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PSYCHIATRY

F A 2 0 1 4 , P. 5 0 0 - 5 2 0
IN GENERAL, PSYCH IS SDAM. HOWEVER, THERE ARE
S O M E M A J O R T H I N G S T H AT YO U M U S T F O C U S O N
WHEN STUDYING THIS CONTENT

ERRATA
2013:
None
2014:
Pg. 512
Eating disorders In the entry for anorexia nervosa, change the
lower limit of normal :
BMI from 17 to 18.5 kg/m2

PATH POINTERS:
Know all of thetiming cutoffsanddiagnostic criteriathat are
mentioned in FA!! This ishuge.
The question will often hinge on whether or not a patient's
symptoms fall within the correct diagnostic time period or
not!
(E.g. does this patient have dysthymia or MDD?)

LEARNING THE DRUGS


Know the unique uses of specific drugs in each class or the
specific drug that is useful in a specific patient.
Examples:
buproprion for depression + smoking cessation
buproprion as an option in a patient who is struggling with a typical
SSRI (2/2 sexual side effects)
mirtazapine in a pt who is depressed + anorexic
Definitely know all of the special circumstances for psych
meds like these.

CLASSICAL VS. OPERANT CONDITIONING


Know the difference
Classical:
Learning, which elicits Classic/Involuntary responses
Condition classic response with stimuli

Operant
Learning which elicits Voluntary response
Positive, Negative, Punishment, Extinction

TRANSFERENCE AND
COUNTERTRANSFERENCE
SDAM
Transference: patients projection
Counter Transference: doctors projection

EGO DEFENSES & INFANT DEPRIVATION


Ego Defense
SDAM
Not worth reviewing in class;
these are tested so do encourage their review upon self study.
Infant Deprivation
Reactive Attachment Disorder -DIT
fairly straightforward, review
Continued separation from caregiver/ failure to provide nurturing bond
Causes: Decreased development of language, feeding, muscle tone, trust,
withdrawn
Can remember via 4 Ws
Reversible
>6 months= Irreversible
E.g.: orphanage in Russia

CHILD ABUSE
child abuse is usually tested in a vignette with a pediatric patient
being examined after some sort of incident
There may be fractures on exam, found on imaging studies, etc
Retinal Hemorrhage/ Detachment
Shaken baby syndrome clue, esp. if bilateral!!
Subdural Hematoma
Different phases of healing on Xray
Must report to CPS
the vignette will neither rule in/rule out child abuse and the question
will basically be should you just trust the parent's story or not
with the answer being some variation on no.

CHILDHOOD AND EARLY-ONSET


DISORDERS
ADHD:
know that the onset isbefore 12 years old (DSM V)
different from DSM IV 2013
characterized by hyperactivity/impulsivity/inattention inmultiple settings.
Know thetreatments!
Methylphenidate Ritalin, most common
amphetamine
Pimp side who is bitching
athomexetine
behavioral

Conduct dd:
Symptoms ofantisocial personality in someone who is<18 yo
Bad behavior ingrained, cruelty to animals, setting fire to things
Conduct disorder <18yo
Antisocial personal dd >18yp

Oppositional defiant dd:


conduct dd light
less drastic than conduct dd, no serious violations of behavior
disobey authority but not violating rights of others
anenduring patternofdefiant behavior

TOURETTE'S SYNDROME:
onsetbefore age 18,
Know the stereotypical behaviors:
copralalia (only 20%, e.g.: involuntary 4 letter words)
Must beboth motor and vocaltics thatendure for at least 1
year.
Know the treatments and associations
Anti-Dopa agents
Fluphenazine
Pimozide
Pimp side who is bitching= Pimozide for Tourette's
Tetrabenazine

SEPARATION ANXIETY DISORDER

DSM V= Before age 18! (via DIT)


common onset @ 7-9 years old

theme of vignettes:
Child with fake complaints to avoid school or other activities.
Fear of separation: parent, safety blanket, etc.

