PRITE High Yield Topic Discussion Thread

[Admin]

Hi Friends.

This thread is dedicated to PRITE (Psychiatry Resident-In-Training Examination) Preparation.
Please contribute important high yield topics and notes here.

INDEX:

Page 1:
• Typical Antipsychotics
• Borderline Personality Disorder
• Schizophrenia
• Dopaminergic Pathway Functions & Effect of Antipsychotics
• Sigmund Freud’s Structural Model- The id, ego, and superego
•  Major depression with Atypical features
• Akathisia treatment
• Rabbit Syndrome
• Risperidone vs Clozapine

Page 2:
• Cluster A Personality disorder- differential diagnosis
• Cluster B Personality disorder- differential diagnosis
• Cluster C Personality disorder- differential diagnosis
• Personality disorder in toto (HY Facts)
• Frontotemporal dementia Vs Alzheimer’s dementia
• Autoreceptors Vs Heteroreceptors
• Visual Pathway And Associated Visual Defects
• Myasthenia Gravis
• Jean Piaget's Cognitive Development Stages
• Normal Aging- Facts
• Erikson's Stages of Psychosocial Development
• Cognitive Theory for depression Management

Page 3:
• Interpersonal Therapy (IPT)
• Valproate
• Childhood Onset Schizophrenia
• Recommenda​tions for monitoring adults on atypical antipsycho​tics
• Pediatric Depression- Which SSRI is Superior
• Neuroleptic Malignant Syndrome
• Hispanic culture-bound syndromes
• Elevated Clozapine Levels
• Pervasive Developmental Disorder Not Otherwise Specified (Including Atypical Autism)
• Diagnostic criteria for Attention-Deficit/Hyperactivity Disorder
• Diagnostic criteria for Gender Identity Disorder
• Freud's Topographical Model
• HIV Dementia/Toxoplasmosis/CNS Lymphoma/Cryptococcal Meningitis/PML
• Gait Abnormalities

Page 4:
• Trigeminal neuralgia Vs Post Herpetic Neuralgia
• Carbon Monoxide Toxicity: Brain MRI Findings
• Lumbar & Sacral Nerve Root Compromise
• Classic Conditioning Vs Operant Conditioning
• Observational Study Design: Case control Vs Cohort
• Alexia/Apraxia/Agnosia/Akinesia/Aphasia
• Adjustment Disorders Vs Acute Stress Disorder
• SNRIs: Venlafaxine Vs Duloxetine
• DSM IV Criteria for Manic Episode
• Bipolar Disorder: 15 Minutes CORE Psychiatric Evaluation- 4 Decision Points
• Bipolar Depression Vs Unipolar Depression
• Difference Between Classical Conditioning & Extinction
• "Neurology" Questions/HY Facts for PRITE (Post 1 & 2)

Page 5:
• Catatonia
• CVA
• "Delirium" & "Dementia"
• Seizure
• Obsessive-compulsive disorders
• Role of Ziprasidone in combination therapy for Bipolar maintenance
• Recognition of GAD in Primary Care Setting
• Social Anxiety Disorder
• Panic Disorder
• ADHD (Recent Facts)
• Basics of Nor-Epinephrine, Dopamine & Seretonin Neurons.
• Hyperprolactinaemia With Antipsychotics
• Idiopathic Parkinson Ds Vs Other Parkinsonian Syndrome
• Pathophysiology of Neuroleptic Malignant Syndrome (NMS)

Page 6:
• Treatment of Juvenile Myoclonic Epilepsy
• Borderline Personality Disorder- What Questions to Ask?
• Transient Global Amnesia- Facts.
• Effective Dose for Antipsychotics- ED50 & Near-Maximal ED
• Fatal Familial Insomnia
• Medications for Alcohol Dependence
• Serotonin Toxicity- Diagnostic Criteria
• Alexithymia
• AACAP Practice Parameters for Bipolar Disorder in Children
• Progressive Supranuclear Palsy Vs Parkinson's disease
• Treatment of Depression with Atypical Features
• Types of Aphasia
• The Social Learning Theory of Julian B. Rotter

***** Updated Daily *****

Regards
Administrator

[Admin]

Typical Antipsychotic (Dopamine Receptor Antagonist)

1 • Following a first episode of psychosis: patient maintained on medications for 1-2 years.
• Following a second episode of psychosis: patient maintained for 2-5 years.
• Following multiple episodes: patient maintained on lifelong treatment.

