Thursday,

September 8, 2016

9:22 PM

PSYCHIATRY
-Mental Status exam is always the Dx test of choice
-Tactile hallucination (formication) >> Rx >psych. = cocaine, DT
-olfactory hallucination >> temporal seizures
-flight of ideas are connected unlike loose assoc. which are not connected
-Constructional Apraxia >> affected is non-dominant parietal lobe
-a woman whose husband died is cooking and playing = DENIAL
-as long as denial ptn is not interfering w Tx >> leave him alone and do nothing, if interfering w Tx >> Intervene
- died baby >> his father shows no emotions
-OCD who is washing his hands all the time >> UNDOING
-OCD wants to touch everything (O) so he thinks that everything is dirty (C) & this is Reaction formation (act = undoing, thought =
reaction formation)
-Sublimation is the most mature defense mechanism (kill baby >> abortionist)
-Depression = more than 2 weeks
-depression more common in woman but suicide in men is more
-5HIAA is low in suicide and aggression (disinhibition)
-Aggression >> Rx: SSRI
-Dexa suppression test >> abn. (high cortisol) in depression (also TRH >> no increase in TSH)
-The most effective and best Tx for depression is ECT
-psychoTx (individual or cognitive) + SSRI are better than SSRI alone
-ECT is safe in preg. (Relative CI are high ICP and heart problems)
-right side CVA >> Apathy >> Depression
-The strongest genetic assoc. >> Bipolar 75% monoZygote
-Dysthimia >> if more than 2 yrs (Depression will go away in 1 yr)
-Grief >> Support PsychTx
-after death >> denial > anger > bargain > depression > accept (not necessary in order)
-Schizo >> 6 Mo (men are young and worse)
-High emotion family >> SCHIZO (Tx: relax)
-CT w Ventricular enlargement >> SCHIZO (more neg Sx w that)
-PET scan hypo frontal lobe
-supportive psych Tx in SCHIZO not intrusive
-SCHIZO who is masturbating in public or making bizarre voices >> Disorganized type YOUNG + worst (paranoid type occurs in late and
in men>), echolalia, coprolalia = catatonic
-catatonic type (psychomotor) fixed position or wont stop moving
-Resedual type >> NO POS Sx (no hallucination, nor delusion) but a lot of neg. Symptoms
-Schizophreniform >> less than 6 Mo, Brief psychotic is less than 1Mo
-Delusional disorders >> individual pychoTx to make ptn trust u
-Brief psychosis >> Rx Respiridol before halloo
-SOmatization = a lot of Sx of diff. organs (DONT refer them it should be one physician Dont tell them u absolutely healthy DO
REGULAR VISIT)
-Hit on head >> paralysed >> Conversion (MUST be a stressor)
-CONVERSION >> 1 gain = keep internal stress out, 2nd gain from being sick (labelle indifference = dont care about the injury) even if
blind >> no trauma no going into walls
-Pain disorder >> individual psychTx
-Malingering the problem is Sx while in Facticious is clinical finding
-Compulsion = EgoDYStonic, Impulsion = EgoSYNtonic
-Aggression out of proportion to the stressor >> Intermittent explosive Disorder (tend to have head trauma, lessens w age)
-Violence Disorders >> SSRI, Mood stabilizers, BB
-BULIMIA >> KLEPTOMANIA
-Mood personality >> lessens w age, thought personality >> worsens w age
-Alone + no concern = Schizoid
-Stage II is the longest in sleep
-Deepest stages = delta = III, IV
-REM is the easiest to arouse (REM is common in the 2nd half of sleep)
-short REM latency (60 in depression, 10 in Narcolepsy, 90 NL)
-REM decreases in percentage in elderly
-BZD shouldnt be given for more than 2 weeks
-ETOH, BARB >> less REM
-Depression >> less DELTA
-NARCOLEPSY feels refreshed after sleep (ETOH WONT)
-cataplexy (loss of muscle tone) is pathognomonic to NARCOLEPSY = REM precipitated by BOO (Tx: TCAs) NARCO Tx: forced sleep in the
day
-Nightmare = REM we remember > Rx: TCAs, Nightterror >> no remember
-Night walk = Delta sleep
-best long term Tx for insomnia = behavioral technique (stimulus control)
-Sexual ID >> 2nd sexual characteristics
-sexual gender (whats in head) is feeled by 3yrs (determined by parents)

-BZD shouldnt be given for more than 2 weeks

-ETOH, BARB >> less REM
-Depression >> less DELTA
-NARCOLEPSY feels refreshed after sleep (ETOH WONT)
-cataplexy (loss of muscle tone) is pathognomonic to NARCOLEPSY = REM precipitated by BOO (Tx: TCAs) NARCO Tx: forced sleep in the
day
-Nightmare = REM we remember > Rx: TCAs, Nightterror >> no remember
-Night walk = Delta sleep
-best long term Tx for insomnia = behavioral technique (stimulus control)
-Sexual ID >> 2nd sexual characteristics
-sexual gender (whats in head) is feeled by 3yrs (determined by parents)
-sexual rule = ext. behavioral
-sexual orientation = who u chose to love
-Premature Ejaculation >> Tx: stop and go, partner squeeze, SSRI
-Paraphilia >> Rx AntiAndrogens reduces the ugre
-ETOH is the commonest cause of periodic impotence
-if due 2 medical cause >> DM, if 2 psych >> FEAR
-old antipsych >> alfa, muscainic, histaminic BLOCKERS
-newer which causes EPS >> Respiridone (D2 like old new D4+5HT)
-mesolimbic block >> antipsych (CLOzapine selectively)
-nigrostriateal block >> movement disorder
-tubuloinfundibular block >> PRL
-Young man is more prone to acute dystonia (Rx: anti-ch also for prev.)
-elderly is more prone to EPS (parkinsonism) Rx: amantadine or anti-ch
-TD will go away in sleep (high sens after chronic blockade)
-After NMS u can regive it in lower dose (not CI) but no one will do it!
-elderly who need typical >> halo better than chlorpromazine (CH)
-Clozapine >> SE drooling, weight gain
-Ziprasidone >> prolong Qt, OlanZ, CloZ >> DM
-NO CATARACT IN QUEITIAPINE
-IF compliance is an issue >> Haldol, Fluphenazine
-TD in IRReversible in the exam
-Nortryptiline, desipramine are the safetest of TCAs (less sedation)
-Amytriptyline is the worst of TCAs (hypotension-AntiCH)
-dont switch Rx for depression until 6W
-Doxipen is the most cause sedation
-Citalopram (SSRI) and Bupropione >> LEAST SEXUAL DYSFx
-OCD >> Citalopram
-Bupropion = works on dopamine
-Lithium >> Acne, HypoT4 (do TSH). Nephro Di
-IF LITHIUM TOX (GAIT D) >> DIALYSIS
-Rapid Bipolar >> Divaloproex
-Bipolar >> 1st LI >> 2nd CARBAMA, Divalo
-TOPIRAMATE >> helps to lose weight
-BUSPIRONE IS NOT ADDICTIVE (LIKE BZD) + NO WITHDRAWL
-OTL (Oxazepam, Timazepam, LORAZ) dont mess w P450 (liver disease)
-Number one risk factor for suicide = ELDERLY? prior
-if one w depression has friend who committed suicide >> ask how his friend committed suicide
-HIV >> this is secret dont tell anybody in the exam
-Erik Erikson >> based on experience
-Preoperational stage (2-7) child blame themselves, dont understand death, dont understand (amount and volume tall+thin >
short+wide) low of conservation
-Understand the death is irreversible at 9-10 (operational)
-Adjustment D. >> supportive Psych.
-Adjustment occurs within 3 Mo from the stressor and once it occurred it has 6 Mo to resolve. NO adj after death
-mild MR >> 6t h grade (can make decision), moderate MR >> 2nd (DOWN), severe no work
-Methylphenidate for ADHD above 6, Dextroamphetamin for above 3 yrs
-Bell is better than Rx for enuresis
-stranger anxiety start at 8 Mo to 2 yrs
-Separation from 1-3 yrs
-School phobia 3-5 yrs = separation anxiety DISORDER
-Tourrette >> 50% ADHD, 40% OCD (high Dopa > Rx: Pimoside, haldol, respiridone)
-Anxiety >> most common NT >> GABA (BZD)
-Panic attack occurs wo precipitant (Alpra for short, SSRI for long, also IMI)
-PANIC >> Drugs over psych CLOmipramine for OCD
-Acute Distress disorder lasts less than 1 MO after stressor (PTSD more)
-internal locus of control (u r the one who determine the future)
-external locus of control (luck is the one who determine future dont want stop smoking coz his friend smoked wo illness and dad
died wo smoking >> more prone to illness of psych + medical)
-PTSD can occur months after the stress (worse than immediately)
-Buspirone can be DOC for GAD (coz long Tx needs Rx wo addicting features like Benzo)
-fear of speak in public >> social phobia (NOT PANIC - doesnt have stress)
-MiniMental Exam >> if lower than 24 >> dementia
-Senile plaque is the most specific finding in Alzheimer
-Vascular > male, HTN, Stepwise, younger
-ALZ >> women, elderly, no Finding
-Kluever-BUCY syn. Hypersexuality, hyperphagia, passivity (Amygdala D.)
-HUNTINGTON >> loss of GABA (chromosome 4)
-Multiple personality D. >> prone to dissociative D.
-Dissociative FUGE = Travel + when asked about name >> new name
-Dissociative Amnesia = doesnt know his name (aware of memory loss)
-Amnesia GAPS =Dissociative Identity disorder = someone is making me crazy
-girl thinks she is obese although she is thin = ANOREXIA
-Anorexia is worse when is late
-WHAT KILLS IN ANOREXIA IS ELECTROLYTES D. ESP. HYPOKALEMIA

