Summary (1/2): NMS vs Serotonin Syndrome: - Serotonin Syndrome has myoclonus, both have febrile and rigidity - Look in the history. It helps a lot. SS Antidotes: - Benzos or cyproheptadine Tyramine Crisis: - MAOIs - Treat for hypertensive emergency o Nitroprusside, hydralazine, labetalol, etc. EPS symptoms of Antipsychotics: - Dystonia, Akathisia, Parkinsonism, Tardive Dyskinesia - Dystonia o Happens within hours, basically non-relaxing muscle spasms, usually affects the sternocleidomastoid (torticollis) o Treatment: Benztropine, diphenhydramine (Benadryl) - Akathisia o Feel like they have to keep moving, can’t sit still o Treatment: Benzos or beta blocker or benztropine - Parkinsonism o Tremor, Rigidity, Bradykinesia o Treatment: Amantadine, benztropine - Tardive Dyskinesia o Chronic, months or years after using antipsychotics, lip smacking. o Treatment: Discontinue antipsychotic, switch to clozapine, valbenazine Clozapine - With clozapine check for decreased white blood cells - Lowers suicide risk - Agranulocytosis, seizures Lithium - Most likely to decrease suicide risk - Lithium toxicity: hydrate, dialysis o Dialysis: AEIOU (acidosis, electrolytes, intoxicants, overload, uremia) o Dialyzable intoxicants: methanol, aspirin, lithium, ethylene glycol TCA Toxicity: - Antidote: sodium bicarbonate (the sodium is important, flushes out the TCA) Cocaine Overdose: - Treat with benzos (IV lorazepam) - Don’t give beta blockers Alcohol Withdrawal: - Treat with benzodiazepines - Alcoholic hallucinosis vs Delirium Tremens o Vitals are pretty stable with AH, but hypertension and tachycardia with DT o Hallucinosis occurs sooner PCP Overdose: - Treat: Benzos - Diagnosis: violence, psychosis, nystagmus, blood test will show elevated CPK o CPK is elevated in neuroleptic malignant syndrome as well Benzo Overdose: - Antidote: Flumazenil o Only for people who are not addicted to benzos (otherwise withdrawal) - Withdrawal: tachycardic, diaphoretic, hypertensive o Treat with benzodiazepines again and then taper slowly Opioid: - Overdose: Naloxone - Withdrawal: Supportive because not life threatening (clonidine) o Alcohol and benzodiazepines are withdrawal status epilepticus and death Antipsychotic Pathways: - Mesolimbic: positive symptoms - Mesocortical: negative symptoms - Tuberoinfundibular: prolactin (antipsychotic blocks dopamine, increase prolactin) o Risperidone - Nigrostriatal: parkinsonism Schizophrenia: - Good prognosis: late onset, female, fast onset - Bad prognosis: early onset, male, slow onset First Generation Antipsychotics: - High Potency: Haloperidol, fluphenazine o Side effects: EPS - Low potency: chlorpromazine, chlorprothixene, thioridazine o Side effects: HAM Block (antihistamine, alpha 1 blockade, anti-muscarinic) Anti-alpha predisposes to orthostatic hypertension Anti-muscarinic and antihistamine can be sedating Second Generation Antipsychotics: - Side effects: metabolic syndrome (hyperlipidemia, hyperglycemia, obesity) - Olanzapine: most likely to cause metabolic syndrome o Check glucose, lipids Schizoaffective Disorder: - If baseline is schizophrenia, then schizoaffective. If baseline is depression, then MDD with psychotic features o Periods of time without depression or mania but still schizophrenic = schizoaffective - Treatment: second gen antipsychotics or mood stabilizers (valproate, carbamazepine) Delusional Disorder: - At least one month of delusions (no other schizophrenia symptoms), function normally Prognosis: - Mood disorders have better prognosis than psychotic. Bipolar: - Mania requires hospitalization, at least 3 DIGFAST for at least one week - Hypomania no hospitalization, can have 4 DIGFAST but no hospitalization TCAs: - HAM blockade and three Cs (cardiotoxicity (long QT and arrythmias), convulsions, coma) Serotonin Syndrome: - Typical vignette: stop SSRI for like a week and then start MAOI right away - When you stop SSRIs it takes a few weeks to wash out serotonin before starting another one Antidepressants: - Take 4-6 weeks to start work - Should take for at least 6-9 months - Side effects but working: different SSRI in same class - Not working at all: switch drug classes ECT: - Patient who will not eat or drink, high suicide risk, psychosis - Side effect: amnesia for around 6 months which will resolve Catatonia and Catalepsy: - Can be antipsychotic induced - Treatment: benzodiazepine (specifically lorazepam)
