Features: Hundreds of high-yield facts, mnemonics, clinical images, and summary tables help you ace the boards and in-service exams Covers must-know psychiatry and neurology topics in one complete volume Written by recent, successful test-takers and reviewed by top faculty so you know you're studying the most relevant, up-to-date material possible Integrated mini-cases review frequently tested scenarios and classic patient presentations Great for in-service and board exams and the perfect refresher before recertification Insider Coverage of All the Must-Know Topics: Guide to the ABPN Examination, Psychiatry Topics Disorders of Childhood Onset, Unipolar Depressive Disorders, Bipolar Disorder, Primary Psychotic Disorders, Substance Abuse and Dependence, Anxiety Disorders, Personality Disorders, Eating Disorders, Somatoform Disorders, Sleep and Sleep Disorders, D.
Score: 5. Focusing on the practical information you need to know, it teaches how to analyze a clinical vignette in the style of a morning report conference, sharpening your clinical decision-making skills and helping you formulate an evidence-based approach to realistic patient scenarios.
Questions are placed throughout the case to mimic practical decision making both in the hospital and on the board exam. Introductory chapters discuss practical psychiatry skills for daily functioning including taking a history, presenting and writing a note, briefly reviewing psychopharmacology, and ethical considerations. This text provides a comprehensive analysis of antipsychotic medications, covering historical, social, and scientific viewpoints on this important and controversial class of medications.
It is an invaluable resource for behavioral science foundation courses and exam preparation in the fields of medicine and health, including the USMLE Step 1. Stuber, MD, Professor of Psychiatry and Biobehavioral Sciences at UCLA, nearly 40 leading educators from major medical faculties have contributed to produce this well-designed textbook.
Sexual Dysfunctions and Paraphilic Disorders Chapter Psychotherapies Chapter Psychopharmacology Chapter Show more. Show less. About the Authors. Sean M. Publisher's Note: Products purchased from 3rd Party sellers are not guaranteed by the Publisher for quality, authenticity, or access to any online entitlements included with the product.
Wolters Kluwers is dedicated to providing quality content. This is a reprint of the Seventh Edition, corrected to address typographical errors identified by reviewers. Apply the proven First Aid formula for Psychiatry Board success! Using abbreviated and high yield chapters, this book presents the most up-to-date and useful information on psychiatric and neurologic concepts related to the ABPN examination.
Based on feedback from recent test-takers, this review offers high-yield information, mnemonics, and visual aids -- along with mini-cases for oral board success. The content is written by recent test-takers so you know you are studying the most current and relevant material possible.
Now you can get real answers to real board questions! You'll find radiologic images divided by modality, clear guidelines on when to order a specific modality and how to read the results, and illustrations of classic results of important conditions.
The Eleventh Edition of this this trusted review simulates the USMLE Step 2 CK test-taking experience by delivering multiple-step clinical vignette questions and updates on the latest therapies for psychiatric diseases and disorders.
Questions are carefully selected to match the style and difficulty level of what students will face on the test. This must-have fourth edition of top-selling Case Files: Family Medicine is reorganized by topic for easier learning during the clerkship, and is updated to reflect the latest guidelines on management of common conditions.
Features Updated to reflect new guidelines for common conditions, including HTN and cholesterol management 60 realistic family medicine cases with high-yield discussions aligned with the national family medicine clerkship curriculum USMLE-style review questions and clinical pearls accompany each case Primer on how to approach clinical problems and think like an experienced doctor.
Skip to content. Author : Latha Ganti,Matthew S. Kaufman,Sean M. Author : Matthew S. Introductory Textbook of Psychiatry Seventh Edition. Author : Donald W. Black, M. No jeans, no sneakers, no short-sleeved shirts. Women should wear long pants or knee-length skirt and a blouse or dressy sweater. Both men and women may wear scrubs occasionally, during overnight call for example. Do not make this your uniform.
Act in a Pleasant Manner It can be stressful to be around psychiatric patients. Smooth out your experi- ence by being nice to be around. Be Aware of the Hierarchy The way in which this will affect you will vary from hospital to hospital and team to team, but it is always present to some degree. In general, address your questions regarding ward functioning to interns or residents.
Address your medical questions to attendings; make an effort to be somewhat informed on your subject prior to asking attendings medical questions. Although you may feel these names are friendly, patients will think you have forgotten their name, that you are being inappropriately familiar, or both. As- sist the team in developing a plan; speak to consultants and family.
Never de- liver bad news to patients or family members without the assistance of your supervising resident or attending. All patients have the right to have their personal medical information kept private.