2 • In cases of Phencyclidine intoxications: Benzodiazepines should be used instead of DRAs.
Reason: Anticholinergic effect of DRAs

3 • In patients experiencing hallucinations or delusions result of alcohol withdrawal: DRAs may increase the risk of seizure.

[psychinmymind]

most common defense mechanisms used by people with borderline personality disorder are
Splitting, denial, projection, projective identification, acting out, idealization, and devaluation.

[psychinmymind]

The CNS structure consistently different in borderline personality-disordered patients with a history
of trauma is the amygdala which is consistently reduced in volume. ALso, there is associated hyperactivity of the amygdala. The hypothalamic pituitary adrenal axis has also been shown to be hyperactive in these individuals.

[psychinmymind]

Admin, Could you please explain more on 2 • In cases of Phencyclidine intoxications: Benzodiazepines should be used instead of DRAs.
Reason: Anticholinergic effect of DRAs

[Admin]

Admin, Could you please explain more on 2 • In cases of Phencyclidine intoxications: Benzodiazepines should be used instead of DRAs.
Reason: Anticholinergic effect of DRAs

Explanation is as follows:
At high doses of Phencyclidine (PCP) use- PCP have anticholinergic action. Hence neuroleptics with potent intrinsic anticholinergic property should be avoided. As a precautionary measure- BZD should be used first followed by DRAs, but there is no convincing evidence that either of them is clinically superior.

[Admin]

Schizophrenia

* First Rank symptoms of Kurt Schneider indicates poor prognosis.

First rank symptoms include:
- Audible thoughts
- Voice arguing or discussing or both
- Voice commenting
- Somatic passivity experience (e.g., control of pt body by influence of other)
- Thought withdrawal & other experiences of influenced thought
- Thought broadcasting
- Delusional perceptions
- All other experiences invloving volition made affect, and made impulses.

[Admin]

Found an interesting fact:

Q- What is the reason for "Auditory Hallucinations" in Schizophrenics

Schizophrenic pt exhibits an inability to filter out irrelevant sounds & are extremely sensitive to background noise. The flooding of sounds that results make concentration difficult & may be a factor in production of auditory hallucinations.

[Admin]

Dopaminergic Pathway Functions & Effect of Antipsychotics

Dopamine Track	Pathway	Function	Antipsychotic Drug Effect
Nigrostriatal	substantia nigra in the midbrain to the caudate nucleus in the basal ganglia	Extrapyramidal System	Movement disorders
Mesolimbic	midbrain to limbic system	Arousal, Memory, Stimulus processing, Motivation	Relief of Psychosis
Mesocortical	midbrain to temporal & frontal lobes of the cerebral cortex	Cognition, communication social function, response to stress	Relief of Psychosis, Akathisia?
Tuberoinfundibular	hypothalamus to the median eminence of the anterior pituitary	Regulates prolactin release	Increased prolactin Concentrations

[Admin]

Sigmund Freud’s Structural Model- The id, ego, and superego

[img][/img]

Freud proposed three structures of the psyche or personality:

Id: a selfish, primitive, childish, pleasure-oriented part of the personality with no ability to delay gratification.
Superego: internalized societal and parental standards of "good" and "bad", "right" and "wrong" behaviour.
Ego: the moderator between the id and superego which seeks compromises to pacify both. It can be viewed as our "sense of time and place"

[Admin]

Q. Young female pt
C/C: fatigue
HOPI: For past 2-3 weeks, c/o profound tiredness, increased need for sleep & increased appetite. These symptoms started after a break up with her boyfriend.
Pt's symptoms rapidly improved after she reunited with her boyfriend.

What is the diagnosis:
(a) Bipolar disorder with rapid cycling
(b) Borderline personality disorder
(c) Major depression with Atypical features.

*************************************************

Answer: Major depression with Atypical features
*************************************************

Explanation:
This is an important question, because "Major depression with Atypical features" is the most common subtype of depression (so more chances of questions on this topic on PRITE & related exams).