-Senile plaque is the most specific finding in Alzheimer

-Vascular > male, HTN, Stepwise, younger
-ALZ >> women, elderly, no Finding
-Kluever-BUCY syn. Hypersexuality, hyperphagia, passivity (Amygdala D.)
-HUNTINGTON >> loss of GABA (chromosome 4)
-Multiple personality D. >> prone to dissociative D.
-Dissociative FUGE = Travel + when asked about name >> new name
-Dissociative Amnesia = doesnt know his name (aware of memory loss)
-Amnesia GAPS =Dissociative Identity disorder = someone is making me crazy
-girl thinks she is obese although she is thin = ANOREXIA
-Anorexia is worse when is late
-WHAT KILLS IN ANOREXIA IS ELECTROLYTES D. ESP. HYPOKALEMIA
-WHAT IS THE PERSONALITY DISORDER THAT IS ASSOC. W EATING DOSORDERS >> BORDERLINE PERSONALITY DISORDER
-BULIMIA = LOW SEROTONIN >> Rx: SSRI
-KLEPTOMANIA ASSOC. W BULIMIA NERVOSA
-woman: 5 feet = 100 pound, every inch = 5pound (IDEAL BODY WEIGHT)
-man: 5 feet = 106, every inch = 6 pound
-u cant take the urine wo ptn concent
-the drug that will stay for long time in urine is MARIJUANA
-short >> CACAINE (2-3d), MARIJUANA 30 d
-Naltrexone for ETOH
-AA is the most effective way to stop alcohol
-Heroine >> Methadone then tape gradually
-Most frequently used illict drug is marijuana
-COCAINE >> PARANOID, COCAINE WITHDRAW >> DEPRESSION >> SUICIDE
-commonest Opioid = heroine
-PCP >> VIOLENCE (>> PUT HIM IN DARK QUIET ROOM)
-LSD >> FLASH BACK AFTER 10 YRS
-Anabolic steroid >> PSYCHOSIS
-U dont have to stop the whole drug to have withdraw just lowering the dose is sufficient
-Hx of ETOH >> Folic + Thiamine + BZD to prevent DT for 5 days (peak DT)
KAPLAN BOOK
-EGO: shortly after birth, reality, object relationship, defense mechanism
-no emotions for died baby = ISOLATION
-WAIS-R for Adults, WISC-R for Children, Stanford-Binet for MR, super
-projective personality test: TAT, Rorschach, sentence completion, drawing
-Objective personality test: MMPI
-traveling man w drowsiness through the day + diff sleep at night + early awakening + not able to sleep again = Circadian rhythm sleep
disorder
-Resident chose to put off his pity to handle ptn = Suppression
-man w poor self image gives 1/5 of salary to charity = Altruism (hob gher)
-Erik Erikson: yr 1= trust/mistrust 1-3= Autonomy/doubt (COOPERATIVE/STUBBORN) 3-5=initiative/guilt (sexual CURIOSITY) 6-11=
Industry/inferiority 11-20= identity/Role 20-40=intimacy/isolation 40-60= generativity/stagnation >60= integrit/despair
-After 2 yrs object permanence is achieved (wont cry if mom gone)
-death is IRReersible at 7-11, lack low of conservation in 2-7
-see things in others perspective = 7-11
-IV Rx Abuser said that his hep.C is due 2 inadequate control of hep.C = DISTORSION (this is real but he is altering the perception of
REALITY)
-Rationalism = explain but this is unreal (failed coz diff. exam while exam was easy)
-Autism risk factors: encephalitis, rubella, PKU, Tuberus sclerosis, fragile X syn., perinatal anoxia
-ADHD >> Tx: multiple sensory modality for teaching, short instruction w repeat
-Strangers anxiety: 8-24 Mo
-Separation anxiety: 12-36 Mo
-Conduct disorder >> Tx: Role models + no punishment
-Tourette assoc. w ADHD 50% and OCD 40%
-Conduct assoc. w ADHD
-Coprolalia >> schizoid, Tourette
-duration of Tx for depression is 6 Mo
-Depression >> individual and cognitive psychTx
-Dysthemic > 2 yrs + psych > Rx
-seasonal affective disorder is caused by abn. Melatonin (low MSH)
-Grief >> treated by supportive psychTx, can last up to 1 yr but most will resolve within 2 Mo (depression can last for more than 1 yr)
-PP depression usually after 2nd child while PP psychosis after 1st child
-MANIA IN PREG. >> NO LITHIUM NO DIVALOPROEX Rx: new anti-psych
-non-psych mania > if less than 12 yr (DIVALOPROEX) more than 12 yr Li
-UTD: DOC initially for Bipolar = Li
-schizo >> early in men + worse
-large ventricles + cortical atrophy in SCHIZO assoc. w NEG. Sx
-hypo in frontal + hyper in basal ganglia = SCHIZO
-SCHIZO >> supportive
-Regression to primitive >> DISORGANIZED
-Echolali, coprolalia >> CATATONIC
-Paranoid in older, disorganized in youner
-3 manic episodes >> life-long LITHIUM
-1 manic episode >> 1 yr if wo new episodes
-AVIOD BZD IN PTSD (Rx TCAs, SSRI)
-ANOREXIA W NL PERIODS OR NL BMI = not otherwise classified
-BULIMIA WO BINGE = not otherwise classified
-BULIMIA MUST HAVE BINGE-EATING AND PURGING
-If one parent give u consent >> DO IT regardless of the other
-kids of alcoholic even if raised by others are prone to be alcoholics
-SOMATIZATIONs RELATIVES: in male (antisocial) in female (histrionic)
-SOMATIZATION = 4 pain, 2 GI, 1 sexual, 1 pseudoneuro
-Conversion assoc. w HYSTRIONIC, ANTISOCIAL, DEPENDENT
-Picks cells = swollen neurons, Picks bodies = intraneuronal argentophillic inclusions
-PICK assoc. W Kluver-BUCY syn. = hypersex, hyperphagia, PASSIVITY