All patients have the right to refuse treatment. This means they can refuse treatment by a specific individual you, the medical student , or of a specific type no electroconvulsive therapy. Patients can even refuse life-saving treatment. The only exceptions to this rule are if the patient is deemed to not have the capacity to make decisions or under- stand situations, in which case a health care proxy should be sought, or if the patient is suicidal or homicidal.
All patients should be informed of the right to seek advanced direc- tives on admission. Often, this is done by the admissions staff, in a booklet. If your patient is chronically ill or has a life-threatening ill- ness, address the subject of advanced directives with the assistance of your attending. Volunteer Be self-propelled, self-motivated. Volunteer to help with a procedure or a diffi- cult task.
Volunteer to give a minute talk on a topic of your choice. Volun- teer to take additional patients. Volunteer to stay late. Be a Team Player Help other medical students with their tasks; teach them information you have learned. Support your supervising intern or resident whenever possible. Never steal the spotlight or make a fellow medical student look bad. Keep Patient Information Handy Use a clipboard, notebook, or index cards to keep patient information, includ- ing a miniature history and physical, and lab and test results, at hand.
Plan is [state plan]. Some patients have extensive histories. The whole history should be present in the admission note, but in ward presentation, it is often too much to ab- sorb.
In these cases, it will be very much appreciated by your team if you can generate a good summary that maintains an accurate picture of the patient. To study for the clerkship or shelf exam, we recommend: 2 or 3 weeks before exam: Read this entire review book, taking notes. Do not have any caffeine after 2 P. Other helpful studying strategies include: Study with Friends Group studying can be very helpful. Other people may point out areas that you have not studied enough and may help you focus on the goal.
If you tend to get distracted by other people in the room, limit this to less than half of your study time. Study in a Bright Room Find the room in your house or in your library that has the best, brightest light.
This will help prevent you from falling asleep. Eat Light, Balanced Meals Make sure your meals are balanced, with lean protein, fruits and vegetables, and fiber. Here, he or she has the opportunity to gather vital information by maintaining a relaxed and comfortable dialogue.
During the first meeting, the psychiatrist must es- tablish a meaningful rapport with the patient. This requires that questions be asked in a quiet, comfortable setting so that the patient is at ease.
The patient should feel that the psychiatrist is interested, nonjudgmental, and compas- sionate. Establishing trust in this manner will enable a more productive and effective interview, in turn facilitating an accurate diagnosis and treatment plan. Taking the History The psychiatric history follows a similar format as the history for other types of patients.
It is the nuts and bolts of the psychiatric exam. It does not comment on what the patient thinks, only how the patient expresses his or her thoughts. A patient who remains Neologisms—made-up words expressionless and Word salad—incoherent collection of words monotone even when Clang associations—word connections due to phonetics rather than ac- discussing extremely sad or tual meaning.
It hurts my head. A patient who is laughing one second and crying the Examples of disorders: next has a labile affect. Identify if the plan is well formulated. Ask if the pa- tient has intent i. A patient who giggles while Phobias—persistent, irrational fears telling you that he set his Obsessions—repetitive, intrusive thoughts house on fire and is facing Compulsions—repetitive behaviors usually linked with obsessive criminal charges has an thoughts inappropriate affect.
Who was Picasso? Problems with insight include complete denial of illness or blaming it on something else. The MMSE is a simple, brief test used to assess gross cognitive functioning. The areas tested in- are fruits. It is impor- he may plan on dying tant to offer reassurance that he or she can improve with appropriate therapy. If contemplating for suicide. If the patient is planning or contemplating suicide, he or she must suicide, ask the patient if be hospitalized or otherwise protected.
Axis I: All diagnoses of mental illness including substance abuse and de- velopmental disorders , not including personality disorders and mental re- Examination and Diagnosis tardation Axis II: Personality disorders and mental retardation Axis III: General medical conditions Axis IV: Psychosocial and environmental problems e.
Axis V: The Global Assessment of Function GAF , which rates overall level of daily functioning social, occupational, and psychological on a scale of 0 to See table on next page. Rate current GAF vs. These scores are adjusted for age and sometimes gender. An IQ of signifies that mental age equals chronological age and corresponds to the 50th percentile in intellectual ability for the general population. Suicidal Flat affect and Depressed expectable Largely hallucinations. Difficulty life.
Occasional argument with family members. Serious suicidal Some danger of Serious Major Any serious Moderate Some difficulty No more than Good Superior act with clear hurting self or impairment in impairment in impairment in difficulty in in social, slight functioning in functioning in a expectation of others.
Suicide attempts school, family school school functioning. Depressed man generally school work. Child interpersonal frequently beats relationships. Persistent Occasionally Inability to Sought out by inability to fails to maintain function in others because maintain minimal almost all areas.
