Review for final 2002. Systems of Care What is an HMO, PPO? How does managed care differ from ‘fee for service’ insurance? What is HCFA / CMS? What is.

Review for final 2002

Systems of Care

What is an HMO, PPO? How does managed care differ from ‘fee

for service’ insurance? What is HCFA / CMS? What is provider profiling?

Psychiatry and the law

Describe the components of capacity to make medical decisions

Describe the elements of informed consent Describe the criteria for involuntary

hospitalization Describe six situations where there is an

exception to confidentiality What is the difference b/w insanity defense and

incompetency to stand trial? What is the cognitive test and the volitional test?

Introduction to Clinical Psychopathology

1. multi axial diagnostic system used in DSM IV

• What is the hierarchy when a behavioral disorder is identified as a result of a medical condition?

2. Define• mood and affect. • thought content and thought form

Introduction to Clinical Psychopathology

loosening of association, tangentiality, circumstantiality, derailment, symbolic logic, primary process, secondary process, abstract thought, concrete thought.

neologisms, paraphasias. the significance of auditory, visual, olfactory and

tactile/haptic hallucinations Compare the allied symptoms of depression and

mania

Personality Disorders

Distinguish cluster A, cluster B, and cluster C disorders

Distinguish avoidant and schizoid personality disorder.

paranoid PD and schizophrenia What happens to personality when a

person has a significant medical or neurological illness

Sleep disorders

Describe DIMS and DOES What is Narcolepsy Describe the sleep EEG

What is meant by reduced REM latency Describe the insomnia of depression,

anxiety What is sleep hygiene?

Sleep disorders

What effect does alcohol and most sleeping pills have on sleep architecture?

What is cataplexy? What are the REM on cells? What are parasomnias? What is REM sleep

disturbance? What is sleep apnea? Treatment of restless legs? What is night terrors?, Enuresis? When is it

abnormal? What is somnambulism?

Psychological assessment Cordes

Define Reliability, Validity, and standardization. What are objective tests and projection test? Give examples of

each? Is the MMPI a projective or objective test? How is intelligence measured? What is meant by cultural bias?

What are neuropsychological tests? Distinguish these from a list of other test?

Which is the neuropsychological test of choice for identifying frontal lobe dysfunction?

What is the Rorschach test? How can the Rorschach test help identify psychotic thought disorders?

What is the Thematic Apperception Test?

Gender disorders

1.) Distinguish sex, sexual identity, gender identity, intersexual disorders.

2.) By what age is gender identity usually established (according to analysts)?

3.) Distinguish Turner's, Klinefelter's, adrenogenital syndrome, androgen insensitivity syndrome, and pseudohermaphoditism.

4.) Describe transvestism vs transsexual disorders 5.) What are paraphilias? What is the typical age

of onset?

Human sexuality

Describe the four stages/phases of the human sexual response in men and women.

Describe in general the change s which may occur in the human sexual response with aging.

What is sensate focus? What is the squeeze technique? Describe the effect of dopamine, serotonin, and

norepinephrine on sexual functioning. Name common medication causes of sexual dysfunction. Which sexual dysfunctions are most common Describe sexual dysfunctions related to the specific stages

of the sexual response

What are the 3 general types of phenothiazine antipsychotics? What are the six general types of typical antipsychotics? How

do low potency and high potency antipsychotics differ? How are antipsychotic agents thought to work? What is

depolarizing blockade? What is EPS Describe, tardive dyskinesia, torticollis, akathisia,

pseudoparkinsonism, bruxism, oculogyric crisis, neuroleptic mallignant syndrome.

How are EPS probllems managed? How are atypical antipsychotic agents different ? Describe medication specific side effects for clozapine,

thioridazine, chlorpromazine

Eating disorders

Distinguish anorexia from bulimia. What percentage of anorectics also binge purge?

What are the clinical features of anorexia? Describe the statistics of anorexia in US. Describe the monoamines and opiate findings in

anorexia nervosa What is the mortality rate from AN? What are the laboratory findings in active

bulimia? What are the medical complications?

Compliance

1.        Define Compliance. Describe the magnitude of the problem. What are some adverse consequences of noncompliance.

2.        Describe a suitable way to assess compliance. Compare various methods.

3. Describe the types of noncompliance. How might you reduce noncompliance or increase compliance?

Death and dying questions

How do you notify a relative of a patients death? How do you manage bereavement? When is it

considered pathological? What are the 5 stages of death as described by

Kubler-Ross? Describe how a 1 to 3 year old might view death

as compared to a 3 to 5 year old , 5 to 10 year old, adolescent, adult, and oldster.

What is a living will?   Distinguish assisted suicide and euthanasia.

Dementia

Compare dementia and delirium. What are the most common forms of dementia? What are the perfusion patterns characteristic of SDAT, Multi-infarct dementia and frontal lobe degeneration?Which neuroanatomic nucleus is primarily associated with SDAT? Which neurotransmitter does this structure produce? What are the other pathologic findings in SDAT? Describe agents used in Rx of SDAT?

