Hoy
My brain is getting full. Possibly from >48 hours of lectures and seminars.
This course has been excellent. Primarily, it has given me a confidence boost, in that virtually everything we discussed, I have at a bare minimum _heard of_ before, even though I might still need to memorize the details. Additionally, every now & again I learn something interesting, although not necessarily critical for the exam, certainly relevant for clinical practice.
I was particularly excited yesterday, when I attended a seminar on violence in psychiatry. I did a city-wide grand rounds on this topic approximately one year ago, and was surprised to learn a few new things at the seminar. The course, being taught by some of the world's experts in various fields, has also been a great opportunity for me to hear that a lot of my understanding of the science of psychiatry, which some my colleagues/supervisors disagree with me on, are in fact correct.
Here's some of the interesting tidbits I learned in the first two days:
Hallucinations are much more common than we think. Some studies have found their rates to be as high as 39% in the non-psychiatric population, 'though our professor estimates that if you factor out all illnesses, drugs, and hypnogogic / hypnopompic hallucinations, the rate is probably 5%. Sleep deprivation results in (with roughly the following order): fatigue, irritability, illusions (often visual), paranoia, hallucinations (often auditory/gustatory/olfactory), but does NOT lead to death unless the cause of the sleep deprivation is irritation of the reticular activating system (for example by tumor or infection, which may be the cause of death anyway).
The prevalence of major depressive disorder in medical students, despite no increased risk at the _start_ of medical school, increases with increasing seniority, is 15-25% overall, and as much as 500% higher than the rate in the similarly-aged general populace (similarly-age college students have an only slightly increased prevalence compared to norms).
The fear medical students have, that seeking treatment for depression will be counted against them in residency placement/licensing/etc., is _not_ totally unfounded (at least in North America)!!!
I need to be more vigilant for "roughening" states in my patients.
Pharmacological response to treatment of depression is not affected by anxiety.
The massive public-health campaign against tobacco has made a large drop in rates of nicotine dependence in the general population, but not in the depressed population.
2/3 of people with clinical depression have no psychiatric/psychological care.
In terms of prevalence, 4 of the 10 most prevalent illnesses worldwide are psychiatric (major depressive disorder, bipolar affective disorder, schizophrenia, obsessive compulsive disorder).
It is predicted that by 2020, depression will be be second leading cause of disability in the world.
Followed long enough, approximately one in three patients with depression developed bipolar affective disorder.
The kindling concept is overstated.
Although all atypicals (and probably all antipsychotics) are anti-manic, only some of the anticonvulsants are, and indeed some of them are pro-manic.
Pharmacological response rates for bipolar depression, are very poor (15% of intent-to-treat).
Bipolars' cycle acceleration due to antidepressant use seems only to increase depressive episodes.
It really is true, that there are no absolute contraindications to ECT.
ECT can result in a decreased cycling speed for rapid cyclers.
Delirium is often a case of hypo-cholinergic states, which explains why so many anticholinergics cause delirium.
Serotonin acts at _two_ different types of receptors, both a G-protein coupled receptor, and an ion-gated channel.
Amphetamines work both to enhance dopamine release and antagonize dopamine reuptake.
Everything we need to know about neurotransmitters can fit on six PowerPoint slides.
The genetics of various disorders, for which I unfortunately have to memorize the "correct" values for the exam, have no correct values.
Apo-lipoprotein E4 (Alzheimer's) is inherited like the manx cat's tail.
Americans need to know far more neurology than we do (I already knew that, but, Wow!)
Most reversible coma states and become irreversible after one hour.
Sartre's definition of consciousness (1956) is bullshit.
"Animals that have eyes that look at you, have consciousness."
The thalamus is a microcosm or homunculus of the cortex.
The absolute need to get a CAT scan before performing an LP puncture, which we were all taught in medical school, is a complete fallacy, based on an article in 1982 from Good Housekeeping.
Deaths attributed to syrup of ipecac appear to begin at a threshold of _10_ uses.
