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The$Ninja's$Guide$To$PRITE$ $ Loma%Linda%Department%of%Psychiatry’s The$Ninja’s$Guide$to$PRITE$ 2015$Edition$ $ ! ! The!Best!PRITE!Review…..EVER!! ! Foreword$ In!2007,!a!ragamuffin!group!of!interns!and!residents!set!out!to!create!a!highEyield!PRITE!guide.!Equipped!with! laptops,!pencilEmarked!PRITEs!from!2001E2006,!and!enough!junk!food!to!feed!a!small!country,!the!“Loma! Linda!Department!of!Psychiatry!PRITE!Sweatshop”!was!started.!After!multiple!revisions!to!the!guide!over!the! past!seven!years,!The!Ninja’s!Guide!to!PRITE!continues!to!focus!on!the!most!important!areas!to!cram!into! your!brain!in!the!month!preceding!PRITE.!It!is!suggested!that!going!over!old!PRITE!exams!is!the!best! preparation!for!PRITE.!This!guide!provides!a!comprehensive!summary!of!old!PRITEs!in!an!attempt!to!help! with!a!more!efficient!review.!Other!items!in!this!guide!include!a!psychopharmacology!review,!a! psychotherapy!review,!and!a!miscellaneous!topics!highEyield!review.!The!various!Ninja!reviews!combine! information!from!the!Massachusetts!General!Hospital!Psychiatry!Review,!Synopsis!of!Psychiatry!and!Synopsis! of!Psychopharmacology!by!Kaplan!and!Sadock,!the!APA!Psychiatry!Textbook!and!other!excellent!sources.! Remember!that!these!materials!are!copyrighted,!so!please!do!not!sell!this!free!learning!tool.!With!these! tools,!it!is!my!hope!that!you!will!completely!rock!the!PRITE.! ! Best!of!Ninja!Luck,! Melissa!Pereau,!MD! Associate!Psychiatry!Residency!Training!Director! Loma!Linda!Department!of!Psychiatry! Loma!Linda!University!School!of!Medicine! ! ! ! Go!to!Table!of!Contents! 2! Table$of$Contents$ FOREWORD! 2! TABLE$OF$CONTENTS$...................................................................................................................................$3! A$NINJA'S$GUIDE$TO$PSYCHOPHARMACOLOGY$............................................................................................$6! ANTIPSYCHOTICS$.............................................................................................................................................$6! TYPICAL!ANTIPSYCHOTICS! 6! ATYPICAL!ANTIPSYCHOTICS! 9! MOOD$STABILIZERS$........................................................................................................................................$12! LITHIUM! 12! VALPROIC!ACID! 13! CARBAMAZEPINE!(TEGRETOL)! 14! OXCARBAZEPINE!(TRILEPTAL)! 16! LAMOTRIGINE!(LAMICTAL)! 16! GABAPENTIN!(NEURONTIN)! 17! TOPIRAMATE!(TOPAMAX)! 17! ANTIDEPRESSANTS$.........................................................................................................................................$18! TCAS! 18! TETRACYCLIC!ANTIDEPRESSANTS! 20! MONOAMINE!OXIDASE!INHIBITORS! 21! SELECTIVE!SEROTONIN!REUPTAKE!INHIBITORS!(SSRIS)! 22! SOME!OBSERVATIONS!ON!THE!GENERIC!MEDICATIONS!WE!NOW!PRESCRIBE! 26! VILAZODONE!HCL!(VIIBRYD)! 27! BUPROPION!(WELLBUTRIN,!ZYBAN)! 27! MIRTAZAPINE!(REMERON)! 28! VENLAFAXINE!(EFFEXOR)!AND!DESVENLAFAXINE!(PRISTIQ)! 28! DULOXETINE!(CYMBALTA)! 29! ANXIOLYTICS$................................................................................................................................................$29! BUSPIRONE!(BUSPAR)! 29! BENZODIAZEPINES! 