First aid psychiatry 4th edition pdf free download

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. An essential part of the First Aid series, the book includes a guide to wards success and what to expect on clinical rotations with practical information for all clerkships. The result is proven information and strategies that maximize your study time and deliver the results you want!

Popular Books. Most serious consequences are stroke and possibly death. Treat with nitroprusside or phentolamine. Treat with benztropine Cogentin or diphenhydramine Benadryl. If clinically appropriate, reduce the dose, discontinue the medication, or switch to another agent.

Nausea, vomiting, slurred speech, ataxia, incoordination, myoclonus, hyperreflexia, seizures, nephrogenic diabetes insipidus, delirium, coma. Discontinue Li, hydrate aggressively, consider hemodialysis. Sodium bicarbonate, activated charcoal, cathartics, supportive treatment. Discontinue the medication. With prac tice, you will develop your own style and learn how to adapt the interview to the individual patient.

In general, start the interview by asking open-ended questions. Carefully note how the patient responds, as this is critical infor mation for the mental status exam. Consider preparing for the interview by writing down the subheadings of the exam see Figure Find a safe and private area to conduct the interview. Use closed-ended questions to obtain the remaining pertinent information. During the first interview, the psychiatrist must establish a meaningful rapport with the patient in order to get accurate and pertinent information.

This requires that the questions be asked in a quiet, comfortable setting so that the patient is at ease. In psychiatry, the history is the most important factor in formulating a diagnosis and treatment plan. Ta k i n g t h e Hi s t o r y The psychiatric history follows a similar format as the history for other types of patients.

Sources of information. Past psychiatric history include as applicable: history of suicide attempts, history of self-harm [e. Medical history ask specifically about head trauma, seizures, pregnancy status. Family psychiatric and medical history include substance use, suicides, and response to specific psychotropic agents as patient may respond similarly.

Medications ask about supplements and over-the-counter OTC medications, as well as compliance. Allergies: Clarify if it was a true allergy or an adverse drug event e. Also include income source, employment, education, place of residence, who they live with, number of children, support system, religious affiliation and beliefs, legal history, and amount of exercise.

For all initial evaluations, ask why the patient is seeking treatment today as opposed to any other day. If a heavy smoker is hospitalized and does not have access to nicotine replacement therapy, nicotine withdrawal may cause anxiety and agitation. M e n ta l S tat u s E x a mi n at i o n This is analogous to performing a physical exam in other areas of medicine.

It is the nuts and bolts of the psychiatric exam. It should describe Ch The term akinesia is used in extreme cases where absence of movement is observed. The mental status exam tells only about the mental status at that moment; it can change every hour or every day, etc. Speech Rate pressured, slowed, regular , rhythm i. Range describes the depth and range of the feelings shown. Parameters: flat none —blunted shallow —constricted limited —full average — intense more than normal.

Motility describes how quickly a person appears to shift emotional states. Parameters: sluggish—supple—labile. Appropriateness to content describes whether the affect is congruent with the subject of conversation or stated mood.

Parameters: appropriate—not appropriate. It does not comment on what the patient thinks, only how the patient expresses his or her thoughts. Circumstantiality is when the point of the conversation is eventually reached but with overinclusion of trivial or irrelevant details.

Loosening of associations: No logical connection from one thought to another. Neologisms: Made-up words. Word salad: Incoherent collection of words. Clang associations: Word connections due to phonetics rather than actual meaning. It hurts my head. Thought Content Describes the types of ideas expressed by the patient.

Delusions are classified as bizarre impossible to be true or nonbizarre at least possible. Identify if the plan is well formulated. Ask if the patient has an intent i. Phobias: Persistent, irrational fears. Obsessions: Repetitive, intrusive thoughts. Command auditory hallucinations are voices that instruct the patient to do something. Illusions: Inaccurate perception of existing sensory stimuli e. Patients usually are aware that these hallucinations are not real.

In contrast to delirium tremens DTs , there is no clouding of sensorium and vital signs are normal. Orientation: To person, place, and time. Who was Picasso? Abstract concepts: Ability to explain similarities between objects and understand the meaning of simple proverbs.

Proverb interpretation is helpful in assessing whether a patient has difficulty with abstraction. Similarities: How are an apple and orange alike? Problems with insight include complete denial of illness or blaming it on something else.

