Asperger syndrome vs Autism key points

Asperger disorder
-Impairment in social interaction (few interests)
-They are aware that they do not fit in socially.
-Unlike autistic children, they do not express basic language impairment (only minor problems)
-Treatment is behavior modification and cognitive-behavioral therapy are used to improve level of function.
-Some consider this condition as high functioning autism

Autism
-Usually manifests itself before age 3 years (Asperger may be later)
-Triad of
---Impairment in social interaction (no friends, no empathy)
---Language delay
---Ritualistic behaviors and a strong need for sameness and consistency
-Treatment includes intense family support, behavior modification, speech and language training, auditory integration training, and medication.

Rett syndrome key points

Rett syndrome
-X-linked dominant (Affects girls).
-Onset is in the second year of life.
-Typically there is regression in motor and language development
-Autistic behaviors are common
-There is acquired microcephaly
-Characteristic hand-wringing behavior

Poor prognosis. No specific treatment.

Extrapyramidal side effects of antipsychotics

Akathisia refers to an urge to keep moving. Typically the patients will pace about in the house and sit down and get up again. First line treatment of akathisia is propranolol although benzodiazepines have also been used. Akathisia can occur any time after starting the medication.

Tardive duskinesia (TD) refers to involuntary movements which can be perioral (such as lip smaking, chewing and darting tongue movements) or choreoathetoid movements of extremities or other body parts. TD usually does not occur within the first 3 months of starting the medications. TD can be difficult to treat and may require changing to medications that do no cause this side effect such as clozapine.

Dystonia occur within hours or days of starting the therapy. Characteristic features include muscle spasms (e.g. torticollis). Treatment of dystonia is acomplished by antihistaminic medications like diphenhydramine (Benadryl) or anticholinergics like benztropine or trihexphenidyl.

Neurolept maligant syndrome is a known side of antipsychotics that presents with hyperthermia, muscle rigidity and mental status changes. It usually occurs after 1-2 weeks of starting the therapy. Treatment includes stopping the medication and use of dantrolene, bromocriptine and amantidine.

Commonest antipsychotics leading to these side effects inlcude: chlorpromazine (Thorazine, Largactil), Fluphenazine (Prolixin) - Available in decanoate (long-acting) form, Perphenazine (Trilafon), Prochlorperazine (Compazine), Thioridazine (Mellaril, Melleril), Trifluoperazine (Stelazine), Mesoridazine, Periciazine, Promazine, Triflupromazine (Vesprin), Levomepromazine (Nozinan), Promethazine (Phenergan), Pimozide (Orap), Chlorprothixene (Cloxan, Taractan, Truxal), Clopenthixol (Sordinol), Flupenthixol (Depixol, Fluanxol), Thiothixene (Navane), Zuclopenthixol (Cisordinol, Clopixol, Acuphase)

Depressed anyone?

CYMBALTA (Duloxetine hydrochloride)is a combined serotonin and nor epinephrine reuptake inhibitor (SNRI). It is a sustained release drug formulation.
Indications------ Major depressive disorder, General anxiety disorder, Diabetic peripheral neuropathic pain and Fibromyalgia. USFDA no longer approves it for Stress urinary incontinence.
S/E------ Nausea, constipation, dry mouth, orthostatic hypotension, syncope, weight loss. Cymbalta and thioridazine should not be co-administered.

Panic Attacks

Intravenous Na-lactate and Cholecystokinin tetrapeptide (CCK-4) and inhaled CO2 can induce panic attacks in susceptible individuals.
Emergency treatrment of panic attack-- Rapidly acting Benzodiazepine like Alprazolam/Clonazepam
Long term maintenance therapy-- SSRIs like Paroxetine considered to be first-line agents                                        

Binswanger's disease

is dementia in elderly due to subcortical arteriosclerotic encephalopathy.

Marijuana

Marijuana is the most common drug of abuse in US

Not very common, but for the sake of USMLE remember that marijuana can cause gynecomastia!

Alcohol withdrawal

Alcohol withdrawal syndrome is usually treated with long-acting benzodiazepines. (e.g. chlordiazepoxide)