Clinical Psychiatry and Pharmacology Review

Comprehensive vocabulary flashcards covering treatment-resistant schizophrenia, typical and atypical antipsychotics, extrapyramidal symptoms, mood stabilizers, eating disorders, child and adolescent neurodevelopmental disorders, palliative pain management, and addiction medicine based on the lecture notes.

Treatment-Resistant Schizophrenia (TRS)

Schizophrenia characterized by persistent positive symptoms despite adequate trials of at least two different antipsychotics (including at least one second-generation antipsychotic) given for at least 6 weeks at an adequate dose.

Clozapine

An atypical antipsychotic that is the gold standard for treatment-resistant schizophrenia and persistent suicidality in schizophrenia; requires regular absolute neutrophil count (ANC) monitoring due to the risk of agranulocytosis.

Mesolimbic Dopamine Pathway

The dopaminergic brain pathway where $D_2$ receptor antagonism by antipsychotic medications reduces the positive symptoms of psychosis, such as hallucinations and delusions.

Mesocortical Dopamine Pathway

The dopaminergic brain pathway associated with emotions and cognition, where low dopamine levels cause negative symptoms and where $D_2$ blockade by typical antipsychotics can cause or worsen negative and cognitive symptoms.

Tuberoinfundibular Dopamine Pathway

The brain pathway where dopamine limits prolactin secretion; blockade of $D_2$ receptors here leads to hyperprolactinemia, galactorrhea, gynecomastia, and amenorrhea.

Nigrostriatal Dopamine Pathway

The brain pathway involved in motor control; dopamine $D_2$ receptor blockade in this pathway results in extrapyramidal symptoms (EPS) and tardive dyskinesia.

Acute Dystonia

An extrapyramidal symptom occurring within hours to 5 days of initiating or increasing an antipsychotic, characterized by sudden, sustained involuntary muscle contractions (such as torticollis or oculogyric crisis); treated with IM or IV benztropine or diphenhydramine.

Akathisia

An extrapyramidal symptom occurring within days to weeks of antipsychotic therapy, presenting as subjective motor restlessness and an irresistible urge to move the limbs; treated with propranolol, lorazepam, or benztropine.

Tardive Dyskinesia

A late-onset, potentially irreversible extrapyramidal symptom caused by chronic dopamine receptor blockade, characterized by constant, involuntary, rhythmic movements of the perioral muscles (such as lip smacking or tongue protrusion).

Neuroleptic Malignant Syndrome (NMS)

A life-threatening reaction to antipsychotics characterized by a tetrad of altered mental status, severe hyperthermia ($>40^\text{o}\text{C}$ / $104^\text{o}\text{F}$), generalized lead-pipe muscle rigidity, and autonomic instability, accompanied by elevated creatine kinase (CK) and leukocytosis.

Serotonin Syndrome

A toxic condition caused by excessive serotonergic activity that presents acutely (within hours) with hyperreflexia, myoclonus, clonus, tremors, autonomic instability, and dilated pupils, distinguishing it from neuroleptic malignant syndrome.

Tourette Syndrome

A neurodevelopmental disorder characterized by multiple motor tics and at least one vocal tic lasting over one year with onset before 18 years of age; aripiprazole is a first-line pharmacologic agent when behavioral therapy and alpha-agonists fail.

Aripiprazole

A second-generation antipsychotic acting as a partial agonist at dopamine $D_2$ and serotonin $5\text{-HT}_{1A}$ receptors and an antagonist at $5\text{-HT}_{2A}$ receptors; it has a low risk of extrapyramidal symptoms, metabolic dysfunction, and hyperprolactinemia.

Olanzapine

A second-generation antipsychotic indicated as a first-line agent for acute mania in bipolar disorder, but associated with high metabolic risk including significant weight gain, hyperglycemia, and dyslipidemia.

Benztropine

An anticholinergic medication that restores the dopamine-acetylcholine balance in the basal ganglia, serving as the primary treatment for antipsychotic-induced acute dystonia and drug-induced parkinsonism.

Lithium Carbonate

A classic mood stabilizer for acute mania and bipolar maintenance that acts primarily by inhibiting inositol monophosphatase (IMPase); requires regular monitoring of serum levels, renal function, and thyroid function.

Therapeutic Lithium Concentrations

Target serum concentrations of $0.8\text{--}1.2\text{ mmol/L}$ ($\text{mEq/L}$) for acute mania and $0.6\text{--}1.0\text{ mmol/L}$ ($\text{mEq/L}$) for maintenance therapy, drawn 12 hours after the last dose.

Indications for Hemodialysis in Lithium Toxicity

Criteria for emergent hemodialysis, defined as a serum lithium level $>4.0\text{ mEq/L}$, or $>2.5\text{ mEq/L}$ in the setting of severe renal impairment, coma, seizures, or severe neurological toxicity.

