Eating disorders. Anorexia versus bulimia. Anorexics are those really really thin women. They are about 5’8″ and they weigh about 80 pounds. Bulimics are normal weight and sometimes overweight. The anorexics starve themselves, the bulimics binge and purge. They eat all these Twinkies; they eat all these donuts and then the throw it all back up. The anorexics have to weigh like less than 85% of their normal body weight, and they have to have missed three consecutive periods, if they are post-menarche. Bulimics just basically do the eating and then the purging. Now there’s all kinds of funny variations. There’s anorexics who will purge, there’s bulimics who will starve themselves. Sometimes they won’t do the bingeing and purging, sometimes they will use laxatives or diuretics. There’s a thing called Russell’s sign, which is scraping the back of their palm in bulimics. What’s that from? Making yourself throw up. They remove tooth enamel, they become hypokalemic, bulimics do.
Pure Natural Hoodia
Two zebras: this is important, under eating disorder differential. There’s two zebras, particularly I think for neurologists. One is Klüver-Bucy. When somebody loses their temporal lobes because they had such bad seizures, the neurosurgeon had to take them both out. Or they have something like Herpes encephalitis and they lose a temporal lobe. They get this syndrome where they are hyper-oral, hyper-sexual, constantly masturbating or constantly mounting things. It’s really a tragic disorder. Loss of rage, sometimes loss of memory, very docile. And also Kleine-Levin syndrome. Classically adolescent males with hyper-somnolence and bingeing. The way I tell people to remember it is to think about adolescent males and what they do normally; sleep a lot and eat a lot. Right? Just multiply that tenfold and that’s Kleine-Levin. And there are mental status changes that you will see with that. Patients may also be confused or psychotic.
Canadian pharmacy levitra
Adjustment disorders. An adjustment disorder is having so bad a to a situation that you are suicidal. Post-traumatic stress disorder is the opposite. Post-traumatic stress disorder is you see something that’s not normal. Unfortunately, in some neighborhoods to see a lot of violence and stuff like that. But in post-traumatic stress you see something that would rattle anybody. You are raped, or you are assaulted, or you see combat, or an accident. That would disturb anybody. Adjustment disorder, you have something that everybody has had. You know, loss of a job, something like that. A breakup of a marriage or a relationship or an engagement. Something that’s pretty much part of the normal human experience but it goes beyond normal sadness. Your adjustment to that is terrible. You are suicidal or you are just intensely anxious, more so that your average person would be.
Gender identity disorder. How does that differ from transvestic fetishism? The male or female is uncomfortable with their assigned biological gender. What does that mean, assigned biological gender? Just means what you were born as. “I was born as a man and I feel like I’m trapped in a man’s body. I’m really a woman.” Or vice-versa. Often in childhood. This starts early. The kid may start dressing in the opposite gender clothing and they just kind of always felt like they should have been a little boy, or they should have been a little girl. And eventually they save up their money and commonly have sex reassignment surgery, a sex change operation. Sexually these people may be attracted to men, women, both, neither. It’s very independent of homosexuality or heterosexuality. It’s not who I’m attracted to, it’s who I am. Now classic Boards question is “How do you differ this from transvestic fetishism?” The person with gender identity disorder, that guy, he’s dressing like a woman because he want to be a woman and he feels inside that he is a woman. The transvestic fetishes patient, he’s dressing that way because he feels sexy, he feels aroused when he does that.
Homosexuality has been a controversy among psychiatrists for decades, even Freud addressed it. He wrote a letter to a homosexual patient’s mother and talked about it, “You know, it’s not that bad” and stuff like that. Currently it is not considered as pathology, per se, by the American Psychiatric Association. The APA came out and said this is not pathology. There was a time in history when there used to be what was called ego-syntonic versus ego-dystonic homosexuality where gay men who were happy with themselves were ego-syntonic, gay men who were not happy with themselves were ego-dystonic. People who have done research in this area have come to the conclusion that most gay men have what is called a “coming out” process. That is a period where they are unhappy with their sexual orientation before they accept their sexual orientation. So they got rid of that ego-syntonic, ego-dystonic stuff.
Sexual and gender identity disorders. Sexual dysfunctions: problems with desire, orgasm, function and pain. Always consider medical causes. Don’t say, “Gosh, you have this repressed hostility and that’s why you are impotent.” Well, maybe you have diabetes. Thioridazine, Mellaril. Remember there’s three Board important things about thioridazine or Mellaril. Trazodone. What can trazodone do, or Desyrel? Priapism. Painful erection that you can get with trazodone, which is an antidepressant. In reality, you don’t really see a lot of priapism with that. You’ll see women come in and say, “You know what? I can’t have an orgasm anymore since starting Prozac and this is ruining my relationship.” Or you’ll see women come in and say, “You know, I’m not interested in sex anymore, and this is really okay because I don’t like men. Men are a pain in the butt, I’m not in a relationship and actually it makes my life easier.” Similarly you will see men who will say, “Since I started Prozac it takes two hours for an orgasm, and this is terrible. It’s ruining my relationship. I don’t even want to have sex anymore.” Or you’ll have men come in and say, “You know, sex used to be five minutes and now it’s 35 minutes. Sometimes you will see SSRIs used for premature ejaculation specifically.