1st line treatment of chronic persistent Restless Leg Syndrome is now Gabapentin (and the others in that class). The dopamine agonists are now 2nd line
Thank you so much for everything Dr. hy 🙏🏽🙏🏽🙏🏽 A little reminder for new treatment of restless leg syndrome based on uw: Supplemental iron (if serum ferritin
✿Updated treatment for restless leg syndrome: alpha-2- delta calcium channel ligands aka Gabapentin, Pregabalin ✿ Second line treatment for RLS: ropinerole and pramipexole
Your videos are amazing! Really Helpful! Thank you SO MUCH! One thing I noted for Restless leg syndrome treatment Dopamine agonists (eg, pramipexole, ropinirole) not preferred. Rather treat with : Supplemental iron (if serum ferritin
Note for people watching this video: Vaginismus is now called Genito-Pelvic Pain/Penetration Disorder - severe vulvovaginal or pelvic pain during intercourse or attempted penetation - severe anticipatory anxiety - severe tightening of pelvic floor muscles during attempted penetration cannot be better explained by: severe stress (eg partner violence), meds or substances, or med conditions first line: pelvic floor physical therapy
Thanks for very comprehensive review :D I think another difference b/w NMS and SS is: Neuroleptic malignant syndrome has characteristic muscle rigidity, while in serotonin syndrome its absent
Abdullahi do not thank God for them, psychs do not believe in God thats why everything about religion to them they will say its a mental illness, delusional, incoherent thinking etc etc.
These are really very helpful videos. Wondering if you could make one on EKGs , CTs , EEGs and X-rays separately. Especially on how to read EKGs on the 2Ck test
Correct me if I'm wrong, but around 28:00 when you begin talking about APD vs SAD, I've found the difference to be more in how the patient sees themself being judged. Social anxiety disorder patients do not think they are inferior to others but are afraid of inappropriate judgment or making a mistake. Avoidant personality disorder patients on the other hand think they are inadequate and feel helpless. The difference concerning their wants to have a social life is a contrast between avoidant personality disorder and schizoid PD. I had a question on AMBOSS between these two and remembered this rationale for the correct answer.
Amazing content, great review! Thank you so much. Just wanted to add an edit in there about the new guidelines for Restless leg syndrome: 1ST line= alpha-2-delta ligands (GABAPENTIN, PREGABALIN). 2nd line= Low-dose non ergot dopamine agonists (Ropinrole or pramixpexole)
PMDD is different from PMS which is different from Primary Dysmenorrhea. They are 3 distinct entities. Only primary dysmenorrhea happens during menstruation. PMS can have mood sx, but they are not as severe or as depressive as experienced during PMDD.
This one is great. Wish it it was redone to include more personality disorders from clusters ABC. It's also hard to hear the people in the back when they answer. otherwise I love your videos!
Thank you for this awesome review!! -- quick update: OCPs + lifestyle changes are now considered first line for PMDD; SSRIs are added either around menstruation or daily for severe PMDD
Pardeep Singh depends on the severity. The problem with making a 1 hour high yield video is I can't include everything and go into super details otherwise it will take much longer. my source was first aid psychiatry and for severe SX eg severe vomiting and diarrhea or unstable vitals then you can use buprenorphine or methadone. More commonly though it is just supportive care and on top of that clonidine can be used. Hope that helps
Oh noooo you use a Mercedes-Benz symbol for benzodiazepines but Sketchy uses a Mercedes-Benz symbol for benztropine!!! My brain!!!!!!! That aside, thanks for another kickass review :) :) :) EDIT: just realized that your DIGFAST @ 17:07 is similar but not quite the same as what I learned in school/through Amboss: Distractibility, Impulsivity, Grandiosity, Flight (flight of ideas), Activity (psychomotor hyperactivity), Sleep (sleep deficit), Talk (pressured speech)
Pre-menstrual dysphoric disorder is NOT the medical word for PMS. These are totally separate, and PMDD is a medical diagnosis that severely impacts patient lives.
hey! great review, I really enjoy it! Actually, I found that first line treatment for fibromyalgia is excercise and good sleep 51:28, if does not work consider pharmacotherapy!