30! COGNITIVE$ENHANCERS$..................................................................................................................................$32! MISCELLANEOUS$TOPICS$.................................................................................................................................$33! TREATMENT!OF!MEDICATION!SIDE!EFFECTS! 33! TREATMENT!OF!OVERDOSE! 33! A$NINJA’S$GUIDE$TO$NEUROLOGY$.............................................................................................................$34! CORTEX$.......................................................................................................................................................$34! ANATOMY!OVERVIEW! 34! ! Go!to!Table!of!Contents! 3! PEREAU’S!“CRAM!THE!BRAIN!USING!THE!MMSE”!REVIEW!TOOL! 35! HIGH!YIELD!PRITE!REVIEW! 38! BRAINSTEM$AND$SPINAL$CORD$.........................................................................................................................$40! ANATOMY!OVERVIEW! 40! PEREAU’S!“THE!BRAINSTEM!AS!A!FACE”!REVIEW!TOOL! 41! HIGH!YIELD!PRITE!REVIEW! 43! A$NINJA’S$GUIDE$TO$PSYCHOTHERAPY$......................................................................................................$52! PSYCHOANALYTICAL!PSYCHOTHERAPY! 52! EXPRESSIVE!PSYCHOTHERAPY!(“INSIGHTEORIENTED!THERAPY”)! 53! BRIEF!PSYCHOTHERAPY! 54! INTERPERSONAL!THERAPY! 55! SUPPORTIVE!PSYCHOTHERAPY! 55! BEHAVIORAL!THERAPY! 56! BIOFEEDBACK! 56! COGNITIVE!BEHAVIORAL!THERAPY! 57! GROUP!THERAPY! 59! FAMILY!THERAPY! 60! COUPLES!THERAPY! 61! A$NINJA’S$GUIDE$TO$FREUD$&$OTHER$STUFF$.............................................................................................$63! SIGMUND$FREUD$...........................................................................................................................................$63! INTERPRETATION!OF!DREAMS! 63! THE!TOPOGRAPHICAL!MODEL!OF!THE!MIND! 64! INSTINCT!AND!DRIVE!THEORY! 64! PLEASURE!VS.!REALITY!PRINCIPLES! 64! NARCISSISM! 64! THE!STRUCTURAL!THEORY!OF!THE!MIND! 65! DEFENSE!MECHANISMS! 65! PSYCHOSEXUAL!DEVELOPMENTAL!STAGES! 67! ERIK$ERIKSON$...............................................................................................................................................$69! TRUST!VS.!MISTRUST!(0E18!MONTHS,!CORRELATES!WITH!ORAL)! 69! AUTONOMY!VS.!SHAME!AND!DOUBT!(18!MONTHSE3!YEARS,!CORRELATES!WITH!ANAL)! 69! INITIATIVE!VS.!GUILT!(3E5!YEARS!OLD,!CORRELATES!WITH!PHALLIC)! 70! INDUSTRY!VS.!INFERIORITY!(5E13!YEARS!OLD,!CORRELATES!WITH!LATENCY)! 70! IDENTITY!VS.!ROLE!CONFUSION!(13E21!YEARS!OLD,!CORRELATES!WITH!GENITAL)! 70! INTIMACY!VS.!ISOLATION!(21E40!YEARS!OLD)! 70! GENERATIVITY!VS.!STAGNATION!(40E60!YEARS!OLD)! 71! INTEGRITY!VS.!DESPAIR!(60!YEARS!OLD!UNTIL!DEATH)! 71! PATHOLOGIC$DEVELOPMENT$............................................................................................................................$72! BIRTH!TO!18!MONTHS! 72! ! Go!to!Table!of!Contents! 4! 18!MONTHS!TO!3!YEARS! 72! 3!TO!5!YEARS! 73! 5!TO!13!YEARS! 73! 13!YEARS!TO!20S!(ADOLESCENCE)! 73! 20S!TO!40S! 74! 40S!TO!60S! 74! 60S!TO!END!OF!LIFE! 74! NEUROPSYCHOLOGIC$TESTING$..........................................................................................................................