PRITE High Yield Topic Discussion Thread

[Admin]

First topic message reminder :

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 *****

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Administrator

[Admin]

Treatment of Juvenile Myoclonic Epilepsy

Avoid Triggers:
○ Sleep deprivation
○ Alcohol
○ Recreational drugs: Stimulants such as cocaine, amphetamines, GHB, and ketamine may exacerbate or trigger seizures and should be avoided.
○ Poor compliance: Importance of adherence to AEDs should be emphasized
○ Drug Interactions: interactions of AEDs with hormonal contraceptives.
○ Photosensitivity: Patients with photosensitive JME should be warned to avoid flashing lights, high luminescence contrast, or rapidly changing images, such as the stroboscopic light effects of clubs, some television programs, and video games.

Pharmacotherapy:
○ First line: Valproate
○ Levetiracetam and lamotrigine are preferred first-line options for young women, in view of the high teratogenic risk of valproate.
○ Drugs to be avoided in JME are carbamazepine, phenytoin, and oxcarbazepine, which can exacerbate absences and myoclonic jerks.
○ When access to treatment is limited or too costly, phenobarbital can be used

Source: Current Treatment Options in Neurology (2011) 13:355–370

[Admin]

Borderline Personality Disorder- What Questions to Ask?

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Transient Global Amnesia- Facts

* An attack must be witnessed by an observer who can provide additional information
* Anterograde amnesia must be present
* No other cognitive impairment or loss of personal identity may be present
* Patients know their names and have had no recent history of head trauma or seizures in the past two years
* Focal neurologic signs and epileptic features are absent
* Resolution of the attack should occur within 24 hours

* Most cases are preceded by an emotional stress, intense pain or cold, or strenuous physical activity.

* There is no increased incidence of vascular deaths or epilepsy in patients with an episode of transient global amnesia, BUT
* Significantly greater proportion of persons with recurrent episodes of transient global amnesia go on to experience epilepsy than do control subjects

[Admin]

[Admin]

Fatal Familial Insomnia- Facts

- Very rare autosomal dominant inherited prion disease.
- Mostly caused by a mutation to the protein PrPC.
- Age of onset: variable, ranging from 18 to 60, with an average of 50.
- Clinical: The disease has four stages, taking 7 to 18 months to run its course:
1. The patient suffers increasing insomnia, resulting in panic attacks, paranoia, and phobias (~ 4 months).
2. Hallucinations and panic attacks become noticeable, (~ 5 months).
3. Complete inability to sleep is followed by rapid loss of weight (~ 3 months).
4. Dementia, during which the patient becomes unresponsive or mute (~ 6 months). This is the final progression of the disease, after which death follows.
Other symptoms: profuse sweating, pinpoint pupils, the sudden entrance into menopause for women and impotence for men, neck stiffness, and elevation of blood pressure and heart rate. Constipation is common as well.
- Treatment: No treatments have proven efficacious

[Admin]

Medications for Alcohol Dependence- Comparison

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Serotonin Toxicity- Diagnostic Criteria

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Alexithymia is defined by:
- difficulty identifying feelings and distinguishing between feelings and the bodily sensations of emotional arousal
- difficulty describing feelings to other people
- constricted imaginal processes, as evidenced by a scarcity of fantasies
- a stimulus-bound, externally oriented cognitive style.

Alexithymia is not classified as a mental disorder in the DSM-IV

[Admin]

AACAP Practice Parameters for Bipolar Disorder in Children
Source: J. Am. Acad. Child Adolesc. Psychiatry, 2007;46(1):107Y125

Recommendation 1. Psychiatric Assessments for Children and Adolescents Should Include Screening Questions for Bipolar Disorder.
- Screening questions include inquiries about distinct, spontaneous periods of mood changes associated with sleep disturbances and psychomotor activation.
- Histories of depression and family histories of mood disorders are also important to assess.
- Symptoms of irritability, reckless behaviors, or increased energy are important to assess, but they occur in a number of different conditions and therefore lack specificity.
- Because emotional and behavioral difficulties in children are often context dependent, it is important to assess symptom reports in perspective given family, school, peer, and other psychosocial factors, rather than simply using a checklist to identify psychopathology.

