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Psych Objectives 2015

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List the major parts of the mental status examination


Define terms used in a mental status examination (hallucinations,
delusions, affect, tangential speech, circumstantial speech, etc.)
Describe similarities and differences in the mental status exam of
patients with different diagnoses. (For example, describe
similarities in the mental status exam of patients with
Schizophrenia and Bipolar Affective Disorder).
Perform a mental status exam on a patient.
Compare Kraepelin and Freud with respect to their different
approaches to psychiatry.
Explain how infecting patients with malaria led to a Nobel prize for
a psychiatrist.
List the three complementary approaches for understanding
psychopharmacologic agents recommended by Rubin.
Reproduce and use the equations defining the relationships
between half-life, volume of distribution, and clearance.
Answer the study questions on the lecture handout.
Explain what happens to t1/2, VOD, and clearance for a fat soluble
drug inactivated primarily by the liver in a patient as s/he ages
from 25 yo to 85 yo. What happens to each of the above variables
if that 25 yo patient gains 50 pounds?
Discuss the different pharmacokinetic issues involved in using
diazepam (Valium) for each of the following: (a) treating status
epilepticus, (b) helping a patient get one good nights sleep, and
(c) relieving chronic generalized anxiety.
List the criteria for Major Depressive Disorder and recognize a
patient presenting with Major Depressive Disorder.
Describe the natural history of Major Depressive Disorder (age of
onset, duration, recurrence, comorbid factors).
Describe the rates of Major Depressive Disorder in men and
women.
List the most common symptoms of patients with Major
Depressive Disorder.
List the risk factors associated with suicide.
Describe the treatments for Major Depressive Disorder, and the
effectiveness of each treatment.
Describe at least three types of depressive disorders that require
different categories of pharmacologic treatment.
Describe putative mechanisms of action for each category of
antidepressant on the accompanying handout.
Discuss possible explanations for the fact that antidepressants
take several weeks to fully work and describe why it is important
to discuss this delay with patients.

21. List the major side effects of the tricyclic antidepressants (TCAs)
and discuss the difference between tertiary amine TCAs and
secondary amine TCAs regarding these side effects.
22. Predict drug interactions of TCAs based on receptor mechanisms.
23. Describe the role of gut MAO and brain MAO in terms of tyraminerelated hypertensive crisis.
24. Compare fluoxetine and sertraline in terms of half-life and P450
2D6 interactions.
25. Discuss why SSRIs are thought to be safer than TCAs.
26. Discuss the similarities and differences of SSRIs and SNRIs.
27. Discuss the ways bupropion may be a different type of
antidepressant.
28. Describe the receptor influences of mirtazapine.
29. Describe trazodone's use as an antidepressant vs. its use as a
soporific.
30. Answer the study questions on the lecture handout.
31. A patient with a three-month history of major depression is started
on paroxetine. Three days later she calls reporting marked
improvement. What are some possible explanations of this and
how does this information influence your treatment plan?
32. The t1/2 of tranylcypromine (Parnatean MAO inhibitor) is about
2 hours. You have decided to stop this medication in order to start
a patient on another category of antidepressant. How long does it
take for this drug to no longer be detectable in plasma? Why is it
necessary to wait at least 10 days before starting the new
medication?
33. You have an elderly patient who has been successfully treated for
chronic depression with amitriptyline. (She has been on it without
difficulties for 20 years.) A neurologist starts this patient on
trihexyphenidyl (Artane), a medication used to treat Parkinsonism,
at a dose of 2 mg three times a day. What side effects would you
specifically watch for? If they appear, what do you do?
34. An elderly patient was only partially responsive to 125 mg of
imipramine, so the general practitioner lowered the dose to 100
mg and added 20 mg of fluoxetine. The next week the patient
returned confused, dizzy, and mildly agitated. In addition, his EKG
showed first-degree heart block. What happened? How could you
determine whether your hypothesis is correct and what would you
do?
35. To develop an understanding of concepts of developmental theory
(e.g., stages, critical periods, risk and protective factors).
36. To understand fundamental stages of cognitive development
according to Piaget.
37. To understand milestones in motor, sensory and language
development.

