Psychiatry board review - frequently missed
Terms
undefined, object
copy deck
- anorexia - diagnostic criteria
-
*weight less than 85% expected
*fear of weight gain
*body dysmorphy
*miss 3 consecutive menustral cycles
*subtypes: restricting or binging and purging - bulimia - diagnostic criteria
-
*recurrent binge eating
*lack of control
*recurrent compensatory (vomiting laxatives excercise)
*2 binges weekly for 3 mo
*overconcern with weight or shape - anorexia-pathophysiology
-
*genetic ties
*earlier age of onset than BN
*hypothalamic disturbance
*increased CRF
*decreased NE activity
*amenorhhea before weight loss in 20% - anorexia - physical signs
-
*emaciation
*hypothermia
*edema
*bradycardia
*hypotension
*lanugo -
anorexia labs
*GH
*cortisol
*gonadotropin
*thyroxin, TSH, T3
*electrolytes in purging
*LFT
*lipids -
*GH elevated
*cortisol elevated
*gonadotropins decreased
*Thyroixine and TSH normal, T3 reduced
*hypokalemic alkalosis, decreased CA
*increased LFT, fatty deposition
*increased cholesterol and carotenemia
*parotid hypertrophy and elevated amylase
*abnormal dexamethasone suppresssion and glucose tolerance
*hypocholeremia
*leukpenia -
eating disorder treatments
*indications for hospital
*special med treatments -
* in AN restore weight in BN restore electrolyte abnormalities
*starvation weight loss psychosis electorlyte abnormalities hypotension or hypothermia
*cyproheptadine chlorpromazine, lorazepam, antidepressants decrease binging and purging - Epidemiology: most common disorders
- *NIMH catchment area study US - substance use disorder
-
Freud and Erikson
the anal stage -
autonomy vs shame and doubt
ages 1-3
shame from elimination or self consciousness, holding and letting go -
Freud and Erikson
Phallic-oedipal -
initiative vs guilt
age 3-5
guilt over aggressive goals
mimicry of adults
sibling rivalry, competition and aggression
Oedipal conflict resolved with the creation of the superego (internalized parental values and standards but not a contoller of drives) -
Freud and Erikson
latency -
industry vs inferiority
age 6-11
creation building and accomplishment
socially decisive stage -
Freud and Erikson
genital -
identity vs role diffusion
age 11-adolescense
ego formation, preoccupation with appearance.
formation of group identity
morality and ethics watershed -
Erikson
generativity vs stagnation -
age 40-65
not child dependent
altrusim and creativity -
Erikson
integrity vs despair -
over age 65
life has been productive and worthwile
despair is fear of death
integrity is your place in the life cycle -
Freud and Erikson
oral -
trust vs mistrust
birth to 1 year - Erikson intimacy and isolation
-
age 21 to 40
tasks are to love and work
friendships and intimacy -
structural model of the mind
*components - ego id and superego
-
the superego
*consicious or unconsious?
*modulates drives? -
largely unconscious
*nope, that belongs to the ego -
executive organ of the psyche?
*consioucous preconsious or unconsious
*contains? -
*ego
*spans consiousness
*contains logical and abstract thinking (conscious and preconsious)and defenses
*controls the reality and pleasure principle (not the id) - sublimation
- negative energies are put or diverted into personally and socially acceptable activities.