Judgment can be described as excellent, good, fair, or poor. W is a year-old Asian-American woman who arrives at the emergency room reporting that her deceased husband of 25 years told her that he would be waiting for her there. To meet him, she drove nonstop for 22 hours from a nearby state.

She claims that her husband is a famous preacher and that she, too, has a mission from God. Although she does not specify the details of her mission, she says that she was given the ability to stop time until her mission is completed. She reports experiencing high levels of energy despite not sleeping for 22 hours. She also reports that she has a history of psychiatric hospitalizations but refuses to provide further information. While obtaining her history you perform a mental status exam.

Her appearance is that of a woman who looks older than her stated age. She is obese and unkempt. There is no evidence of tattoos or piercings. She has tousled hair and is dressed in a mismatched flowered skirt and a red T-shirt. Upon her arrival at the emergency room, her behavior is demanding, as she insists that you let her husband know that she has arrived.

She then becomes irate and proceeds to yell, banging her head against the wall. Her eye contact is poor as she is looking around the room.

Her speech is loud and pressured, with a foreign accent. Her thought process includes flight of ideas. Her thought content is significant for delusions of grandeur and thought broadcasting, as evidenced by her refusing to answer most questions claiming that you are able to know what she is thinking.

She denies suicidal or homicidal ideation. She expresses disturbances in perception as she admits to frequent auditory hallucinations without commands. She is uncooperative with formal cognitive testing, but you notice that she is oriented to place and person. However, she erroneously states that it is Her attention and concentration are notably impaired, as she appears distracted and frequently needs questions repeated.

Her insight, judgment, and impulse control are determined to be poor. You decide to admit Mrs. W to the inpatient psychiatric unit in order to allow for comprehensive diagnostic evaluation, the opportunity to obtain collateral information from her prior hospitalizations, safety monitoring, medical workup for possible reversible causes of her symptoms, and psychopharmacological treatment.

The test and its instructions are available online Figure Memory immediate—repeating five words; and recent—recalling the words 5 minutes later. Attention serial 7s, tapping hand with certain letters, repeating digits. Language naming, repetition, fluency. Abstraction e. Interviewing Skills G e n e r a l A p p r o a c h e s t o T y p e s o f Pat i e n t s Violent Patient Do not interview a potentially violent patient alone.

Inform staff of your whereabouts. Know if there are accessible panic buttons. To assess violence Ch Do 2 trials, even if 1st trial is successful. Do a recall after 5 minutes. The subject must tap with his hand at each letter A. Nasreddine MD Similarity between e.

Nasreddine MD. Reproduced with permission. Copies are available at www. It is important to offer reassurance that he or she can improve with appropriate therapy. If the patient is actively planning or contemplating suicide, he or she should be hospitalized or otherwise protected. Ask directly about killing self or suicide. Criteria and codes for each diagnosis are outlined in the DSM Diagnostic Testing Intelligence Tests Aspects of intelligence include memory, logical reasoning, ability to assimilate factual knowledge, and understanding of abstract concepts.

Intelligence Quotient IQ IQ is a test of intelligence with a mean of and a standard deviation of These scores are adjusted for age. An IQ of signifies that mental age equals chronological age and corresponds to the 50th percentile in intellectual ability for the general population.

The mean score for each scale is 50 and the standard deviation is Intelligence tests assess cognitive function by evaluating comprehension, fund of knowledge, math skills, vocabulary, picture assembly, and other verbal and performance skills. Assesses overall intellectual functioning. Four index scores: Verbal comprehension, perceptual reasoning, working memory, processing speed. Ob j e c t i v e P e r s o n a l i t y A s s e s s m e n t T e s t s These tests are questions with standardized-answer format that are objectively scored.

Post-psychotic depression is the phenomenon of schizophrenic patients developing a major depressive episode after resolution of their psychotic symptoms. This may be due to the downward drift hypothesis, which postulates that people suf fering from schizophrenia are unable to function well in society and hence end up in lower socioeconomic groups. Many homeless people in urban areas suffer from schizophrenia.

Evidence to support this hypothesis is that most antipsychotics successful in treating schizophrenia are dopamine receptor antagonists. In addition, cocaine and amphetamines increase dopamine activity and can cause schizophrenia-like symptoms.

