• Mechanism: Dopamineric antagonist, blocks D2 receptor
• Indications: Schizophrenia, mania, Tourette
• Side effects: EPS*, galactorrhea, anti-muscarinic effects, alpha-blockade, antihistamine, NMS

Atypical: Clozapien, Olanzapine, risperidone, aripiprazole, quetiapine, ziprasidone

• Mechanism: Dopamine, 5-HT, alpha, and H1 antagonist
• Indications: Schizophrenia (will improve positive and negative symptoms due to 5-HT effect). Olanzapine for OCD< anxiety D/O, depression, mania, Tourette
• Fewer extrapyramidal and anticholinergic side effects. Agranulocytosis (w/ clozapine)

*Extra-Pyramidal Side Effects: dystonia, akinesia, akathisia, tardive dyskinesia

1. Paranoid
2. Schizoid – social withdrawal
3. Schizotypal – eccentric, awkward, odd beliefs

Cluster B (Bad)

1. Antisocial – disregard for others, criminality, m > f, conduct disorder if age<18
2. Borderline – unstable mood and relationships, impulsive, f > m splitting
3. Histrionic -attention seeking, sexually provocative
4. Narcissistic – grandiose, lacks empathy

Cluster C (Mad)

1. Avoidant – socialy inhibited but desires relationships with others
2. Obsessive-Compulsive – perfectionist, egosyntonic (vs. OCD)
3. Dependent – submissive and clingy, low self-confidence

I mpulsive
M oody
P aranoid under stress
U nstable self image
L abile intense relationships
S uicidal
I nappropriate anger
V ulnerable to abandonment
E mptiness

Wernicke’s Encephalopathy: triad of confusion, ataxia, and ophthalmoplegia
Rx: thiamine 100mg PO OD x1-2wks

Korsakoff’s Syndrome: persistent (i.e. after withdrawal) anterograde amnesia and confabulation
Rx: thiamine 100mg PO BID-TID x3-12mo

Symptoms
Stage 1 (6-12 hrs): tremor, diaphoresis, agitation, anorexia, cramps, diarrhea, sleep disturbances
Stage 2 (1-7 d): hallucinations (visual, auditory, tactile, olfactory)
Stage 3 (12-72 hrs): seizures (usually grand mal)
Stage 4 (3-5 d): delerium tremens diaphoresis, tachycardia, tachypnea, tremor, insomnia, psychomotor agitation, anxiety, n/v, grand mal sz, hallucinations, persecutory delusions

Monitoring CIWA-A Scoring System -/67
mild <10
moderate 10-20
severe >20

Mgmt
1. Supportive therapy
2. Diazepam 20mg PO q2h until symptoms subside
3. thiamine 100mg IV, then thiamine 100mg PO OD x3d
if unable to take PO meds, give diazepam 2-5mg IV/min up to 20mg/h; or lorazepam SL
if liver failure or age>65, give short-acting benzo instead (lorazepam 1-4mg PO/SL/IM q1-2h)
if seizures persist, give Dilantin
if hallucinosis, give haldol 2-5mg PO/IM q1-4h up to 5 doses/d (can also use atypical anti-psychotics)
admission: withdrawal after >80mg diazepam, DT, recurrent arrhythmias, multiple sz, or otherwise unsafe to d/c home