psychology

-thoughtful responses: if you are working in a group and you have to offer solutions/answers to complicated questions 

-regulate their behavior, monitor social cues, and adjust their responses accordingly to convey professionalism and engage effectively with the interviewer

-Cognitive communication involves interpreting language beyond its literal meaning, such as understanding humor, sarcasm, or metaphors

-Recall and relay information: in a classroom setting, a student might listen to a lecture, encode the information into memory, and later recall key concepts or details when asked questions or during discussions.

-A child with strong cognitive communication skills can listen to a set of instructions, retain the information, and carry out the tasks sequentially.

it is a multimodal approach (using various sensory modalities) to prevent, assess/diagnose/treat speech/language/social and cognitive communication.

males

there is no obvious reason as to why there is difficulty in reading and spelling 

reasons include: overall low IQ, brain damage, inadequate schooling, sensory handicap, mental retardation

--disorder in using or understanding language spoken or written that causes impaired IQ scores 

imperfect ability to listen, think, speak, read, write, spell, do math and has to exclude the reasons of handicap/physical disability, mental retardation, and any sort of cultural, environmental, economic disadvantage

You always start at the lowest dose and then keep increasing and if doesn't help or you are getting side effects like MOODINESS consider the following depending on the severity: 

–  If mild side effects (e.g., insomnia, low appetite, tension) switching to another stimulant (within same class or different)

–  If partial/lack response, consider alternate stimulant

–  If moderate or greater side effects or lack of response to both stimulant classes, consider trial of non-stimulant or if relative contraindication: e.g., substance abuse to the stimulant they will be directly put on the nonstimulant

MULTIMODAL: GOLD STANDARD 

Stimulants: amphetamine and methylphenidate 

Behavioral Therapy: develop adaptive behaviors, improve self-control, and manage impulsivity. These techniques often involve setting clear expectations, providing positive reinforcement for desired behaviors

Cognitive-Behavioral Therapy (CBT): CBT aims to help individuals with ADHD identify and challenge negative thought patterns, develop coping skills, and improve problem-solving abilities.

Educational interventions: training you to prioritize and time manage etc

Clinically-- there is NO imaging that will determine--mainly conversations with the patient and family--there are also rating scales that ask you about your behavior, work, school, social life --indicative of the symptoms you have and can hint at whether or not you have ADHD

Misguided attention comes where there is too much catecholamines and is basically when you are focused on irrelevant things-- teacher is teaching and you are focusing on the noises outside 

Unguided attention is the opposite but you have no control over your thoughts and they wander around a lot... over here the attention is not guided in any way

• DORSAL: 
• LEFT Frontal: inferior and pre-central gyrus both=sound info and sequencing of sounds. precentral gyrus (articulation: actual production of sound)

Left temporoparietal region: superior temporal, angular, and supramarginal are all associated with decoding-- linking sound to each letter and then linking a mean to it (when you are first reading and you emphasize the sounds to say the word) 

• Ventral: 
• Left occitotemporal (fusiform, inferior and middle temporal): visual recognition--immediate--sight words and meaning-- you look at a word and can immediately read it and process a meaning

differences in connectivity, functional, and structural differences. These differences have been found prior to learning to read. 

But difficulties with reading (especially decoding) can be rectified with appropriate reading instruction and can show normalization of affected regions

primary: problems in reading and spelling-- basic issues with blending sounds to form words and manipulating sounds in general 

secondary: are the broader setbacks like poor comprehension, self esteem, drop out, poor math, letter reversals 

usually associated with dyslexia are: articulation/production of sound (may have lisps), memory and attention issues

When you have an urge to set fires (stimulated by curiosity and pleasure only)..impulse control disorder  

a alot of them have poor social skills and learning disabilities and will go on to become firefighters (males)...associated with gambling and substance use disorders (other impulse control)

co-occurence of ADHD and substance use

slower resting heart rate 

low skin conductance in response to autonomic fear conditioning (experience lower to no fear)

Associated with Conduct disorder and must have at least 2 for 12 months. more likely to be associated with the severe childhood type 

Lack of remorse/guilt, lack of empathy, unconcerned about performance , insincere/fake/absent emotions

• Childhood type: before the age of of 10 sx begin--more associated with likelihood of developing antisocial personality disorder 
• Adolescent: after the age of 10 sx begin 

Mild/moderate/severe: depends on the harm caused to others 

Some have limited prosocial emotions

medical management and consult

• Nigrostriatal pathway 
• dorsal striatum

-antimuscarinic: (dry, constipation, urinary retention, blurry vision, tachy)

