Podcast
Questions and Answers
What is a common characteristic of mood and cognitive symptoms in psychiatric diseases?
What is a common characteristic of mood and cognitive symptoms in psychiatric diseases?
In psychiatric assessment, what is a key aspect to understand about psychiatric diseases?
In psychiatric assessment, what is a key aspect to understand about psychiatric diseases?
Which class of drugs can potentiate the effects of opioids by inhibiting CYP4502D6?
Which class of drugs can potentiate the effects of opioids by inhibiting CYP4502D6?
What is a common risk associated with atypical antidepressants?
What is a common risk associated with atypical antidepressants?
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Which category of drugs is known for being effective mood stabilizers but also inducing the CYP450 system?
Which category of drugs is known for being effective mood stabilizers but also inducing the CYP450 system?
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What preoperative workup is recommended for patients with alcohol abuse?
What preoperative workup is recommended for patients with alcohol abuse?
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What is a specific medical implication of chronic marijuana use?
What is a specific medical implication of chronic marijuana use?
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What is the medical implication of cocaine on cardiac function?
What is the medical implication of cocaine on cardiac function?
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Why should ketamine be avoided in patients who have used cocaine?
Why should ketamine be avoided in patients who have used cocaine?
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What should be the focus of the preoperative assessment for patients addicted to heroin?
What should be the focus of the preoperative assessment for patients addicted to heroin?
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Study Notes
Psychiatric Disease
- 10% of men and 20% of women experience major depression, with minor depression being difficult to quantify
- Mood and cognitive symptoms of psychiatric diseases are common, including OCD, panic disorders, anxiety disorders, phobias, and bipolar disease
- Psychoses like schizophrenia can occur
Medical Problems Leading to Psych
- Hypothyroidism
- Cushing syndrome
- AIDS
- Seizure disorders
- Brain tumors
- Encephalitis
- Nutritional deficiency
- Toxic substance poisoning
Psych Assessment
- Determining if the patient is legally able to give consent
- Determining medical versus non-medical power of attorney
- Understanding that psych diseases are only managed, not cured
- Identifying the length and effectiveness of treatments is key
Psych Drugs
- SSRIs: continued perioperative use, potent inhibitors of CYP4502D6 (think opioids)
- TCAs: can slow cardiac conduction (ECG), exaggerated responses to pressors
- MAOIs: can produce serotonin syndrome, hypertension, coma, and death, continued perioperative use
- Symptoms of serotonin syndrome include hypertension, coma, and death
Atypical Antidepressants
- Increased risk of seizures (lower threshold), used for chronic pain treatment
- Impact on NDNMB
Substance Abuse
- Identified by the WHO as a pandemic in nature, both a social and public health problem
- Usually occurs with a psych diagnosis
- Ranked: alcohol > prescription drugs > marijuana > cocaine
Substance Abuse: Alcohol
- Medical implications affect ALL organ systems
- CNS: atrophy, tremor
- CV: dilated cardiomyopathy, HTN, PVD
- GI: gastritis, esophageal varices, ulcers, pancreatitis, hepatitis, and cirrhosis
- Preoperative workup includes ECG, coags, CBC, and consideration for blood products
- ACUTE vs. CHRONIC alcohol use
Substance Abuse: Marijuana
- Acute intoxication and anesthesia interactions are rare
- Chronic use impacts ANS (tachycardia & increased CO)
- Synergy with other sedatives
- Acute intoxication CAN lead to direct myocardial depression
- Avoid use 1 week prior to anesthesia
Substance Abuse: Cocaine
- Never perform an elective anesthetic on someone acutely intoxicated on cocaine
- Direct and profound depression on LV function
- Slowing of cardiac conduction
- AT LEAST 1 week of no cocaine use; some recommend 30 days
- Avoid ketamine
Substance Abuse: Heroin
- Rapidly converted to morphine in the plasma
- As with other chronic opioid users, be mindful of the last dose and compliance with treatment
- Avoid elective anesthesia when acutely intoxicated on heroin
- Preoperative assessment focused on treatment of heroin addiction
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Description
Test your knowledge on psychiatric diseases, major and minor depression, mood and cognitive symptoms, as well as medical problems that can lead to psychological issues. Topics include OCD, panic disorders, anxiety disorders, phobias, bipolar disease, schizophrenia, hypothyroidism, Cushing syndrome, AIDS, and more.
