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2.
1.
1. Psychotic
Disorders
Normal development
:
:
:
:
:
AntiPsychotics
4.
3.
2. Mood Disorders
Anxiolytics
Treatment:
Antidepressants
Mood Stabilizers
Treatment:
5.
6.
9. Dissociative Disorders
Dissociative Disorders in general involve memory loss, loss of identity or sense of self.
Definition: Have 2+ more distinct personalities that alternately control their behaviors and thoughts
ECCENTRIC
PECULIAR
WITHDRAWN
2. DISSOCIATIVE FUGUE:
4. DEPERSONALIZATION DISORDER:
Truth Serums
Ethanol
Scopolamine
3-Quinuclidinyl Benzilate,
Benzos:
Midazolam (Versed)
Flunitrazepam (Rohypnol)
Temazepam (Restoril)
Barbs:
Sodium Thiopental (Na-Pentothal)
Sodium Amobarbital (Na-Amytal)
DDx Dementia:
AEIOU TIPS
6. Cognitive
Disorders
Alcohol
Electrolytes
Iatrogenic
Anticholinergics
Benzodiazepines
Antiepileptics
Blood Pressure Medicines
Insulin
Hypoglycemics
Narcotics
Steroids
H2 Receptor Blockers
Nsaids
Antibiotics
Antiparkinsonians
DDx: Dementia
Depression (pseudodementia)
Delirium
Schizophrenia
Malingering
Cortical dementias
2. Structural:
Normal aging,
PD
HNT
Downs
TBI
CNS Tumor
NPH
MS
SDH
3. Metabolic
Hypothyroidism
Hypoxia
Malnutrition (B12, Folate, Thiamine Df)
Wilsons
Lead Tox
4. Infectious:
Lyme Disease
HIV Dementia,
CJD
Neurosyphilis
Meningitis
Encephalitis
5. Drugs
Oxygen = Hypoxia
Bleeding
Central Venous
Pulmonary)
Subcortical dementias
(#1 affective and movement symptoms)
Uremia/Hepatic Encephalopathy
CJD
LC Brainstem
AD (Alzheimers Dz)
Picks / FTD
Vascular Dementia
PD
Prognosis: 30% develop dementia, 50% suffer from MDD
Etiology: Idiopathic (MC), Traumatic (Ali), Drug-induced, Encephalitic, Familial (rare)
PD S/s:
CJD, BSE,
DDx vs AD
stepwise
focal neurological dfs (hyperreflexia or paresthesias)
onset = more abrupt
personality changes more pronounced
of Meynert @ Midbrain
ACh
NE
of Meynert @ Midbrain
Trauma
Infection
Poisons
Seizures (Post Ictal)
S/s: progressive dementia 6 to 12 months, 90% myoclonus, EPS, Ataxia, LMN signs
Path: spongiform cerebral cortex, neuronal loss, and hypertrophy of glial cells
Prognosis: death within 1yr
Dx Definitive: Pathological @ autopsy
Dx Probably: rapidly progressive dementia + sharp waves on (EEG) + 2/6 of
1. Bradykinesia
2. Cogwheel rigidity
4. Masklike facial expression
5. Shuffling gait
6. Dysarthria (abnormal speech)
Dx: MRI
PD Drugs
HNT Dz
AD DSM Criteria:
AAA + personality, cognitive functioning
Aphasia: scanning, word finding)
A. -Amyloid plaques in AD
DfDx: do not have any fixed delusions, are not frankly psychotic
Tx: Therapy > Anxiolytics or Antipsychotics (briefely)
B. NFT (tau) in AD
NPH
Etiologies of Delerium
CNS injury or disease
Systemic illness
Drug abuse/withdrawal
Hypoxia
Fever
Sensory deprivation
Medications (anticholinergics, steroids, antipsychotics, antihypertensives, insulin)
Postop anesthesia
Electrolyte imbalances
DDx Delerium
CVA Delerium + hemiparesis / FND
Dx: CT/MRI
Hypertensive Encephalopathy Delerium + elevated BP + papilledema
Dx: CT/MRI
Drug Intoxication Delerium + dialated pupils + tachycardia
Dx: UDS
Meningitis Delerium + fever + nucal rigidity + photophobia
Dx: Lumbar puncture
Thyrotoxicosis Delerium + tachycardia + tremor + thyromegaly
Dx: T4 + TSH
DDx delirium:
IM DELIRIOUS
SOURCES OF INFO
K-ABC: IQ 2.5-12yo
68-95-99.7 Rule:
Etiology
36% Chromosomal:
Downs (1/700) > FXS (1/4000)
Kleinfelters (1:700) not always have MR
18yo
WISC-R: IQ 6-16
b. LEARNING DISORDERS
2. Math
3. Writing
4. NOS
5%
5%
d. ADHD
c. DISRUPTIVE BEHAVIORAL DISORDERS
1. Conduct Disorder
-Structured environment
-Firm rules that are consistently enforced
-Individual dynamic psychotherapy
+behavior modification
