Psychiatry discussions at Albert Einstein Medical Center Philadelphia

A case of an elderly female who was exhibiting bizarre behavior with auditory and visual hallucinations. Notably she was on two antipsychotic medications. A discussion on how one would approach this case - paranoia, dual antipsychotic therapy, long term benzodiazepines, possibly Neuroleptic induced deficit syndrome was discussed. A paper of interest -  How to distinguish between the neuroleptic-induced deficit syndrome, depression and disease-related negative symptoms in schizophrenia. The topic of long term benzodiazepines use and its risks benefits came up and Dr. Nemes talked about two treatment approaches to get people off of benzodiazepines. The first approach would be to switch them to a long acting benzodiazepine and then taper it down safely so that the patient has no more withdrawal symptoms. The second approach would be to switch the patient to an appropriate anti seizure medication like Phenobarbital and then stop the benzodiazepine. We closed on the topic of Po...

Today morning we discussed the differences between Serotonin syndrome , Neuroleptic malignant syndrome and    acute dystonias . Some of us shared our clinical experiences and what our preferences were in the  Diagnosis & Treatment of Dystonia . Treatment protocols for each were discussed and some thoughts on prophylactic use were brought up. An interesting case of an elderly woman with a history of schizophrenia with a recent diagnosis of squamous cell carcinoma was presented. Notable characteristics of her symptoms were discussed and mention was made of her habit of organizing the sugar packets and the toilet roll in her room and her habit during interviews of bringing up a concern and before it could be addressed she would move on to another topic. (Eg. Dialysis peg on her bed) decreased sleep, auditory and visual hallucinations. Overall patient was a poor historian. Physical exam was notable for bilateral upper extremity intentional tremors. Pt's treatment wi...

Today at morning report Chris Blazes made an excellent suggestion: - That we maintain a blog about the interesting discussions that go on during our morning rounds. This is what came out of that This way we can have a record of these interesting cases and discussions. It may serve as a nidus to those who may want to explore the topic further. Residents can share posts that are relevant to the discussion so others can keep abreast of it.