38. To understand fundamental stages in fundamental areas of social


and emotional development, the development of attachment and
emotional development. To apply these principles to the
understanding of the correlate childhood mental disorders,
attachment disorders, and disorders of emotional regulation and
mood disorders. To understand how the integration of theory and
clinical phenomena can be used as a model for how knowledge of
basic development impacts our understanding of the development
of mental disordersa.k.a. "developmental psychopathology."
39. To understand the ways in which experience-expectant processes
in early development affect long-term social behavior in children.
40. To understand the extent to which the condition of being abused
or neglected in childhood raises the relative risk for
psychopathology over the life course, and to be familiar with
landmark studies that have demonstrated the magnitude of those
risks.
41. To recognize at least one viable strategy for preventing child
abuse and neglect and its consequences.
42. Understand what is currently known about the etiology of autism
spectrum disorder, including knowledge about the relative
contributions of genetic and environmental influences to its
development.
43. Recognize clinical manifestations of deficits in reciprocal social
behavior and know how to evaluate a child for "the presence of an
autism spectrum disorder."
44. Be able to devise a treatment plan for a child with autism
spectrum disorder.
45. List the DSM-5 criteria for Somatic Symptom Disorder.
46. Recognize red flags for the Somatic Symptom Disorders in clinical
practice.
47. Summarize the epidemiology of Somatic Symptom Disorder
(Somatization Disorder) and Conversion disorder, including
demographic features, natural history, heritability, and prognosis.
48. Know co-morbid conditions seen with the Somatic Symptom
Disorders.
49. Discuss the differential diagnosis of symptoms of the Somatic
Symptom Disorders.
50. Describe effective management of the Somatic Symptom
Disorders in clinical practice.
51. Distinguish Somatic Symptom Disorders from Factitious Disorder
and malingering.
52. Discuss the different goals and pharmacologic strategies used in
the initial treatment of acute mania versus maintenance therapy.
53. Discuss the main difference between a mood stabilizer and an
antidepressant.

54. List three mood stabilizers and discuss their putative mechanisms
of action.
55. Compare the mechanisms of clearance and VOD of lithium vs. a
TCA (e.g., nortriptyline.)
56. Discuss the mechanisms underlying the interaction of lithium and
hydrochlorthiazide as well as lithium and a NSAID (non-steroidal
anti-inflammatory drug).
57. Describe the changes in steady state levels of carbamazepine
over the first 8 weeks of use.
58. Discuss the use of plasma level monitoring with regard to mood
stabilizers.
59. Discuss the problems of giving high dose aspirin to a patient on
valproate.
60. Answer the study questions on the handout.
61. Would regulating the lithium level be more difficult in a patient
with chronic renal failure or hepatic disease? Why?
62. Describe the effect of aging on T1/2, VOD, and clearance for
lithium.
63. A patient has treatment resistant mania and has failed lithium.
She partially responds to valproate alone and carbamazepine
alone. She does better on both together. What are the
pharmacokinetic effects of each drug on the other?
64. A young, female patient with mania is on birth control pills and
requires carbamazepine for treatment of her bipolar illness. What
are your concerns?
65. Describe diagnostic criteria for mania.
66. Describe diagnostic criteria for depression.
67. Describe the impact of Bipolar Disorder on mortality.
68. Features of psychosis. DDX
69. Mania. DDX
70. Depression. DDX
71. Common childhood disordersAttention Deficit Hyperactivity
Disorder (ADHD) and conduct disorder. DDX
72. Describe Familial Disorder.
73. Treatments (Lithium. Anticonvulsants. Antidepressants. ECT.
Antipsychotics. Psychotherapy.)
74. Alcohol use complications
75. Describe and define schizophrenia. (Ep, Etiol, PG, PP, Sx, PG)
76. Understand basic principles for diagnosis and management of
schizophrenia. (Criteria, DDX)
77. Compare the old generation and new generation antipsychotics in
terms of the dopaminergic and serotonergic systems.
78. List the differences in common side effects between the low
potency old generation antipsychotics and the high potency old
generation antipsychotics.