-Rx: ANTIPSYCHOTICS, LITHIUM, SSRI
3. AMNESTIC DISORDERS
CAUSES
Hypoglycemia
Systemic illness (such as thiamine deficiency)
Hypoxia
Head trauma
Brain tumor
CVA
Seizures
Multiple sclerosis
Herpes simplex encephalitis
Substance use (alcohol, benzodiazepines, medications)
PROGNOSIS:
a. Full recovery: seizures, drug induced, metabolic, nutritional
b. Permanent: hypoxia, trauma, HSV, CVA
Types of ADHD:
Dx ADHD
-Inattentive ADHD
-Hyperactive impulsive ADHD
-Combined ADHD
Problems Listening
Concentrating
Paying Attention To Details
Organizing Tasks
Easily Distracted
Often Forgetful
B. Hyperactivity / Impulsivity
Blurting Out
Interrupting
Fidgeting,
Leaving Seat
Talking Excessively
Incidence = 1/100
Etiology: Genetic, Familial, Prenatal insults, Immuno
Associate with: FXS, TS, MR, Seizure d/o
2. DELERIUM
Rapid Onset
Periods of Altered Levels of Consciousness
Perceptual Disturbances (Hallucinations / Illusions)
Fluctuating Course w/ Lucid Intervals
Potential Reversal
Stuporous or Agitated
Anxious, Incoherent
Disrupted Sleep
OC-PD
Narcissistic PD
Hallmarks:
8. Psychiatric
Disorders
in Children
e. PDD =
Tx: underlying cause, cut polypharmacy, low dose antipsychotics, sedative hypnotic to correct sleep
Avoid using BENZOS in delirious patients, as they will often exacerbate the delirium.
FEUD: Fluids/Nutrition + Environment + Underlying cause + Drug withdrawal
DDx Dementia
C. Lewy bodies (-synuclein) in PD D. TDP-43 inclusions in MNs in ALS
3. HISTRIONIC-PD
8.
Dependent PD
MMSE scoring:
Perfect score: 30
Passing = 25
Dysfunction: < 25
PD Sx:
SPLITTING
Instability @ relationships, affect,
behavior, self image, Impulsivity
10% suicide rate (often a gesture that goes wrong)
Associated: MDD, Drugs, Suicide
Tx: Therapy > Pharmacotherapy
Histronic PD
Personality changes
2. BORDERLINE
Borderline PD
Avoidand PD
1. must be recurrent
2. patient can always recall details about event
1. DEMENTIA
PPD Criteria
Antisocial PD
Schizoid PD
C:
AVOIDANT
DEPENDENT
OBSESSIVECOMPULSIVE
B) CLUSTER B = Wicked
A) CLUSTER A = Wacky
Schizotypal PD
B:
EMOTIONAL
DRAMATIC
INCONSISTENT
7.
Stable, persistant, inflexible emotional, MALADAPTIVE PATTERN of behavioral traits that are EGO-SYNTONIC
EPI: each personality disorder is present in 1% of the population
Etiology: Bio-Psycho-Social
Cognition,
Affect
Personal Relations
Impulse control
A:
1. DISSOCIATIVE AMNESIA:
4. Personality Disorders
Dx Autistic d/o
1. Problems with social interaction,
2. Impairments in communication
3. loss of milestones
4. Hand writhing
5. Seizures
+ TIC DISORDERS
Epi: 1/2000 children, 3B : 1G, onset @ 7-8
Association with OCD and ADHD
Rx: Haldol, Pimozide (Orap)
Etiology = Genetic: HI = 46
Neuro: df of DA @ Caudate Nucleas
Df endoopiates, df NE
Definition:
The most severe tic disorder
Characterized by multiple daily motor or vocal tics
Onset before age 18
Dx:
1. Multiple motor and vocal tics (both must be present)
3. Onset < 18
4. Distress
DDx: Motor Tic Disorder or Vocal Tic Disorder
h. OTHER
1. Selective Mutism: F > M
g. ELIMINATION DISORDERS
1. Enuresis, MC: Secondary Nocturnal
Epi: 7% of 5yo
Etiology: genetic, small bladder, ADH dysregulation
Primary: never established
Secondary: between 5-8
Diurnal: daytime episodes
Nocturnal: nighttime
Tx: therapy
2. Encopresis
Dx: >4yo, once/month for 3months, inappropriate shitting
Epi: 1% of 5yo
DDx: R/O GMCs
-Metabolic abnormalities (hypothyroidism)
-Lower GI problems (anal fissure, IBS)
-Dietary factors
3. Child Abuse
MDs are mandated to report all cases suspected
Associated: with children of abuse, all axis 1 disorders
Sexual Abuse
Usually a Male who knows the child
25% of women, 12% of men
MC @ 9-12 yo
10.