• -anti-adernergic
• -anti-histaminic-sedation

• chronic:
• more prolactin 
• weight gain
• extrapyramidal effects-parkinsons
• tardive dyskinesia 
• akathesia (restlessness)

they want to move away from simply blocking dopamine receptors and consider 5ht2a antagonism (serotonin usually inhibits dopamine release you want to prevent this so that you dont cause parkinson)... DA receptor partial antagonist- they bind and cause some stimulation but they cut the effect of dopamine off after a certain level

• Quetiapine 
• Ziprasidone 
• Aripiprazole 
• olanzapine

• Loxapine
• brexipiprazole 
• cariprazine 
• molindone

SSRIs and bupropion

SNRIS and tricyclics are more prone to cause mania in patients with underlying bipolar which is often diagnosed as depressive bc that presents first

• Antidepressant monotherapy (especially
• venlafaxine and tricyclic antidepressants--ipramine or –triptyline) in major depressive disorder to someone with underlying bipolar disorder they are at greater risk of developing manic episode 

if they do then you have to put them on mood stabilizers

severe mania that includes psychosis (hallucinations, delusions, paranoia) should be treated with mood stabilizers and antipsychotics

indicated for bipolar conditions: lithium first line and then valproate


carba. lamo

Similar to bipolar but you do not meet the criteria for either major depressive or hypomanic 

• and has been going on for majority of the 2 years in adults 
• 1 children 

there is only a 2 month period where you are normal--cannot be more than this

you need to meet the criteria for either major depressive or manic (can be both too) and episodes have to have occurred at least 4 times in a year 

also increases Ach release from presynaptic cell.

• bad dreams 
• and cardiac issues because increased Ach causes bradycardia

• 1. plaque dissolution 
• 2. glial activation vs ab activation 
• 3. bring to the blood for faster clearance

Fcr=Fc receptors

• 1. Donepezil, Stigmines, galantamine
• -TACRINE 

block AchE 

2. Amantidine, memantidine: block NMDA receptors--plaques inhibit glutamate uptake and breakdown by glial cells leading to glutamate buildup 

3. lecanemab

neurons that make Ach

not present in AD

• medial temporal lobes 
• enterohinal 
• hippocampus

is the first line mood stabilizer for bipolar disorders along with an antipsychotic 

although it is contradicted in people with renal complications, thyroid, and tremors

and can cause extreme thirst and dehydration

• the mood changes are more frequent: 
• need 5 

• Identity unstability (self esteem is wavering)
• Disordered mood 
• Emptiness 
• Suicidal 
• Paranoia 
• Abandonment intolerance 
• Impulse 
• Rage 
• Relationship problems

decreased rem latency... rem sleep starts soon after falling asleep and spend more time in rem sleep

must be 5 symptoms persisting 2 weeks 

SIGECAPS: 

Sleep disturbance, interests, guilt, energy, concentration, appetite (either increased or decreased), psychomotor retardation, suicidal intent

symptoms are not as severe as manic and they do not display psychosis (grandiosity, delusions, hallucinations etc)  

have an inflated self esteem but thoughts are not too extravagant... their energy is usually more productive

Distracted, irresponsible (spend all their money, reckless sexual behavior), grandiosity, flight of thoughts, agitated, sleep lessened, talkative/speech is pressured

you need atleast 3 of these symptoms if inflated/elevated mood.. but if irritable mood then you need 4 for 7 DAYS 

3 of the following in the past 12 months, with 1 within the past 6 months: violation of rules, theft, deceit, aggression (physical), and destruction 

after age 18 it is known as antisocial personality disorder

good to excellent validity for tobacco, alcohol, and marijuana use identification.

screening and assessment tool for those who test positive

any time there is an acute onset of mood change, hypertension, blood pressure change, hallucinations, formication, sympathetic stimulation

any sensation that resembles ants crawling under your skin

can be used illicitly to make amphetamines

-a local anesthetic and vasoconstrictor, most commonly for ENT surgery.

