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Defense mechanisims
Tools of the EGO to manage INTERNAL CONFLICT btw the ID and Super-ego
All unconscious : EXCEPT SUPPRESSION
Psychology random
IQ: mental age/ chronological age X 100 ( if equal then 100 is avg )
-SD is 15
- below two SD is retardation
Less 70: mental retardation
Mild
70-50 (20)
Moderate
Severe
Profound
49-35 (14)
34-20 (14)
<20
ADHD
Lower frontal lobe volumes
Normal IQ just difficulty focusing
Treat with stimulants : Methylphenidate (increase NE and serotonin)
Autism
Majority IQ LESS THAN 70 (mental retard)
Social interaction not reciprocated ( no separation anxiety, dont make eye
contact, dont hold out arms to parents)
Stereotyped behavior ( small interest number)
Potential causes
* NOT ASSOCIATED WITH MMR
Failure apoptosis cortex
Prenatal/perinatal trauma and infection
* Aspergers ( NORMAL IQ and language )
Rett
Causes Dementia
1. Alzheimers
Order of loss : time, place, person
Chromosome 21 APP ( amyloid precursor protein)
Chromosome 1 ( prenesilin 2) and chromosome 14 (prenesilin 1)
Chromosome 19 ( Apoprotein E)
Diffuse atrophy brain
Can be reduction in choline acetyl transferase
Die from infection (pneumonia)
HIPPOCAMPUS affected first
2. Vascular dementia (stroke)
3. HIV
HIV encephalitis and myelitis
Kills brain cells and prevents their regeneration
Most people with AIDS have HIV dementia
Survive 4 months after onset
HIV level in spinal cord good predictor
Often misdiagnosed as depression
4. Picks Disease ( have tau also but neurofibrillary balls not tangle)
Frontal and temporal lobes deteriorate
5. Lewy Body dementia ( FAST DEMENTIA , AND LEWY BODY IN CORTEX)
6. Parkinsons ( late onset dementia, and lewy body in substantia nigra)
7. Substance abuse ( neurotoxic
8. CJD (prions, protein that cause this)
9. Huntington Chorea
10. Wilsons
Defect in chromosome 13
Ceruloplasmin deficiency
Copper accumulate in tissues ( cant be bound or excreted )
11. Normal Pressure hydrocephalus
Differentiate Alzheimers vs stroke
HTN in Stroke
Fast onset in stroke
Stroke has other neurological signs that are lateralize ( EX sensory loss,
Alzhimers dont have lateralized signs)
Depression may present like dementia in elderly patients(PSEUDODEMENTIA)
Psychology diseases
Psychotic Disorders
Schizophrenia
Genetic predisposition ( if sibling or parent= 12 %, if both parents= 40%)
Subtypes
1. Paranoid * better prognosis
2. Catatonic : Increase or decrease activity
-Decrease: mute, rigid, echopraxia (repeat), automatic obedience
-Increase: violent, destructive, repetitious stereotyped behavior
3. Disorganized * worst prognosis
-disorganized speech, behavior, appearance, explosive laugh,
grimacing
4. Undifferentiatted: combo of many
5. Residual: has episode but on general exam look fine with no psychosis
Positive Symptoms : associated with Dopamine high (mesolimbic)
Negative symptoms : associated with muscarninic ( Ach)
Good prognosis :
-Paranoid
-Late onset
-FAST onset
- Positive sympotms better than negative
-no family history
-* mood disorders better ( so schizoaffective better)
* differences:
- Schizophrenic 2 weeks WITHOUT MOOD ( Schizoaffective)
-IF Mood + psychotic together : Bipolar with psychotic features
Delusional disorder:
Beliefs lasting >1
Fixed, non-bizarre ( woman thing shes a movie star)
Functioning other than this is normal
Mood disorders
Depression sleep
Increase REM sleep, and latency to it decrease ( get there faster)
Decrease slow wave sleep (stage 4 the refreshing sleep)
Post partum
1. Blues : NORMAL, follow up in two weeks
2. Depression: 2 week- 2 months
3. Psychosis : days to weeks ( delusion, homicidal/suicidal)
Bipolar
Need mood stabilizers: lithium, valproic acid (antiepileptic), carbamazepine
atypical antipsychotics
Hypomania doesnt cause disturbance in social or occupational functioning
Suicide risks
NUMBER ONE RISK : PERSON WHO HAS TRIED BEFORE
Men succeed more, women try more
-success both from gun #1, women attempt with pills and poision
Age : teens highest is natives, elderly (lowest is native)
