe. For example, some patients with suicidal ideation but no intent or plan can be treated as outpatients, but other patients who report intent and a specific plan, must be immediately hospitalized and even committed if necessary. The measure of response should be recorded and monitored.

Some responses are clinical, such as improvement or lack of improvement in the level of depression, anxiety, or paranoia. Obviously, the student must work on becoming skilled in eliciting the relevant data in an unbiased, standardized manner. Other responses can be followed by laboratory tests, such as a urine toxicology screening for a cocaine abuser or a determination of lithium level for a bipolar patient.

The student must be prepared to know what to do if the measured marker does not respond according to what is expected.

Is the next step to reconsider the diagnosis, to repeat the test, or to confront the patient about the findings? It can be based on symptoms the patient feels better or on a laboratory or some other test a urine toxicology screening. It is the official psychiatric coding system used in the United States.

The DSM-IV describes mental disorders and only rarely attempts to account for how these disturbances come about. Specified diagnostic criteria are presented for each disorder and include a list of features that must be present for the diagnosis to be made. The DSM-IV also systematically describes each disorder in terms of its associated descriptors such as age, gender, prevalence, incidence, and risk; course; complications; predisposing factors; familial pattern; and differential diagnosis.

Axes I and II make up the entire classification of mental disorders. Each patient should receive a five-axis diagnosis, which usually appears at the end of a write-up in the assessment section. Axis I: Clinical disorders and other disorders that may be the focus of clinical attention Axis II: Personality disorders and mental retardation only Axis III: Physical disorders and other general medical conditions.

The physical condition may be causing the psychiatric one eg, delirium, coded on axis I, caused by renal failure, coded on axis III , be the result of a mental disorder eg, alcoholic cirrhosis, coded on axis III, secondary to alcohol dependence, coded on axis I , or be unrelated to the mental disorder eg, chronic diabetes mellitus.

Information about these stressors may be helpful when it comes time to develop treatment plans for the patient. The scale is based on a continuum of health and illness, using a point scale on which is the highest level of functioning in each area. People who had high GAF values before an episode of illness often have a better prognosis than those whose functioning was at a lower level.

Furthermore, a reader retains more information when reading with a purpose. In other words, the student should read with the goal of answering specific questions. There are several fundamental questions that facilitate clinical thinking: 1. What is the most likely diagnosis?

What should the next step be? What is the most likely mechanism for this process? What are the risk factors for this condition? What complications are associated with this disease process? What is the best therapy? How can you confirm the diagnosis? Note that questions 3 through 5 are probably used less in the field of psychiatry than in other specialties, such as medicine, where the pathophysiology and risk factors of a particular disease process are known.

Likewise, confirmation of a diagnosis question 7 is less often made by further laboratory tests or other diagnostic studies but can be achieved by carefully obtaining additional history obtained from family, colleagues, and so on.

The above questions should, however, be kept in mind for all patients. What Is the Most Likely Diagnosis? The method of establishing a diagnosis was covered in the previous section. It is helpful to understand the most common presentation of a variety of illnesses, for example, a common presentation of major depression.

Clinical pearls appear at the end of each case. The clinical scenario might be the following: A year-old woman presents to her physician with a chief complaint of a depressed mood and difficulty sleeping.

With no other information to go on, the student notes the depressed mood and the vegetative symptom of insomnia. However, what if the scenario also includes the following? Then the student would use the clinical pearl: A diagnosis of acute stress disorder should be considered in a patient with a depressed mood, insomnia, and a history of trauma.

These symptoms, however, are common in instances of trauma and bereavement as well, and so these details must be investigated in reference to the patient. What Should the Next Step Be? This question is difficult because the next step has many possibilities; the answer may be to obtain more diagnostic information, rate the severity of the illness, or introduce therapy.

It is often a more challenging question than what is the most likely diagnosis because there may be insufficient information to make a diagnosis and the next step may be to pursue more diagnostic information.

Another possibility is that there is enough information for a probable diagnosis and that the next step is to assess the severity of the disease. Finally, the most appropriate answer may be to start treatment. This ability is learned optimally at the bedside, in a supportive environment, with freedom to make educated guesses and with constructive feedback. Smith has major depression because she has a depressed mood, problems with concentration, anhedonia, insomnia, loss of appetite, anergia, and a weight loss of 10 lb in 3 weeks.

This question goes further than making the diagnosis and also requires the student to understand the underlying mechanism of the process. The student must first diagnose a conversion disorder, which can occur after an emotionally traumatic event, once physical explanations for blindness have been ruled out. Then the student must understand that there is a psychodynamic explanation for the particular nature of the symptoms as they have arisen.

While many mechanisms of disease are not well understood in psychiatry at the present time, it is anticipated that they will be further elucidated as the fields of neuropsychiatry and neuroimaging continue to grow. Understanding the risk factors helps a practitioner to establish a diagnosis and to determine how to interpret tests. For example, understanding the risk factor analysis may help in treating a year-old man who presents to a physician with a chief complaint of loss of memory.

Thus, the presence of risk factors helps to categorize the likelihood of a disease process. What Are the Complications of This Process? Clinicians must be cognizant of the complications of a disease so that they understand how to follow and monitor the patient. Sometimes the student has to make a diagnosis from clinical clues and then apply their knowledge of the consequences of the pathologic process.

For example, a woman who presents with a depressed mood, anhedonia, anergia, loss of concentration, insomnia, and weight loss is first diagnosed as having major depression. A complication of this process includes psychosis or suicidal ideation. Therefore, understanding the types of consequences helps the clinician to become aware of the dangers to the patient. Not recognizing these possibilities might lead the clinician to miss asking about psychotic symptoms and treating them or to overlook a potentially fatal suicidal ideation.