Mesolimbic: Excessive dopaminergic activity; responsible for positive symptoms. Elevated norepinephrine: Long-term use of antipsychotics has been shown to decrease activity of noradrenergic neurons. Low levels of glutamate receptors: Schizophrenic patients have fewer NMDA receptors; this corresponds to the psychotic symptoms observed with NMDA antagonists like ketamine.

A biological child of a schizophrenic person has a higher chance of developing schizophrenia, even if adopted into a family without schizophrenia.

Good social support. Positive symptoms. Mood symptoms. Acute onset. Female gender. Few relapses. Good premorbid functioning. Poor social support. Negative symptoms. Family history. Gradual onset. KEY FACT Computed tomography CT and magnetic resonance imaging M scans of patients with schizophrenia may show enlargement of the ventricles, diffuse cortical atrophy, and reduced brain volume. A neologism is a newly coined word or expression that has meaning only to the person who uses it.

Many relapses. Poor premorbid functioning social isolation, etc. Comorbid substance use. Second-generation antipsychotic medications are referred to as atypical antipsychotics.

A multimodal approach is the most effective, and therapy must be tailored to the needs of the specific patient. Pharmacologic treatment consists pri marily of antipsychotic medications. WARDS TIP Schizophrenic patients who are treated with second-generation atypical antipsychotic medications need a careful medical evaluation for metabolic syndrome.

This includes checking weight, body mass index BMI , fasting blood glucose or HbA1c, lipid assessment, and blood pressure. KEY FACT High-potency antipsychotics such as haloperidol and fluphenazine have a higher incidence of extrapyramidal side effects, while low-potency antipsychotics such as chlorpromazine have primarily anticholinergic and antiadrenergic side effects.

Second-generation or atypical antipsychotic medications e. The selection requires the weighing of benefits and risks in individual clinical cases. Patients are helped through a variety of methods to improve their social skills, become self-sufficient, and minimize disruptive behaviors. Family therapy and group therapy are also useful adjuncts. Anticholinergic symptoms especially low-potency first-generation anti psychotics and atypical antipsychotics : Dry mouth, constipation, blurred vision, hyperthermia.

Treatment: As per symptom eye drops, stool softeners, etc. Consider metformin if the patient is not already on it. Monitor lipids and blood glucose measurements. Refer the patient to primary care for appropriate treatment of hyperlipidemia, diabetes, etc. Encourage appropriate diet, exercise, and smoking cessation. Tardive dyskinesia more likely with first-generation antipsychotics : Choreoathetoid movements, usually seen in the face, tongue, and head.

Treatment: Discontinue or reduce the medication and consider substituting an atypical antispsychotic if appropriate. The movements may persist despite withdrawal of the drug. Although less common, atypical antipsychotics can also cause tardive dyskinesia. Reflexes are decreased. Prolonged QTc interval and other electrocardiogram changes, hyperprolactinemia gynecomastia, galactorrhea, amenorrhea, diminished libido, and impotence , hematologic effects agranulocytosis may occur with clozapine, requiring frequent blood draws when this medication is used , ophthalmologic conditions thioridazine may cause irreversible retinal pigmentation at high doses; deposits in lens and cornea may occur with chlorpromazine , dermatologic conditions such as rashes and photosensitivity.

Prognosis One-third of patients recover completely; two-thirds progress to schizoaffective disorder or schizophrenia. A small percentage of patients will experience spontaneous remission, so discontinuation of the agent should be considered if clinically appropriate. It is a very effective medication, but as it can rarely cause agranulocytosis, patients must be monitored WBC and absolute neutrophil counts regularly.

Delusions or hallucinations for 2 weeks in the absence of mood disorder symptoms this criterion is necessary to differentiate schizoaffective dis order from a mood disorder with psychotic features. Mood symptoms present for a majority of the psychotic illness. Symptoms not due to the effects of a substance drug or medication or another medical condition.

Prognosis Worse with poor premorbid adjustment, slow onset, early onset, pre dominance of psychotic symptoms, long course, and family history of schizophrenia.

These are considered part of their underlying personality disorder and are not diagnosed as a brief psychotic disorder. Hospitalization if necessary and supportive psychotherapy.

