Auras of an unpleasant odor can indicate a temporal lobe partial complex seizure.
Prepubescent kid suddenly becomes OCD, anxious, oppositional?
PANDAS - pediatric autoimmune neuropsychiatric disorder associated w/strep A
Bedwetting aka nocturnal enuresis most likely to happen in first third of the night
Garlic breath - could also be arsenic poisoning
Lifetime prevalence of psych disorders (chiefly anxiety and depression) in epileptic patients - 20-30%
How to differentiate a generalized tonic-clonic from a non epileptic seizure?
check prolactin levels - they are elevated in the epileptic form, but have to get sample within 20minutes
postcardiotomy delirium is differentiate from delirium tremens of alcohol withdrawal because the former does not have the autonomic activation. The prevalence of postcardiotomy delirium has remained constant at 32% over the years!!!!
Mental retardation
IQ:
50-70 mild retardation - 90% (6th grade level)
35-55 moderate ret... - 7% (preschool level)
25-40 severely ret... - 3%
20-25 profoundly ret - less than 1% (death in early 20's)
prevalence of schizophrenia in siblings - 10%
which antipsychotics treat negative symptoms of schiz? olanzepine/clozapine
uneven pigmentation after exposure to sun - which antipsychotic? chlorpromazine
delusions -fixed false belief not culturally shared is a dysfunction of thought content
suicide rate for schizophrenic patients- 10%
concordance rate in homozygotic twins for mood disorders - 70%!!!
which cancer most likely to manifest w/depressive symptoms? pancreatic adenocarcinoma
prevalence of depression in post stroke patients estimated to be 30-50%
post stroke depression risk extends for approximately 2 years
Heinz Kohut - his theory was all psychopathology comes from bad parenting. neglectful, unempathetic
Beck - depression results from cognitive distortions in depression prone people
Bowlby - attachment
Mahler - separation/individuation (rapprochement - kid comes back to mom for check in supports)
ECT improves motor symptoms associated with Parkinson's
Lithium, thyroid, stimulants, estrogens can all augment anti-depressants
Prevalence of alcoholism in bipolar is 60%
REM latency is shortened in depression and narcolepsy
Treatments for panic disorder - SSRI, TCA, benzos
OCD tx - ssri, clomipramine,
GAD tx - buspirone, SSRI, imipramine
Causes of restless leg syndrome - pregnancy, anemia, renal failure
Symptoms of meperidine intoxication - resp. depression, stupor, coma and seizure!
Hypnosis is contraindicated in paranoid personality disorder (it just won't work)
Important to remember that when living with a schizophrenic the emotional environment of the home is very important- keep fights, arguing etc to a minimum
Freudian concept of abstinence -refrain from making an major life decisions while receiving psychoanalytic treatment.
Akathisia occurs early during neuroleptic treatment, treat it w/beta blocker
Want to knock down both ADHD and depression in a 16 year old? tx with bupropion
Trazodone priapism risk is highest with LOW doses (50-150mg/day)
How to treat sexual side effects of SSRI (decreased libido, anorgasmia) without changing medication? add cyproheptadine
treatment for involuntary tics, grunts, and coproalia (obscene outbursts) - haloperidol
Person being treated with disulfiram presents with facial flushing, tachycardia, hypotension, N?V - denies alcohol use what else could do it? Cough syrup has 40% alcohol.
Lithium treatment begins to work after roughly 7-14 days.
treatment of cataplexy? SSRI, MAOi, TCA
The drug of choice to knock down both bedwetting and ADHD is imipramine.
Going to be sued for malpractice? Plaintiff has to prove the 4 D's
Duty - you had a duty to act and didn't
Deviation from the standard of care
Direct - harm was directly caused by physician's actions
Damages - there were actual damages as a result
Tarasoff v. Regents of California - provider has to warn the potential victim of a violent patient if identity becomes known
Two most common cause of malpractice claims?
1. maltreatment
2. suicide
Principles
Beneficence - promote well being
Nonmaleficence - do no harm
mens rea - state of mind that indicates criminal intent at the time of the crime
Durham rule - defendant is criminally liable if it can be shown the unlawful act was a result of mental disease
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