- denial vs repression
-
denial - disavowing
repression - not available - Interpretation of Dreams
-
expression of unconsious fantatsies or wishes
*latent dream content derives from the id - ego ideal
-
not the same as the superego
an amalgam of internalized representations
prescribes what you should do by making reference to the superego, connected with shame not guilt. - topographic theory
-
unconsious preconsious and conscious
*presented in 1900 in Interpretation of Dreams
*Ego and Id (1923) was the debut of the structual model
*Anna Freud - first systematic study of defenses, agents athat act to keep conflcits out of consiousness, the birth of Ego psychology in 1936. - mature defenses
- altruism anticipation ascetism humor sublimation suppression
- head balanced
- 16 weeks
- visual accomodation
- 16 weeks
- sits steadily/leans
- 28 weeks
- sits alone
- 40 weeks
-
creeps
pulls self to stand
points - 40 weeks
-
walks with one hand
stand brifely - 52 weeks
- responds to sounds
- 4 weeks
- follows moving object
- 16 weeks
- social smile
- 16 weeks
- separation anxiety
- 40 weeks
- peek a boo
- 40 weeks
- feeds self
- 40 weeks
- dresses self
- 52 weeks
- draws cross
- 4 years
- copies square
- 5 years
- copies triangle
- 6 years
- walks up stairs with one hand held
- 18 months
- names self
- 2 years
- put on shoes
- 3 years
- object constancy
- 2 to 5 years (mahler)
- babbles and sounds
- birth to 6 mo
- pat a cake and peek a boo
- 7-11 months
- vocabulary at 12-18 months
-
150 understood
uses 20 - speech intelligble, language to tell stories and ideas
- 54 months on
- two words
- 12 months
- phrases
- 18 months
- one word
- 40 weeks
- grasping and manipulation
- 16 weeks
- creeping and poking
- 40 weeks
- anal sphincter control
- 3 years
- first smile, social smile
- 1-2 weeks, social smile 4-8 weeks
- visual fixation
- 2-4 weeks
- 5 stages
- DABDA: denial anger bargainging depression acceptance
- normal auditory perception
- 2 years
- Pick's Disease
-
*dementia
*incidence peaks in late 50's
most cases younger than 65
*rare with familial tendency
*frontal and anterior prominence (spares parietal lobes)
*Pick Bodies (silver staining)
*early personality changes
*frontal lobe syndrome, Kluver Bucy hyperorality
speech preserved -
psychosis
Argyll Robertson pupils
facial tremor
strokes
tabes dorsalis - neurosyphilis
-
visual disturbances
white matter lestions on MRI
dementia - PML
-
cognitive fluctuation without memory impairment
dementia
Parkinsonism
VH -
Dementia with Lewy Bodies
avoid EPS -
Apo e4
amyloid precursor -
chromosome 19
chromosome 21 -
early memory loss
progressing to disorientation
then aphasia
depression
agitation gait disturbance - AD
- CJD EEG
- non specific sharp waves and spikes
-
diarrhea
glossitis
dementia
glossitis
anemia
skin lesions
alcohol use - Pellegra (niacin deficiency)
-
dementia
necrosis of corpus callosum
dysarhtria
gait problems - Marchiafava bignami
-
amnestic syndromeof recent memory impairment
bitemporal hemianopia
visual agnosisa
alexia without agraphia - bilateral PCA occlusion
-
dementia
related to degeneration of dorsomedial thalamic nuclei
polyneuropathy
nystagmus
ataxia
confabulation and apathy - Korsakoff dementia/amnestic syndrome (thiamine B1 deficiency)
-
opthalmoplegia
ataxia
confusional state - Wernicke encpehalopathy
-
gait apraxia
urinary incontinence
dementia - NPH
- Parkinson tremor
-
4-6 hz
pill rolling
greater at rest and stress
starts unilateral and goes to generalized - kiddie epidemiology: child abuse
-
neglect most common
15/1000 kids
2-3% - BZD without active metabolites
-
LOT
lorazepam, oxazepam, temazepam. - treatment of hypertensive crisis
- phentolamine IV
- MAO and SRI
- serotonin syndrome (fever diaphoresis confusion myoclonus htn tremor and diarrhea)
- MAO stopping and starting
- wait 2 weeks before normal diet, or using TCA
- TCAs with plasma levels
- nortryptiline desiprmaine and imimpramine
- TCA and SRI
- keep dose of TCA low
- TCA and MAOI
-
start them together
after a medication free period. - Tertiary amines
-
amytriptiline
imiparamine
doxepin
more prominent antilcholinergic side effects - cardiac complications of TCA
-
long conduction
avoid in 1st degree of RBBB;anyone highter than first degree block should not get TCA - Lithium levels
-
.9-1.4 for acute mania MEQ/L
maintenance .6-.8
mostly antimanic
works as well as antidepressant for unipolar pts. - Lithium kinetics
-
no metabolites
presnent in all fluids
levels 12 hrs after the last dose - Lithium side effects
- thirst or polyuria, tremor, diarrhea, weight gain, edema, hypothyroid,
- Lithium toxicity and adverse events
-
dehydration
thiazides
anything that increases sodium reuptake in the proximal tubule
may cause hypercalcemia and PTH elevation
T wave changes like in hypokalemai
acne
leukocytosis
nephrogenic DI
nephrotic syndrome
rare Parkinsonia sx - LI contraindications
-
renal dz
d/c for MI for 10-14 days
MG
PD
d/c in 1st trimester
no breast feed - adolescent suicide
-
3rd leading cause of death behind MVA and homocide
gun most common
girls attempt but boys complete more.
major risk factor is trying before
ppt is argument in fmaily
more common as older
hanging second
ingestions in females
not always with mood d.o.