Recommendation 2. The DSM-IV-TR Criteria, Including the Duration Criteria, Should Be Followed When Making a Diagnosis of Mania or Hypomania in Children and Adolescents.
- The pattern of illness, duration of symptoms, and association with psychomotor, sleep, and cognitive changes are important diagnostic clues.
- The illness represents a marked departure from baseline functioning, and it should be evident and impairing in different realms of the child`s life (i.e., not isolated to one setting).
- Acute psychosis in an adolescent may be the first presentation of mania, and it needs to be carefully assessed for other associated features, including a marked decrease in the need for sleep, affective lability, a lack of negative symptoms, and/or a positive family history.
- It is helpful to organize the clinical information using a life chart to characterize the course of illness, patterns of episodes, severity, and treatment response.
- Structured diagnostic interviews and questionnaires are available that may be helpful for diagnosing bipolar disorder in youth, with the K-SADS and the WASH-UKSADS being the most commonly used diagnostic tools in published research.

Recommendation 3. Bipolar Disorder NOS Should Be Used to Describe Youths With Manic Symptoms Lasting Hours to Less Than 4 Days or for Those With Chronic Manic-Like Symptoms Representing Their Baseline Level of Functioning .
- Youths characterized as having bipolar disorder NOS typically have high rates of comorbid disorders including ADHD, disruptive behavior disorders, posttraumatic stress disorder, anxiety disorders, and developmental disorders.
- It is important to examine for environmental triggers, patterns of events that reinforce the outbursts, significant pragmatic language impairment, and risk factors (e.g., history of maltreatment).

Recommendation 4. Youths With Suspected Bipolar Disorder Must Also Be Carefully Evaluated for Other Associated Problems, Including Suicidality, Comorbid Disorders (Including Substance Abuse), Psychosocial Stressors, and Medical Problems .

Recommendation 5. The Diagnostic Validity of Bipolar Disorder in Young Children Has Yet to Be Established. Caution Must Be Taken Before Applying This Diagnosis in Preschool children .
- Preschool children who present with mood and behavioral concerns must be carefully assessed for other contributing factors, including developmental disorders, psychosocial stressors, parent-child relationship conflicts, and temperamental difficulties.
- There are no definitive studies outlining a developmentally valid method for assessing manic symptoms in this age group, including grandiosity, flight of ideas, and attention that is too easily drawn to irrelevant stimuli.
- Moreover, patterns of disrupted sleep and energy must be assessed in the context of the developmental period.
- The diagnosis of a bipolar spectrum disorder in very young children potentially exposes them to aggressive pharmacotherapy.
- It is particularly important with preschoolers that intervention strategies address environmental, developmental, temperamental, and social factors that may relate to symptom presentation.

Recommendation 6. For Mania in Well-Defined DSM-IV-TR Bipolar I Disorder, Pharmacotherapy Is the Primary Treatment .
- The only agent with FDA approval for bipolar disorder in youths (age 12 years and older) is lithium, although that decision was made historically based on the adult literature.

Recommendation 7. Most Youths With Bipolar I Disorder Will Require Ongoing Medication Therapy to Prevent Relapse; Some Individuals Will Need Lifelong Treatment .

Recommendation 8. Psychopharmacological Interventions Require Baseline and Follow-up Symptom, Side Effect (Including Patient`s Weight), and Laboratory Monitoring as Indicated .

Recommendation 9. For Severely Iimpaired Adolescents With Manic or Depressive Episodes in Bipolar I Disorder, Electroconvulsive Therapy (ECT) May Be Used If Medications Either Are Not Helpful or Cannot Be Tolerated .

Recommendation 10. Psychotherapeutic Interventions Are an Important Component of a Comprehensive Treatment Plan for Early-Onset Bipolar Disorder .

Recommendation 11. The Treatment of Bipolar Disorder NOS Generally Involves the Combination of Psychopharmacology With Behavioral/Psychosocial Interventions .

[Admin]

Progressive Supranuclear Palsy (PSP) Vs Parkinson's disease

- Pt with PSP usually stand straight or occasionally even tilt their heads backward (and tend to fall backward), while those with Parkinson's disease usually bend forward.
- Problems with speech and swallowing are much more common and severe in PSP than in Parkinson's disease, and tend to show up earlier in the course of the disease.
- Eye movements are abnormal in PSP but close to normal in Parkinson's disease.
- Tremor, very common in individuals with Parkinson's disease, is rare in PSP.
- Both diseases share other features: onset in late middle age, bradykinesia (slow movement), and rigidity of muscles.
- Pt with Parkinson's disease markedly benefit from the drug levodopa, people with PSP respond poorly and only transiently to this drug.

[Admin]

Treatment of Depression with Atypical Features.
Source: Henkel V, et al, Psychiatry Res. 2006.