Look for following points:
(1) Mood brightens in response to actual or potential positive events (Compared to Melancholic subtype: mood doesn't brighten even in response to positive events).
(2) 2 or more of following features:
- Significant weight gain/increase in appetite
- Hypersomnia
- Leaden paralysis (heavy, leaden feelings in arms & legs)
- Long standing pattern of interpersonal rejection sensitivity that results in significant social & occupational impairment.

[psychinmymind]

β-Blockers and benzodiazepines are useful for the treatment of akathisia but not dystonia.

[psychinmymind]

Rabbit syndrome is a focal, perioral, Parkinsonian tremor that is a side effect of antipsychotic agents. It usually has a
late onset of presentation and responds to drug dosage decrease or antiparkinsonian agents

[psychinmymind]

Risperidone appears to have higher efficacy in patients with psychosis and depression, but is more likely to cause
mania than clozapine. Clozapine appears to control manic states much better than depressive states.

[Admin]

Risperidone appears to have higher efficacy in patients with psychosis and depression, but is more likely to cause
mania than clozapine. Clozapine appears to control manic states much better than depressive states.

Good Info PsychInMyMind. What is the source of this information (any citations). Thanks

[psychinmymind]

taught in our didactics

[Admin]

taught in our didactics

Thanks for sharing. Keep up the good work

[Admin]

Cluster A Personality Disorders- Differential Diagnosis

1. Paranoid Personality Disorder

Paranoid Personality Disorder	Delusional disorder and Schizophrenia
Reality testing intact	Reality testing lost

Paranoid Personality Disorder	Schizoid and Avoidant personality disorder
	Amount and Degree of paranoia is significantly less

2. Schizoid Personality Disorder

Schizoid Personality Disorder	Schizophrenia
1. Reality testing intact	Reality testing not intact
Abstracting ability normal	Abstracting ability impaired
Presence of formal thought process	formal thought process impaired

Schizoid Personality Disorder	Paranoid Personality Disorder
Less socially oriented ideations	More socially oriented ideations
Amount and Degree of paranoia is significantly less

Schizoid Personality Disorder	Obsessive Compulsive & Avoidant Personality Disorder
	often socially isolated, but view loneliness as ego-dystonic or ego-alien and they enjoy a richer interpersonal history

3. Schizotypal Personality Disorder

Schizotypal Personality Disorder	Paranoid & Schizoid Personality Disorder
	Share many core features; but differs by degree or absence of eccentricity

Schizotypal Personality Disorder	Borderline Personality Disorder
	Share unusual speech & perceptual style; but demonstrates stronger affect & connection to others

Schizotypal Personality Disorder	Avoidant Personality Disorder
	Also uncomfirtable & inept in social situations; but are not eccentric & crave for contact with others.

Schizotypal Personality Disorder	Schizophrenia
	1) Reality testing lost. 2) Psychosis present

[Admin]

Cluster B Personality Disorder- Differential Diagnosis

- Share the common features of being dramatic, emotional, and erratic
- Said to combine abnormalities in both thinking and affect, but not to be predominantly one or the other cluster, such as cluster A (thinking) or cluster C (affect)



1. Antisocial Personality Disorder

Antisocial Personality Disorder	Borderline Personality Disorder
	demonstrate more repetitive suicidal and parasuicidal behaviors, as well as intense affect and self-loathing

Antisocial Personality Disorder	Narcissistic Personality Disorder
Blue collar crime (primary motivation is short-term material gain)	White collar crime (primary motivation is to maintain their grandiose self-image- power and money)

Antisocial Personality Disorder	Bipolar Mania
	often lack a significant degree of childhood conduct problems, & antisocial behavior is usually limited to manic episodes

Antisocial Personality Disorder	Substance abuse disorder
	criminal behaviors associated with substance abuse disorders generally center around using and obtaining the drugs

2. Borderline Personality Disorder

Borderline Personality Disorder	Histrionic, Narcissistic, & Dependent disorders
	more stable identities & rarely engage in self-mutilation or chronic suicidal behaviors

Borderline Personality Disorder	Bipolar Spectrum Disorder
mood swings does not meet criteria for manic or hypomanic episodes	mood swings meet criteria for manic or hypomanic episodes