Smears feces. The tests often ask for in- terpretation of ambiguous stimuli. Schizophrenia and substance-induced psychosis are examples of commonly diagnosed psychotic disorders. Examples: Tangentiality, circumstan- Clinically, one can quickly tiality, loosening of associations, thought blocking, perseveration, etc. There is no single symptom must have symptoms of the that is pathognomonic, and the disease can produce a wide spectrum of clini- disease for at least 6 cal pictures.
It is usually chronic and debilitating. His friends have Symptoms of schizophrenia usually present in three phases: noticed that over the past 9 1.
The patient may become socially withdrawn and irritable. He reveals to you that he is 2. Residual—occurs between episodes of psychosis. It is marked by flat af- human race. Think: fect, social withdrawal, and odd thinking or behavior negative symp- Schizophrenia. Patients can continue to have hallucinations even with treat- ment.
Delusions negative symptoms : 2. Hallucinations 1. Anhedonia 3. Disorganized speech 2. Affect flat 4. Grossly disorganized or catatonic behavior 3. Alogia poverty of 5. Paranoid type—highest functioning type, older age of onset. Disorganized type—poor functioning type, early onset. Catatonic type—rare. One society. Downward Drift Lower socioeconomic groups have higher rates of schizophrenia.
This may be due to the downward drift hypothesis, which postulates that people suffering from schizophrenia are unable to function well in society and hence enter lower socioeconomic groups. Many homeless people in urban areas suffer from schizophrenia. Pathophysiology of Schizophrenia: The Dopamine Hypothesis Though the exact cause of schizophrenia is not known, it appears to be partly Psychotic Disorders related to increased dopamine activity in certain neuronal tracts.
Evidence to support this hypothesis is that most antipsychotics that are successful in treat- It is often impossible to ing schizophrenia are dopamine receptor antagonists. In addition, cocaine and differentiate an acute amphetamines increase dopamine activity and can lead to schizophrenic-like psychotic episode related to symptoms. Elevated norepinephrine—long-term use of antipsychotics has been shown to decrease activity of noradrenergic neurons.
Pharmacologic treatment consists primar- schizophrenic patients who ily of antipsychotic medications, otherwise known as neuroleptics. For more take antipsychotic detail, see Psychopharmacology chapter. These are dopamine mostly D2 antagonists. They are clas- sically better at treating positive symptoms than negative. They have important side effects and sequelae such as extrapyramidal symptoms, neuroleptic malignant syndrome, and tardive dyskinesia see below. These antagonize serotonin receptors 5-HT2 as well as dopamine receptors.
Atypical neuroleptics are classically bet- ter at treating negative symptoms than traditional neuroleptics. They have a much lower incidence of extrapyramidal side effects. If the medication fails, it is appropriate to switch to another medication in a different class. Patients are helped through a variety of methods to improve their social skills, become self-sufficient, and act appropriately in public.
Family therapy and group therapy are also useful adjuncts. Benzodiazepines, beta blockers, and cholinomimetics may be used short term.
The movements often persist despite withdrawal of the offending drug. Tardive dyskinesia occurs 5. Weight gain, sedation, orthostatic hypotension, electrocardiogram most often in older women changes, hyperprolactinemia leading to gynecomastia, galactorrhea, after at least 6 months of amenorrhea, diminished libido, and impotence , hematologic effects medication.
The only difference between the two is that in schiz- ophreniform disorder the symptoms have lasted between 1 and 6 months, Neuroleptic malignant whereas in schizophrenia the symptoms must be present for more than 6 syndrome is most common months. In Psychotic Disorders symptoms last from 1 day to 1 month. Symptoms must not be due to general the past winter, he never medical condition or drugs.
This is a rare diagnosis, much less common than went outside for this reason schizophrenia. Antipsychotic medications are often ineffec- tive, but a course of them should be tried usually a high-potency traditional antipsychotic or one of the newer atypical antipsychotics is used.
TABLE Schizophrenia vs. Most people suffering from shared psychotic disorder complain about him to the are family members. The first step is to separate the patient from the person who is the source of shared delusions usually a family member with an underlying psychotic disor- Think: Delusional disorder. Amok Sudden unprovoked outbursts of violence of Malaysia, which the person has no recollection. Southeast Asia Psychotic Disorders Person often commits suicide afterwards.
Think: Shared eccentric, lack of friends, social anxiety. Criteria for true psychosis are psychotic disorder. Both external and internal stimuli can trigger moods, which may be labeled as sad, happy, angry, irritable, and so on.