-1 manic episode >> 1 yr if wo new episodes

-AVIOD BZD IN PTSD (Rx TCAs, SSRI)
-ANOREXIA W NL PERIODS OR NL BMI = not otherwise classified
-BULIMIA WO BINGE = not otherwise classified
-BULIMIA MUST HAVE BINGE-EATING AND PURGING
-If one parent give u consent >> DO IT regardless of the other
-kids of alcoholic even if raised by others are prone to be alcoholics
-SOMATIZATIONs RELATIVES: in male (antisocial) in female (histrionic)
-SOMATIZATION = 4 pain, 2 GI, 1 sexual, 1 pseudoneuro
-Conversion assoc. w HYSTRIONIC, ANTISOCIAL, DEPENDENT
-Picks cells = swollen neurons, Picks bodies = intraneuronal argentophillic inclusions
-PICK assoc. W Kluver-BUCY syn. = hypersex, hyperphagia, PASSIVITY
-Behavioral changes + Disinhibition = PICK
-Urinary In. + Gait problem = NPH
-Depressive ptn will answer When asked I Dont know
-Demented ptn will answer when asked CONFABULATE
-HUNTINGTON = loss of GABA-ergic neurons + CAUDATE Atrophy
-Commonest cause of amnestic disorder is ETOH
-Wernicke = Nystagmus + Ophthalmoplegia + Ataxia
-Monitor BP in ptn taking Bupropion for smoking cessation (seizures is CI)
-mother dont want to VACC her child >> respect her wishes wo telling her husband
-ACUTE CATATONIC SCHIZO >> ECT or BZD
-Mother of child w osteogenic CA tells u that she is no longer concern about prognosis coz she saw a dream tells her that her child will
live long >> Defense mechanism = FANTASY
-Highest risk factor for suicide = prior suicide attempt
-MAOI + TCA = NO reaction
-MAOI for major atypical depression
-Masturbate in public + laugh inappropriately = DISORGANIZED
-Memory gap >BOOK> Dissociative amnesia although in videos it was identity
-I wrote (~UW) Dementia remember some of events in the past while amnesia cant
-Head Trauma >> Dissociative FUGE
-Covert sensitization: smoker is trained to imagine himself lying on bed w lung CA in order to stop smoking
-less anxiety w repeated entry to psych room >> Habituation
-Atypical features of depression = heavy feeling of ext. leaden paralysis
-Parkinson w L-dopa + psychosis >> Rx: CLOZAPINE (least D2 antagonist)
-Needle sharing >> TB
-commonest abused SUBSTANCE in USA is EtOH
-commonest used ILLICIT (FORBIDDEN) is Marijuana
-Crystal or ice = methAmphetamine
-PCP >> Psychosis, Violence
-Designer = XTC = amphetamineS
-Date Rape Rx = Flunitrazepam
-COCAINE, AMPH = Euphoria (Tx VIT.C) withdraw = depression
-cannabis (marijuana) = slow sense of time, conj. Injection, increase appetite
-Hallucinogens >> Dissociation + IDEA OF REFERENCE (thinks a news in TV is about him)
-Opiates withdrawal = colicky abd pain, fever, chills, RUNNY NOSE, YAWNING
-Intermittent explosive D. = low 5HIAA
-ARSON = like pyromania but the goal is to get money from insurance co.
-Amenorrhea may preceed abn. Eating d. in anorexia
-Anorexia has intrest in making food but not in eating
-Anorexia >> Russel sign, peripheral edema
-Anorexia >> Tx: FAMILY Tx (not insight oriented nor psychodynamic)
-Anorexia >> may burges water or put water in her cloth to appear that she is gaining weight
-DONT USE ANTI-PSYCH in Bulimia
-Anorexia >> loss in gray matter (ant. Cingulated cortex)
-Absolute CI to BuProPion = EPilePsy (CHF is relative)
-Mania >> if less than a week >> hypomania
-Large ears, prominent jaw, high pitched voice, large testes = FRAGILE X
-2nd commonest cause of MR is Fragile X after Down
-Antisocial + Borderline >> lessens w age
-Paranoid + Schizoid + Narcissistic >> worsen w age
-SLEEP STAGE I = loss of alfa + appearance of thata
-STAGE II = longest + K complex + Spindles
-REM >> Bursts of sawtooth waves
-BZD >> suppress STAGE DELTA III, IV
-REM latency = 90 Min (10 in NARCOLEPSY, 60 in DEPRESSION)
-ETOH + BARB >> suppress REM (+TCAs)
-Depression = short REM latency, increased REM time, less delta
-NARCOLEPSY feels refreshed after sleep (ETOH doesnt)
-CATAPLEXY is PATHOGNOMONIC for NARCO
-Forced naps is TOC for NARCO
-hot bath before sleep is helpful in insomnia
-Nightmare = REM = Rx TCAs
-Night TERROR = Delta = Rx BZD
-Sleep talking = ANY STAGE = NO Tx
-Sleep WALKING = Delta = Rx BZD
-Dysthemia-Anxiety D. >> Cognitive behavioral Tx (replace bad w happy)
-Magical thinking >> Schizotypial
-XanaX withdraw >> Seizures
->15 yr + want OCP = OK, >13 + emancipated = OK
-HOMO is not a disorder but variant!
-Desire, Arousal disorders >> Individual psycho Tx
-Fetishisim = non-living objects
-Frotteurism = rubbing agains non-conconsenting partner
-Voyeurism = observe a person
-periodic impotence >> ETOH