-along with decreasing re-uptake of the monamines it also blocks NA channels

cardiovascular symptoms: typically stimulants cause vasodilation of the coronary arteries...but when there is too much stimulant the alpha receptors will also be affected and cause vasoconstriction-- angina

acute: benzos (pams) avoid beta blockers 

chronic CBT

Mostly clinically, although drug screens can help

• wakefulness 
• increased arousal 
• euphoria 
• grandiosity 
• anorexia 
• rhabdo (due to excessive muscle use)
• fever (due to excessive muscle use)
• sexual 
• tactile hallucinations 
• impaired judgement 

• Psychomotor slowing--slow thinking and slow motor function/agitation 
• Increased appetite 
• Somnolence 
• Sleep disturbance--vivid nightmares (either hypersomnia or insomnia)

IV and smoked have a shorter onset and duration than inhaled/nasal 

IV/inhaled/smoked have a shorter onset than oral

inactive metabolite of cocaine

about an hour although it increases in the use of alcohol 

inactive metabolite lasts for longer: benzoylecgonine

• about 12 hours 
• active form is amphetamine 

False positive: there are many products that have amphetamine--not necessarily in the form of drug abuse

usually used in ADHD but is often abused as a stimulant that prevents the reuptake of monamines and increases vesicular release of them

prevents the re-uptake of monamines

Crack: rocks, cheaper, can only be smoked. shorter duration but higher intensity 

powder: HCL , various methods of injection... longer duration

• Snorting: nasal perforation 
• Injecting: endocarditis, HIV
• Smoking: pulmonary complications

TBI

CBT and physical rehab

• Resistance to opening eyes
• no lateral tongue biting 
• convulsions last longer than 2 hours 
• asynchronous limb movements

positive: evident physical findings are present initially but they absent when distracted--Neurological exam maneuver

swallowing symptoms, sensory, motor, speech problems with no workup results supporting cause

conversion disorder

Exposure based: more used for somatic symptoms-- confront the patient with their anxiety as opposed to just making them aware of their negative thought processes

GAD

• --CBT (you are exposing patients to their anxiety triggers)
• --psychodynamic (to determine unconscious conflicts)  
• --can add ANTIDEPRESSANT (if depression present) 

tell them their dx, avoid ordering repeat tests-- phrases things like amplifiers "I understand that you have x but i think y might be making it worse"

they are afraid that they will develop some condition (usually do not have any associated symptoms) 

care avoidant --because they are afraid that dr will find something 

care seeking

-worried about symptoms they have 

• Stressed about seriousness 
• Anxiety 
• Energy

• to avoid loneliness
• to gain sympathy 
• psychological escape from environments that scare them they they do not want to be at 

Falsification and exaggerated stories

hospital jumping (peregrination)

Cluster B

Falsifying a condition for a secondary external incentive 

often associated with antisocial personality disorder, legal issues, discrepancy between individuals stress levels/disability and objective findings, lack of cooperation during exam

• unreal
• dreamlike
• foggy
• lifeless
• visually distorted

• -perceptual alterations-they feel like -no control over their thoughts
• -distorted sense of time
• -unreal or absent self
• -emotional and/or physical numbing

They know what they are feeling is weird and not right.

they feel deattached from themselves and feel like they are viewing their life from outside perspective

world feels unreal

• don't forget all aspects of life but autobiographical aspects of life (name, job, etc
• not psychotic 
• they may go and live another life w/ no recollection of prior life. 

• Due to a traumatic incident 
• May be associated with fugue. 
• Not repression of a particular trauma

Physicians: even after surgery they won't be content-- so they will try to sue/violence 

Patient: may attempt dangerous methods on their own

Obsessive thoughts and actions stemming from negative perception of how you look-- Normal BMI but you think you are fat, so you will constantly check yourself in the mirror and attempt ways to reduce your body fat on your own

Nausea, loss of appetite, feeling of fullness or swollen stomach, and/or stomach upset, Dry mouth, increased thirst, and increased urination

• mood stabilizers such as lithium, carbamazepine, divalproex sodium, and gabapentin.
• SSRIs and tricyclic antidepressants can also be effective in reducing aggression.

Depression, Anxiety, substance use disorders 

decreased cerebral serotonergic transmission, low CSF levels of 5-hydroxyindoleacetic acid, and high CSF levels of testosterone in men.