Race: white most
Depression and alcohol number ones
Lack of support, medical illness, sexual assault history
Anxiety disorders
Eating Disorders
Anorexia
BMI < 17.5
Restrictive and Purging types
Bulimia
Normal or overweight a bit
Binge and then compensate
Purging, non-purging
* at least twice a week for 3 month
Electrolyte imbalance: hypokalemia and
leads to arrhythmias)
Lanugo : very fine bodily hair
Dental cavities
Somatoform Disorders
Somatization: must have 4 pain, 2 GI, 1 sexual, 1 psuedoneuological
Conversion: stress to physical neurological la belle
Hypochondriasis: still think something wrong although results negative
Pain disorder: prolonged pain with no physical finding
Factitious/ Muchausen: know faking it but drive unconscious
Malingering: know faking and know drive
Sex
Gender Dysphoria: not happy with their sex at birth ( usually change it Transsexual)
-born male, wants to be female, attracted to males (heterosexual)
Substance
PCPAM
1. precontemplation: dont think they have a problem
2. Contemplation: know have a problem but havent done anything
3. Preparation: make a plan
4. Action: change
5. Maintenance: prevent things that can relapse you
6. Relapse
Substance dependence (BODY): Tolerance and withdrawal
Subtance abuse (LIFE EFFECT): affect school, work, fail fulfill obligation,
compulsive use (even if dangerous), legal issues
-All drugs work on dopamine mesolimbic reward pathway
-Injection cause
- Right side endocarditis
-Hepatitis, abscesses
-HIV, AIDS
-overdose
Alcohol
Wernike Korsakoff
Periventricular necrosis of mammillary bodies
Wernike: confusion, ataxia, opthalmolegia ( cerebellum anterior
destroyed)
Korsafoff: IRREVERSIBLE memory loss, confabulation, personality
(mammillary bodies)
Wallory Weiss: longitudinal and painful vs esophagueal varies (painless)
Treat : thiamine, sedative- hypnotics, lorazepam if seixure
Withdrawal
1. Day 1: autonomic hyperactivity
2. 2: seizure
3. 3: Delirium Tremens: psychotic and confusion ( LIFE THREATENING)
Fetal Alcohol Syndrome: #1 cause mental retardation ( then Downs and
Fragile X)
Statistics
The median always captures half of the patients, so can always get the number from
normal curve or skewed ones.
Prevalence
Sensitivity and specificity come with the test ( they dont chancge with
Prevalence)
Prevalence directly correlated with PPV increase together, NPV decrease
Prevalnce= incidence X duration ( but can have incidence increase without
prevalence increase if the those who die or recover the same)
Sensitivty = NPV related due to False Negative
Specificity = PPV due to False Positive
Accuracy : TP + TN/ Total
Weird biases names
Pygmalion: experimental expectancy prophecy
Hawthorne: if group knows they are studied they act different
Berkson: select patients only in the hospital
Variability
Range: highest lowest value
SD(s)
Variance (s^2)
Standard Eror Mean (SEM) indirectly to population: as population increase
the SEM decreases
Ethics
When informing a patient of difficult information, the most appropriate
course of action is to:
1) immediately inform the patient of the bad news you have cancer
2) give the patient a moment to think about and process the information
3) explain what the bad news means for the patient
4) answer any questions the patient may have
Capacity ( medical term) VS competence (legal term)
Competent unless
1. History suicide
2. Psychotic
3. Patient cannot communicate
Life in U.S
Divorce
50% divorce
#1 reason for mental hospitalize
doctor occupation highest divorce
Well being index : lowest for separated highest for married
Most likely risk : kid of parents who divorced
-education of woman low
Suicide
Health
HIV
With AIDs right now then were homo/ bisexual
With HIV right now IV drug abuse
Recent increase transmission male female especially if on period
Most dangerous sexual practice : ANAL SEX
Mom HIV + then 100% kids test positive since antibodies transfer this is why
dont do ELISA
-do PCR to see if infected
-RT-PCR to quantify amount virus