3. Histrionic Personality Disorder

Histrionic Personality Disorder	Narcissistic Personality Disorder
is more outwardly emotional and deeply involved with others	lack empathy for others ; and more preoccupied with grandiosity and envy

Histrionic Personality Disorder	Dependent Personality Disorder
	Both shares the need for acceptance and reassurance; DPD lacks the degree of emotionality seen in histrionic individuals

Histrionic Personality Disorder	Dependent Personality Disorder
	Both shares the need for acceptance and reassurance; DPD lacks the degree of emotionality seen in histrionic individuals

Histrionic Personality Disorder	Somatization disorder
	greater emphasis on physical complaints

4. Narcissistic Personality Disorder

Histrionic Personality Disorder	Narcissistic Personality Disorder
is more outwardly emotional and deeply involved with others	lack empathy for others ; and more preoccupied with grandiosity and envy

Antisocial Personality Disorder	Narcissistic Personality Disorder
Blue collar crime (primary motivation is short-term material gain)	White collar crime (primary motivation is to maintain their grandiose self-image- power and money)

[psychinmymind]

Frontotemporal dementia ----------Alzheimer’s dementia

Early loss of social skills----------Social skills preserved until late
Memory loss late in disease----------Memory loss often presenting symptom
Early loss of executive function----------Late loss of executive function
Stereotyped speech with terminal mutism----------Fluent aphasia
Semantic anomia----------Lexical anomia
Visuospatial deficits late in disease----------Visuospatial deficits characteristic
Frontotemporal hypoperfusion/hypometabolism----------Parietal and posterior temporal abnormalities
No specific neuron type affected----------Cholinergic neurons targeted
Initial presentation of personality change----------Personality change is late

[psychinmymind]

Autoreceptors are receptors located on neurons that produce the endogenous ligand for that particular receptor (e.g., a serotonergic receptor on a serotonergic neuron).
By contrast, heteroreceptors are receptor subtypes that are present on neurons that do not contain an endogenous ligand for that particular receptor subtype (e.g., a serotonergic receptor located on a dopaminergic neuron).

[Admin]

Cluster C Personality Disorders- Differential Diagnosis

1. Avoidant Personality Disorder

Avoidant Personality Disorder	Schizoid Personality Disorder
Desire relationships with others	Do not desire relationships with others

Avoidant Personality Disorder	Dependent Personality Disorder
	greater fear of abandonment, and embraces, rather than avoids, relationships

Avoidant Personality Disorder	Social phobia
	more specific fears around social performances

2. Dependent Personality Disorder

Dependent Personality Disorder	Histrionic Personality Disorder
Both shares the need for acceptance and reassurance; DPD lacks the degree of emotionality seen in histrionic individuals	have issues of dependency, but shorter and more numerous relationships

Dependent Personality Disorder	Borderline Personality Disorder
become more placating around real or perceived abandonment	express more affect and anger around real or perceived abandonment

Dependent Personality Disorder	Avoidant Personality Disorder
When faced with rejection or termination of a relationship, they quickly seek out a new relationship to fill the void	When faced with rejection or termination of a relationship, they withdraw from further contact

Dependent Personality Disorder	Agorophobia
	higher level of fear around leaving specific safe environments, especially home

3. Obsessive-Compulsive Personality Disorder

Obsessive-Compulsive Personality Disorder (OCPD)	obsessive-compulsive disorder (OCD)
have true obsessions and compulsions that they find ego-dystonic	find that their behaviors are ego-syntonic and rewarded by others

[Admin]

Personality Disorders (High Yield Facts)

Cluster A Personality Disorders- Differential Disgnosis. http://bit.ly/qVvufk

Cluster B Personality Disorders- Differential Disgnosis. http://bit.ly/qKFSsl

Cluster C Personality Disorders- Differential Disgnosis. http://bit.ly/qEAhR0

Facts:

- Schizotypal Personality Disorder: there appears to be a higher occurrence of this disorder in the biological relatives of schizophrenic patients, and the disorder is frequently diagnosed in women with fragile X syndrome.

- Personality disorders in cluster B are said to combine abnormalities in both thinking and affect, but not to be predominantly one or the other cluster, such as cluster A (thinking) or cluster C (affect).