-Sleep talking = ANY STAGE = NO Tx

-Sleep WALKING = Delta = Rx BZD
-Dysthemia-Anxiety D. >> Cognitive behavioral Tx (replace bad w happy)
-Magical thinking >> Schizotypial
-XanaX withdraw >> Seizures
->15 yr + want OCP = OK, >13 + emancipated = OK
-HOMO is not a disorder but variant!
-Desire, Arousal disorders >> Individual psycho Tx
-Fetishisim = non-living objects
-Frotteurism = rubbing agains non-conconsenting partner
-Voyeurism = observe a person
-periodic impotence >> ETOH
-Verbigeration = repeating meaningless word
-Lithium >> Flare of psoriasis, metallic taste, intention tremor
-Old APM: D2, Respirodone: D2-5HT-2, Cloza: D4-2-5HT-2, other: D2-4-5HT
-cardiac conduct w thioridazine
-Acute dystonia w young age and Parkinson w elderly
-CLOZAPINE: 5% SEIZURES + DROOLING
-Respiridone >> MINIMAL SEDATION, CLOZA + OTHERS >> SIG. SEDATION
-Panic >> IMIPRAMINE, PAIN >> AMITRYLPILINE, ENURESIS >> IMI
-ADs + Sedation + ANTI-CH = Doxipen, Amitrypliline
-Tertiary TCAs = Amitryp, Clomipramine, IMIpramine
-Secondary TCAs = Desipramine, Nortryptiline
-sedation + orthostatic hypotension = teriary (IMI, AMI, CLO)
-phenelZine, isocarboxaZide = MAOI = Sedative Z
-Tranylcypromine = activating, LITHIUM >> ACNE
-BuSpirone >> anXieolytic, Bupropione = AD + smoking cessation (PiPe)
-Buspirone = no addiction, no withdrawal, no additive effect w others
-PANIC assoc. w ETOH NOT MVP
-Feels used by others + do favors to them = DM: Reaction formation
-Ganser syn = malingering of prisoner (middle traffic light is blue)
High-Yield
-0-15 the goal is attach to mother (recognize parent at 6 Mo)
-15-30 the goal is separation
-Stranger anxiety 7-11 (8) Kaplan 8-24
-Separation anxiety 12-15 Kaplan 12-36
-If hospitalized 15-30 Mo (12-36 separation anxiety) FEAR OF SEPARATION
-If hospitalized 30 Mo 6 yrs >> FEAR OF PHYSICAL INJURY (sexual curiosity is 3-5 yrs) worst time for elective SURG
-social smile >> 2-3 Mo
-sits unassisted >> 5-6 Mo
-lifts head when lying on his stomach >> 2-3 Mo
-Turn over >> 5-6 Mo
-forms an attachment w caregiver >> 5-6 Mo
-Coos, gurgles >> 2-3 Mo
-Babbles (repeat single sound over and over) >> 5-6 Mo
-Imitate sounds, use gestures >> 7-11 Mo
-says first words >> 12-15 Mo (1yr)
-Two-word sentence >> 15-30 (2yr)
-Complete sentence >> (2.5-4 yrs)
-PLAYS INDEPENDENTLY, NEGATIVITY (fav. Word NO) >> 15-30 Mo
-Play parallel but not w another child >> 2.5-4 yrs
-Play w other children >> 4-6 yrs
-Tolerate hospitalization well >> 6-11 yrs
-Dextroamphetamine for over 3 yrs, methylphenidate for over 6 yrs
-unusual specific abilities in autisim (girls have more severe disease, more common in boys)
-Asperger >> onset 3-5 yrs more in boys
-Rett >> onset before 4 yrs like Autisim
-CHILDHOOD DISINTEGRATIVE DISORDER = regression in verbal, motor, social after 2 yrs of NL Fx + ONSET 2-10 yrs
-Tourette is linked to ADHD + OCD
-Selective mutisim = speaks in home but not in school (more in girls) Tx behavioral or family Tx Precipitated by stressful event
-Separation anxiety DISORDER: onset 7-8 (prior name school phobia but he is afraid that his mother die rather than school fear)
-Separation anxiety disorder at RISK for AGORAPHOBIA
-Reactive attachment disorder of infancy or early childhood (inhibited type: failure to responde in a socially normal way,
DISINHIBITED type: formation of indiscriminate attachment to others even if he hasnt seen them before) = stanger anxiety that
dont wanna go away
-During Bargaining ptn uses UNDOING as defense mechanism (I will never smoke again if the tumor goes away)
-Tx of NL grief = short sedatives (high-yield didnt mention AD)
-PHYSICIAN DONT HAVE TO TELL PARENTS THAT HE SUSPECTS ABUSE
-demented 83 yr smells of urine + bruises + deny that anyone has harmed him >> Elder abuse (neglect + tying to bed + spiral fractures)
-erection + ejaculation dont have to occur to say RAPE
-SODOMY = oral or anal penetration
-no resistant required for rape
-there is spousal rape (no one can mandate anyone even spouse for sex)
-Consensual sex may be considered rape statutory rape if the victim is under 18 or 16 or mentally ill
Public Health: Self-Study
-1-35 commonest cause of death is unintended injury
-35-65 the commonest cause is death is CANCER (this is for both sexes + female), over 65 is cardiac
-MALE: 1-45 unintended injury, 45-55 heart, 55-65 CANCER, over 65 heart
-Top nongenetic cause of death is smoking
-Whites have the highest rate of suicide
-Suicide >> April September (summer)
-Adolescent suicide >> December March (winter)
-over 65 >> August (summer)
-Report all abuses EXCEPT spousal abuse, give information about local shelters and counselling