I am still below my Ideal Body Weight (which is 182 pounds).
100% of those who answer three or four positive on the CAGE have alcohol use disorders.
Both slow and fast alcohol metabolizers are at increased risk for alcohol use disorders.
Court mandated treatment for drugs and alcohol is effective.
"Interventions" are only 30% effective.
Ultra-Rapid Detox, which many of my patients ask for, is tantamount to malpractice, regardless of outcome.
The mechanism of action of the cannabinoid receptors results in increasing dopamine at the nucleus accumbens, and a global increase in GABA.
2 weeks (and not up to 6-24 months as I was taught) is a reasonable abstinence cut-off to determine whether psychosis is drug-related or not.
TIAs have a 25% all-cause mortality within 90 days, half of those within 48 hours.
Exercise, diet, and stopping smoking + alcohol would reduce incidence of strokes in Canada by ~6660 per year.
A blood pressure drop of ~4/3 reduces risk of stroke recurrence by ~15%.
Almost no-one actually does "sculpturing" family therapy anymore, thank God.
I know what I'm doing in family therapy.
My kids really are perfectly normal.
An assault is legally defined as an intentional, unlawful threat of physical injury, leading to well-founded apprehension in the victim.
I have always believed that I should declare a patient who refuses to speak to me not competent, legally, to make decisions. I am correct.
We are, in fact, better than a coin toss at predicting suicidal and homicidal_behavior_.
Tarasoff, and all other statutory/common-laws about the duty-to-warn, have been nixed in Texas. This means that if my patient tells me he's now going to go home and kill his wife, I am not allowed to warn her, nor phone the police, if I am a physician in Texas. Oil makes you stupid.
Lilly scares the shit out of me.
While cocaine was once in Coca-Cola, lithium used to be in 7-Up. I should drink more sodas.
I'm now on day five of six, and, while I do not necessarily feel ready to pass the exam, I certainly feel like I am competent to practice unsupervised in most situations.
And now, to bed. Shorter day manana, then I'll go to the aquarium. Back to cuddles Sunday.
This course has been excellent. Primarily, it has given me a confidence boost, in that virtually everything we discussed, I have at a bare minimum _heard of_ before, even though I might still need to memorize the details. Additionally, every now & again I learn something interesting, although not necessarily critical for the exam, certainly relevant for clinical practice.
I was particularly excited yesterday, when I attended a seminar on violence in psychiatry. I did a city-wide grand rounds on this topic approximately one year ago, and was surprised to learn a few new things at the seminar. The course, being taught by some of the world's experts in various fields, has also been a great opportunity for me to hear that a lot of my understanding of the science of psychiatry, which some my colleagues/supervisors disagree with me on, are in fact correct.
Here's some of the interesting tidbits I learned in the first two days:
Hallucinations are much more common than we think. Some studies have found their rates to be as high as 39% in the non-psychiatric population, 'though our professor estimates that if you factor out all illnesses, drugs, and hypnogogic / hypnopompic hallucinations, the rate is probably 5%. Sleep deprivation results in (with roughly the following order): fatigue, irritability, illusions (often visual), paranoia, hallucinations (often auditory/gustatory/olfactory), but does NOT lead to death unless the cause of the sleep deprivation is irritation of the reticular activating system (for example by tumor or infection, which may be the cause of death anyway).
The prevalence of major depressive disorder in medical students, despite no increased risk at the _start_ of medical school, increases with increasing seniority, is 15-25% overall, and as much as 500% higher than the rate in the similarly-aged general populace (similarly-age college students have an only slightly increased prevalence compared to norms).
The fear medical students have, that seeking treatment for depression will be counted against them in residency placement/licensing/etc., is _not_ totally unfounded (at least in North America)!!!
I need to be more vigilant for "roughening" states in my patients.
Pharmacological response to treatment of depression is not affected by anxiety.
The massive public-health campaign against tobacco has made a large drop in rates of nicotine dependence in the general population, but not in the depressed population.