Patients with mood disorders experience an abnormal range of moods and lose some level of control over them. Distress may be caused by the severity of their moods and their resulting impairment in social and occupational func- tioning. Mood disorders have also been called affective disorders. Mood Disorders Versus Mood Episodes Mood episodes are distinct periods of time in which some abnormal mood is present. Mood disorders are defined by their patterns of mood episodes.
Depressed mood Guilt 2. Anhedonia loss of interest in pleasurable activities 3. Change in appetite or body weight increased or decreased Energy 4. Feelings of worthlessness or excessive guilt Concentration 5. Insomnia or hypersomnia Appetite 6. Diminished concentration 7. Psychomotor agitation or retardation i. Fatigue or loss of energy Suicidal ideation 9.
A period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week and including at least three of the following four if mood is irritable : 1. Distractibility 2. Inflated self-esteem or grandiosity Mood Disorders Symptoms of mania: 3. Decreased need for sleep Distractability 5. Flight of ideas or racing thoughts Insomnia 6. More talkative or pressured speech rapid and uninterruptible Grandiosity 7. Excessive involvement in pleasurable activities that have a high risk of negative consequences e.
Seventy-five percent of Thoughtlessness manic patients have psychotic symptoms. Mixed Episode Criteria are met for both manic episode and major depressive episode.
These criteria must be present nearly every day for at least 1 week. As with a manic episode, this is a psychiatric emergency. Irritability is usually the predominant mood state in mixed episodes. Patients Hypomanic Episode with mixed episodes have a A hypomanic episode is a distinct period of elevated, expansive, or irritable poorer response to lithium.
There are significant differences between mania and hypomania see below. Always investigate medical or substance-induced causes see below be- fore making a diagnosis. Patients may be unaware of their depressed mood or may been put into a geriatric express vague, somatic complaints. Patients re- attending her Thursday spond to treatment with light therapy. Decreased brain and cerebrospinal fluid CSF levels of serotonin and its main metabolite, 5-hydroxyindolacetic acid 5-HIAA , are found in depressed patients.
Abnormal regulation of beta-adrenergic recep- tors has also been shown. Drugs that increase availability of serotonin, norepinephrine, and dopamine often alleviate symptoms of depression. Other Neuroendocrine Abnormalities 1. High cortisol: Hyperactivity of hypothalamic—pituitary—adrenal axis as shown by failure to suppress cortisol levels in dexamethasone sup- pression test. Abnormal thyroid axis: Thyroid disorders are associated with depres- sive symptoms, and one third of patients with MDD who have other- wise normal thyroid hormone levels show blunted response of thyroid- stimulating hormone TSH to infusion of thyrotropin-releasing hormone TRH.
Many other neurotransmitters and hormonal factors have also shown poten- tial involvement in the pathophysiology of mood disorders, including gamma- aminobutyric acid GABA and endogenous opiates. Stable family and social functioning have been shown to be MDD may have psychotic good prognostic indicators in the course of major depression. Generally, episodes occur more frequently as the disorder progresses.
Antidepressant medications significantly reduce the length and severity of symptoms. They may be used prophylactically between major depressive episodes to reduce the risk of subsequent episodes.
Medications include sedation, weight gain, orthostatic hypotension, and anticholin- usually take 4 to 8 weeks ergic effects. Can aggravate prolonged QTC syndrome. Most common side effect is orthosta- tic hypotension. Tyramine is an intermediate in the conversion of ty- Serotonin syndrome is rosine to norepinephrine.
Coma or such as the terminally ill or patients with refractory symptoms. Though death may result. Characterized by anhedonia, early morning awakenings, psychomotor dis- turbance, excessive guilt, and anorexia.
May also be applied to bipolar disorder. Characterized by the presence of delusions or hallucinations. It is tradi- tionally known as manic depression. Be- your differential of a tween manic episodes, there may be interspersed euthymia, major depressive episodes, dysthymia, or hypomanic episodes, but none of these are required for psychotic patient. Over First-degree relatives of patients with bipolar disorder are 8 to 18 times more the past 2 weeks, he comes likely to develop the illness.
Concordance rates for monozygotic twins are ap- home at 3 A. The course is usually Gates. Think: Bipolar disorder. Lithium prophylaxis between episodes helps to decrease the risk of relapse.
They rarely need hospitalization. Depressed mood for the majority of time of most days for at least 2 years in children for at least 1 year 2. Double depression: Patients with major depressive disorder with dysthymic disorder during residual periods Dysthymia can never have psychotic features. Think: Cyclothymia. Autonomic symptoms of anxiety include palpitations, perspiration, dizziness, mydriasis, gastrointestinal disturbances, and urinary urgency and frequency.