Medical therapy: Antipsychotics second-generation medications may target both psychotic and mood symptoms ; mood stabilizers, antidepres sants, or electroconvulsive therapy ECT may be indicated for treatment of mood symptoms. Brief Psychotic Disorder Diagnosis and DSM-5 Criteria Patient with psychotic symptoms as in schizophrenia; however, the symptoms last from 1 day to 1 month, and there must be eventual full return to premorbid level of functioning.

Symptoms must not be due to the effects of a substance drug or medication or another medical condi tion. This is a rare diagnosis, much less common than schizophrenia. It may be seen in reaction to extreme stress such as bereavement and sexual assault. Prognosis High rates of relapse, but almost all completely recover.

Immigrants, the hearing impaired, and those with a family history of schizophrenia are at increased risk. Does not meet criteria for schizophrenia. Functioning in life not significantly impaired, and behavior not obviously bizarre.

While delusions may be present in both delusional disorder and schizophrenia, there are important differences see Table Grandiose type: Delusions of having great talent.

Somatic type: Physical delusions. Persecutory type: Delusions of being persecuted. Jealous type: Delusions of unfaithfulness. Mixed type: More than one of the above. Unspecified type: Not a specific type as described above. No history of major depressive episode, hypomania, or manic episode.

Mean age of onset for specific phobia is 10 years. Specific phobia rates are higher in women compared to men but vary depending on the type of stimulus.

Social Anxiet y Disorder Social Phobia Social anxiety disorder social phobia is the fear of scrutiny by others or fear of acting in a humiliating or embarrassing way.

The phobia may develop in the wake of negative or traumatic encounters with the stimu lus. The diagnostic criteria for social anxiety disorder social phobia are simi lar to specific phobia except the phobic stimulus is related to social scrutiny and negative evaluation. The patients fear embarrassment, humiliation, and rejection. Exposure to the situation triggers an immediate fear response. Situation or object is avoided when possible or tolerated with intense anxiety.

Symptoms cause significant social or occupational dysfunction. Symptoms not solely due to another mental disorder, substance medica tion or drug , or another medical condition. Social anxiety disorder occurs equally in men and women. First-line medication, if needed: SSRIs e. Benzodiazepines e. Beta-blockers e. Selective Mutism Selective mutism is a rare condition characterized by a failure to speak in specific situations for at least 1 month, despite the intact ability to compre hend and use language.

Symptom onset typically starts during childhood. The majority of these patients suffer from anxiety, particularly social anxiety Ch The patients may remain completely silent or whisper. They may use nonverbal means of communication, such as writing or gesturing. Mutism is not due to a language difficulty or a communication disorder. Symptoms cause significant impairment in academic, occupational, or social functioning.

Medications: SSRIs especially with comorbid social anxiety disorder. S e pa r at i o n A n x i e t y D i s o r d e r As part of normal human development, infants become distressed when they are separated from their primary caregiver.

Stranger anxiety begins around 6 months and peaks around 9 months, while separation anxiety typically emerges by 1 year of age and peaks by 18 months. When the anxiety due to separation becomes extreme or developmentally inappropriate, it is considered pathologic. Separation anxiety disorder may be preceded by a stressful life event. Excessive worry about loss of or harm to attachment figures.

Excessive worry about experiencing an event that leads to separation from attachment figures. Reluctance to leave home, or attend school or work.

Reluctance to be alone. Reluctance to sleep alone or away from home. Complaints of physical symptoms when separated from major attachment figures. Nightmares of separation and refusal to sleep without proximity to attachment figure.

Symptoms cause significant social, academic, or occupational dysfunction. Symptoms not due to another mental disorder. Medications: SSRIs can be effective as an adjunct to therapy. She has had trouble falling asleep and feels chronically fatigued. The patient complains of frequent headaches and has difficulty concentrating on her assignments.

Over the last year since starting law school, her symptoms have become debilitating. What is the most likely diagnosis? Like many patients with GAD, she is described as a worrier. She reports typical associated symptoms: insomnia, fatigue, and impaired concentration.

Her symptoms have been present for over 6 months. What is the next step? A complete physical exam and medical workup should be performed to rule out other medical conditions or substance use contributing to or causing her anxiety symptoms.