Suicide even after comorbidies like ADHD and conduct disorder are adjusted for 

at increase risk for developing things like antisocial personality disorder, impulse control disorder, anxiety, and depression

Have to be 6 and above  

• Verbal/physical aggression TIW x 3 months 
• Damage related 3 episodes x 12 months 

There is a trigger/stressor that triggers an un-proportionate response of anger (not premeditated) approximately 30 minutes... most of these individuals feel remorse after the event

ADHD and Conduct disorder although most people do not go on to develop conduct disorder

• Mild: if its confined to one setting 
• Moderate: two settings 
• Severe: 3 or more settings

1,2,3,4,5,6

They are irritable, purposely annoy others, argumentative to authority, will blame others, are spiteful, but usually do not damage property, steal, and physically hurt people 

• (at least 4 symptoms must be present for 6 months)
• -if you are under the age of 5, you should have these most days 
• -if you are greater than the age of 5, you should have at least once a week

basal ganglia-especially the caudate and the frontal lobe 

amygdala

amygdala and hippocampus possibly

amygdala and possibly hippocampus

monamines (dopamine: nucleus accumbans, NE: locus coereleus, serotonin: ralphe nuclei)

• GABA 
• cortisol

• anxiety (alerting) is worry about a threat that has not occurred yet
• and fear is response to a threat that is occurring

specific phobias

• So make sure to test for these as well when patient comes in with depression:
• Cancer (pancreatic) 
• Neurological 
• Hypothyroid 
• Autoimmune 
• Anemia 
• B12 and D deficiency 

electric currents applied externally to the skull to initiate a seizure. can be first-line tx for psychotic depression, severe depression associated with suicidal

once the stressor has been terminated the symptoms cannot last more than 6 months

symptoms began after substance intoxication or withdrawal 

• Depressants (alcohol, benzos) 
• Stimulants (cocaine, amphetamine) withdrawal) 
• isotretinoin (accutane) 
• steroids
• interferon 

give a washout period and reassess because they may not be suicidal after the washout period

At least 2 years of depressed mood that is not suffice enough to fit major depressive (different than cyclothymic disorder because that one is more associated with bipolar like... but otherwise criteria is the same)... have to be more than 1 sigecap criteria in addition to depressed mood... and less than 5

• screening test that more so identifies the anxiety factor that is associated with the postpartum depression 
• score of 13 is  depressive

MEDICAL EMERGENCY: hallucinations delusions confusion delirium sleeplessness extreme agitation can lead to killing of the baby or self  

occurs within 3 to 14 days post partum.. but can occur later on after a month as well

• -during pregnancy (more chance of persisting after delivery)
• -within 4 weeks after delivery 

often presents as anxiety and panic attacks as opposed to traditional SIGECPAS (DIFFERENTIATE FROM PARTUM PSYCHOSIS)

usually onsets during a particular season and can be treated with light therapy 

typically in winter months because of less sunlight

major depressive disorder but with hallucinations and delusions--differentiate from others because in this the psychosis has to occur with the depression 

treatment: antidepressants, antipsychotics and possibly ECT

can be agitated: so greater motor function and increased speech 

can be decreased: where motor fx and speech are decreased

You have to have 5 symptoms in 2 weeks but the one symptom HAS to be loss of interest/pleasure or decreased mood

anxiety

the distress comes with getting rid of things so they hoard--they usually come to be evaluated for functional impairment as opposed to distress.

symptoms resemble Prader Willi

• hyperthyroid 
• pheochromocytoma (adrenal gland tumor)

• sympathomimics 
• stimulants 
• depressants (during withdrawal)
• thyroid meds 
• weed

"3 Worry WARTS"

• 3 symptoms for 6 months 
• wound up (irritable)
• Worry (worried about everything)
• Absentminded 
• Restlessness 
• Tension in muscles 
• Somnolent/sleep disturbance

• "FEAR"
• Four symptoms within the panic attack (usually lasts 30 minutes) are required and requires either excessive worry and avoidance to prevent for at least a month 

Autonomic symptoms (nausea/vomiting. derealization. fear of loosing control/dying)

Reduced CO2--basic conditions (limb numbness)

Fear being in public places for the reason of being ridiculed/negatively looked upon must last for 6 months or more (social scrutiny) 

alcohol helps with this

consistent failure to speak in selective situations-- excluding the first month of school

thought processes, feelings, and actions. 

CBT identifies these thought processes and attempts to implement strategies and behaviors to overcome these thinkings

dont tell them to just talk to people

ask them about their experiences and why they are afraid and then teach them ways to deal with this

thought that if they do something, the worst possible thing will happen 

social anxiety: if they interact with other individuals they will be made fun of

the motivation the individual has to make the changes that are desired

both mom and child should go through CBT... when the kid says her stomach hurts (which it could be because stress induces physiological symptoms with cortisol release) if the mom lets her stay home she in reinforcing the behavior of skipping school.

