PSYCHIATRY - PSYCHOPHARM + EMERGENCIES + DISPOSITION
YEAR 3 | PAGE 31C - INDICATION -> MECHANISM -> SIGNATURE TOXICITY -> MONITORING
-> SAFE SETTING E. PSYCHOPHARMACOLOGY - KNOW THE SAFETY SIGNATURE
| Class | Core use / principle | High-yield adverse effect / monitoring logic |
|---|---|---|
| SSRIs / SNRIs | First-line across many depressive/anxiety disorders; delayed therapeutic response. | GI/sexual effects, activation, discontinuation; serotonin toxicity and drug interactions. SNRIs can raise BP. |
| Bupropion / mirtazapine / trazodone | Alternative antidepressant profiles chosen by comorbidity and adverse-effect tradeoffs. | Bupropion lowers seizure threshold and is avoided in relevant eating/seizure risk; mirtazapine can increase appetite/sedation; trazodone sedation/priapism. |
| TCAs / MAOIs | Effective but generally later-line because of toxicity/interactions. | TCA anticholinergic/cardiac toxicity in overdose; MAOI tyramine/serotonergic interactions and washout requirements. |
| Antipsychotics | Psychosis, mania and selected augmentation; typical vs atypical profiles. | EPS/tardive dyskinesia, NMS, hyperprolactinemia, metabolic effects, QT issues; clozapine requires blood-count monitoring because of severe neutropenia risk. |
| Lithium | Mood stabilization and suicide-risk reduction in bipolar disorder. | Narrow therapeutic index; renal/thyroid effects, tremor, DI and toxicity risk. Levels and renal/thyroid context matter; dehydration/drug interactions can increase toxicity. |
| Valproate / carbamazepine / lamotrigine | Mood stabilizers chosen by phase/comorbidity. | Valproate hepatic/platelet/teratogenic risk; carbamazepine cytopenia/hyponatremia/drug interactions; lamotrigine rash/SJS risk with rapid titration. |
| Benzodiazepines / buspirone | Short-term acute anxiety/agitation/withdrawal contexts vs chronic anxiolytic strategy. | Benzodiazepine sedation/respiratory risk, dependence and dangerous withdrawal; buspirone has delayed onset and no rapid rescue role. |
| Stimulants / ADHD medications | Attention-deficit/hyperactivity disorder after diagnosis across settings and safety review. | BP/HR, appetite/sleep and misuse/diversion considerations; screen for relevant cardiovascular/substance/mania risk. |
F. PSYCHIATRIC EMERGENCY FIRST STEPS
| Presentation | First reasoning move | Do not miss |
|---|---|---|
| Suicidal / violent risk | Immediate safety, direct risk questions, collateral/lethal-means context, supervision and disposition. | Intoxication, psychosis, severe mood episode, recent attempt, agitation, inability to collaborate with safety plan. |
| Acute agitation / psychosis / mania | Protect patient/staff, de-escalate, evaluate medical/substance causes, then supervised medication/restraint decisions if necessary. | Delirium, intoxication/withdrawal, hypoglycemia/hypoxia, neurologic disease; use least restrictive safe intervention per policy. |
| Serotonin syndrome vs NMS | Medication timeline + neuromuscular exam + autonomic findings; stop offending agents and escalate medical care. | Serotonin: clonus/hyperreflexia; NMS: severe rigidity with dopamine-blockade context - both can be life-threatening. |
| Withdrawal / overdose | ABCs and toxidrome; identify alcohol/benzodiazepine withdrawal and opioid overdose promptly. | Seizures/delirium tremens, respiratory depression, co-ingestants, electrolyte/glucose problems. |
| Catatonia / delirium | Recognize syndrome and urgent medical evaluation; avoid assuming "behavioral" etiology. | Malignant catatonia, NMS overlap, infection/metabolic/medication causes and inability to maintain intake. |
F. PSYCHIATRIC EMERGENCY FIRST STEPS — CLINICAL BOUNDARY
This Academy supports education and supervised clerkship performance. Suicide/violence emergencies, capacity determinations, involuntary treatment, restraints, medication selection and management of intoxication/withdrawal must follow supervising clinicians, institutional policy and applicable law.
F. PSYCHIATRIC EMERGENCY FIRST STEPS — Focused video reinforcement
Dirty Medicine - Dopamine Pathways, Antipsychotics, and EPS Dirty Medicine - Serotonin Syndrome vs Neuroleptic Malignant Syndrome 2026/27 clerkship-expanded edition - verify school and official exam updates before testing