Public Health: Self-Study

-1-35 commonest cause of death is unintended injury
-35-65 the commonest cause is death is CANCER (this is for both sexes + female), over 65 is cardiac
-MALE: 1-45 unintended injury, 45-55 heart, 55-65 CANCER, over 65 heart
-Top nongenetic cause of death is smoking
-Whites have the highest rate of suicide
-Suicide >> April September (summer)
-Adolescent suicide >> December March (winter)
-over 65 >> August (summer)
-Report all abuses EXCEPT spousal abuse, give information about local shelters and counselling
-commonest surg procedures are 1-D&C 2-HYSTERECTOMY
-alfa + beta = awake
-eyes closed + relaxed >> alfa
-active mental concentration >> Beta
-REM period is 10-40 min
-REM deprivation (sleep deprivation) >> Psychosis, anxiety
-Dopa awakes u (SAND) >> APM causes u to sleep more
-high NorEpi >> less REM and less sleep
-high Ach >> more REM and more sleep
-high serotonin >> more sleep
S^ A^ N! D!
-DAMAGE TO DORSAL RAPHE NUCLEI (which produces serotonin) decreases sleep time and delta sleep
*Slow pulse + respiration + low BP = STAGE I
*Bed-wetting (enuresis) = STAGE DELTA
*increased cardiovascular + erection = REM
-DEPRESSION >> short REM latency, REM increased early in the night and decreases later
-Narcolepsy occurs in adolescents and young adults
-Dyssomnia = insomnia, hypersomnia, OSA, Narcolepsy, circadian rhythm sleep disorder
-parasomnia = sleepwalking, terrors, nightmare
-SLEEP TERRORS THAT BEGIN IN ADOLOSCENT MAY INDICATE TEMPORAL LOBE EPILEPSY (terror should be in a child)
-Nocturnal myoclonus and restless leg syn. >> Rx: CLONAZEPAM
-Menstural assoc. syn occurs in the premenstrual syn (hypersomnia, hyperphagia)
-Sleep drunkiness = diff awakening after adequate sleep (genetic factors)
-KLEINE-LEVIN Syn. = recurrent hyperphagia + hypersomnia (Kol + sLeep)
-In delirium loss of orientation to time first then place then person
-Subcortical dementia = HUN, PARK, HIV (inf. Demyeilnation)
-ANS dysfx occurs in delirium not dementia
-Delirium >> worse at night (sundowning)
-EEG NL in dementia abn in delirium
-Thiamine deficiency (wernicke, korsakoff) >> damage to mammillary bodies, hippocampus, fornix
-speed, ice, ecstasy = amphetamine
-crack, freebase = inhaled cocaine
-angel dust = PCP
-Tactile hallucination = Cocaine, Amphet. Use + DT
-cocaine, amphet withdraw = myosis, hunger, depression
-opiates: hypothermia, EUPHORIA
-opiates withdraw: runny nose, mydriasis, piloerection, lacrimation, cramps, yawning, fever
-Horizontal + vertical nystagmus = PCP
-FLASH BACK = REEXPEIRENCE OF THE ASSOC SENSATION IN THE ABSENCE OF Rx = LSD
-Decreased motivation amotivation syn = chronic marijuana
-halluc. = high serotonin, sedation= high GABA, euphoria= high dopa
-Marijuana + Hallucinogens >> calm him down
-arabic: thought blocking is pathognomonic to schizo
-2 schizo parents >> 40%, Monozygotic >> 50%
-schizo >> decreased size of hippocampus, amygdale, parahypocampal
-Schizo: high serotonin (hallucination 5HT-2 blocker is useful), high NorEpi (PARANOID), high dopa, loss of GABA
-EEG in schizoid = decreased alfa, increased theta + delta + epileptiform
-schizo >> decreased FSH, LH
-Blue-gray skin discoloration >> chlorpromazine
-Retinal pigmentation = thioRidazine
-deposits in lens and cornea = chlorpromazine
-good prognosis for schizo = female, positive Sx
-Brief psychotic disorder common in histrionic + borderline
-Schizophreniform impairment or social dysfx are not necessary for Dx
-Schizoaffective (high-yield) MOOD > PSYCH
-19 yr girl whose psych mother believes that police are going to arrest her begins to believe the same thing. This disappears when her
mom is pit of state >> Dx Shared psychotic disorder (folie a deux)
-Delusional disorder >> psychTx and trial of Pimozide or haldol
-Cyclothemic + dysthemic >> more than 2 yrs
-Depression >> hypochondriasis, somatic delusion (my inside rotting)
-Depression is better in the evening (Diurnal variation)
-The most rapid onset Rx for depression (no 3-6w) is Methylphenedate or dextraamphetamine
-MAOI is usefull for atypical depression (mixed w anxiety)
-unTx depression lasts 6-12 Mo (self-limiting) Mania >> 3 Mo
-Depression w substance abuse >> Admit to hospital
-severe depression has no energy to commit suicide but once AD Rx is given the risk of suicide increases
-prediction of Depression that will be part of bipolar: 1- mania/hypomania after AD 2- Depression w psych Sx (remember arabi) 3- POST
PARTUM DEPRESSION
-Bipolar Monozygotic 75% (schizo 50%), 2 parents 60% (Schizo 40%), 1st degree 20% (schizo 12%), general 1% (=schizo)
-UTD+UW 1 st degree relative bipolar >> 5-10 %, general 1%, monoZ 75%
-Rapid bipolar = more than 4 episodes annually (Divaloproex)
-Double Depression = depression + dysthemia between episodes
-Anxiety = less GABA, Serotonin + more NorEpi
-Separation anxiety disorder assoc. w PANIC ATTACKS + AGORAPHOBIA

-MAOI is usefull for atypical depression (mixed w anxiety)

-unTx depression lasts 6-12 Mo (self-limiting) Mania >> 3 Mo
-Depression w substance abuse >> Admit to hospital
-severe depression has no energy to commit suicide but once AD Rx is given the risk of suicide increases
-prediction of Depression that will be part of bipolar: 1- mania/hypomania after AD 2- Depression w psych Sx (remember arabi) 3- POST
PARTUM DEPRESSION
-Bipolar Monozygotic 75% (schizo 50%), 2 parents 60% (Schizo 40%), 1st degree 20% (schizo 12%), general 1% (=schizo)
-UTD+UW 1 st degree relative bipolar >> 5-10 %, general 1%, monoZ 75%
-Rapid bipolar = more than 4 episodes annually (Divaloproex)
-Double Depression = depression + dysthemia between episodes
-Anxiety = less GABA, Serotonin + more NorEpi
-Separation anxiety disorder assoc. w PANIC ATTACKS + AGORAPHOBIA
-PTSD >> no good Rx although sertraline can be used
-OCD >> decreased REM latency (like depression)
-After stress >> if life-threatening (9/11-earthquake-rape) ASD/PTSD, after serious but not life-threatening events (divorce,
bankruptcy) adjustment
-Buspirone = no addiction + need 2-3 weeks to work (5HT1A)
-40 yr woman reports nausea. This Sx causes her to drop from work. Everything is NL >> Dx Somatoform disorder not otherwise
specified (just like somatization but just few Sx)
-Dissociative amnesia = selected memory loss (dont remember the battle)
-Dissociative identity disorder = 2 or more personalities
-enjoy dating men but not any sexual act including kissing = sexual aversion disorder
-Progesterone inhibit desire in both men and women
-Sexual position for ptn w MI is to have the partner in the superior position
-ETOH + Marijuana increases sexuality but chronic ETOH decreases it
-Amphet. Cocaine increase sexuality
-Heroine and methadone decrease interest
-Necrophilia = desire w dead bodies, Telephone sscatologia = talk about sex w unsuspected women
-Distress about ones sexual preference = sexual disorder not otherwise specified (formerly called ego-dystonic homosexuality)
-For obesity: Sibutramine, Orlisatat
-Most effective Tx for ANOREXIA is FAMILY Tx
-arabi: Binge eating disorder = binge wo restriction wo purging wo concern about body image
-arabi: PURGING MUST BE FOUNF FOR BULIMIA otherwise its BED
-Night eat syn NES: eat at night wo rest. Wo purging wo concern about image
-bulimia wo bing eating = NOS, Anorexia w nl BMI, menses = NOS
-me: Binge eating purging MUST BE FOUND FOR BULIMIA
-Intermittent explosive disorder assoc. w low 5HIAA >> Rx SSRI
-Adjustment disorder >> impairment in social functioning
-ASD >> do poorly in work
-most effective Tx for adjustment >> SUPPORTIVE disorder
-Adjustment >> no more than 6 Mo
-45 yr says after fired said that her boss looks lazy compared to her hard working >> Personality >> PARANOID
-mAd = psychosis, Bad = substance abuse + somatoform + mood
Sad = anxiety
-passive-aggressive Personality = procrastinates (tomatel) + inefficient
-Paranoid >> Projection, denial
-Histrionic >> somatzation, regression, repression
-Narcissistic >> denial, displacement
-Borderline >> displacement, denial, splitting
-OCPD: intellectualization, rationalization, Isolation of affect
-BRONCHIAL ASTHMA assoc. personality = DEPENDENCY
-CANCER assoc. w inability to express feeling, bereavement, after death
-Migrane, UC >> assoc w OCPD
-OBESITY >> REGRESSION (whenever upset, she eats like a child)
-SEVERE DEPRESSION >> 3 Mo later >> PANCREATIC CANCER
-Suicidal threat >> suggest hosp. voluntarily then involuntarily
-Thioridazine belongs to low potency older APM (low APM = 2)
-Lithium for cluster headache
-Buspirone is ineffective in ptn who took BZD or ETOH
-Altruism, humor, sublimation, supresssion = mature defense mechanism
-Denial, splitting, projection are immature
-15 yr boy w no Hx of conduct disorder steals a car after divorce of his parents >> DM: Acting out
-Soldier doesnt remember the battle >> DM: Dissociation
-a man who was physically abused abuses his children >> DM: Identification
-physician puts off his pity of ptn >> suppression (consc.)
-Tx of paraphilia (esp. pedophilia) = aversion conditioning (c video tape of children with electric shock)
-Flooding + implosion = Tx for phobia (IMagine plane = IMplosion, agree to ride plane of 14h = flooding)
-Token economy (desirable behavior like shaving is awarded w token) for MR
-Biofeedback for migrane, HTN, Raynaud, (ptn c the monitor of BP and try to use mental techniques to lower his BP)
-Cognitive therapy = replace negative thoughts w positive self-assuring thoughts for depression
-Family therapy for substance abuse, eating disorders, family conflict, Behavioral problems in children (oppositional defiant)
POISONING WORLD
-Serotonin toxicity = hyperthermia, tachycardia, mydriasis, diaphoresis, hypertension wo anti-cholenergic Sx
-Cocaine = Euphoria, HTN, cardiac ischemia, tachy, ICH
-ETOH withdraw = hallucination = delirium tremens = Rx: Chlordiazepoxide
-Opioid withdraw = Piloerection, dysphoria, abd. Pain, dilated pupils = Rx: Methadone
-TCAs toxicity >> NaHco3 by Na reduces the block of Na channels not by alkalization of urine (ASA)
-NMS >> idiosyncrinatic >> 1 st dantroline then bromocreptin & amantadine
-U may C a case w opioid intox. Wo mydriasis (meperidine)
-Fe intoxication >> GI phase 0-6h (N&V, melena, hematemesis) >> aSx 6-24h >> Shock + MET. Acidosis + hepatotoxicity 6-72h >>
BOWEL OBS due 2 mucosal scarring several weeks
-Best indicator of severity and prognosis in TCAs >> QRS duration
-ETOH >> hypoMg >> torsades de point
-BZD, ETOH, Phenytoin> BZD causes no nystagmus while ETOH and PHT do