Canadian pharmacy cialis
Paraphilias. paraphilias are what used to be called the perversions. Commonly associated with males. Include exhibitionism. Guys like to expose themselves and they get sexually aroused by doing that. Fetishism. This is sort of like where a person is into boots, or leather, or rubber, or something like that. Now people will ask, and patients will ask, “Gosh my husband really likes to see me wear boots. Is that pathology?” and the answer is, not necessarily. It’s pathology when the wife comes in and says that the “Husband likes the boot more than he likes me.” Or, “We can’t just have sex. We can’t just make love. It’s 2 o’clock in the morning and I’ve got to put on those damn boots, otherwise he can’t …” It’s a problem when either the spouse or the partner or the law says it’s a problem. Frotteurism (?): rubbing against a non-consenting partner, like on a subway or an elevator. Obviously that’s always going to be a problem because you’ve got a non-consenting partner. Pedophilia: obviously always a problem, sex with children. That’s always considered pathology. Sexual masochism, “I like to be tied up.” Sexual sadism, “I like to tie my partner up” that’s pathology if it interferes with your relationship or the law. But you know, a lot of people will come in and say, “Yeah, I like to tie my wife up, I like it, she likes it.” Not necessarily pathology. Voyeurism: people will come in and say, “Hey, I like to watch Baywatch. Is that pathology?” No. It’s pathology if you have binoculars and you are looking into your neighbors windows and you are now on probation because of your behavior.
Cheap canadian pharmacy levitra
Transvestic fetishism, what used to be called cross-dressing or transvestism. Paraphilia, not otherwise specified, like bestiality, sex with animals, necrophilia, sex with corpses, and telephone scatologia, making dirty phone calls. Transvestic fetishism is a person, usually a male, classically heterosexual. He likes women and likes to wear women’s clothing.
Generic viagra online
Generalized anxiety disorder. Chronic excessive worry about real life events. Okay, it’s not like a phobia where somebody is worried about … they see a praying mantis and they kind of freak out. This is like, “I’m worried about my job, my finances, my health, my parents health, my husband’s health.” It’s what we all do but they do it so much and so often that they really need a psychiatrist because it’s really getting out of hand. Health care mall
Agoraphobia is not a specific phobia. A specific phobia is a thing that isn’t a social situation. It has nothing to do with people. If it’s people it’s a social phobia. Specific phobia is airplanes, blood, bats, trains, tunnels, thunder, dark, water. It’s things like that. Spiders, snakes, insects. Agoraphobia is … now if agoraphobia wasn’t associated with panic disorder they might have thrown it in there but agoraphobia, literally speaking, is fear of open places. But in reality it plays out as fear of going outside your home and mixing in the world. Sometimes you can see it without panic attacks, but really classically, and I think for the Boards, it’s very associated with panic disorder. The agoraphobia usually goes hand-in-hand with panic, because it’s secondary to the panic, classically at least.
Free floating anxiety: I’m nervous and I don’t know why. I’m feeling anxious and I don’t know what I’m anxious about. “What are you worried about?” “I don’t know.” One of the things to screen for is first of all, if it’s panic or not panic. That’s definitely an important thing. If there’s no panic attacks – in other words they are not having the tachycardia and palpitations – just “I’m feeling nervous and I don’t know why.” You definitely want to do a medical workup and make sure they don’t have thyroid or something weird like carcinoid or pheochromocytoma. A lot of people come in with this free floating anxiety and what you do is send them to the psychiatrist and the psychiatrist puts them on Prozac, starts them in therapy, has trouble coming up with a diagnosis, and then maybe it gets better and maybe it doesn’t. That was back in the old days with the Freudian cartoons where the guy comes in and sits on the couch once a week and talks about his childhood. That was supposedly what that was supposed to treat, that sort of free floating anxiety. But it doesn’t really have a neat name anymore.
Obsessive-compulsive disorder (OCD. OCD is sort of the hand-washing, the checking, the counting. How many of you have some OCD traits? You don’t have to raise your hand because I know the answer. Probably all of us do. Probably 80-90% of college and professional athletes have some OCD stuff going on. The basketball player who has to bounce the ball three times before he makes a free-throw.
The etiology of OCD. There’s a few things going on. One, there may be some evolutionary components. You know, chimpanzees groom each other. It might be grooming rituals gone nuts.
