New Year, New Rotation

Tuesday was the first day of my mental health rotation, after 2 months of vacation! 

It’ll take some getting used to having a set schedule again, but I’m ready to be back. 

Psych medications in general are weakness for me, so I’m looking to get the most 

out of this rotation. I’ve already learned a few things today.

• Olanzapine and quetiapine are FDA approved for bipolar, but not PTSD.This 

is important when looking at nonformulary consults for atypicals andverify whether 

or not the patient has either disease state.

• Ziprasadone – one side effect of antipsychotics in general is the metabolic syndrome. 

This medication needs to be taken with a high fat meal in order to absorb…so metabolic 

syndrome + high fat meal? Not the best combination. Plus this medication is dosed BID, 

which can affect compliance.

• Symptoms to be looking for for bipolar vs PTSD: With bipolar, the patient will 

experience manic episodes, and can go without sleep for days and then crash and 

sleep for days. For PTSD, The patient will have nightmares and feel the need to 

“sleep with a gun” for example, and will want to go to sleep, but can’t. These are subtle 

differences to watch out for.

• Citalopram: can prolong QT interval, and the max dose was recently changed

 to 40mg/day.

• Tramadol: can cause seizures.

• Bupropion: high seizure risk, has a black box warning for this. Not for patients 

with history of seizures, head trauma, alcoholics (d/t seizing during withdrawal), 

and bulimic patients (d/t electrolyte imbalances).

• 5 traditional mood stabilizers: if a patient needs a mood stabilizer, then one or 

a combination of the following should be tried before anything else: lithium, 

valproic acid, carbamazepine, oxcarbamazepine, and lamictal. The latter 4 are also 

anti-seizure medications.

• New medical abbreviations: SI/HI: suicidal ideation or homocidal ideation. 

MST: military sexual trauma (form of PTSD)

• DSM-IV Multiaxial Classification
          o  Axis I: Diagnosis of psych issue as an infant, child, or adolescent. 

Examples include delirium, dementia, amnesia, substance-related, schizophrenia, 

mood disorders, anxiety, sexual/gender identity disorders, eating/sleep/impulse-control/

adjustment disorders.
          o  Axis II: Mental retardation and personality disorders. Examples include: 

paranoia, antisocial/narcissistic/avoidant/dependent/and obsessive compulsive disorders.
          o  Axis III: General medical conditions
          o  Axis IV: psychosocial and environmental problems – things that affect 

diagnosis and treatment of Axis I and II problems.
          o  Axis V: Overall function, noted as the GAF (global assessment of function).

• Delusion – a false belief that one firmly holds.
          o  Bizarre: a delusion a patient has that would be culturally implausible.
          o  Delusional jealousy: delusion that sexual partner is unfaithful.
          o  Erotomanic: delusion that someone (usually of higher status) is in love with individual.
          o  Grandiose: delusion of inflated worth, etc.
          o  Persecutory: delusion that patient is being attached or conspired against.
          o  Somatic: delusion dealing with function of body.
          o  Thought broadcasting: delusion that thoughts are being broadcasted.
          o  Thought insertion: delusion that thoughts are being inserted into patient’s head.

• Hallucination – sensory perception of reality.
          o  Auditory
          o  Gustatory
          o  Olfactory (usually of decaying fish or burned rubber)
          o  Somatic
          o  Tactile (ex. Formication – something is crawling under skin).
          o  Visual

• Mood ~ climate as affected ~ weather