There is often a shortness of breath or choking sensation. Anxiety is a common, normal response to a perceived threat. It is important for clinicians to be able to distinguish normal from pathological anxiety. When anxiety is pathological, it is inappropriate; there is either no real source of fear or the source is not sufficient to account for the severity of the symp- toms.
In people with anxiety disorders, the symptoms interfere with daily functioning and interpersonal relationships. They are associated with neurotransmitter imbalances, including increased activity of norepinephrine and decreased ac- tivity of gamma-aminobutyric acid GABA and serotonin. Anxiety disorders develop more frequently in higher socioeconomic groups. Panic attacks often peak in several minutes and subside within 25 minutes. Attacks may be either unexpected or provoked by specific triggers.
They may be described as a sudden rush of fear. Spontaneous recurrent panic attacks see above with no obvious pre- cipitant 2. In addition to physical symptoms such as tachycardia, sweating, and shortness of breath , the patient experiences ex- shows no abnormalities. Attacks occur an average of two times per week but may range from several times per day to a few times per year. They usually last be- tween 20 and 30 minutes, and anticipatory anxiety about having another attack is common between episodes.
Research has revealed dysregulation of the autonomic nervous complaining of a pounding system, central nervous system, and cerebral blood flow in patients with panic heart, shortness of breath, disorder.
Increased activity of norepinephrine and decreased activity of sero- and sweating that began tonin and GABA have also been shown in these patients. She expresses that she thought Certain substances have been shown to induce panic attacks in patients with she was going to die. Think: Panic disorder. Social and specific phobias 4.
It is important to rule out these conditions before making the diagnosis of panic disorder. Always start SSRIs at low TREATMENT dose and increase slowly in panic disorder patients, as Pharmacological they are prone to develop Acute Initial Treatment of Anxiety activation side effects from Benzodiazepines only short course if necessary, as dependence may occur these medications anxiety with long-term use ; Dose should be tapered as treatment with selective sero- symptoms that mimic those tonin reuptake inhibitors SSRIs is instituted.
Maintenance SSRIs, especially paroxetine and sertraline, are the drugs of choice for long- term treatment of panic disorder. These drugs typically take 2 to 4 weeks to become effective, and higher doses are required than for depression. Clomipramine, imipramine, or other antidepressants may also be used.
Treat- ment should continue for at least 8 to 12 months, as relapse is common after discontinuation of therapy. It often develops sec- ondary to panic attacks due to apprehension about having subsequent attacks in public places where escape may be difficult. She states that these symptoms also occur when Clinical progression: A person who has a panic attack while shopping in a she is in crowded waiting large supermarket subsequently develops a fear of entering that supermarket.
She has decided to As the person experiences more panic attacks in different settings, he or she develops a progressive and more general fear of public spaces agoraphobia. Think: Panic disorder with agorophobia. Since agoraphobia is usually associated with panic disorder, SSRIs are also considered first-line treatment. Behavioral therapy may also be indicated. As coexisting panic disorder is treated, agoraphobia usually resolves. When ago- raphobia is not associated with panic disorder, it is usually chronic and debili- tating.
Specific and Social Phobias A phobia is defined as an irrational fear that leads to avoidance of the feared object or situation. A specific phobia is a strong, exaggerated fear of a specific object or situation; a social phobia also called social anxiety disorder is a fear of social situations in which embarrassment can occur. Exposure to the situation brings about an immediate anxiety response. Patient recognizes that the fear is excessive. The situation is avoided when possible or tolerated with intense anxi- Common Social Phobias ety.
If person is under age 18, duration must be at least 6 months. He Phobias are the most common mental disorders in the United States. The diagnosis of specific pho- a project on the 50th floor bia is more common than social phobia. Onset can be as early as 5 years old and has had trouble doing for phobias such as seeing blood, and as old as 35 for situational fears such as a fear of heights.
The average age of onset for social phobias is mid-teens. Think: Specific phobia. Women are two times as likely to have specific phobia as men; social phobia occurs equally in men and women. First-degree rel- especially alcohol-related atives of patients with social phobia are three times more likely to de- disorders. Up to one third velop the disorder. For example, people who were in a car accident may develop a specific phobia for driving. This has led to the successful treat- ment of some phobias.
Most notably, performance anxiety is often suc- Anxiety and Adjustment cessfully treated with beta blockers. Last Monday, she Specific Phobia stayed home although she Pharmacological treatment has not been found effective. Systemic desensiti- had to give a speech in zation with or without hypnosis and supportive psychotherapy are often use- class, because she did not ful.
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