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18 you just started college his grades are declining because he spends 2-3 hours in the shower scrubbing because on days he doesnt he worries about contracting an illness
diagnosis - obsessive compulsive disorder
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Comorbid condition wiht OCD
- High prevelance of vocal motor ticks &
- 5-7% of OCD pt have full blown tourettes
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What is the treatment for Obessive compulsive disorder.
First line
Gold standard
- First line- SSRI
- Gold standard - Clomipramine
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25 y/o sexual assult survivor comes to you with a six week hisotry of of recurrent night mares of when she was raped at knifepoint she now avoids situations where unknown men are present and she had to quite her job.
Diagnosis
PTSD - reliving, hyperarousal and avoidance
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Treatment for PTSD -
Treatment for the night mares specifically
- PTSD - SSRI- sertraline or paroxetine
- Nightmares give the alpha blockers - prazosin
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Acute stress disorder vs PTSD
- acute stress disorder id <1 mo
- PTSD >1 mo
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IF someone had hyperarousal, avoidance behaviours and re-living of an experiance present for only 3 weeks - in responce to a traumatic event like rape
diagnosis :
- Diagnosis - acute stress reaction
- stop with in 1 month
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IF someone had hyperarousal, avoidance behaviours and re-living of an experiance present for only 3 weeks - in responce to a bad breakup
diagnosis
- adjustment disorder
- onset w/in 3 months and goes away by 6 months
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A women complains of pelvic pain during menses you review the chart adn it says that she has also sought help over the past 10 years for pain in her low back, neck arms and feets. tingling in the arms She also complains of sonstipation
Diagnosis ---
comorbid condition ---
Best txt ---
- Diagnosis --- somatoform disorder
- comorbid condition --- depression/ anxiety + personality disorder.
- Best txt --- frequent follow with 1 physcian
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What are the critea for somatization disorder
- NOt intentinally produced
- -- onset before age 30
- 4 pain symptosm
- 1 gi symptoms
- 1 sexual
- 1 pseudoneurological symptom
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33 y/o is brought ot the ER after having a seizure in the waiting room of her neurologist office.
Her worried hisband describes the episode as lasting 20 min. consisiting of shaking with her eyes closed.
WHAT TesTs
- Notice no urination or defication
- - conversion diseorder
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Conversion Disorder
- Not intentionally produced
- -Not limited to pain or sexual dysfunction
- - view as a cry for help
- not always la belle indifference
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What test to confrim or deny a seizure is a pseudoseizure
- LOOK FOR HIGH PROLACTIN --
- or NORMAL EEG
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A 54 y/o RN has a history of 2 mon of diarrhea and ab pain.
He has been to 4 other hospitals w/ the same complaints
-- Colonscopy reveals pigmentation in the wall of the colon
- - melanosis coloni - from laxatives
- - giving himself diarrhea - muchausen syndrome ( they make themselves sick )
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Munchausen syndrome
more severe then simple factitious( these people complain of symptoms but dont do anything to create them) b/c they actually induce sxs and do it for primary gain
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Munchausen syndrome
more severe then simple factitious( these people complain of symptoms but dont do anything to create them) b/c they actually induce sxs and do it for primary gain
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A concerned mother presents with 15 mon baby who is having recurrent seizures. She requests an MRI, sleep deprived EEG with intercranial leads
- munchausen syndrom by proxy
- a form of child abuse
- - this is munchausen becuase the mother is giving the baby something to cause the seizures
- next step alert the child protective agency
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45 y/o unemployed man is involved in a car accident. HE sues the drive stating he has nerve damage to his legs that keeps him from walking
Video evidence shows him dancing at a club the night before
- MALIGERING
- --- Goes as a v- code----
- Associated w/ antisocial personality disorder, they do it for secodnary gain
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18 y/o presents with no menstrual cycle for 3 mo. A PREGNACY TEST is negative but her BMI is 17. her teeth are eroded and she has calluses on her knuckles ( russels sign): What are the
vital signs :
CBC:
Chemistry:
TFT:
Fasting lipid profile:
Hormones :
- ANOREXIA puring type - Amenoia ( endocrine abnormality) , and low bmi -
- VItal signs: Hypotension, braycardia and hypothermia
- CBC: leukopenia
- Chemistry: high H3co, low cl, low K, high carotene( may cause yellowing of the skin), high lfts and amylase
- TFT: nomral
- Fasting lipid profile: elevated
- Hormones: elevated cortisol, low estrogen, low LH/fsh
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Long term complications of anorexia
osteoporosis - also lentigo- downey hair, possible parotitis
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Most common cause of death anorexia
heart disease ( ARRTHYMIA), suicide #2
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Complication of anorexia
needs intensive counseling, needs nutritions ( give tpn)
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Complications of TPN in anorexia
Re-feeding syndrom = low PO4, low mg, low ca caused by fluid retention
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Sleep EEG FOR AWAKE what are the characteristics
Beta (highest frequency, lowest amplitude
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Sleep EEG For stage 1
theta - consists about 5% of sleep
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Sleep EEG for stage 2
- Deeper sleep; when bruxism occurs
- Sleep spindles and K complexes 45%
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Sleep EEG for stage 3
- Delta (lowest frequency, highest amplitude) 25%
- Stage 3 is the less then 50% theta waves and stage 4 is greater then 50% theta waves
- Deepest non-REM sleep (slow-wave sleep);
- when sleepwalking, night terrors, and
- bedwetting occur
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What drugs decrease stage 3/4 sleep 3
- Impramine,And Benzodiapazems and Alcohol also decrease stage 3 and 4 sleep
- impramine used to decrease betwetting
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EEG for rem sleep
- REM. 25%
- Skeletal muscle paralysis
- Loss of motor tone, increase brain O2 use, and
- variable pulse and blood pressure; when
- dreaming and penile/clitoral tumescence
- occur; may serve a memory processing
- function
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DEpression sleep eeg
Decrease rem latency and increase REM %
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Sleep eeg in the elderly
- Decrease latency o rem and increase cycling
- often less
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Trouble falling asleep or staying asleep causes impairment in fxn >1mo.
Insomnia. Educate about sleep heigyne 1st, then try benzos (reduce sleep latency and incr SWS and REM). Zolpidem, zaleplon, escopiclone are GABAa recp
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As falling asleep, feel creepy-crawlies on legs, better when they get up and move
- Dyssomnia NOS. - (Restless leg syndrome and peroid leg movement syndrome)
- R/o medical causes 1st-->Fe-def anemia or chronic kidney dz. Neuropathy.
- Tx w/ ropinirole (SE:pathological gambling) or pramipexole (Da-ag)
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Daytime sleepiness and depression in a big fat guy with a big neck.
Obstructive Sleep Apnea. Goes on axis III, "breathing related sleep d/o" goes on axis I. Need polysomnogram to diagnose --> >10 hypopneic/apneas per hour. Need CPAP to reduce pulmonary HTN.
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Irresistible attacks of refreshing (REM) sleep. Upon intense emotion, they lose muscle tone or have hallucinations as waking or falling asleep.
- Narcolepsy. Tx w/ scheduled naps and Modafinil
- ( need cataxpecy or hynogognic or hypnopmonic hallucinations)
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