@ 42:11 you lost me what you were asking for first line treatment and you were talking about ADH agonists/antagonists .. don't know for what. all I heard was "ur-an-alarm" LOL
The way I remembered it was that grief usually has ups and downs. The patient is functioning. Grief comes in waves. Depression is constant and associated with feelings of worthlessness.
Summary (1/2):
NMS vs Serotonin Syndrome:
- Serotonin Syndrome has myoclonus, both have febrile and rigidity
- Look in the history. It helps a lot.
SS Antidotes:
- Benzos or cyproheptadine
Tyramine Crisis:
- MAOIs
- Treat for hypertensive emergency
o Nitroprusside, hydralazine, labetalol, etc.
EPS symptoms of Antipsychotics:
- Dystonia, Akathisia, Parkinsonism, Tardive Dyskinesia
- Dystonia
o Happens within hours, basically non-relaxing muscle spasms, usually affects the sternocleidomastoid (torticollis)
o Treatment: Benztropine, diphenhydramine (Benadryl)
- Akathisia
o Feel like they have to keep moving, can’t sit still
o Treatment: Benzos or beta blocker or benztropine
- Parkinsonism
o Tremor, Rigidity, Bradykinesia
o Treatment: Amantadine, benztropine
- Tardive Dyskinesia
o Chronic, months or years after using antipsychotics, lip smacking.
o Treatment: Discontinue antipsychotic, switch to clozapine, valbenazine
Clozapine
- With clozapine check for decreased white blood cells
- Lowers suicide risk
- Agranulocytosis, seizures
Lithium
- Most likely to decrease suicide risk
- Lithium toxicity: hydrate, dialysis
o Dialysis: AEIOU (acidosis, electrolytes, intoxicants, overload, uremia)
o Dialyzable intoxicants: methanol, aspirin, lithium, ethylene glycol
TCA Toxicity:
- Antidote: sodium bicarbonate (the sodium is important, flushes out the TCA)
Cocaine Overdose:
- Treat with benzos (IV lorazepam)
- Don’t give beta blockers
Alcohol Withdrawal:
- Treat with benzodiazepines
- Alcoholic hallucinosis vs Delirium Tremens
o Vitals are pretty stable with AH, but hypertension and tachycardia with DT
o Hallucinosis occurs sooner
PCP Overdose:
- Treat: Benzos
- Diagnosis: violence, psychosis, nystagmus, blood test will show elevated CPK
o CPK is elevated in neuroleptic malignant syndrome as well
Benzo Overdose:
- Antidote: Flumazenil
o Only for people who are not addicted to benzos (otherwise withdrawal)
- Withdrawal: tachycardic, diaphoretic, hypertensive
o Treat with benzodiazepines again and then taper slowly
Opioid:
- Overdose: Naloxone
- Withdrawal: Supportive because not life threatening (clonidine)
o Alcohol and benzodiazepines are withdrawal status epilepticus and death
Antipsychotic Pathways:
- Mesolimbic: positive symptoms
- Mesocortical: negative symptoms
- Tuberoinfundibular: prolactin (antipsychotic blocks dopamine, increase prolactin)
o Risperidone
- Nigrostriatal: parkinsonism
Schizophrenia:
- Good prognosis: late onset, female, fast onset
- Bad prognosis: early onset, male, slow onset
First Generation Antipsychotics:
- High Potency: Haloperidol, fluphenazine
o Side effects: EPS
- Low potency: chlorpromazine, chlorprothixene, thioridazine
o Side effects: HAM Block (antihistamine, alpha 1 blockade, anti-muscarinic)
Anti-alpha predisposes to orthostatic hypertension
Anti-muscarinic and antihistamine can be sedating
Second Generation Antipsychotics:
- Side effects: metabolic syndrome (hyperlipidemia, hyperglycemia, obesity)
- Olanzapine: most likely to cause metabolic syndrome
o Check glucose, lipids
Schizoaffective Disorder:
- If baseline is schizophrenia, then schizoaffective. If baseline is depression, then MDD with psychotic features
o Periods of time without depression or mania but still schizophrenic = schizoaffective
- Treatment: second gen antipsychotics or mood stabilizers (valproate, carbamazepine)
Delusional Disorder:
- At least one month of delusions (no other schizophrenia symptoms), function normally
Prognosis:
- Mood disorders have better prognosis than psychotic.