What Is the Best Therapy? To answer this question, the clinician needs to make the correct diagnosis, assess the severity of the condition, and weigh the situation to determine the appropriate intervention. For the student, knowing exact doses is not as important as understanding the best medication, route of delivery, mechanism of action, and possible complications.

It is important for the student to be able to verbalize the diagnosis and the rationale for the therapy. A common error is for a student to jump to a treatment by making a random guess; as a result he or she receives correct or incorrect feedback. There was no mention of a general medical condition like hyperthyroidism or a substance abuse problem like cocaine use that would account for these symptoms.

Therefore, the best treatment for this patient with probable bipolar disorder would be lithium or valproic acid after the final diagnosis is made. There is no need to hospitalize all patients with major depression, but it may be lifesaving to do so if suicidal ideation with intent and plan are present.

How Can You Confirm the Diagnosis? In the previous scenario, the year-old woman is likely to have bipolar disorder— manic phase. Further information about the presence of other symptoms common in mania can also be helpful, as is ruling out any general medical conditions or substance abuse problems. The student should strive to know the limitations of various diagnostic tests and the manifestations of disease. There is no replacement for a meticulously constructed history and a physical examination.

There are four steps in the clinical approach to a patient: making a diagnosis, assessing the severity of the disease, treating based on the severity of the disease, and following the response to treatment. There are seven questions that help to bridge the gap between the textbook and the clinical arena.

Current diagnosis and treatment in psychiatry. Goldman HH, ed. Review of general psychiatry, 5th ed. Kaplan H, Sadock B. Synopsis of psychiatry, 8th ed. Psychotherapy PART 2. Individual psychotherapy: Varies according to the time frame used psychotherapy can be either brief or protracted.

It can be supportive, directive, and reality-oriented versus expressive, exploratory, and oriented toward a discussion of unconscious material. Supportive psychotherapy 1. Insight-oriented psychotherapy 1. Indicated in the treatment of anxiety, somatoform and dissociative disorders, personality disorders, neuroses, and trauma.

It should be noted that although psychotherapy may be indicated for all these disorders, the degree of patient insight and motivation for undergoing treatment are critical to its success. Behavior modification: Includes a group of loosely related therapies that work according to the principles of learning. A short list of examples of these therapies follows.

Systematic desensitization: Exposing the patient to increasingly anxiety-provoking stimuli and at the same time teaching him or her to relax. This therapy is used in the treatment of phobias and in preventing compulsions. Substitution: Replacing an undesirable behavior smoking with a desirable one chewing gum.

Hypnosis works in selected patients in the management of pain, the resolution of conversion disorders, and relaxation training. Cognitive-behavioral therapy A. Focuses on the cognitive responses that are the primary targets for intervention. Used in changing maladaptive behavior occurring as a result of cognitive responses. The most common use for this form of therapy is in the treatment of major depression, where the self-defeating attitudes that are so common are identified, challenged, and replaced with more realistic thoughts.

Social therapies: These therapies use the principles of supportive and individual or marital therapy, but occur in groups of similar patients, a family, or a couple. PART 2. Tables through summarize the characteristics of these agents. Many of these medications affect neurotransmitters Figure The main neurotransmitters are monoamines norepinephrine, dopamine, serotonin, acetylcholine, histamine , amino acids gamma-aminobutyric acid , and glutamic acid. Antidepressants: Antidepressants can be placed in three main categories.

Tricyclics and heterocyclics, which once represented the first line of treatment. These drugs work by increasing the level of monoamines in the synapse by reducing the reuptake of norepinephrine and serotonin. Although they are quite effective, they are dangerous in overdose, causing fatal cardiac arrhythmias Table Selective serotonin reuptake inhibitors SSRIs are the most commonly used antidepressants today.

Major side effects include gastrointestinal and sexual dysfunction Table Monoamine oxidase inhibitors MAOIs are not commonly used because a tyramine-free diet no wine or cheese must be followed or a hypertensive crisis may result. These agents may be more helpful in depression with atypical features overeating, oversleeping, irritability Table Miscellaneous medications Table Mood stabilizers: These medications are used to treat mania and include agents such as lithium, valproic acid, and carbamazepine.

Neurotransmitters in the neuronal synapse. Selective serotonin reuptake inhibitors block the reuptake of serotonin by the presynaptic neuron top , allowing more serotonin to be available at the postsynaptic receptor. Monoamine oxidase inhibitors block the ability of this enzyme to inactivate monoamines such as norepinephrine in the synaptic cleft bottom , allowing more neurotransmitter to bind to the postsynaptic receptor.

It is characterized by confusion, muscle rigidity, high temperature, muscle twitching, shivering, and loss of consciousness, and it may be fatal. Lithium and valproic acid are both teratogenic and must be used with caution in women of childbearing age Table Antipsychotic agents A.

First-generation antipsychotics typical antipsychotics 1. These medications work by blocking central dopamine receptors. They are most effective in reducing the positive symptoms of schizophrenia, including hallucinations and delusions.

Side effects Table include the following. Central nervous system effects: i. Extrapyramidal symptoms EPS : Parkinsonian syndrome, acute dystonias, akathisia ii. Tardive dyskinesias: Late onset of choreiform and athetoid movements of the trunk, extremities, or mouth iii.

Sedation iv. Neuroleptic malignant syndrome NMS : Can occur at any time with an antipsychotic agent; typically movement disorder muscle rigidity, dystonia, agitation and autonomic symptoms high fever, sweating, tachycardia, hypertension. Treatment includes medication with dantrolene and bromocriptine. Anticholinergic effects c. Save my name, email, and website in this browser for the next time I comment. Notify me of new posts by email. Been Medical Video Lectures Dr.

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