psychiatry 1. definition of major depression : if 5 out of 9 symptoms persist for more than 2 weeks symptoms can be remembered with mnemonics: low mood SIGECAPS S-sleep I-loss of interest G-guilty/ worthlessness E-lack of energy C- concentration/ attention A-Appetite loss P-psychomotor changes S-suicidality Low mood In adjustment disorder, the precipitant can be anything except bereavement. what is the difference between normal grief vs major depression? In normal grief about the death of a loved one, the idea ruminates around that loved one only. she may think she would have died with her loved ones. She can feel auditory/visual hallucinations of her loved ones. But these do not significantly impair daily life functioning. these episodes occur intermittently but in major depression, these symptoms are persistent. In major depression, there is greater social and occupational dysfunction. 2. How to differentiate schizoaffective disorder from mood disorder with psychotic features and
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Treatment of ADHD first-line treatment is drugs in children aged 6 and above. In children below 6 years, the first line of treatment is behavioral therapy. Among drugs, first, try stimulants (amphetamine/ methylphenidate). Second-line options are atomoxetine and clonidine. what is the mechanism of action of atomoxetine norepinephrine reuptake inhibitor How to titrate the dose of the stimulant? we should titrate it every week until max dose is reached or the patient experiences intolerable side effects. H ow long to wait to see whether the stimulant will be effective? its effect is seen within 1 week. if the patient does not feel improvement within 1 week, change to alternate medications. what are the features of stimulant toxicity? diaphoresis, mydriasis, tachycardia, hypertension, dilated pupil, anxiety, agitation, psychosis, decreased appetite cannabis intoxication also causes tachycardia, and hypertension; then how to differentiate it from stimulant toxicity? in cannabis intoxicat
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Difference between serotonin syndrome (SS) and neurolept malignant syndrome (NMS): in SS, a patient has neuromuscular hyperactivity (hyperreflexia, myoclonus, ocular clonus) instead of bradykinesia and rigidity in NMS. Fluoxetine has a half-life of 5 weeks, so, before switching to MAOi, wait for 5 weeks because it will cause serotonin syndrome.
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HPV vaccination in boys/ girls: Vaccination at 9-12 years of age (if missed then can take till 26 years of age) what are the conditions where it can be given after 26 years of age? answer: HCPs who are involved in surgery of HPV wounds; people who have not been previously exposed to HPV due to few sexual partners schedule of vaccination: under 15 years of age: 2 vaccinations at 6 months apart if the age is more than 15 years or immunocompromised patients, give 3 vaccination: 0, 1-2month and 6 month
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Ethics practice in medicine 1. if any colleague is doing substance abuse, this must be reported to the state licensing board because the primary aim is to maintain patient safety. 2. if any patient gives a gift to a physician with some expectation that he will give me preference, do not accept the gift. otherwise, physicians can accept inexpensive gifts. 3. if any intoxicated patient comes to the ER and needs emergency treatment but the patient denies treatment, then sedate him and do an investigation and treatment. Because the patient is not currently in a state of being able to make the correct decision. so, assume that his decision will be further treatment and go ahead without consent.
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Health insurance system in the USA 1. Medicare 2. Medicaid 3. Medicare-Medicaid (Medi-Medi) 4. Medigap (medicare supplemental insurance) Medicare: it is for people aged more than 65; physically or mentally disabled, with end-stage renal disease, and only certain neurodegenerative diseases (e.g. amyotrophic lateral sclerosis). It has 4 parts: A, B, C, D part A covers inpatient services part B covers outpatient services, outpatient surgery, and preventive care. part C (medicare advantage): this is provided by private insurance companies and it includes both inpatient and outpatient expenses PART D covers prescription drugs Medi-medi includes very low-income seniors, disabled who qualify for both Medicare and Medicaid. Medigap covers expenses not covered by parts A, B, and D. It covers copays and deductibles.