2/3 of people with clinical depression have no psychiatric/psychological care.
In terms of prevalence, 4 of the 10 most prevalent illnesses worldwide are psychiatric (major depressive disorder, bipolar affective disorder, schizophrenia, obsessive compulsive disorder).
It is predicted that by 2020, depression will be be second leading cause of disability in the world.
Followed long enough, approximately one in three patients with depression developed bipolar affective disorder.
The kindling concept is overstated.
Although all atypicals (and probably all antipsychotics) are anti-manic, only some of the anticonvulsants are, and indeed some of them are pro-manic.
Pharmacological response rates for bipolar depression, are very poor (15% of intent-to-treat).
Bipolars' cycle acceleration due to antidepressant use seems only to increase depressive episodes.
It really is true, that there are no absolute contraindications to ECT.
ECT can result in a decreased cycling speed for rapid cyclers.
Delirium is often a case of hypo-cholinergic states, which explains why so many anticholinergics cause delirium.
Serotonin acts at _two_ different types of receptors, both a G-protein coupled receptor, and an ion-gated channel.
Amphetamines work both to enhance dopamine release and antagonize dopamine reuptake.
Everything we need to know about neurotransmitters can fit on six PowerPoint slides.
The genetics of various disorders, for which I unfortunately have to memorize the "correct" values for the exam, have no correct values.
Apo-lipoprotein E4 (Alzheimer's) is inherited like the manx cat's tail.
Americans need to know far more neurology than we do (I already knew that, but, Wow!)
Most reversible coma states and become irreversible after one hour.
Sartre's definition of consciousness (1956) is bullshit.
"Animals that have eyes that look at you, have consciousness."
The thalamus is a microcosm or homunculus of the cortex.
The absolute need to get a CAT scan before performing an LP puncture, which we were all taught in medical school, is a complete fallacy, based on an article in 1982 from Good Housekeeping.
Deaths attributed to syrup of ipecac appear to begin at a threshold of _10_ uses.
I am still below my Ideal Body Weight (which is 182 pounds).
100% of those who answer three or four positive on the CAGE have alcohol use disorders.
Both slow and fast alcohol metabolizers are at increased risk for alcohol use disorders.
Court mandated treatment for drugs and alcohol is effective.
"Interventions" are only 30% effective.
Ultra-Rapid Detox, which many of my patients ask for, is tantamount to malpractice, regardless of outcome.
The mechanism of action of the cannabinoid receptors results in increasing dopamine at the nucleus accumbens, and a global increase in GABA.
2 weeks (and not up to 6-24 months as I was taught) is a reasonable abstinence cut-off to determine whether psychosis is drug-related or not.
TIAs have a 25% all-cause mortality within 90 days, half of those within 48 hours.
Exercise, diet, and stopping smoking + alcohol would reduce incidence of strokes in Canada by ~6660 per year.
A blood pressure drop of ~4/3 reduces risk of stroke recurrence by ~15%.
Almost no-one actually does "sculpturing" family therapy anymore, thank God.
I know what I'm doing in family therapy.
My kids really are perfectly normal.
An assault is legally defined as an intentional, unlawful threat of physical injury, leading to well-founded apprehension in the victim.
I have always believed that I should declare a patient who refuses to speak to me not competent, legally, to make decisions. I am correct.
We are, in fact, better than a coin toss at predicting suicidal and homicidal_behavior_.
Tarasoff, and all other statutory/common-laws about the duty-to-warn, have been nixed in Texas. This means that if my patient tells me he's now going to go home and kill his wife, I am not allowed to warn her, nor phone the police, if I am a physician in Texas. Oil makes you stupid.
Lilly scares the shit out of me.
While cocaine was once in Coca-Cola, lithium used to be in 7-Up. I should drink more sodas.
I'm now on day five of six, and, while I do not necessarily feel ready to pass the exam, I certainly feel like I am competent to practice unsupervised in most situations.
And now, to bed. Shorter day manana, then I'll go to the aquarium. Back to cuddles Sunday.