Valproate-Lamotrigine Interaction

Valproic acid inhibits the glucuronidation of lamotrigine, doubling its serum concentration and requiring a mandatory 50% dose reduction of lamotrigine to prevent serious dermatological toxicity such as Stevens-Johnson syndrome (SJS).

Valproic Acid Adverse Effects

Dose-dependent adverse effects associated with valproate therapy that require CBC and liver function monitoring, notably thrombocytopenia, transaminitis/hepatotoxicity, and weight gain.

Treatment-Resistant Depression (TRD)

Major depressive disorder defined by an inadequate response to at least two adequate trials of antidepressants from different pharmacological classes given at therapeutic doses for sufficient duration.

SCOFF Questionnaire

A 5-question screening tool for eating disorders where an affirmative response to 2 or more questions indicates a positive screen requiring a comprehensive diagnostic psychiatric assessment.

Anorexia Nervosa

An eating disorder characterized by restriction of energy intake leading to a significantly low body weight ($\text{BMI} < 18.5\text{ kg/m}^2$), intense fear of weight gain, and body image distortion.

Refeeding Syndrome

A life-threatening metabolic complication occurring during nutritional restoration in severely malnourished patients, driven by an insulin surge that shifts phosphate, potassium, and magnesium intracellularly, resulting in severe hypophosphatemia, cardiac arrhythmias, and potential cardiac arrest.

Bulimia Nervosa

An eating disorder characterized by recurrent binge-eating episodes followed by inappropriate compensatory behaviors (such as self-induced vomiting or excessive exercise) at least once weekly for 3 months, occurring in individuals with normal or slightly elevated BMI.

Russell's Sign

Calluses, sores, or scars on the dorsum of the hand or knuckles caused by repeated contact with the incisor teeth during manual self-induced vomiting.

Bulimia Nervosa Electrolyte Pattern

Metabolic alkalosis accompanied by hypokalemia and hypochloremia resulting from chronic self-induced loss of hydrochloric acid in gastric emesis.

Binge-Eating Disorder (BED)

An eating disorder characterized by recurrent episodes of eating large quantities of food with a sense of loss of control and marked distress, occurring at least once weekly for 3 months without compensatory behaviors.

Avoidant/Restrictive Food Intake Disorder (ARFID)

An eating or feeding disturbance leading to persistent failure to meet appropriate energy needs and significant weight loss or growth failure, driven by sensory food aversion or fear of negative consequences, without body image distortion or fear of weight gain.

Attention-Deficit/Hyperactivity Disorder (ADHD)

A neurodevelopmental disorder defined by persistent patterns of inattention and/or hyperactivity-impulsivity across at least two settings, with symptom onset before age 12, causing functional impairment.

Methylphenidate

A first-line stimulant medication for ADHD in children aged 6 and older that increases synaptic dopamine and norepinephrine in the prefrontal cortex without increasing the risk of future substance use disorder.

Autism Spectrum Disorder (ASD)

A neurodevelopmental disorder characterized by persistent deficits in social communication and social interaction alongside restricted, repetitive patterns of behavior, interests, or activities.

Selective Mutism

An anxiety disorder characterized by a consistent failure to speak in specific social situations where speaking is expected (such as school), despite speaking normally in other comfortable environments.

Oppositional Defiant Disorder (ODD)

A disruptive behavior disorder characterized by a persistent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness toward authority figures, primarily treated with Parent Management Training (PMT).

Conduct Disorder (CD)

A repetitive behavior disorder violating the basic rights of others or major age-appropriate societal norms, characterized by aggression to people/animals, destruction of property, deceitfulness/theft, and serious rule violations (TRAP).

Opioid Tolerance Threshold for Transdermal Fentanyl

The requirement that a patient receive at least $60\text{ mg}$ of oral morphine daily (or equivalent) for one week or longer prior to initiating transdermal fentanyl, to prevent fatal respiratory depression in opioid-naïve individuals.

Opioid-Induced Constipation Management

Prophylactic and ongoing treatment of opioid-induced bowel dysfunction using stimulant laxatives (such as senna) or osmotic agents (such as polyethylene glycol), while avoiding supplemental bulk-forming fiber like psyllium.

Pediatric Opioid Contraindications

FDA contraindications prohibiting the use of codeine and tramadol in all children under 12 years of age, and in adolescents under 18 years following tonsillectomy or adenoidectomy, due to risks of severe respiratory depression and death.

Opioid Overdose Triad

The classic clinical presentation of acute opioid toxicity consisting of decreased level of consciousness, severe respiratory depression, and miosis (pinpoint pupils), treated immediately with intravenous or intranasal naloxone.

Persistent Hiccups in Palliative Care

Hiccups lasting greater than 48 hours but less than 2 months, commonly triggered in cancer patients by dexamethasone, gastric distension, or diaphragmatic irritation; first-line pharmacotherapy includes baclofen or gabapentin, or rotation from dexamethasone to methylprednisolone.