High Yield Psychiatry Review for Step 2 CK & Shelf Exam 

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)

Recommended this to our study advisor and now she email blasts 160+ students recommending they watch your videos before Shelf exams. Great stuff.

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

I wish u were my roommate during medschool

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 :)

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

Bless your soul for these videos. Thank you thank you THANK YOU x10000000000

I'm surprised you don't have more followers. This is great review information. You've been super helpful for my previous shelf exams.

This is the best review I have ever seen.I even wrote some down as notes for study.Thank you!

Thank you so much Dr. HY for all your help, you are truly a blessing!

You are the HY Goljan for Clinicals. Thanks, Dr. HY!

Thank you so much for these videos. I watched them all and succeeded on my shelf exams. You are amazing!

this is ridiculously helpful and HY!! very succinct without fluff. thank you!!

Thank you so much! My psych shelf is on Friday and this was super helpful :)

Let me know if you ever need a kidney

I'm soooo grateful to you for all these HY videos - THANK YOU!!

Wohoo ! Just finished my psych review with ur fabulous lecture! Gracious!

Great reviews! Thanks for creating/posting

You’re amazing please please keeps up the videos ! I’ve been sharing non stop !

Always so helpful! Love your videos!

Loving your vids! Perfect review since I take CK Monday🙌🏾

Thanks for this video. Love the way you go through topics. Keep it up. :)

Watching all these videos again day before level 2 thanks!

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

This is the most useful video ever, thank you very much for sharing this

Thanks for fantastic series. It helped me a lot to pass MCCQE1 ( Canada exam) effortlessly. Massive thanks !

Your IM shelf was on point. I had three questions based on your video,!

Your amazinggg!! Love that your straight to the point and cover so much! 😭 Thank you!!

Loved this !

Super helpful, thank you!

You are awesome! Thank you for the great review!

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

Bro please keep making these videos...i am taking step2ck in 3 days it really helps

just found you and having my psych shelf tomorrow, this is so helpful!

Great Job Doctor All your videos are very useful.

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

Thank you! I have my exam in two days and this video helped me a lllllllllllllllot!! Wish me luck guyz :)

Thank you so much doctor...that’s really really fantastic...God blessings brother.

thank you so much!! please don't forget to repeat answers from the audience because it can be hard to hear them

Sir, You're an absolute ANGEL!!! 😇 👼 Thank you SO very much!

That’s amazing! Thank you!

High quality review!

Hey you dropped this 👑

The GOAT does it again!

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!!

Awesome ! Please upload soon

wow keep it up we need more of these please.

you really helped me so much!!!

Yes. Our legend did finally came back. Thank you God for giving us this doctor.

You are the best!

amazing, so helpful, and engaging!! thanks so much :)

Amazing video!

Thankful for your life

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)

✿Updated treatment for restless leg syndrome: alpha-2- delta calcium channel ligands aka Gabapentin, Pregabalin ✿ Second line treatment for RLS: ropinerole and pramipexole

just amazing!

Thank you so much!

thannks so much , that was really helpful

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.

You are a USMLE GOD !! god bless you, thank you for all the amazing ,super helpful videos! :)

Speechless 👏

This was awesome

Fabulous!

thank you papa

So good . Thnx

Thank You man

Thank you so much

thank you so muchhhh

I work across the street from you! Hope to see you around town/in the hospital ;)

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.

In SS vs NMS, hyperreflexia with SS is also a dead giveaway.

thanks homie

This is great. Is everything still up to date four years later?

Amazing videos!!! Do you have any book for step 3? or which is the most helpful for step 3?

high yield shelf reviews...updated on my channel. Here is a link to the high yield Emergency Medicine Shelf Playlist: ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-o21iBZxlo_M.html

thx Dr.High yield

I'm dying every time you say benzo and a picture of a sls pops up

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!

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

Great video Doctor 👍 Thanks for this. From where I can get the pdf form of high yield notes of Psychiatry, neurology and psychology

For IBS, TCAs are used rather than SSRIs

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!

Treatment for opioid withdrawal is methadone/buprenorphine in addition to supportive.

Thank youuuu

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

Do you have a review for Social Sciences please? quality ethics?

you da man

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)

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!

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.

First-line for restless leg syndrome is not dopamine agonists

Sodium Oxybate is first line for narcolepsy, helps with their sleep quality I believe

👏👏

Modafinil is not an orexin agonist.

Sorry another question. For pms is the treatment OCP not NSAID? I didn’t hear the answer at the end. I heard the nsaid answer/question, just not the one right before. Thanks!!

ECT - add safe in pregnancy

Do you have PPTs or word Document type notes for these videos?! they are amazing!!

is there a way to distinguish between atypical depression and grief? since atypical has mood reactivity.

there is nystagmus in alcohol intox?