PDDS= PERVASIVE DEVELOPMENT


DISORDERS
Know PDD= Difficulties with LANGUAGE and failure to acquire/ early loss of
SOCIAL skills
Autism:
language + poor social interactions is thekeyhere
intelligence is usually below average
more often boys
vignette will often describe repetitive behavior (e.g. hand motions).
Know the basics of tx
Asperger's:
social difficulty, trouble interacting with peers
(e.g. consumed with repetitive motions)
normal intelligence, no language impairment, , less impaired than autism

Rett's:
XLgenetics (one of few x linked dominants)
Girls !! (males die in utero)
Stereotypicalhand wringing /hand to mouth = vignette tip off!
Other signs: decreased IQ, decreased verbal, ataxia
Diff from autism: Girls, only constant hand wringing
Childhood disintegrative dd:
have normal initial development, then get worse around 2 yo
usually male
significant loss of verbal / social / motor skills.
In all honesty it can be hard to distinguish CDD from Rett's superficially.,
helpful formula
Retts: girl + hand wringing
CDD: boy + severe regression

Neurotransmitter changes with disease


SDAM
Amnesias
SDAM
Note: know the strict definition of Korsakoff's amnesia
1. caused by thiamine deficiency (ALCHOHOLICS) and destruction of
mammillary bodies
2. anterograde/retrograde amnesia, confabulation

DELIRIUM & DEMENTIA


Delirium:
waxing and waningis the key here. Be sure you can differentiate it from dementia!!
Particular noteworthy differences between dementia:
hallucinations more commonly visual
cognitive dysfunction onset is abrupt and not permanent
Commonly due 2/2 anticholinergic drug effects on the boards, watch out for
that!
Also:antipsychoticsare the med tx of choice not benzos!!
Dementia: Agradualdecrease in cognitive ability is the key here.
Know the various causes!!
(e.g. AD, vascular dementia, HIV, Pick's, NPH, B12 deficiency, etc).
Note: many of these causes will be reviewed in the neuro section!

I suggest knowing dementia & delirium very well.


Especially make sure you are able to distinguish them. I would not spend a ton of
time in class as most of this is SDAM but I would consider going over the main
differences between delirium and dementia in class. Table 4 from this AFP
article is pretty good. http://www.aafp.org/afp/2003/0301/p1027.html

PART 3:
p. 510
Malingering vs Factitious dd
SDAM; emphasize the importance of being able to
distinguish.
Malingering: conscious motivation
Factitious: motivation is unconscious
> Munchausen's
Somatoform disorders
SDAM

Personality Dds
SDAM! Be able to recognize each of these. Grouping them in the
clusters is helpful for memorization purposes.

EATING DISORDERS
Bulemia often has a weight in the normal range
+
Anorexia can have purging!
Otherwise, SDAM.

GENDER IDENTITY DISORDER


TERMINOLOGY
The 2013 FA edition lists these (2014 does too but calls it
Gender Dysphoria)
In any event, because there is much controversy re: whether or not
this should even be considered a disorder, the boards in my
experience does not really test on this topic.
For the curious: the official classification of gender dysphoria as a
disorder in the DSM-5 only pathologizes the discontent experienced
as a result of gender identity issues; gender identity disorder
is not the currently accepted termgender dysphoria is.

SUBSTANCE DEPENDENCE VS ABUSE


SDAM + know the differences!!
In general: dependence is worse than abuse
Dependence Criteria: has changed since 2013, less signs needed
you need to have 2 of the following in 1 year (used to need 3):
tolerance, withdrawal, more substance take over time, can't
cut down, etc.

DRUG INTOX / WITHDRAWAL


SUPER HY!! SDAM!
It could be fun to quiz the class with these as a way to quickly
review

HALLUCINOGENS
SDAM; thisis tested!
My only tips here:
LSD > visual / auditory / anxiety / paranoia / olfactory / etc.
hallucinations. ALL sorts of hallucinations!!
PCP > areally angryperson with hallucinations

WERNICKE-KORSAKOFF
SUPER HY!! Know all that is listed in first aid!!

DELERIUM TREMENS
Know when they tend to occur :
2-5 days after last drink (know!!)
Know withdrawal signs and the order they appear!

QS, CH 14
6, 12, 13, 15, 16, 19