79. List and describe the extrapyramidal syndromes associated with


the old generation antipsychotics.
80. Discuss movement side effects and weight-related metabolic side
effects of antipsychotics in the context of old and new generation
antipsychotics.
81. Apply the pharmacokinetic principles discussed in our first lecture
to the antipsychotics, including understanding depot injections.
82. Discuss the different issues involved in acute versus chronic use of
old generation and new generation antipsychotics.
83. Answer the study questions on the handout.
84. For antipsychotic agents that are fat soluble and inactivated
mainly by the liver, what are the age-related changes you would
expect in terms of the pharmacokinetics?
85. What are the risk/benefit issues involved in deciding to use any
antipsychotic in treating symptoms associated with DAT?
86. List the criteria for substance use disorders (SUD) and be able to
recognize a patient presenting with a substance use disorder.
87. Describe the natural history of SUDs (age of onset, duration,
recurrence, comorbid factors).
88. Describe the rates of SUDs in men and women.
89. Describe the treatments for SUDs and the effectiveness of
treatments.
90. Be able to recognize withdrawal syndromes and plan appropriate
treatment to minimize withdrawal problems (i.e., plan a safe
detoxification).
91. Describe the ways in which each of the major categories of
substances (nicotine, alcohol, opiates, cocaine, amphetamines,
and cannabinoids) impact the central reward pathways.
92. List differences in metabolism of substances of abuse with
emphasis on benzodiazepines and alcohol.
93. Describe how the pharmacokinetics of different formulations of
substances impact their addictive potential.
94. List the main pharmacotherapies of SUDs and the reasons for their
usefulness.
95. List the three major characteristics of delirium.
96. List the estimated rate of delirium for hospitalized patients.
97. List causes of delirium, including the most common cause.
98. Describe characteristics of individuals at greater risk for the
development of delirium.
99. Describe the natural history of delirium.
100. Describe the evaluation of delirium.
101. Describe the differences between dementia and delirium.
102. Outline a treatment plan for delirium.
103. Understand the diagnostic criteria for each (discussed) anxiety
disorders.

104. Differentiate between anxiety disorders on the basis of their


presenting symptoms.
105. Describe the treatment, course, and prognosis of these anxiety
disorders.
106. Understand current epidemiological, genetic, and other biologic
research focusing on these disorders.
107. Integrate the above material into a discussion of the similarities
and differences of these anxiety disorders.
108. Compare the benzodiazepines (e.g., diazepam) to buspirone (an
azaspirodecanedione) in terms of mechanisms and applicability in
acute vs. chronic anxiety.
109. Explain the specific effects of benzodiazepines on the GABA
receptor complex.
110. List the different important pharmacokinetic considerations in
choosing a specific benzodiazepine for acute anxiolytic effects,
acute sedative effects, and chronic anxiolytic effects.
111. Explain the main difference in the metabolism of lorazepam or
oxazepam versus diazepam.
112. Explain the difference in mechanism between zolpidem and
diazepam.
113. Answer the study questions on the handout.
114. Discuss the difficulties that might exist in using a benzodiazepine
with a half-life of less than two hours in aiding sleep. Similarly
discuss the disadvantages of using a benzodiazepine with a halflife of longer than 24 hours to aid in sleep.
115. Benzodiazepines can be helpful in the treatment of ethanol
withdrawal. Would buspirone be similarly helpful? Why or why not?
116. Become familiar with the burden of child and adolescent
psychiatric illness in the US and internationally.
117. Become familiar with the epidemiology of several common and
often enduring child psychiatric disorders across development.
118. Appreciate the substantial gap between needs and child mental
health services in the US and internationally.
119. Understand prevention paradigms in child and adolescent
psychiatry.
120. Become familiar with at least one randomized controlled
intervention trial to prevent severe psychopathology.
121. Become familiar with definitions and terms related to Child
Maltreatment.
122. Become familiar with the Epidemiology and Risk Factors for Child
Maltreatment.
123. Understand the relationship between Child Maltreatment and a
range of adverse developmental outcomes.
124. Give a definition of psychotherapy.
125. Understand the common factors of psychotherapy.
126. Identify some representative schools of psychotherapy.