Distinguish pseudodementia, normal pressure hydrocephalus, Cruetzfeldt-Jakob disease, and Pick's

Compare SDAT and MID. What is the typical pattern of decline in each? What is the regional pathology encountered in each? What diseases predispose to MID? What is the relationship of SDAT and trisomy 21?

Psychotherapy

1) Describe the difference between cognitive and behavioral therapy

2) Describe the tripartite model of Freud. What is the Ego, ID, and Superego?

3) What is meant by oedipal struggle or conflict? 4) Describe Freud's developmental theory of behavior. Describe

the stages. What is meant by fixation? 5) What is meant by transference neurosis? 6) How does psychoanalytic therapy differ from cognitive and

behavioral therapy? 7) What is interpersonal psychotherapy? 8) Which psychotherapies have been shown to be useful in

treating outpatient depression?

Behavioral modification

1. What is behavioral modification? 2. Define biofeedback, reciprocal inhibition, flooding, implosion, progressive relaxation, systematic desenitization.

3. What are the major forms of biofeedback?

4. Name diseases which may be responsive to biofeedback.

Behavioral modification

What are the basic assumptions of behavioral therapy?

Describe the characteristics of patients who benefit from behavioral techniques\

What is contingency management? What are precontemplative, contemplative

and action stages of change?

Delirium

What is the rate of mortality in the first 12 months after the initial diagnosis of a delirium?

Describe the environmental strategies which may be useful in managing the delirious patient

Describe conditions associated with high risk for delirium

PTSD

1. How does PTSD differ from other anxiety disorders? What is the role of arousal in the development of the disorder?

2. Describe the effects of yohimbine and lactate on panic disorder and PTSD. What neuroanatomic structure has been implicated in the development of PTSD? Which neurotransmitter is synthesized by neurons of this structure?

3. What is meant by startle response?

4. What is DaCosta's syndrome? Briefly describe the purported etiology of the PTSD syndrome.

5. What is Alexithymia? Describe the diagnostic criteria for PTSD.

6. Describe the course and prognosis of PTSD and Acute stress syndrome.

Somatoform

How does somatization disorder differ from conversion disorder?

How do these patients differ from patients who purposely fake their symptoms?

Describe an effective way to deal with the somatization disordered patient in order to reduce 'doctor shopping'.

What type of pathologic disorders would be considered in treating the somatization disordered patient?

What is la belle indifference? What is primary gain? How does physician bias affect

the diagnosis of conversion?

Alcohol abuse

1. Describe the epidemiology of alcohol abuse and dependence, opiate abuse and dependence, marijuana abuse and dependence.

2. Compare ethnic differences in alcohol abuse and dependence

3. Describe the metabolism of ethanol. what is zero order kinetics? What role does disulfiram play in alcohol treatment? What is AA? Name another drug with disulfiram-like effects

4. Describe the genetic factors believed to be important in alcoholism. What is the gender effect of alcoholism?

Alcohol abuse continued

1. Describe the relationship of BAL and effect.2. What are DT's? Describe other medical

complications of alcohol abuse. What are the effects of alcohol on lab tests?

3. How do you treat alcohol withdrawal? Describe the similarities and differences

between alcohol withdrawal, opiate withdrawal, stimulant intoxication, and sedative hypnotic withdrawal syndromes

Substance abuse

1. Describe the difference between intoxication, withdrawal, tolerance, and sensitization.

2. Explain the general criteria for substance dependence, abuse, and intoxication..

3. Describe how Potency, rapidity of onset and duration of effect relate to the reinforcing properties of drugs of abuse in general.

4. Describe the neuologic substrate for reinforcing effects of drugs. What is ICSS and which structures are relevant for ICSS?

5. What is Kindling and behavioral sensitization?

Sedative hypnotic abuse

1. Describe the statistics of sedative/hypnotic abuse and dependency.

2. What are the effects of sedative/hypnotic intoxication ingeneral? What are the signs and symptoms of sedative/hypnotic withdrawal?

3. What is the pentobarbital challenge and when is it used? How would you detoxify someone off of sedative/hypnotic agents? What is meant by cross tolerant?

4. How could you reverse benzodiazepine effects in an overdose situation?

Mood disorders and the management of depression

Distinguish mood and affect. Distinguish Unipolar depression and bipolar disorder. Distinguish major depression and dysthymia.

Describe the symptoms of a depressive episode. What is the lifetime risk for suicide in patients with major depressive disorder? What percentage of patients with major depression also have psychotic symptoms?

Depression

What are the major neurotransmitter hypotheses for depressive disorders?

How common is depressive illness? Describe the behavioral genetics of unipolar depression and bipolar disorder. (see the behavioral genetics handout)

Describe the animal models of depression. What is learned helplessness?

Describe the changes in sleep architecture which are associated with depressive illness?