The present meta-analysis addressed the empirical evidence regarding the treatment of major depression with atypical features.
Only eight publications met inclusion/exclusion criteria, resulting in 11 comparisons.
Results contrast an effect size of 0.45 (95% CI) for a comparison of MAOIs vs. placebo with an effect size of 0.02 (95% CI: - 0.10-0.14) for a comparison of MAOIs vs. SSRIs. The effect size for MAOIs vs. TCAs was 0.27 (95% CI: 0.16-0.42).

MAOIs may be more effective for atypical major depressive disorder than tricyclic antidepressants. Most clinical research has been conducted on irreversible MAOIs. Additional studies testing more recently developed antidepressants (including reversible MAOIs) with an improved safety profile would be warranted. The available data are insufficient for a direct comparison between MAOIs and selective serotonin reuptake inhibitors.

Also read a typical case presentation of Depression with Atypical Features ---> http://bit.ly/mU2Wxa

[Admin]

[Admin]

The Social Learning Theory of Julian B. Rotter

Rotter has four main components to his social learning theory model predicting behavior. These are behavior potential, expectancy, reinforcement value, and the psychological situation.

Behavior Potential:
Behavior potential is the likelihood of engaging in a particular behavior in a specific situation. In other words, what is the probability that the person will exhibit a particular behavior in a situation? In any given situation, there are multiple behaviors one can engage in. For each possible behavior, there is a behavior potential. The individual will exhibit whichever behavior has the highest potential.

Expectancy:
Expectancy is the subjective probability that a given behavior will lead to a particular outcome, or reinforcer. How likely is it that the behavior will lead to the outcome? Having "high" or "strong" expectancies means the individual is confident the behavior will result in the outcome. Having low expectancies means the individual believes it is unlikely that his or her behavior will result in reinforcement. If the outcomes are equally desirable, we will engage in the behavior that has the greatest likelihood of paying off (i.e., has the highest expectancy). Expectancies are formed based on past experience. The more often a behavior has led to reinforcement in the past, the stronger the person's expectancy that the behavior will achieve that outcome now.

It is important to note that expectancy is a subjective probability, because one common source of pathology is irrational expectancies. There may be no relationship whatsoever between the person's subjective assessment of how likely a reinforcement will be and the actual, objective probability of the reinforcer's occurring. People can either over- or underestimate this likelihood, and both distortions can potentially be problematic.

Reinforcement Value:
Reinforcement is another name for the outcomes of our behavior. Reinforcement value refers to the desirability of these outcomes. Things we want to happen, that we are attracted to, have a high reinforcement value. Things we don't want to happen, that we wish to avoid, have a low reinforcement value. If the likelihood of achieving reinforcement is the same, we will exhibit the behavior with the greatest reinforcement value (i.e., the one directed toward the outcome we prefer most).

As with expectancy, reinforcement value is subjective, meaning that the same event or experience can vastly differ in desirability, depending on the individual's life experience. Punishment from a parent would be negatively reinforcing to most children, and something to be avoided. However, children who get little positive attention from parents can seek out parental punishment because it has a higher reinforcement value than neglect.

The least amount of reinforcement that still has a positive value is known as the minimal goal. If people achieve an outcome that equals or exceeds their minimal goal, they will feel that they have succeeded. When the level of reinforcement falls below an individual's minimal goal, that reinforcement feels like failure. People differ in their minimal goals. Thus, the same outcome may represent success to one person (with a lower minimal goal) while it feels like failure to another person (with a higher minimal goal).

Predictive Formula. Behavior Potential (BP), Expectancy (E) and Reinforcement Value (RV) can be combined into a predictive formula for behavior:

BP = f(E & RV)

This formula can be read as follows: behavior potential is a function of expectancy and reinforcement value. Or, in other words, the likelihood of a person's exhibiting a particular behavior is a function of the probability that that behavior will lead to a given outcome and the desirability of that outcome. If expectancy and reinforcement value are both high, then behavior potential will be high. If either expectancy or reinforcement value is low, then behavior potential will be lower.

Psychological Situation:
Although the psychological situation does not figure directly into Rotter's formula for predicting behavior, Rotter believes it is always important to keep in mind that different people interpret the same situation differently. Again, it is people's subjective interpretation of the environment, rather than an objective array of stimuli, that is meaningful to them and that determines how they behave.

Source: http://psych.fullerton.edu/jmearns/rotter.htm

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