127. Distinguish Medical and Contextual meta-models for therapy.


Understand the research basis for psychotherapy, including
characteristics of efficacy vs. effectiveness studies and their
associated strengths and weaknesses.
128. Know some evidence-based findings from psychotherapy
research.
129. Know that successful psychotherapy appears to change brain
functioning, including different pathways taken by psychotherapy
versus medication in alleviating depression.
130. Understand that relational and communication skills are important
for all healers (e.g., improve adherence/health status.
131. Identify who are trained psychotherapists and make appropriate
referrals.
132. Know the incidence of Anorexia Nervosa, Bulimia Nervosa and
Binge Eating Disorder.
133. List the DSM criteria for Anorexia Nervosa, Bulimia Nervosa and
Binge Eating Disorder.
134. Describe the longitudinal course of each eating disorder.
135. Explain treatment goals for the eating disorders.
136. Discuss the population prevalence of traumatic events and posttraumatic stress disorder.
137. List the DSM 5 criteria for PTSD.
138. Discuss the incidence and prevalence of postdisaster psychiatric
disorders and describe predictors of psychopathology.
139. Discuss the differential diagnosis of symptoms of PTSD.
140. Explain basic principles of treatment of PTSD.
141. Discuss the definition of personality traits vs. personality disorder.
142. List the DSM-IV diagnostic criteria for personality disorder and
summarize definitions of 11 specific personality disorders.
143. Distinguish Axis I and Axis II categorization of psychiatric
disorders.
144. Describe categorical and dimensional models of personality.
145. Discuss the pathophysiology, neurobiology, and heritability of
personality.
146. Discuss the differential diagnosis of personality disorders.
147. Summarize the epidemiology of personality disorders, including
demographic features, natural history, and prognosis.
148. Describe effective management of personality disorders in clinical
practice.
149. Know major anxiety and mood disorders affecting children and
adolescents and their epidemiology and known outcomes across
development.
150. Be familiar with findings and controversies related to childhood
onset Bipolar Disorder.
151. Be familiar with pediatric mandates to screen adolescents for
depression and suicide risk factors.

152. Be familiar with approaches to screening, diagnosing and initiating


treatment for main anxiety and mood disorders affecting children
and adolescents.
153. Know the prevalence rates of Oppositional Defiant Disorder (ODD),
Conduct Disorder (CD) and Attention-Deficit/Hyperactivity Disorder
(ADHD) in the general population.
154. Know the DSM criteria for ODD, CD and ADHD and how they differ.
155. Explain the assessment process for the Disruptive Disorders and
ADHD.
156. Understand the treatment options for the Disruptive Disorders and
ADHD.
157. Describe 3 classic parenting styles.
158. Explain the role of amyloid in the pathogenesis of DAT.
159. Describe the different pharmacologic goals in treating a chronic,
progressively deteriorating illness such as DAT compared with
treating an illness such as epilepsy or depression.
160. Explain why cholinergic augmenting agents have only modest
effects.
161. Choose rational pharmacologic treatments for the noncognitive
symptoms of DAT.
162. Answer the study questions on the handout.
163. Why would amitriptyline be an especially poor choice for a
depressed patient with DAT?
164. Why is clinical prevention an achievable goal with DAT?
165. Understand the requirements for competency.
166. Understand the rationale and requirements for the insanity plea.
167. Understand the rationale and process of involuntary civil
commitment.
168. List the requirements of and exceptions to informed consent.
169. Consider certain fascinating questions that arise in psychiatric
practice, using Tourette syndrome as an example and springboard
for discussion.
170. Recognize key phenomenological features of tics and the typical
natural history of the illness.
171. Become acquainted with some recent areas of research on TS and
recognize that there are opportunities for student research in
psychiatry.
172. Be able to state some ways in which neurology and psychiatry
specialty areas are similar and different, and in practical terms
what defines the practice areas of the two.
173. Know how "biological psychiatry" is defined at WUSM.
174. Understand the principles of electrical stimulation.
175. List the indications for ECT and TMS.
176. Explain the risks of ECT and TMS.
177. Understand the proposed neurobiological basis for ECT and TMS.

178. Understand the research-based evidence for use of TMS in Major


Depressive Disorder.