Bipolar:
- Mania requires hospitalization, at least 3 DIGFAST for at least one week
- Hypomania no hospitalization, can have 4 DIGFAST but no hospitalization
TCAs:
- HAM blockade and three Cs (cardiotoxicity (long QT and arrythmias), convulsions, coma)
Serotonin Syndrome:
- Typical vignette: stop SSRI for like a week and then start MAOI right away
- When you stop SSRIs it takes a few weeks to wash out serotonin before starting another one
Antidepressants:
- Take 4-6 weeks to start work
- Should take for at least 6-9 months
- Side effects but working: different SSRI in same class
- Not working at all: switch drug classes
ECT:
- Patient who will not eat or drink, high suicide risk, psychosis
- Side effect: amnesia for around 6 months which will resolve
Catatonia and Catalepsy:
- Can be antipsychotic induced
- Treatment: benzodiazepine (specifically lorazepam)
Thankyou!!
THANK YOU! Do you happen to have part 2/2? Would really appreciate it!
any luck getting part 2 of the summary @@softbee8265
hey, do u have part 2 of the summary. thanks
@thefenerbahcesk4156 summary part 2?
1st line treatment of chronic persistent Restless Leg Syndrome is now Gabapentin (and the others in that class). The dopamine agonists are now 2nd line
Recommended this to our study advisor and now she email blasts 160+ students recommending they watch your videos before Shelf exams. Great stuff.
Bless your soul for these videos. Thank you thank you THANK YOU x10000000000
not me coming back again before step 2 :'-) Thank you x10000000000000000000000000000000~
Thank you so much for everything Dr. hy 🙏🏽🙏🏽🙏🏽
A little reminder for new treatment of restless leg syndrome based on uw:
Supplemental iron (if serum ferritin
omg! This is amazing review for Psych. I just did 3 blocks of UW and got 70, 80, 80!!!! Right on! Thank you :)
Watching your videos the night before my shelves make all the difference! Thanks for teaching all of us :)
Let me know if you ever need a kidney
Kelli Tichy 😂
hahaha
HAHAHHA
I read this as hickey on accident 😂
😂😂
I wish u were my roommate during medschool
You are the HY Goljan for Clinicals. Thanks, Dr. HY!
✿Updated treatment for restless leg syndrome: alpha-2- delta calcium channel ligands aka Gabapentin, Pregabalin
✿ Second line treatment for RLS: ropinerole and pramipexole
I think Benzo's are second line now right? I don't think ropinerole or pramipexole are recommended at all now
I'm surprised you don't have more followers. This is great review information. You've been super helpful for my previous shelf exams.
Your videos are amazing! Really Helpful! Thank you SO MUCH!
One thing I noted for Restless leg syndrome treatment Dopamine agonists (eg, pramipexole, ropinirole) not preferred. Rather treat with :
Supplemental iron (if serum ferritin
Note for people watching this video:
Vaginismus is now called Genito-Pelvic Pain/Penetration Disorder
- severe vulvovaginal or pelvic pain during intercourse or attempted penetation
- severe anticipatory anxiety
- severe tightening of pelvic floor muscles during attempted penetration
cannot be better explained by: severe stress (eg partner violence), meds or substances, or med conditions
first line: pelvic floor physical therapy
Thanks for very comprehensive review :D
I think another difference b/w NMS and SS is:
Neuroleptic malignant syndrome has characteristic muscle rigidity, while in serotonin syndrome its absent
Yes. Our legend did finally came back. Thank you God for giving us this doctor.