9.
15. Psychotherapies
5. Substance-Related Disorders
7. Geriatric Psychiatry
NORMAL AGING
11.
NORMAL AGING:
Criteria = 1 or more of: Failure to fulfill obligations, Dangerous Use, Legal Consequences, Social Consequences
Tolerance, Withdrawal, Loss of control, Effort, $$$, other Interests, Continued use despite physical consequences
substance specific syndrome due to the cessation from prolonged use
-More Acute
-Emphasis On Failure
-No Sundowning
-No Confabulation
-Patient Is Aware
123
10
Serotonin Syndrome:
To convert Serum Ethanol Level to BAC
1. move the decimal point 3 places to the left.
EX (100 mg/dL serum ethanol level = a 0.10 (g/dL) BAC, or 0.10% (weight/volume)
This means that one tenth of a percent of a person's blood volume is alcohol
That a person has 1 part alcohol per 1000 parts blood
Most serious form of EtOH withdrawal, begins within 72hrs post cessation
5% of patients hospitalized for EtOH withdrawal develop DTs, 20% untreated mortality
S/s = delirium, visual or tactile hallucinations, gross tremor, autonomic instability
DDx: SDH, EDH, SAH, Look for signs of Cirrosis (ascites, jaundice, caput, coagulopathy)
Rx: Tapering doses of benzodiazepines (chlordiazepoxide, lorazepam)
+ Thiamine, folic acid, multivitamin
+ MgSO4 for postwithdrawal seizures
Wernicke Encephalopathy:
Korsokoffs Syndrome:
12.
Uncousciously
Faking
Primary Gain
Factitious D/O
Gain
(attention)
Secondary Gain
Malingering
Munchausen
13.
Medical conditions
Physical conditions
Sedative withdrawal
Caffeine, amphetamines
Major depression
Mania or anxiety
Neurotransmitter abnormalities:
DA or NE = total sleep time
ACh = total sleep time & REM
5HT = total sleep time & delta wave sleep
Cardiovascular
Myocardial atrophy
Mitral valve prolapse
Pericardial effusion
Brachycardia
Arrhythmia, which may cause sudden death
Electrocardiogram (ECG) changes
Long QT syndrome (QTc prolongation)
Increased PR interval
First-degree heart block
ST-T wave abnormalities
Hypotension
Acrocyanosis
Wake
REM
Endocrine
NREM
Gastrointestinal
14.
2.= abnormal
Parasomnias
events in behavior or physiology during sleep
1.= disturbances
Dyssomnias
in the amount, quality, or timing of sleep
a. Insomnia: 30% general population
a. Nightmare Disorder
Tx: 1. Behavioral,
Tx: 2. Benadryl, Ambien (zolpidem), Sonata (zaleplon), Desyrel (trazodone)
b. Hypersomnia:
Tx: diazepam
Associated with Somnambulism
c. Narcolepsy:
Epi: rare, M = F
= sudden attacks of sleep in the daytime for at least 3 months
-Cataplexy (loss of all muscle tone) in 70%
-Decreased REM latency, sleep paralysis, Hypnogogic, Hypnopompic
Rx: Ritalin, Amphetamines, Modafinil (Provigil), SSRIs, Na-Oxalate for Cataplexy
d. Breathing-Related Disorders:
OSA RFs
Male gender
Obesity
Male shirt collar size 17
Prior upper airway surgeries
Deviated nasal septum
Kissing tonsils
Large uvula, tongue
Retrognathia
Pulmonary
Hematologic
Neurologic
Dermatologic
17.
15.
b. KLEPTOMANIA
Kleptomana
25%
Kelptomania
+ Bulemia
Bulemia Nervosa
c. PYROMANIA
Epi: men and mentally retarded, earlier is better prognosis
d. PATHOLOGICAL GAMBLING
Lithium
e. TRICHOTILLOMANIA
Associated with OCD, OCPD, Relief, SSRIs, Antipsychotics, Lithium, Hypnosis
Substitution, break the habit
16.