Canadian pharmacy Lexapro
It’s one of the few things in psychiatry that is very similar in kids as it is in adults. You see a lot of kids with OCD and they think it may be related to strep infections now. Occasionally, one of the things about OCD by definition, is there has to be some un-comfort with it. People have to say, “I know this is stupid.” That’s what differentiates this from psychosis. The schizophrenic, why does he check all the food in the refrigerator before he eats it? Because he thinks the CIA is coming in and tampering with it. The OCD person says, “No, no. I know this is stupid but I feel like I have to check it because otherwise it’s going to be contaminated somehow by germs and if I don’t check it something bad is going to happen.”
Treatment of OCD. It changes all the time, but clomipramine was thought to be a bit more efficacious than the others, Anafranil. That’s the TCA that looks like a TCA but acts like an SSRI. Clomipramine or Anafranil. The trouble with that is no one wants to start a tricyclic antidepressant. It’s like Elavil. Elavil has a lot of side effects. Clomipramine is similar to Elavil online. So we like to use the SSRIs. Currently approved, I think, fluoxetine, sertraline, and paroxetine – Cheap Zoloft, Canadian Pharmacy Paxil, Prozac Online and Luvox. There’s five American SSRIs now and rour of them are approved for OCD. Luvox may be a little better than the others. The other thing is behavior therapy. What you do, just in a nutshell, if the person has a problem with washing their hands all the time you say to them, “Look, I want you to not wash your hands. Here’s your homework. You don’t wash your hands, and you’ve got to touch everything in the house. Go in the mud, not wash your hands, touch the toilet seats.” And if the person is very motivated – they’ve got to be very motivated – they’ll do it and they will have sky-high anxiety for about three or four days and then it will go down to nothing. That’s very good and they won’t relapse all that often. If they just go on Prozac they’ll feel better but you stop the Prozac and it all gets worse again. There is a schism. There’s people who say that the original studies that validated the efficacy of clomipramine were not that good and that in reality cognitive therapy is better.
Post-traumatic stress disorder. Response to a trauma, like assault, rape, or combat. Characterized by flashbacks, nightmares, avoidance. Easy to startle, insomnia, diminished interest in activities. Used to be in the old DSM, the psychiatry …acute stress disorder is just like PTSD but it resolves in four weeks.
It’s not schizoaffective. In a nutshell, what is schizoaffective? We’ll go through the five schizos before we are done. Unfortunately, psychiatrists thought it was a good idea to name five similar disorders starting with schiz and there’s no real easy way to sort that out. So we’ve got to go through them one by one. Basically, here’s schizoaffective. Let’s say you are a schizophrenic and you are like a street person and you hear voices, and you believe that the moon is made out of cheese or whatever, and you get depressed. You are not a schizophrenic with major depressive illness. Psychiatrists won’t allow you to be that. You have to have a new special name and that new special name is schizoaffective disorder. It’s like congestive heart failure can coexist with a broken arm. Well, in psychiatry-land if you are a schizophrenic you can’t have major depressive episodes. You magically become schizoaffective. That’s all that is. Major depressive illnesses differ in that when you treat the person, the schizophrenic goes back to being a street person, but the major depressive disorder goes back to being a housewife. She’s perfectly fine between episodes. The schizophrenic is not fine between episodes.
Dysthymic disorder is basically a low-level depression. This is like people who are chronically depressed. Major depressive illness is, people are going along fine and then boom! They are down there and then you put them on Prozac and they come back up to their baseline. People with dysthymia, they are like down here. They are not way down at the bottom but they are not normal. They just can’t get excited about life.
Canadian pharmacy Antidepressants
Bipolar disorder, formerly manic depression. Mania means episodes of irritable moods, severe enough to cause problems with function. Classically people feel great but judgment is impaired. The symptoms include for bipolar disorder: they are grandiose, diminished need for sleep, pressured speech. What’s pressured speech? It’s like they have this pressure to keep talking. Flight of ideas. It’s just one idea after another, and “I’m going to write a book, I’m going to paint my house …” and just a whole bunch of ideas at once. Very distractible. Increased goal-directed activity but often sloppy and not really productive, and bad judgment. They get involved in driving too fast, spending, sex, involved in crimes sometimes. I had a patient who committed a string of bank robberies and did a lot of time for that, and alleged to me that he was bipolar. That he was having manic episodes when it was happening. I don’t know. Some patients will get psychotic. People will come in and say, “I’m a special messenger from God. I am king of the United States” when they are manic.
In bipolar type II disorder, the person is hypomanic. Hypomanic is they have problems with depression and they don’t have problems with mania, they have problems with hypomania which is sort of a low level mania. When people are manic they are bad. They are out of control, they are dangerous, and they are just not sleeping, they’ve got to be in the hospital basically. Hypomanic people sometimes can do well. They are just really really up and really really enthusiastic. Sometimes it can help their career.
Recent Comments