-Serotonin toxicity = hyperthermia, tachycardia, mydriasis, diaphoresis, hypertension wo anti-cholenergic Sx

-Cocaine = Euphoria, HTN, cardiac ischemia, tachy, ICH
-ETOH withdraw = hallucination = delirium tremens = Rx: Chlordiazepoxide
-Opioid withdraw = Piloerection, dysphoria, abd. Pain, dilated pupils = Rx: Methadone
-TCAs toxicity >> NaHco3 by Na reduces the block of Na channels not by alkalization of urine (ASA)
-NMS >> idiosyncrinatic >> 1 st dantroline then bromocreptin & amantadine
-U may C a case w opioid intox. Wo mydriasis (meperidine)
-Fe intoxication >> GI phase 0-6h (N&V, melena, hematemesis) >> aSx 6-24h >> Shock + MET. Acidosis + hepatotoxicity 6-72h >>
BOWEL OBS due 2 mucosal scarring several weeks
-Best indicator of severity and prognosis in TCAs >> QRS duration
-ETOH >> hypoMg >> torsades de point
-BZD, ETOH, Phenytoin> BZD causes no nystagmus while ETOH and PHT do
-Mariuana is the most common illicit drug abuse in US and the most involved in the car accedents and causes increased appetite,
conjunctival injection, impaired short time memory, slowed reaction time, HTN, Tachydardia, dry mouth
-Most dialyzable toxin is LITHIUM
-Opioid withdraw doesnt cause seizures unlike sedatives and ETOH
-Opioid withdraw = Mydriasis, piloerection, N&V, carmping abd pain, increased bowel sound, diarrhea, restless, agitation, myalgia,
arthralgia.
-Hallucination + VERTICAL nystagmus = phencyclidine PCP
-Phencyclidine = HTN, Tachycardia, (the only Rx that causes vertical nystagmus), Hallucination (ETOH doesnt cause hallucination),
Psychosis
-Tx of Phencyclidine: URINE ACIDIFICATION, Haloperidol
-BB intox. >> Rx: Fluids + Atropine >> Glucagone (increases cAMP and intracellular Ca and augemting cardian contractility) >>
Epinephrine
-Acetaminophen intox. 2 h ago >> dont give N-acetyl csytein in the 1 st 8h >> Give Charcoal in the 1st 4h >> Do serum level after 4h
from intox. And then decide whether u should give NAS or not
-Bitter almond (loz) breath = cyanide poisoning (burning of plastic or rubber = mattat)
-Alkaline ingestion >> contrast studies + endoscopy (no steroid)
-Fluphenzine = typical anti-psych causes inhibition of thermoregulation and loss of shivering and HYPOTHERMIA
-ETHICS
-Dont go to court EVER
-1st Role: let the person who knows the ptn decide (not necessary family)
-2nd Role: when the ptn is incompetent >> Do best interest (even when religious say not)
-3r d Role: ptns are who makes decisions not DOCs.
-mother w bleed said no transfusion >> she has the right even if the child will die
-warm wife + tell her u need her right now
-parents cant withhold Tx for emergency child unless they r infant
-the only time u go to court is when parents refuses insulin for child (gonna die within few months wo Tx) for religious reasons
-living will should be talked about by the doc as early as possible
-anorexia + 19 yrs + refuses Tx >> Court (if minor do what u want)
-A competent ptn can refuse even life-saving Tx
-older than 13 + living alone = emancipated
-older than 13 + military or married or living alone
-older than 15 + regarding birth control, STD Tx, substance Rx Tx, prenatal care = emancipated (older than 15 = partial emancipated =
for certain issues only)
-parents refuses Tx for child >> if emerg. Go ahead if not but critical (DM) Go to court, if nothing (stitches) go w parents
-when surrogate make decision (1-what ptn said 2-what ptn could say 3-what is the best interest of ptn not the surrogate)
-health power of attorney beats all rules = speak w ptn voice
-ptn said he is going to kill someone >> try to get after him before call police
-Attorney is stronger than living will >> attorney is always gonna win
-informed consent u should give alternatives
-HIV ptn how would u tell his wife >> bring them together and inform her
-Tx Schizo only if he let u treat him unless violence is on the table
-consent can be oral, written is useless if ptn didnt read it
-what if family request not to tell ptn >> find out why + tell ptn
-who own medical records >> health care provider but ptn can have copy
-wife refuses emerg. Tx for her unconscious husband >> Tx
-if the wife has a card stating that >> dont Tx
-17 yr girl whose parents are out of the country living w baby sitter, from whom u should take consent? If a threat to health the
physician can treat under doctrine of in locum parentis !!
-if one parent accept and the other refuse >> only one permission needed
-17 yr boy need stitches coz of playing in school but parents are out >> consent from dean of school (NOT FROM FAMILY
PHYSICIAN)
-man wo clothes refuses to wear anything + refuses Tx but he is calm and not aggressive >> DETAIN HIM FOR OBSERVATION
PENDING A STATUS HEARING IN THE NEXT FEW DAYS
-ptn who is not adherent to anti-HTN Rx says it seems its not a threat to me >> tell him about aSx man who died of aSx HTN
(dont give Rx/1d instead of 3 times a day)
-Mandatory reportable diseases (gono, chlamydia, all hepatits, MMR, chickenpox, syphilis, salmonella, TB, lyme, pertussis,
legionella)
-White man 70 yrs >> most likely to commit suicide
-FHx of breat CA is stronger than obesity or early menarche or high education
-43 female died after hospitalization >> most likely cause is CANCER
-Brain death >> physician may stop Tx
-If Fx members request not tell ptn about his CA due 2 cultural issues and let them decide >> ask ptn u r very sick and ask if he wishes
to make these decisions or prefere to have them made by another
-U must have credible evidence about ur zamil before reporting his illness
-Paternalism = act of ignoring ptn wishes
-Surrogates authority ends when ptn dies (they CANT give consent for autopsy)
-if u r married + have children >> from who should u take consent? Adult Children not parents, if u r alone >> docs make decision for
u
-to declare brain death u have to have neurosurg or neurologist or intensivest
-after brain death even if u have donor card from ptn stating that he wants his organs to be taken out, if family says no then NO (this
is why u should tell ur family before death and convince then should u die)
-if u tried all possible Tx and no improvement and family wants more Tx >> stop Tx coz u have nothing left