What are treatment options? A combination of both modalities may achieve better remission rates than either treatment alone. Often they experience somatic symptoms including fatigue and muscle tension.

Not uncommonly, these physical complaints lead patients to initially present to a primary care physician. GAD rates higher in women compared to men One-third of risk for developing GAD is genetic. Difficulty controlling the worry. Symptoms are not caused by the direct effects of a substance, or another mental disorder or medical condition.

Symptoms of worry begin in childhood. Median age of onset of GAD: 30 years. Course is chronic, with waxing and waning symptoms. GAD is highly comorbid with other anxiety and depressive disorders. SSRIs e. Can also consider a short-term course of benzodiazepines or augmentation with buspirone. Obsessions are recurrent, intrusive, undesired thoughts that increase anxiety. Kindly support us by sharing this Post with your friends. You may send an email to admin cmecde. Save my name, email, and website in this browser for the next time I comment.

Notify me of follow-up comments by email. Notify me of new posts by email. Been Medical Video Lectures Dr. Tuesday, November 23, The best selling resource for the psychiatry clerkship Excel on your rotation, impress on the wards, and score your highest on the shelf exams with this best-selling reference.

This new edition of First Aid for the Psychiatry Clerkship has been updated with the latest clinical perspectives and research.

Ask just about any student who has been through their psychiatry rotation and they will tell you that THIS was the resource they turned to.

It not only aligns with national clerkship curricula, but also follows the shelf exam blueprint and is full of helpful mnemonics, ward tips, exam tips, and integrated mini-cases. The text highlights all of the important topics, presenting a clear, concise review of psychiatry with a strong clinical emphasis that guides you in the diagnosis and treatment of many problems seen by psychiatrists.

First Aid for the Psychiatry Clerkship features: The latest clinical research and perspectives Helpful mnemonics Ward tips and integrated mini-cases Images, diagrams, and flow charts in a fresh new-full color design A complete chapter on How to Succeed on the Psychiatry Clerkship Summary boxes with high-yield information needed for exam success.

The internal medicine clerkship survival guide, from the publishers of First Aid for the USMLE Step 1 Written by students who excelled on their clerkship First Aid for the Medicine Clerkship is a high-yield review of the clerkship's core competencies presented in the trusted First Aid format.

You will find hundreds of recently-tested topics from shelf exams and the USMLE Step 2 CK along with mnemonics, typical scenario boxes, insider tips, margin notes to enhance exam and wards performance, a "classifieds" section with scholarship and award opportunities, and NEW mini-cases.

Features High-yield yet comprehensive review of the most essential topics focuses study. NEW: integrated mini-cases add clinical relevance and prepare students for questions they will see on the exam Exam tips and wards tips help you shine on the shelf exam and impress attendings Written by students who aced the clerkship and based on the clerkship's core competencies Edited and reviewed by internal medicine faculty High-yield review of the clerkship's core competencies in the relied-upon First Aid series format The content you need to excel on the clerkship: Section I: How to Succeed in the Medicine Clerkship; Section II: Database of High-Yield Facts: Cardiology, Endocrinology, Hematology-Oncology, Infectious Disease, Nephrology and Acid-Base Disorders, Pulmonology, Rheumatology, Neurology, Dermatology, Health Maintenance and Evidence-Based Medicine, Section III: Classified, Index.

The new edition of First Aid for the Medicine Clerkship is a comprehensive, high-yield resource, with an expanded focus on pathophysiology and diagnosis and treatment. It provides you with the foundation you need to excel in their internal medicine clerkship and rotations and to ace the shelf exam and Step 2 CK exam. Designed to facilitate the application of knowledge required for the shelf exam and the USMLE Step 2 CK, First Aid for the Medical Clerkship provides the information required to formulate a diagnostic and treatment plan.

This new edition also has brand-new illustrations, photos, and algorithms, presented in a new full-color design. Chock full of useful photos and illustrations NEW: More content on the nuances of diagnostic algorithms e. The pediatrics clerkship survival guide written by students who aced the clerkship. This powerful review for the pediatrics clerkship provides medical students taking required rotations with a single, concise, high-yield resource for excelling on the boards and wards.

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