Behav Sc Neuro:

In situations where patients are unable to make decisions for themselves responsibility for those
decisions falls on the next of kin if the patient has no written directives clearly stating their intentions.
The next of kin for a married person is their spouse followed by their adult children. The next of kin is
to make decisions based on how they believe the patient would have wanted things.
There are numerous defense mechanisms (all of which the USMLE loves). Splitting refers to seeing
the world in black and white and is common amongst patients with borderline personality disorder.
Marijuana contains THC which stimulates cannabinoid receptors to produce effects on mood,
perception, and memory. Marijuana produces a mild euphoria with laughing behavior, slowed
reflexes, dizziness, impaired coordination, and short term memory loss. Rapid heart rate and
conjunctival injection are the two most immediate physical symptoms of marijuana use. It remains in
tissues for a significant amount of time and can be detected up to 30 days after use.
Suppression is a conscious, mature defense mechanism involving withholding troublesome thoughts or
impulses.
There are three categories of postpartum mood disturbances. The most common is the maternity blues,
a benign, self-limited change in affect that lasts up to 10 days postpartum. It is treated with watchful
waiting and the knowledge that up to 20% of these women will develop postpartum depression.
At three years of age a child is expected to be able to play in parallel, speak in simple sentences, copy
a simple shape, and ride a tricycle.
Among drugs of abuse, intoxication with hallucinogens (psychotomimetic drugs), amphetamines, and
cocaine is most commonly associated with violent behavior. Hallucinogens include LSD and
phencyclidine (PCP, angel dust). Belligerence and psychomotor agitation tend to be more common
with PCP than with LSD intoxication.
Obsessive compulsive disorder is characterized by persistent intrusive thoughts that lead to repetitive
behaviors. These thoughts and actions cause significant distress and functional impairment. Affected
individuals recognize the absurdity of their thoughts and actions but are unable to stop them.
Schizoaffective disorder is characterized by symptoms of schizophrenia in the presence of prominent
mood symptoms. A period of at least 2 weeks of psychotic symptoms in the absence of mood
symptoms is required for the diagnosis.
There are five subtypes of schizophrenia each characterized by a set of prominent symptoms.
Disorganized schizophrenia is distinguished by disorganized speech and behavior and a flat or
inappropriate affect.
Opiate withdrawal is marked by abdominal pain, nausea, vomiting, diarrhea, piloerection, pupillary
dilation, diaphoresis and fever. It can occur in patients taking narcotics legally or illegally.
Narcolepsy is a disorder characterized by excessive day time sleepiness and REM sleep-related
phenomena such as cataplexy, sleep paralysis, and hypnagogic hallucinations.
Patients with delusional disorder harbor non bizarre delusions but do not meet the criteria for
schizophrenia and can function without significant impairment in day to day life.
Acute stress disorder and post traumatic stress disorder present with identical symptoms (recurrent
nightmares and flashbacks potential memory loss and exaggerated startle response). Acute stress
disorder can last no more than four weeks however while post traumatic stress disorder lasts longer
than four weeks.
The hallmark of generalized anxiety disorder is excessive worry over several different issues lasting at
least 6 months. It is treated with antidepressants and benzodiazepines
Reaction formation is the replacement of an unpleasant or unacceptable thought or desire with an
emphasis on its opposite.
Alprazolam has a half-life less than twelve hours and is useful for acute anxiety.
Patients with prefrontal lobe injury often experience behavioral and personality changes, secondary to
impairment of the organizational restraint and motivational systems. Frontal lobe syndrome can
manifest in variable ways, but can often be categorized into disorganized, disinhibited, and apathetic
types.
Projection refers to transplanting ones unacceptable impulses or affect onto another person or
situation. It is an immature defense mechanism.

According to guidelines released by the American Psychiatric Association (2002) the mainstay of
therapy for acute mania is a mood stabilizing agent (e.g. lithium, valproate, or carbamazepine) plus an
atypical psychotic (e.g. olanzapine).
Obsessive compulsive disorder is characterized by recurrent obsessive, anxiety inducing thoughts, plus
behavioral compulsions aimed at reducing the anxiety, In most cases of OCD, the patient understands
the unreasonable nature of their thoughts and behaviors. OCD often starts in childhood
Basic interviewing techniques include facilitation, reflection, confrontation, support, empathy, silence,
and direct and indirect questioning. Support involves expressing concern independent of
understanding. This is in contrast to empathy, where the physician expresses understanding and
vicarious experiencing of a patients situation.
Avoidant personality disorder is a maladaptive pattern of behavior characterized by feelings of
inadequacy, timidity and fear of rejection.
Passive-aggressive behavior is the expression of hostile feelings in a non confrontational manner.
Obstructive sleep apnea is the most common medical cause of excessive daytime sleepiness in the US.
It occurs due to poor oropharyngeal tone and results in daytime sleepiness morning headaches and
depression.
Conversion disorder refers to the unconscious manifestation of neurologic symptoms when
pathophysiological explanations for the symptoms cannot be found. It occurs more commonly in
women and often occurs after a significant life stress.
The only serotonin-releasing neurons in the CNS are found in the raphe nuclei. These neurons
disseminate widely to synapse on numerous structures in the CNS.
Altruism is a mature defense mechanism that alleviates guilty feelings through selfless service or
giving.
Bulimia nervosa is an eating disorder characterized by alternating binging and weight reduction
behaviors (either restrictive or purging compensatory behavior). Patients can develop bilateral parotid
gland enlargement, erosion of tooth enamel, and irregular menses. Bulimia and anorexia are
distinguished by body weight (approximately normal versus significantly underweight, respectively)
and absence or presence of amenorrhea.
Psychotic symptoms that interfere with the patient's functional status are classified as brief psychotic
disorder if the symptoms last less than one month, schizophreniform disorder if the symptoms last one
to six months, and schizophrenia if the symptoms last more than six months.
POP or phencyclidine is a hallucinogen that works by stimulating the excitatory NMDA receptor.
Moderate amounts of PCP cause feelings of detachment and distance. Additionally PCP can produce
slurred speech, loss of coordination (ataxia), involuntary movements, exaggerated gait, and
nystagmus. It can induce paranoia and hallucinations and most users will become very hostile and
aggressive.
Transference is the unconscious shifting of emotions or desires associated with one person (e.g. sibling
parent spouse) to another (e.g. physician therapist). It can be positive or negative.
Differentiation of Delirium and Dementia
1 Onset Acuteindeliriumvs gradual in dementia
2 Consciousness Impaired in deliriumvs intact in dementia
3 Course Fluctuating symptoms in delirium vs progressive decline in dementia
4 Prognosis Reversible symptoms in delirium vs irreversible symptoms in dementia
5 Memory impairment Global in deliriumvs remote memory spared in dementia