-Brain death >> physician may stop Tx

-If Fx members request not tell ptn about his CA due 2 cultural issues and let them decide >> ask ptn u r very sick and ask if he wishes
to make these decisions or prefere to have them made by another
-U must have credible evidence about ur zamil before reporting his illness
-Paternalism = act of ignoring ptn wishes
-Surrogates authority ends when ptn dies (they CANT give consent for autopsy)
-if u r married + have children >> from who should u take consent? Adult Children not parents, if u r alone >> docs make decision for
u
-to declare brain death u have to have neurosurg or neurologist or intensivest
-after brain death even if u have donor card from ptn stating that he wants his organs to be taken out, if family says no then NO (this
is why u should tell ur family before death and convince then should u die)
-if u tried all possible Tx and no improvement and family wants more Tx >> stop Tx coz u have nothing left
-if u r in early Tx but u know that this is useless (futile) and family wants Tx >> then u cont. ur Tx
-if ptn said no blood while I am dying >> u can refuse and tell him that u can c a doc who can do this (same for abortion, if ptn wants
abortion that doesnt mean u r the one who should do it)
-if ptn doesnt want blood >> NS >> dont transfuse?? No, the NS is to discuss another option like IV fluid, ringer, ..
-ptn unconsc. And wears a t-shirt says no Tx >> go w Tx and dont listen to shirt even if his wife screaming dont tx , u r still txing
-IF PTN UNCONS + HIS WIFE W LIVING WILL SAYING NO BLOOD >> THEN NO BLOOD (OF COURSE THERE IS OTHER OPTIONS BUT NO
BLOOD!)
High-Yield Ethics
-If brain death >> doc can remove support wo court or family
-high yield says after death if appropriate request autopsy permission
-in terminally ill + no reasonable prespect of recovery support can be withheld although not legally dead (passive euthanasia)
under most circumstances
-ptn w a document (living will) says no heroic measures for saving comatose vegetative state >> after 5 days he enters in
vegetative state and wife wants Tx >> Tx ONLY IF U EXPECT PTN TO RECOVER, WIFE IS IRRELEVANT
-if ptn competence is in Qeustion >> judge makes the determination of competence
-psych. ptn who chose to be in hospital is required to wait 24-48h before he can sign against medical advice (AMA)
-emergent hospitalization >> one physician certificate, if invoulentary hosp. >> 2 physicians required
-post partum psychosis killed her son >> this is not a crime
-malpractice = 4Ds = Dereliction (negligence) of Duty that causes Damage Directly to ptn
-sexual relationship w current or FORMER ptn is inappropriate (there is a limit which is longer for psychiatrists)
-GENITAL HERPES DOESNT HAVE TO BE REPORTED
-drunk medical students >> dean of students
-resident >> chief of medical staff
-60 depressed ptn w Bx for suspecting CANCER, family request not to tell her if Bx is CA >> no, u should tell her but u can ask ptn if she
want family to hear the result w her (U CAN DELAY TELLING HER IF U THINK HER HEALTH MAY BE ADVERSLY AFFECTED)
-OVARIAN MASS SUSPECT OF CA WHILE DOING TUBAL LIGATION >> AWAKE PTN AND GET CONSENT (for all as long as its not emerg.)
-less than 18 but have child taking care of him >> emancipated
-HIV wants Tx, can u refuse to treat him? NO
-needle stuck from hiv pos. ptn >> must doc be tested?? Legally no but ethically and medically yes
-can u refere ptn to HIV pos. doc >> as long as he is competent and complies w precaution
-HIV ptn having unprotected sex w his wife wants u not to tell her about hiv >> NO encourage him to tell her, then c them all in ur
office, then tell her
-HIV MAN WHO IS HAVING SEX W HIS WIFE W CONDOM REQUIRES U NOT TO TELL HER >> U DONT HAVE TO TELL HER!!
-samer: child 10 yrs w disease >> say the Dx infront of his parents to keep child trusting u
-even threatening te ptn of abandon is not acceptable
-when ptn goes to surg waive means if we were wrong I would like the doc to take care of what it was DONT ASSUME WAIVER
UNLESS ITS CLEARLY STATED IN THE Q
-even confirming this ptn is urs is confidentiality
USLME WORLD
-afraid of cheese + MAOI >> Monitor BP for HTN crises
-suspect Hurschprung + need barium enema + parents said no >> this is an emergency (perforation risk) >> test em
-ALL in not emerg. >> go to court
-Bupropion CIs = anything can cause seizures like eating disorders (lytes abn. >> seiaures) Bipolar is ok coz there is depressed
phase
-ptn w resperidone + EPSx like bradykinesia >> Rx: ANTI-CH
-Lithium in 1st trimester >> cardiac
-in 3 rd Trimester Li >> Goitor + neonatal muscular dysfx
-want to be perfectionestic + sleep problems + no concentration + worry about tests = GAD NOT OCD (no compulsion)
-To tell anybody about any ptn get WRITTEN CONSENT (preferred over verbal one)
-The most effective way to prevent relapses of schizo is to keep conflicts to minimum
-I dont enjoy being in company >> Schizoid
-CATATONIC (rigidity, no response) >> ECT OR BZD
-Methylphenedate decreses appetite
-RR 18, dilated pupils, psychosis >> Amphetamine more common than Cocaine (both right, one was on the list)
-If no focal >> multi-infarct dementia is unlikely
-ptn request medical record >> give them a copy wo ASKING WHY (although this Q is justified)
-when ptn refuses Tx >> ASK EM WHY BEFORE RESPECTING HIS WISHES
-Doesnt speak or answer in school, talkative in home, little shy, doesnt play w friends at school >> SELECTIVE MUTISM NOT
SOCAIL PHOBIA
-72 yrs was thinking of suicide but not anymore + insomnia >> SSRI (UW WORLD SAID NO BENZO, NO ECT)
-after going to college (new house) afraid of someone breaking her house + insomnia + bad study = ADJUSTMENT W ANXIETY
-XanaX withdraw = seizures (coz short-acting, long acting dont cause seizures)
-modafinil = psychostimulant for NARCOLEPSY or methylphenidate
-UW: Lithium, Valproate, Carbamazepine are 1 st line for bipolar
-10 yr girl whose her father is alcoholic presents w regression Sx (no sleep until her parent return, talk w her causes tears, wetting her
bed) >> U SHOULD SUSPECT ABUSE (alcoholic father w behavioral changes)
-after argument whenever ptn calls secretory he said there is a lot of ptns in front of u >> PASSIVE AGGRESSIVE BEHAVIOR (ptn
expresses his aggression toward another person by repeated passive failure to meet the others needs.
-Social phobia >> Tx of choice is SSRI + Assertiveness training (kind of cognitive behavioral psychotherapy)
-ptn angry w u while doing physical >> NS >> ask u r angry, and I dont know why NOT let me do physical first, or I need ur
cooperation to do physical SOLVE ANGRY FIRST
-MOM said no VACC. >> then no VACC (coz no life-threatening harm) dont ask her husband