$75! INTELLIGENCE!TESTS! 75! PERSONALITY!ASSESSMENT! 75! COGNITIVE!TESTING! 76! CHILD!AND!ADOLESCENT!PSYCHOLOGICAL!ASSESSMENT! 77! STATISTICS$...................................................................................................................................................$78! A$NINJA’S$GUIDE$TO$PRITE$QUESTIONS$2015$EDITION$...............................................................................$79! NEUROLOGY! 80! AXIS!I!DISORDERS! 119! SOMATIC!TREATMENTS! 161! CHILDHOOD!AND!DEVELOPMENT! 212! CONDITIONING!AND!LEARNING! 224! RESEARCH!AND!STATISTICS! 227! SOCIETY! 236! ! ! ! ! ! Go!to!Table!of!Contents! 5! A$NINJA'S$GUIDE$TO$PSYCHOPHARMACOLOGY$ ! Antipsychotics$ Typical$Antipsychotics$ Phenothiazines!are!compounds!derived!from!the!original!parent!drug,!methylene!blue.!This!chemical!is!used! in!histologic!staining,!analytic!chemistry,!and!as!an!antimalarial!medication!(as!early!as!1891).!During!WW2! methylene!blue’s!use!as!an!antimalarial!due!to!lack!of!access!in!the!Pacific!tropics!and!side!effects!of!turning! urine!green!and!sclera!blue.!The!antihistamine!properties!of!methylene!blue!were!found!to!be!helpful!as! anesthetic!agents.!In!1951,!French!surgeon!Laborit!asked!a!pharmaceutical!company!to!create!a!specialized! phenothiazine!to!reduce!postEsurgical!psychosis.!This!medication!was!chlorpromazine.!Shortly!thereafter,!the! medication!was!used!serendipitously!in!psychiatric!patients!to!reduce!psychosis.!Through!further!research! and!development,!a!similar!structure,!imipramine!was!created.!This!medication!was!one!of!the!first! antidepressants.! ! ! ! Chlorpromazine! Imipramine! Methylene$Blue! ! Indications:!schizophrenia!(improves!positive!symptoms,!may!worsen!negative!symptoms),!acute!mania,! MDD!with!psychosis,!hemiballismus,!hiccups,!Tourette’s.!High!potency!antipsychotics!are!better!used!in! patients!with!psychosis!due!to!tumor/organic!causes.!As!they!decrease!seizure!threshold,!use!with!caution!in! ETOH!detox.!Low!potency!antipsychotics!should!be!avoided!in!the!elderly!and!medically!ill!due!to!multiple! anticholinergic!and!cardiac!side!effects.!Avoid!use!in!1st!trimester!(especially!chlorpromazine);!2nd!and!3rd! trimester!are!safer.!Contraindicated!in!cardiac!patients,!acute!angle!glaucoma,!and!patients!with!a!history!of! TD.! ! Go!to!Table!of!Contents! 6! ! Mechanism$of$Action:!blockade!of!D2!receptors! •! Mesocortical/mesolimbic:!diminishes!psychosis! •! Tuberoinfundibular:!increases!PRL!(DA!decreases!PRL;!DA!blockade!increases!PRL)! •! Nigrostriatal:!basal!ganglia!and!caudate.!Movement!disorders!including!EPS,!PD,!tremor! ! Drug$Interactions$and$P450:!typicals!are!metabolized!by!2D6!and!3A4,!thus!are!increased!in!the!presence!of! Prozac,!Paxil!and!Luvox.!They!are!reduced!by!coadministration!with!Tegretol.!Antacids!decrease!the! absorption!of!typicals.!Anticholinergic!delirium!is!possible!in!the!presence!of!anticholinergic!medications,!low! potency!typical!and!TCA!coadministration.!Typicals!increase!blood!concentrations!of!valproic!acid.!Cigarettes! decrease!blood!concentrations!of!typical.!Thus,!if!a!patient!is!stabilized!on!a!specific!dose!of!a!typical!and! quits!smoking!there!is!risk!for!EPS!and!other!side!effects.!
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