Psychiatry Notes for the USMLE

PEDIATRIC

Autism

‹3 yo, repetitive behavior, marked hearing impairment

Undetected hearing impairment (e.g. hereditary, following repeated ear infections) can produce similar symptoms but detected at older age

Asperger Syndrome

More communicative, appear more socially aware, no language impairments, repetitive behavior

Childhood Disintegrative Disorder

Period of normal development for at least 2 yrs followed by loss of previously acquired skills like expressive or receptive language, social skills, play & motor skills

Attention Deficit Hyperactivity Disorder (ADHD)

Inability to attend to task at hand, ↑ motor activity, impulsivity

Tx: stimulants (Methylphenidate / Dextroamphetamine), psychotherapy / behavioral modification

Enuresis / Bed Wetting

Day & night bladder control usually attained by 5 yo

Causes: UTI, urinary tract abnormalities, developmental delay of bladder, diabetes, stress incontinence, waiting too long to void, medications

Mx: urine analysis (1st step)

Usually self-limited

Tx: non pharmacological → behavioral therapy (bell or buzzer and pad apparatus), ↓ water intake at night, pharmacological → Imipramine, Desmopressin

SLEEPING DISORDERS

Somnambulism (Sleep Walking)

Occurs during stage 4 (Delta sleep)

Tx: Benzodiazepines

Famous Sufferers: heroine in Bellini’s opera ‘La Sonnambula’

Nightmares

Frightening dreams, occur during REM sleep, can be recalled

Night Terrors

Occur during stage 4 NREM (Non-Rapid Eye Movement) sleep, person often unable to fully awaken

Narcolepsy

Sleep attacks, Sleep paralysis / cataplexy (sudden loss of muscle tone), triggered by strong emotions

Hypnopompic, hypnagogic hallucinations

Person falls asleep promptly at night (REM sleep occurs in less than 10 mins)

Excessive daytime somnolence and abnormalities of REM sleep lasting > 3 months

Tx: Amphetamines (Methylphenidrate), Modafinil (non-Amphetamine stimulant), if cataplexy present → Antidepressants

Famous Sufferers: River Phoenix’s character in Gus Van Sant’s 'My Own Private Idaho'

EATING DISORDERS

Anorexia Nervosa

Control issue is key → pts have lost control over everything else in their life except what they put in their mouth – this gives them a sense of control

Distorted body image (perception problem – even when very thin, pts see themselves as obese)

15-20 % loss of body weight

Complications: osteoporosis (↓ Ca+2, ↓ estrogen), ↑ carotene, ↑ cholesterol, euthyroid sick syndrome, amenorrhea (↓ estrogen), small for gestational age baby, cardiac arrhythmias (hypokalemia), hypomagnesemia

Tx: wt gain with hospitalization if necessary

Re-feeding Syndrome

2nd-3rd wk after initiation of feeding → edema, heart failure

Tx: phosphate supplementation

Bulimia Nervosa

Binge eating with sense of lack of self-control, compensatory behavior to avoid gaining wt (vomiting, laxatives etc)

Pts at or above expected wt

Due to repeated vomiting → dental caries, excoriation on knuckles of hand

Tx: SSRI’s even in non-depressed pts (because Serotonin is ↓)

Prognosis is better than for anorexia

Eating Disorder, Not Otherwise Specified

Features of both anorexia and bulimia, doesn’t meet criteria for specific eating disorder

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