- Because patients with antisocial PD are so indifferent to how their actions affect others, this is the personality disorder most resistant to treatment.

- Patients with antisocial PD have an onset of conduct disorder before age 15, and frequently suffer from co-morbid attention-deficit/hyperactivity disorders, polysubstance disorders, and somatization disorder. The exact etiology is unknown, but this disorder occurs five times more commonly in first-degree relatives of males with the disorder

- Under stress, borderline patients may also experience brief reactive psychotic states (also known as “micropsychotic episodes”)

- BPD is the most prevalent personality disorder in all clinical settings (12% to 15%)

- Some believe that while not all borderline patents are histrionic,but most HPD patients have sufficient borderline traits to merit a diagnosis of BPD.

- Narcissistic Personality disorder pt lack empathy for others, although less so than the antisocial patient

- For some narcissistic patient, aging is the ultimate blow to their self-esteem, as many of the qualities that help maintain their identity (e.g., career, health, beauty, and youth) must naturally begin to fade. Consequently, the narcissistic patient is prone to severe midlife crises.

- Avoidant PD are at especially high risk for anxiety disorders and for social phobia

- Patients with a history of childhood separation anxiety or chronic illness may be predisposed to the Dependent personality disorder.

- Interviewing for signs and symptoms of a personality disorder requires a longitudinal developmental perspective. Such longitudinal interviewing should assess the quality of the patient's social function in the areas of school, career, family, romantic relationships, peer group function, and interactions with authority figures. Across these categories, clinicians should listen for recurring themes of interpersonal conflict, disappointment, exploitation, or emptiness, because these can all indicate a personality disorder.

- While personality-disordered individuals often use lower-level defense mechanisms, such as projection and denial, and commonly disown responsibility for their actions, they often confirm a public or family consensus about their behavior if couched in sympathetic terms: “Have you ever been unjustly accused of taking things at your various jobs? How often?” “Do people fail to understand and admire your assertiveness and your refusal to get pushed around? Really? Tell me about that.”

- Patients with cluster C disorders improve more than patients with borderline personality disorder, while borderline patients improve more than schizotypal and antisocial personality-disordered patients.

- Patients with a cluster B personality disorder have a dropout rate of 40%, a cluster A disorder of 36%, and a cluster C disorder of 28%. Patients in group therapy have a higher dropout rate than do patients in individual therapy

- Select pharmacotherapy on the presence of specific target symptoms rather than on a given personality disorder diagnosis

[Admin]

Frontotemporal dementia ----------Alzheimer’s dementia

Early loss of social skills----------Social skills preserved until late
Memory loss late in disease----------Memory loss often presenting symptom
Early loss of executive function----------Late loss of executive function
Stereotyped speech with terminal mutism----------Fluent aphasia
Semantic anomia----------Lexical anomia
Visuospatial deficits late in disease----------Visuospatial deficits characteristic
Frontotemporal hypoperfusion/hypometabolism----------Parietal and posterior temporal abnormalities
No specific neuron type affected----------Cholinergic neurons targeted
Initial presentation of personality change----------Personality change is late

Semantic Anomia:
- Patients appear to suffer interference between related concepts (e.g., tiger-lion).
- Some patients can name natural kinds but not human artifacts, or vice versa.
- Utter grammatically correct speech that has no relevance to the conversation at hand ''

What is Lexical Anomia?.

Thanks

[Admin]

Visual Pathway And Associated Visual Defects

Lesion	Defect	Causes
(1)- Left Optic Nerve	Left Monocular Visual Loss	Trauma, Multiple Sclerosis
(2)- Optic Chiasma	Bitemporal Hemianopia	Pituitary Tumors
(3)- Optic tract	Homonymous Hemianopia	Stroke, Space Occupying Lesions
(4)- Lt Temporal Optic Radiation (Meyer's Loop)	Rt Homonymous Superior Quadrantanopia	Stroke, Space Occupying Lesions
(5)- Lt Parietal Optic Radiations	Rt Homonymous Inferior Quadrantanopis	Stroke, Space Occupying Lesions
(6)- Lt Occipital Lobe	Rt Homonymous Quadrantanopia with Macular Sparing	Stroke (Posterior Circulation)

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