You are promoting behavior either by taking something away or adding something and punishment is decreasing the behavior

• 1 KID 6 Adults (typically normal for 9-18 mo children)
• 3 symptoms for 1 month in kids and 6 months for adults 

• feel distress upon leaving their house
• reluctant to be alone 
• repeated physical complaints-(somatic although no signs of it in actuality)

• Russels sign callouses on knuckles 
• and labs may show elevated alpha amylase

Limit the amount of food you eat along with 1 of these: malnutrition, significant loss of weight, or feeding tube dependence (enteral) 

not associated with perceptional issues of self

not associated with excessive or insufficient consumption 

but likely to regurgitate the food after eating and then you can either rechew, reswallow, or discard

• psycho treatment 
• fluoxetine

binge eating disorder + EXCESSIVE ways to lose the weight (normal or slightly elevated BMI) but are likely to have body distortion

FIRST LINE: renourishment and then can be followed with replenishment of vitamins and such

Binge/purging: Associated with periods of either binging or purging (different from other binging disorders because this is associated with reduced BMI) ---HYPOKALEMIA 

Restrictive: no binging or purging associated--although other things can be associated like excessive exercise

Low BMI and restriction of food intake have to be present 

You have a body distortion issue--where you think you look fat but really you are not and you have an excessive fear gaining weight

"Bingo-3 in a row": need 3 of the following for 3 months: eat more than you can, you eat when you are full, eat super fast, have to hide and eat because you are ashamed, feel disgusting/guilty for doing it

No EXCESSIVE weight loss methods: they may exercise and diet modify but its within normal societal accepting ways.

high BMI

• amneorhea 
• hypogonadism
• stress fracture

• S: Do you make yourself SICK because you feel uncomfortably full?
• C: Do you worry that you have lost CONTROL over how much you eat?
• O: Have you recently lost > ONE stone (14 pounds) in a 3-month period?
• F: Do you believe yourself to be FAT when others say you are too thin?
• F: Would you say FOOD dominates your life?

score of 2 or greater

BED7

• – Cardiomyopathy / Heart failure
• – Rhabdomyolysis
• -unexplained fatigue, shortness of breath

• glucose and cbc and cmp 
• specifically vitamin d, thyroid b12, folate CERUOPLASMIN

• Vitamin B12
• Vitamin D
• Thyroid 
• Glucose levels 
• CMP
• CBC (blood levels since anemia can also cause it) 

You can order cortisol since high or low levels can cause but less likely to unless symptoms call for it

Pancreatic

psychological development is not normal: autonomy vs shame and doubt 

• really deals with coping 
• thoughts
• personality

• temperament 
• family hx 
• neurodevelopment

Predisposing factor: things that make you at risk

Precipitating: situations that percipitate the issue 

Perpetuate: what make the symptoms worse 

Protective factors: things that protect against the above 3

joy and sadness

fear and disgust

biological, psychological, and social factors and their complex interactions in understanding health, illness, and health care delivery.

many people have a fear that is rooted beneath their OCD

many times there is an underlying thought and the compulsions are done to lower the anxiety associated with the thought 

approach the thought and learn to tolerate the discomfort

• -workcoholics 
• -egosyntonic 
• -highly critical of people
• -perfectionist 
• -always think other people are wrong and they are always right

• OCD scale
• above 16 score is concerning for OCD

tics

requires time consuming behaviors or obsessives thoughts 

(greater than one hour daily)

• Sertindole 
• Risperidone 
• Clozapine 

they have more activity on receptors beyond D2

Appears there is increased neurogenesis of the neural stem cells in the dentate gyrus of the hippocampus 

if the mitotic process is blocked then effect of these drugs is mitigated

calming effect-- more immediate 

delayed: reduced positive symptoms but no effect on negative

• prefrontal cortex releases too little glutamate 
• so gaba inter neuron is not stimulated and releases less gaba
• this causes more activation in the nucleus accumbens

• Ach,
• serotonin,
• adrenergic,
• histamine

it blocks dopamine D2 receptors on pre and post synaptic receptors and prevents IP3 increase and CAMP decrease... but also have effects on Ach, serotonin, and adrenergic, histamine 

in the start more dopamine will be released to compensate but after repeat tx there is depolarization inhibition which also reduces the release of dopamine 

• the MEDIAL prefrontal cortex 
• nucleus accumbens

VTA and substania nigra

• elevation (cushing)
• decrease (Addisons)

usually around 12 months. A good amount of kids have delayed language acquisition and do not learn to speak till age 3--most of them acquire normal language and a small fraction will go on to develop language disorders.

Ages of 4 and more, requires evaluation although most of these kids do end up acquiring normal speech