Study Guide

Psychosomatic Medicine
Psychiatric Presentation of Medical/Neurological Illness
Interaction between Medical/Neurological and Psychiatric Illness
Delirium
Dementia
Personality Disorders
Defense Mechanisms
1) A common problem in hospitalized med-surg patients is altered mental status.
How do you go about working up the cause of this acute change? (Especially,
how do you do this without a good record of a patients pre-morbid cognitive
state?) How do you distinguish these changes from pre-morbid dementia or
psychiatric problems?
2) Depressive symptoms (mood, cognitive, and neurovegetative) can be a
maddeningly non-specific first sign of many medical and neurological illnesses.
Which co-morbid conditions can be easily screened through physical exam and
blood tests? Which additional complaints or physical findings would make you
think the patient needs: imaging of their brain, imaging of their chest or abdomen,
lumbar puncture, in-depth cognitive testing, etc.
3) How likely is it that someone with medical problems will develop depressive
symptoms (or other psychiatric symptoms)? What is the likely effect on their
compliance with treatment, morbidity, and mortality if they develop severe
depressive symptoms?
4) Conversion Disorder, Factitious Disorder, and Malingering can be distinguished
on two axes: which of these disorders comes from an unconscious motivation,
which conscious? Which involve unconscious production of symptoms versus
conscious production of symptoms?
5) How many symptoms/complaints do you have to have to meet criteria for
somatization disorder? How many different organ systems? How is somatization
disorder different from hypochondriasis?
6) Do normal people somatize their emotional stress? Does this vary by culture?
(This answer isnt in the book. Just draw from your own experience.)
7) What are the differences between Alzheimers dementia, vascular dementia,
Parkinsons dementia, and fronto-temporal dementia? Describe their different
cognitive findings (which abilities are lost first), course, associated
physical/neurological symptoms, and what can be seen on neuroimaging and
pathology
8) Are psychotic symptoms in people with dementia common? Are particular kinds
of dementia more likely to be associated with psychosis? What are the problems
with treating their psychosis with antipsychotic medications? Why might you
choose to treat them with antipsychotics, even knowing the risks?
9) Why are the personality disorders clustered in 3 groups (or what do the disorders
in the groups have in common)?

10) While DSM distinguishes between Axis I disorders and personality disorders,
there is evidence that these disorders may just represent a continuum (i.e. people
with schizoid personality disorder are over-represented in the families of people
with schizophrenia). What is the difference between someone with ObsessiveCompulsive Personality Disorder and someone with OCD? What is similar and
different between someone with schizoid personality disorder, schizotypal
personality disorder, and schizophrenia? How about borderline personality
disorder vs. someone with bipolar disorder?
11) Defense Mechanisms: denial, projection, regression, somatization,
intellectualization, dissociation, reaction formation, repression, altruism,
anticipation, humor, sublimation are all essential to know. Which of these
defenses are likely to be used by people with serious personality disorders or
psychosis? Which are likely to be used by higher-functioning people (like medical
students and residents)? Do only mentally ill people use defense mechanisms?
From 2nd edition of Blueprints Clinical Cases in Psychiatry:
Read cases 9-12; 36