Abdullahi Abdullahi. The man the myth the legend. JK. 😅
Abdullahi do not thank God for them, psychs do not believe in God thats why everything about religion to them they will say its a mental illness, delusional, incoherent thinking etc etc.
Your IM shelf was on point. I had three questions based on your video,!
These are really very helpful videos. Wondering if you could make one on EKGs , CTs , EEGs and X-rays separately. Especially on how to read EKGs on the 2Ck test
thank you so much!! please don't forget to repeat answers from the audience because it can be hard to hear them
Thank you so much, you're literally so amazing!! Really appreciate everything you do!
Correct me if I'm wrong, but around 28:00 when you begin talking about APD vs SAD, I've found the difference to be more in how the patient sees themself being judged. Social anxiety disorder patients do not think they are inferior to others but are afraid of inappropriate judgment or making a mistake. Avoidant personality disorder patients on the other hand think they are inadequate and feel helpless. The difference concerning their wants to have a social life is a contrast between avoidant personality disorder and schizoid PD. I had a question on AMBOSS between these two and remembered this rationale for the correct answer.
just found you and having my psych shelf tomorrow, this is so helpful!
Hope it went well!
Studying for my psych shelf and I was happy to find a familiar name endorsing the quality of this review!
This is the best review I have ever seen.I even wrote some down as notes for study.Thank you!
Your amazinggg!! Love that your straight to the point and cover so much! 😭 Thank you!!
Chelsy Calhoun no problem!! Wishing you All the best
@@DoctorHighYieldMD I literally heard your voice during my exam😂. I think it went well!!
Chelsy Calhoun hahah nice!! 😝
Bro please keep making these videos...i am taking step2ck in 3 days it really helps
Thank you so much for these videos. I watched them all and succeeded on my shelf exams. You are amazing!
Yoga with Helly congrats!
In SS vs NMS, hyperreflexia with SS is also a dead giveaway.
Yh clonus
Amazing content, great review! Thank you so much. Just wanted to add an edit in there about the new guidelines for Restless leg syndrome: 1ST line= alpha-2-delta ligands (GABAPENTIN, PREGABALIN). 2nd line= Low-dose non ergot dopamine agonists (Ropinrole or pramixpexole)
Thank you! I have my exam in two days and this video helped me a lllllllllllllllot!! Wish me luck guyz :)
You’re amazing please please keeps up the videos ! I’ve been sharing non stop !
amy amelie ok haha I will upload the other ones too, glad I could help
God bless you doc you're amazing!!
Thank you so much Dr. HY for all your help, you are truly a blessing!
Not all superheroes wear capes fr
PMDD is different from PMS which is different from Primary Dysmenorrhea. They are 3 distinct entities. Only primary dysmenorrhea happens during menstruation. PMS can have mood sx, but they are not as severe or as depressive as experienced during PMDD.
Thanks for fantastic series. It helped me a lot to pass MCCQE1 ( Canada exam) effortlessly. Massive thanks !
this is ridiculously helpful and HY!! very succinct without fluff. thank you!!
I'm dying every time you say benzo and a picture of a sls pops up
😂
wow keep it up
we need more of these please.
There's more coming soon, I just gotta upload them haha
Loving your vids! Perfect review since I take CK Monday🙌🏾
Hey Doctor Helene how did it go? I’m about to take it.
Watching all these videos again day before level 2 thanks!
Thank you so much! My psych shelf is on Friday and this was super helpful :)
Hey you dropped this 👑
Wohoo ! Just finished my psych review with ur fabulous lecture! Gracious!
I don't quite understand what the other people are saying. It would be great if you could put some subtitles. Great stuff. Thank you!
Some corrections. Short term psychotic disorders by definition have better prognoses than many chronic MI, mood or otherwise, because they resolve in
First-line for restless leg syndrome is not dopamine agonists
This is the most useful video ever, thank you very much for sharing this
Treatment for opioid withdrawal is methadone/buprenorphine in addition to supportive.
Also antihistamine effect of low potency 1st gen antipsychotics causes increased appeptite
You are a USMLE GOD !! god bless you, thank you for all the amazing ,super helpful videos! :)
how can you compare God to a human
I'm soooo grateful to you for all these HY videos - THANK YOU!!