-after going to college (new house) afraid of someone breaking her house + insomnia + bad study = ADJUSTMENT W ANXIETY
-XanaX withdraw = seizures (coz short-acting, long acting dont cause seizures)
-modafinil = psychostimulant for NARCOLEPSY or methylphenidate
-UW: Lithium, Valproate, Carbamazepine are 1 st line for bipolar
-10 yr girl whose her father is alcoholic presents w regression Sx (no sleep until her parent return, talk w her causes tears, wetting her
bed) >> U SHOULD SUSPECT ABUSE (alcoholic father w behavioral changes)
-after argument whenever ptn calls secretory he said there is a lot of ptns in front of u >> PASSIVE AGGRESSIVE BEHAVIOR (ptn
expresses his aggression toward another person by repeated passive failure to meet the others needs.
-Social phobia >> Tx of choice is SSRI + Assertiveness training (kind of cognitive behavioral psychotherapy)
-ptn angry w u while doing physical >> NS >> ask u r angry, and I dont know why NOT let me do physical first, or I need ur
cooperation to do physical SOLVE ANGRY FIRST
-MOM said no VACC. >> then no VACC (coz no life-threatening harm) dont ask her husband
-she saw a mass in her breast and didnt seek medical attension coz she thinks its not CA coz she doesnt have family history >> DM:
Rationalization (NOT INTELLECTUALIZATION)
-Doc w pancreatic CA searches for latest information about pan CA >> this is intellectualization not rationalization
-depressed who want to stop smoking >> Bupropion better than SSRI
-no depression if he enjoys golf and works
-ANOREXIA is 15% less than AVERG, if less than 25% >> ADMIT TO HOSP
-Dyschezia + Dysparunia >> Endometriosis
-less EPSx w newer APM, why? Coz 5HT-2A
-ptn w flashbacks of death of his wife 2 mo ago + decreased appetite + GAINED WEIGHT 9 Kg + Depressed >> NS >> TFT NOT Refer
for PTSD
-4yr regressed milestones >> childhood disintegrative disorder
-OCD >> Clomipramine or paroxitine ?? >> Paroxitine (SSRI) Clo (TCA)
-ptn wants to c u now and u dont ave time and as u r leaving he showed up and require to examin a rash on his penis >> examin him or
ask him to come tomorrow as this is not an emerg. ?? >> come tomorrow
-ANOREXIA >> POST PARTUM DEPRESSION (NOT PSYCHOSIS), SMALL FOR GESTATIONAL AGE, HIGH CHOLESTEROL AND CAROTENE,
ARRHYTHMIAS (LONG QT), EUTHYROID SICK SYN., HYPONATREMIA (THIS IS THE NOLY ;YTES ABN. IN ANOREXIA, ANY FURTHER ABN.
INDICATE PURGING), IUGR, C-SECTION, MISSCARIAGE, HYPEREMESIS GRAVIDARUM
-HYPOCHONDRIASIS >> Tx IS NOT REASSURING COZ NO BENEFIT OF THAT, RATHER U SHOULD DISCUSS EMOTIONAL STRESSOR +
PYSCH Tx
-Dx of CA >> initiate w how r u feeling today
-Menengitis + rash = MENENGIOCOCCIMIA >> Tx against his wishes
-u r covering ur colleague who did angio wo hydration, then ptn comes w ATN >> NS >> I am not te bet to discuss this or seems
related to angio but this should be discussed w my colleague >> the 2nd one is the right
-Folie a deux >> Tx put the mother and daughter in 2 different psych units
-Panic Disorder >> assoc. w agoraphobia, substance abuse, DEPRESSION (DEPRESSION MORE COMMON THAN ETOH ALTHOUGH BOTH
R RIGHT)
-Anorexia w NL menses = eating disorder NOS (not otherwise specified)
-NMS >> Dantroline, EPS (like dystonia) >> Benztropine
-Tourette >> ADHD or OCD ? >> ADHD 50%, OCD 40%
-Olanzapine >> commonest SE is obesity/weight gain not DM
-Presence of NL menses exclude the Dx of Anorexia
-suspect child abuse >> in order 1- physical -2 skeletal survey 3- coag profile 4- report to services 5-admit if necessary 6- consult psych
-ur friends wife comes and wants to examine her breast wo appointment >> tell her to schedule an appointment
-W ALL Sx OF DEPRESSION U CAN IMAGINE AFTER DEATH OF HER SON (WEIGHT LOSS, NO APPETITE, ON ENTHUSIASIM FOR WORK,
UNREFRESHED SLEEP , EASY FATIGABILITY, THINK TO BE W HER SON BY DEATH) SHE IS STILL WORKING BUT AVOID TALKING W
COWORKERS WHENEVER POSSIBLE >> Dx: NL BEREAVEMENT (COZ SHE IS JUST WORKING!!! UW)
-wife doesnt speak so her husband is answering u >> NS >> ask him to get out and talk w the wife alone.
-ptn on lithium develops manic episode >> check urine and lithium serum level
-palne phobia who will fly the next week wants Tx >> XanaX (buspirone takes 2-3 w to work, clonazepam is no short acting)
-ETOH withdraw >> first anxiety, sweating, palpitation then ETOH hallucination (just hallucination resolves in 1-2 days, vitals NL and
sensorium is intact), then DT
-Acute dystonia >> Anti-CH or diphenhydramin
-ptn w COPD ex. And in resp. failure needs intubation and ventilator but living will says no rescu. And family wants u to Tx >>
discuss this w family (no Tx) and if they still want Tx GO TO COURT (I think no Tx coz he is unlikely to recover)
-wrecked the car after argument >> DM: Displacement (not only humans and dogs, also cars)
-Bereavement = loss of something = lasts no longer than 2 w
-Adjustment disorder >> dynamic or cognitive psychTx (preferred over Rx)
-Citalopram causes not only delayed ejaculation but also IMPOTENCE and DECREASED LIBIDO
-5 Sx of depression to have Dx of Depression
-Chlorpromazine assoc. w non-hemolytic JUANDICE
-woman convinced that she has CA for 5 yrs when asked how could u know since all tests are neg. she said when u have CA, u
know! >> Dx: Delusional disorder (hypochondriasis wasnt on the list)
-5yrs girl often talks w someone and when asked w who she replies nobody, when split milk she said this is MINDY >> she has imaginary
friends which is NL for her age (remember me) and she will go oover that
-Psych finished in 6 days w videos !