Psychiatry and Substances Abuse Course

Explore borderline personality disorder, its impulsivity and fear of abandonment, the splitting ego defense, self-harm, suicide attempts, and self-destructive behaviors, and dialectical behavior therapy as the primary treatment.

Identify generalized anxiety disorder by six months of excessive worry with at least three symptoms. Treat with cognitive behavioral therapy and SSRIs or SNRIs as first line.

PTSD follows severe trauma, with hyperarousal, flashbacks, nightmares, and avoidance lasting at least one month, treat with CBT and SSRIs; consider SNRIs and avoid benzodiazepines.

Body dysmorphic disorder, an obsessive-compulsive spectrum condition, involves preoccupation with appearance, distress, and mirror checking, often with eating disorders; treat with cognitive behavioral therapy, with or without SSRIs.

Catatonia, triggered by psychiatric disorders and treatments, features mutism, negativism, posturing with waxy flexibility, and echolalia. Treat by stopping current medications, then lorazepam, and electroconvulsive therapy if needed.

Delirium affects elderly or hospitalized patients with confusion and sleep disturbance; treat underlying infections or electrolyte issues, orient patients, support sleep, and use haloperidol only if needed, avoiding restraints.

Diagnose gambling disorder by four features: preoccupation, loss recovery attempts, damaged relationships and jobs, and dependence on others. Treat with cognitive behavioral therapy first, then gambling support groups.

Diagnose major depressive disorder by five siege caps symptoms over two weeks with impairment; treat with SSRIs, adding antipsychotics for psychotic features and long-term maintenance when needed.

Malingering involves consciously faking symptoms to gain a specific secondary gain, like sick leave; factitious disorder involves faking symptoms to play sick for sympathy with no secondary gains.

Narcolepsy, caused by decreased orexin, leads to daytime sleepiness and naps, with night insomnia, cataplexy, hypnagogic and hypnopompic hallucinations, and decreased REM latency; treated with meadow perennial and video vinyl.

Compare obsessions and compulsions in obsessive-compulsive disorder and obsessive-compulsive personality disorder, noting egodystonic versus egosyntonic perspectives.

Diagnose panic disorder after at least one month of panic attacks with fear of attacks, worry about consequences, and changes; treat with cognitive behavioral therapy, SSRIs, and lorazepam during attacks.

Explores somatic symptom disorder, illness anxiety disorder, and conversion disorder, detailing unexplained symptoms such as abdominal pain, fear of illness, and neurological symptoms incompatible with known diseases.

Address pediatric bedwetting by ruling out cystitis with urine analysis and sleep hygiene and rewards. Use enuresis alarms and desmopressin to reduce urine output, reserving TCAs as a last option.

Examine childhood neurodevelopmental disorders, including adhd with attention-focused treatment, autism with the repo mnemonic and savant, Rett syndrome, Tourette, separation anxiety, oppositional defiant versus conduct disorder.

Identify Tourette syndrome with onset before 18, with vocal or motor tics including coprolalia and OCD/ADHD, treat with behavioral therapy, then dopamine blockers (tetrabenazine, haloperidol), then alpha-two blockers (guanfacine, clonidine).

Identify age-related autism symptoms from birth to early childhood, including lack of eye contact, not responding to name, reduced facial expressions, and absence of joint attention and interactive play.

Identify autism presentations in early childhood, including social-communication barriers like poor eye contact, limited facial expressions and gestures, and a robotic tone, along with repetitive movements and restricted interests.

Examine hereditary and genetic factors in autism, including family history and Fragile X syndrome, plus risks from older maternal age, toxins, and prenatal medications like thalidomide and valproic acid.

Prioritize therapies over medications, starting with behavioral and communication therapy to reduce social deficits and teach new skills, with preschool one-on-one educational therapy and family therapy as key supports.

Identify the five DSM-5 autism specifiers: intellectual impairment, language impairment, genetic or environmental factors, neurodevelopmental disorders, and catatonia—and the shift from previous diagnoses.

Define schizoaffective disorder as psychosis with mood disturbances lasting at least two weeks, with psychosis persisting between mood episodes, unlike bipolar disorder. Treat with mood stabilizers plus antipsychotics.

Factor in onset age, duration, sex, triggers, and symptoms to shape schizophrenia prognosis; adulthood onset, short duration, positive symptoms, and female sex predict better outcomes.

Identify positive symptoms like delusions, hallucinations, disorganized speech and behavior; negative symptoms such as decreased emotions and flat affect; and cognitive symptoms including memory and learning difficulties in schizophrenia.

Explore cluster a personality disorders, where eccentricity defines three categories: paranoid, schizoid, and schizotypal, with paranoid hypervigilance, distrust and unfounded suspicion, schizoid social detachment, and schizotypal unusual thoughts.

Explore antisocial personality disorder and conduct disorder before 18, plus borderline, histrionic, and narcissistic personality disorders, including dialectical behavior therapy and second generation antipsychotics.

Cover cluster c personality disorders by detailing egosyntonic OCPD versus egodystonic OCD, avoidant traits with sensitivity to criticism, and dependent personality disorder with clingy, caretaker-seeking behavior.

Explore immature and mature ego defenses, including displacement, identification, isolation of affect, projection, rationalization, reaction formation, repression, dissociation, splitting, fixation, regression, intellectualization, denial, sublimation, altruism, suppression, and humor.

Autonomy empowers patients to accept or refuse treatment after receiving complete information on options, risks, benefits, and alternatives, while physicians must not sway decisions.

Examine the beneficence principle in medicine, balancing patient best interests with autonomy, and know when to adapt guidelines to individual cases, such as offering analgesia when surgery is refused.

Promote fairness in medical decisions by aligning impartial, equitable treatment with triage that prioritizes life-threatening needs over non-urgent cases.

Prioritize patient safety by applying nonmaleficence—do no harm and minimize harm when unavoidable—by weighing risks and benefits, even when overriding autonomy to protect the community.

Identify neuroleptic malignant syndrome by fever, encephalopathy, vital dysregulation, elevation of myoglobin, rigidity, and hyperreflexia, then treat with dantrolene and bromocriptine targeting D2 receptors.

Neuroleptic malignant syndrome, caused by antipsychotics, presents with fever, altered mental status, muscle rigidity, and autonomic dysfunction, and can be fatal; culprits include haloperidol, chlorpromazine, fluphenazine, trifluoperazine, prochlorperazine, and risperidone.

Identify drugs that trigger serotonin syndrome, including SSRIs and SNRIs, bupropion, TCAs, MAO inhibitors, and non antidepressants like antimigraine meds, opioids, lithium, and illicit drugs.

Differentiate serotonin syndrome, neuroleptic malignant syndrome, and malignant hyperthermia by tremors, rigidity, and anesthesia history; discontinue agents, provide supportive care, apply cyproheptadine for serotonin syndrome, and consider dantrolene or bromocriptine.

Explore abnormal movements—chorea, myoclonus (hiccups), dystonia, athetosis, and tremors (essential, resting, intentional)—their patterns and links to basal ganglia disorders, hunting syndrome, parkinsonism, and cerebellar disorders.

Explore how REM sleep activates the brain and generates dreams, while muscle atonia prevents movement; in older adults and advanced parkinsonism, atonia fails, leading to REM sleep behavior disorder.

Study major dementia types, including Alzheimer's disease with beta-amyloid plaques and tau tangles, frontotemporal dementia, Lewy body dementia with hallucinations, vascular dementia, and Creutzfeldt Jakob dementia.