For IBS, TCAs are used rather than SSRIs
Awesome ! Please upload soon
yes I will
Great reviews! Thanks for creating/posting
This is great. Is everything still up to date four years later?
This one is great. Wish it it was redone to include more personality disorders from clusters ABC. It's also hard to hear the people in the back when they answer. otherwise I love your videos!
Good Job! You get a thumbs up just for having a dip set interlude at the beginning of your video. Good information Keep it up!!
haha I'm so glad someone mentioned this. Love it.
thank you papa
Do you have a review for Social Sciences please? quality ethics?
Thank you for this awesome review!! -- quick update: OCPs + lifestyle changes are now considered first line for PMDD; SSRIs are added either around menstruation or daily for severe PMDD
Opioid withdrawal treatment you said Clonidine but i’ve seen Methadone as a more common option. Also UTD gives buprenorphine as the best first line.
Pardeep Singh depends on the severity. The problem with making a 1 hour high yield video is I can't include everything and go into super details otherwise it will take much longer. my source was first aid psychiatry and for severe SX eg severe vomiting and diarrhea or unstable vitals then you can use buprenorphine or methadone. More commonly though it is just supportive care and on top of that clonidine can be used. Hope that helps
Sodium Oxybate is first line for narcolepsy, helps with their sleep quality I believe
Classic answer for the boards for narcolepsy will be modafinil.
Sir, You're an absolute ANGEL!!! 😇 👼 Thank you SO very much!
Always so helpful! Love your videos!
Thanks for this video. Love the way you go through topics. Keep it up. :)
Super helpful, thank you!
Oh noooo you use a Mercedes-Benz symbol for benzodiazepines but Sketchy uses a Mercedes-Benz symbol for benztropine!!! My brain!!!!!!! That aside, thanks for another kickass review :) :) :)
EDIT: just realized that your DIGFAST @ 17:07 is similar but not quite the same as what I learned in school/through Amboss: Distractibility, Impulsivity, Grandiosity, Flight (flight of ideas), Activity (psychomotor hyperactivity), Sleep (sleep deficit), Talk (pressured speech)
I work across the street from you! Hope to see you around town/in the hospital ;)
You are awesome! Thank you for the great review!
Thank you so much doctor...that’s really really fantastic...God blessings brother.
Thankful for your life
I clicked for the cute man
The GOAT does it again!
That’s amazing!
Thank you!
Great Job Doctor
All your videos are very useful.
ECT - add safe in pregnancy
Loved this !
amazing, so helpful, and engaging!! thanks so much :)
hey wenna lol
@@hargunsidhu3668 LOL hi hargun!!!
Pre-menstrual dysphoric disorder is NOT the medical word for PMS. These are totally separate, and PMDD is a medical diagnosis that severely impacts patient lives.
OK feminazi back to your cave
thannks so much , that was really helpful
hey! great review, I really enjoy it! Actually, I found that first line treatment for fibromyalgia is excercise and good sleep 51:28, if does not work consider pharmacotherapy!
@ 42:11 you lost me what you were asking for first line treatment and you were talking about ADH agonists/antagonists .. don't know for what. all I heard was "ur-an-alarm" LOL
Sarah Tedesco urine alarm - it's a sensor on the bed that detects urine. It wakes the kid up so that they can get to the toilet to finish peeing
you really helped me so much!!!
Modafinil is not an orexin agonist.
it has a bunch of actions but in terms of its effectiveness in promoting wakefulness is its activation of orexin neurons in the lateral hypothalamus
High quality review!
Great video Doctor 👍 Thanks for this.
From where I can get the pdf form of high yield notes of Psychiatry, neurology and psychology
there is nystagmus in alcohol intox?
just amazing!
Thank you so much!
is there a way to distinguish between atypical depression and grief? since atypical has mood reactivity.
The way I remembered it was that grief usually has ups and downs. The patient is functioning. Grief comes in waves. Depression is constant and associated with feelings of worthlessness.
Thank you so much
Amazing videos!!! Do you have any book for step 3? or which is the most helpful for step 3?
Is it orlistat second line tx ?
Speechless 👏
You are the best!
Thank You man
FM-Relevancy = 21:27 - 38:10
thx Dr.High yield
Fabulous!
This was awesome