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First Aid for The® Psychiatry Clerkship

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FOCUSED LEARNING for the psychiatry clerkship Tips on what to know to IMPRESS ATTENDINGS and EARN HONORS on the shelf exam Completely UPDATED FOR THE DSM-5 FOR FIRST AID THE® PSYCHIATRY CLERKSHIP FOURTH EDITION LATHA GANTI, MD, MS, MBA, FACEP SEAN M. BLITZSTEIN, MD Director, VACO Southeast Specialty Care Director, Psychiatry Clerkship Center of Innovation Clinical Associate Professor of Psychiatry Orlando VA Medical Center University of Illinois at Chicago Professor of Emergency Medicine Chicago, Illinois University of Central Florida Orlando, Florida MATTHEW S. KAUFMAN, MD Associate Director Department of Emergency Medicine Richmond University Medical Center New York, New York New York / Chicago / San Francisco / Athens / Lisbon / London / Madrid / Mexico City Milan / New Delhi / Singapore / Sydney / Toronto Copyright © 2016 by McGraw-Hill Education. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. ISBN: 978-0-07-184175-7 MHID: 0-07-184175-X The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-184174-0, MHID: 0-07-184174-1. eBook conversion by codeMantra Version 1.0 All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefi t of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this book, they have been printed with initial caps. McGraw-Hill Education eBooks are available at special quantity discounts to use as premiums and sales promotions or for use in corporate training programs. To contact a representative, please visit the Contact Us page at www.mhprofessional.com. Previous editions copyright © 2011, 2005, 2002 by The McGraw-Hill Companies, Inc. First Aid for the® is a registered trademark of McGraw-Hill Education. All rights reserved Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confi rm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recom- mendation is of particular importance in connection with new or infrequently used drugs. TERMS OF USE This is a copyrighted work and McGraw-Hill Education and its licensors reserve all rights in and to the work. Use of this work is subject to these terms. Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill Education’s prior consent. You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may be terminated if you fail to comply with these terms. 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Under no circumstances shall McGraw-Hill Education and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise. CONTENTS Contributing Authors v Introduction vii Chapter 1: How to Succeed in the Psychiatry Clerkship 1 Chapter 2: Examination and Diagnosis 11 Chapter 3: Psychotic Disorders 21 Chapter 4: Mood Disorders 33 Chapter 5: Anxiety, Obsessive-Compulsive, Trauma, and Stressor-Related Disorders 47 Chapter 6: Personality Disorders 63 Chapter 7: Substance-Related and Addictive Disorders 79 Chapter 8: Neurocognitive Disorders 97 Chapter 9: Geriatric Psychiatry 113 Chapter 10: Psychiatric Disorders in Children 121 Chapter 11: Dissociative Disorders 133 Chapter 12: Somatic Symptom and Factitious Disorders 139 Chapter 13: Impulse Control Disorders 145 Chapter 14: Eating Disorders 151 Chapter 15: Sleep-Wake Disorders 159 Chapter 16: Sexual Dysfunctions and Paraphilic Disorders 171 Chapter 17: Psychotherapies 179 Chapter 18: Psychopharmacology 189 Chapter 19: Forensic Psychiatry 209 Index 217 iii CONTRIBUTING AUTHORS SEAN M. BLITZSTEIN, MD KELLEY A. VOLPE, MD Director, Psychiatry Clerkship Chief Resident, Department of Psychiatry Clinical Associate Professor of Psychiatry University of Illinois at Chicago College of Medicine University of Illinois at Chicago Chicago, Illinois Chicago, Illinois Eating Disorders Examination and Diagnosis Sleep-Wake Disorders Personality Disorders Psychotherapies Substance-Related and Addictive Disorders Forensic Psychiatry Geriatric Psychiatry Somatic Symptom and Factitious Disorders Sexual Dysfunctions and Paraphilic Disorders ALEXANDER YUEN, MD Resident, Department of Psychiatry University of Illinois at Chicago AMBER C. MAY, MD Chicago, Illinois Resident, Department of Psychiatry Psychotic Disorders University of Illinois at Chicago Mood Disorders Chicago, Illinois Impulse Control Disorders Anxiety, Obsessive-Compulsive, Trauma and Stressor-Related Disorders Psychopharmacology Neurocognitive Disorders Psychiatric Disorders in Children Dissociative Disorders v INTRODUCTION This clinical study aid was designed in the tradition of the First Aid series of books. It is formatted in the same way as the other books in this series; how- ever, a stronger clinical emphasis was placed on its content in relation to psy- chiatry. You will find that rather than simply preparing you for success on the clerkship exam, this resource will help guide you in the clinical diagnosis and treatment of many problems seen by psychiatrists. Each of the chapters in this book contains the major topics central to the practice of psychiatry and has been specifically designed for the medical stu- dent learning level. It contains information that psychiatry clerks are expected to learn and will ultimately be responsible for on their shelf exams. The content of the text is organized in the format similar to other texts in the First Aid series. Topics are listed by bold headings, and the “meat” of the top- ics provides essential information. The outside margins contain mnemonics, diagrams, exam and ward tips, summary or warning statements, and other memory aids. Exam tips are marked by the icon, tips for the wards by the icon, and clinical scenarios by the icon. vii C HAPTER 1 HOW TO SUCCEED IN THE PSYCHIATRY CLERKSHIP Why Spend Time on Psychiatry? 2 KEEP PATIENT INFORMATION HANDY 3 How to Behave on the Wards 2 PRESENT PATIENT INFORMATION IN AN ORGANIZED MANNER 3 RESPECT THE PATIENTS 2 How to Prepare for the Clerkship (Shelf) Exam 4 RESPECT THE FIELD OF PSYCHIATRY 2 STUDY WITH FRIENDS 4 TAKE RESPONSIBILITY FOR YOUR PATIENTS 3 STUDY IN A BRIGHT ROOM 4 RESPECT PATIENTS’ RIGHTS 3 EAT LIGHT, BALANCED MEALS 4 VOLUNTEER 3 TAKE PRACTICE EXAMS 4 BE A TEAM PLAYER 3 POCKET CARDS 5 1 2 CHAPTER 1 HOW TO SUCCEED IN THE PSYCHIATRY CLERKSHIP The psychiatry clerkship will most likely be very interesting and exciting. A key to doing well in this clerkship is finding the balance between drawing a firm boundary of professionalism with your patients and creating a relation- ship of trust and comfort. Why Spend Time on Psychiatry? For most, your medical school psychiatry clerkship will encompass the entirety of your formal training in psychiatry during your career in medicine. Being aware of and understanding the features of mental dysfunction in psy- chiatric patients will serve you well in recognizing psychiatric symptoms in your patients, regardless of your specialty choice. While anxiety and depression can worsen the prognosis of patients’ other medical conditions, medical illnesses can cause significant psychological stress, often uncovering a previously subclinical psychiatric condition. The stress of extended hospitalizations can strain normal mental and emotional functioning beyond their adaptive reserve, resulting in transient psychiatric symptoms.
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