* prevent transmission by giving AZT + C-SECTION + DONT
BREAST FEED
Reportable diseases
Be A SSSMMART Chicken or your Gone with LYME
B: Hepitits B
A: heptatitis A
S: Syphilis
S:salmonella
S:Shigella
M: mumps
M: measles
A: AIDS
R: Rubella
T: T.B
Chicken pox
Gonorrhea + chlamydia
Lyme disease
Cancer: Women LUNG CANCER ON THE RISE
Infant mortality :
Highest African Americans
Native americans
Latin and white low ( except Puerto Ricans)
Sexuality
Avg age first sexual experience 16
50% done use regular birth control
hightest teenage pregnancy: Hispanic highest black Native white
asia
Highest incidence :HPV
Chlamydia number one, then gonorrhea in teens
Gender Identity stablished by 3 years old
Everyone from baby to elderly MASTERBATE , its normal
Paraphilic Disorders
Voyeurism : peeping tom
Frotteurism: rubbing onto people
Coprophilia : poop
Urophilia: urination
Necrophilia: dead people
Hypoxyphilia: hypoxia during orgasm
-Hypoactive (engage in sex but not too fond of it) vs Sexual aversion ( avoid all
sexual contact
-Females report peak sexual desire before period
-erection issues : postage stamp test, snap gauge ( have erection during REM ( high
ACH)
-Dyspareunia: reccurent persisitent pain before, during, after sex
-Vaginismus : involuntary muscle contraction so penis cant enter
-SEXUAL INTEREST DOESNT DECREASE WITH AGE!
Special topics
Anxiety: need medium anxiety to have optimum in performance
Pain is subjective therefore we need to give drugs if they say they are in pain
-Time contingent in hospital
-Pain contingent in Hospice ( self control and self administer)
Holmes and Rahe rate stressful events ( the most stressful is DEATH SPOUSE)
-MORE STRESS= more unhealthy later
-widow have higher rate of <3 attack in a year after spouce dies
IQ is a good predcotr of academic excellence
IQ stable from 5 onwards
IQ tests: Wechsler
1. WAIS-R : adults
2. WISC: 6-17 (children)
3. WPPSI : 4-6 (preschool)
4. Stanford- Binet Scale: 2-18
Personality Test
-Objective
1. Criterion referenced: results compared with present standard
2. Norm referenced: referenced to normal
-MMPI : Minnesota Multiphasic personality inventory
True and False test to over 550 things
-Projective test : ambiguous stimumuli
1. Rorschach Inkblot
2. TAT thematic apperception test: tell a story whats going on in pic
3. Scentence completion
4. Projective drawing: patient given paper and asked to draw something
Neuropsychological Tests TWO NAME TEST
- IQ IS HERE
Sleep
Nightmare
REM
Recall
Random
Incidence: NEW EVENTS / those at risk
Prevalence: ALL CASES( old + new) / total population at risk
If confidence interval doesnt have null then statistically significant, and then the p
value is LESS THAN 0.05
P value : less than 0.05 percent chance that the results obtained were due to chance
-also 0.05 percent that this is an alpha/ type 1 error
confounding variable is is exposure- disease relationship can be described by
another variable (confounder)
ARR= control- treatment
MODE IS MOST RESISTANT TO OUTLIERS
DIFF payment methods
Capitation: doctors paid a fixed amount PER PATIENT (not service). Causes high
preventative care
Fee for service: they are paid for every service therefore they dont care about
preventative medicine
Discounted fee for service
Salary : fixed salary therefore dont care about the services or number or people.
TESTS
Two sample z test and two sample t test used to compare TWO GROUP, MEANS
Chi- square test for CATEGORICAL DATA 2x2 table
ANOVA: MEANS of 2 or more groups
Meta analysis: pooling data from serveral studies to conduct an analysis having a
larger STATISTICAL POWER
Power: 1- beta error
- probability rejecting the null hypothesis when it is truly false
- probability finding true relationship
- depend on sample size. INCREASE SAMPLE SIZE INCREASE POWER
- TYPICALLY SET AT 80%
TYPE 1 error is like specificity but False positive numberator
Type 2 error like sensitivity
Berkson bias: selecting patients only hospitalized as the control group
Z score for 2 SD: 1.96
Z score for 2SD : 2.58