Depression

1. What is the dexamethasone suppression test? Name some medical illnesses associated with depressive illness.

2. What is "double depression", catatonia, melancholia, anhedonia, anorexia, nihilism, rumination.

3. What is the difference between mania and hypomania? Distinguish cyclothymia, bipolar type I and bipolar type II, rapid cycling, and mixed states.

Bipolar disorder

1. What is the importance of rapid cycling for treatment with lithium?

2. Compare bipolar disorder and unipolar depression in terms of incidence, family history and transmission, age of onset, sex ratio, duration of depressive episodes, recurrence risk

3. Describe mood stabilizing medications4. Compare the side effects of valproic acid,

lithium and carbamazepine

Schizophrenia

What are the forms of cognitive pathology in schizophrenia? What is the difference between illusion and hallucination? What is the importance of isolated visual hallucinations in a patient? What is the most common form of hallucination in schizophrenia?

Describe the subtypes of schizophrenia? What is type I and type II schizophrenia? Describe the evidence for frontal lobe, temporal lobe and dopaminergic involvement in schizophrenia.

Schizophrenia

What are the poor prognosis signs in schizophrenia? What is Dementia praecox? What are the 4 A's of Bleuler? What is catatonia? What is hebephrenia?

Describe the scheiderian symptoms. Describe the inheritance patterns in

schizophrenia. What is the Bracha-Wienberger hypothesis? How common is schizophrenia and what is the male female ratios?

Schizophrenia

Distinguish the four dopaminergic pathways. Where is the ventral tegmental area?

What is expressed emotion? Why is it important in the prognosis of schizophrenia?

What is the double bind hypothesis? What are the differences in brief reactive

psychosis, schizophreniform, schizoaffective and delusional disorder?

Management of Pain

Describe the three elements of pain experience Compare somatic and deafferentation pain. Compare the pain mediated by A-delta and C-

fibers. What are four common chemical stimuli which stimulate pain receptors?

What is the basis for pain inhibition which results from mechanical/tactile stimulation of non-pain fibers from the same anatomic locations as the pain?

Pain

Compare the neospinothalamic and paleospinothalamic pathways.

Compare the periaqueductal gray and nucleus raphe magnus as antinocioceptive systems.

Compare the mu, delta, and kappa opiate receptors.

How could inadequate pain relief interfere with recovery from surgery? What problems might arise from as needed dosing of pain medications? What is PCA?

Pain

Describe non-opiate analgesic adjuvant. What is causalgia? What is Alexithymia? Compare acute and chronic pain.

1. Describe the difference between functional and structural evaluation of the nervous system.

2. Describe the strengths and weaknesses of the major types of neuroimaging tools.

3. Describe the electroencephalograph, includin evoked potentials. Describe the alpha, theta, beta and delta frequencies

4. Describe neuroendocrine test

Medical sociology

Describe the basis for cultural and social influences on health and disease

Define culture, society, enculturation, cultural relativism, ethnocentrism, cultural competency, world view. What are common cultural symbols.

What is the importance of subcultural variations for the physician?

Medical sociology

Give an example of the three basic types of health beliefs / systems Western, magical, supernatural?

What is curanderismo? Describe the Melbourne Cancer study, Duke-piedmont study, isreali study of Kibbutz

Describe Whitigo, koro, kuru, latah, piblokto, amok, and mal de ojo / susto

What is the best predictor for poor health? What effects life expectancy the most? What effect does SES have on breast cancer, iatrogenic illness?

Medical economics

What is meant by price elasticity? Describe the RAND study. What is the moral hazard for physicians? …Patients?

Describe market distortions and how they influence the free market? How did ERISA distort the medical market?

What is meant by insurance ratings? What is HCFA? What do they do? What are DRGs?

What percentage of our GDP is spent on health care? How many people do not have insurance at last count?

Medical economics

Which country spends the greatest percentage of GDP on healthcare? Which spends the least?

Which country has the longest life expectancy? Which has the shortest?

Which country has the greatest infant mortality rates? Which has the least?

What is the trend in spending for health care in the US?

What happens to healthcare expenditures when the number of providers goes up in a community?

Eating disorders

Distinguish anorexia nervosa from bulimia nervosa. Describe other types of anorexia.

What is the mortality rate associated with AN What is the age of onset, prevalence, and

clinical course for eating disorders Describe the lab abnormalities found in BN. What are the characteristic findings sometimes

seen in AN and BN?

Epidemiology

Distinguish prevalence and incidence What is usually considered the best type of

study to determine if a drug has a clinical effect? Define prospective, retrospective, open label,

double blind, and case matched as they pertain to research

What are the three types of validity? What is reliability, sensitivity, specificity?

Research design

Describe positive and negative predictive value of a test. Be able to calculate it from a table of false pos and negatives

What are type 1 and 2 errors? What is the power of a study? Distinguish parametric and nonparametric test, chis square and T-test, know how to calculate the percent of a normal distribution between +/- 1 and 2 SD. What does mean , median and mode measure?