Psychiatry MOC review

Lesion causes a kinetic mutism, no effort to communicate

Severe disruption of social conduct

Governs executive functions, personality, intellect, speech, memory

Governs hearing, naming of objects, memory, emotion, visual recogn.

Lesion: Anterograde declarative memory loss

Lesion: loss of emotional attachment to memories, emotional dyscontrol, kluver-bucy

Sensation, speech, understanding, academics

Lesion: severe memory deficits in anterograde memory, confabulation

Lesion: gross abnormal involuntary movement, subcortical dementia, depression

Lesions produce similar picture as caudate, globus palliduc

Lesion: fine abnormal involuntary movement, decrease muscle tone, loss of postural control

Caudate-putamen

Relay station for basal ganglia and cerebral cortex

Caudate, globus pallidus, putamen, substantia nigra

Lesions produce hypothermia, insomnia, hormone secretion, hunger, over-reaction to emotional stimuli

Number 1 producer of NE in the brain.

Mood, motor and sensory tracts, wakefulness

Produces serotonin. Contains the tract that connects thalamus, basal ganglia, and hypothalamus.

70% of mew infections occur in men. Most, 60% due to men w/ men, 25% injection drugs, 15% hetersex

Thrush, Kaposi's, TB reactivation, zoster, herpes, bacterial pneumonia

Primary TB, crypto, toxo, PML, cervical carcinoma

CMV, mycobacterium avium, non-hodskins lymphoma, CNS lymphoma, dementia

6 + combo: abacavir, didanosine, lamivudine, zalcitabine, zidovudine, L + zido

Delaviridine, Efavirenz, Nevirapine,

Combo+ 5, amprenavir, idinavir, lopinavir-rito, nelfinavir, ritonavir, Saquinavir

Adefovir

22-30%

Cognitive impairment thought to involve cell dysregulation. dementia thought to involve cell death

CNS opportunistic infections, malignancy, substance abuse or withdrawal

Acquired cognitive, motor, behavioral abnormalities, mild impairment in ADLs, does not meet criteria for dementia or myelopathy, no other cause

15-20%

Zido (penetrates blood brain barrier well.)

43% to 65%

Seizures, infections, crypto, encephalitis, PML, mass lesions, lymphoma, toxo

Acute onset cognitive deficits

CBC, serum chemistries, arterial blood gas in pts w pneumonia, VDRL, b12

AIDs dementia rating scale, finger tapping test, trail making test

50% til age 9

Impaired brain growth, Progrssive motor dysfunction, loss of developmental milestones (plateau)

Depression:60%
Dysthymia: 25%
Anxiety: 25%
substance abuse co-occurring: 50%

Verbal version of trail making test. Timed

5sections: memory registration, attention, psychomotor speed, memory recall, construction

10 min, 25 bedside test of executive function, word fluency and echopraxia

77

81

13

Let the decision stand

Expressions in a court's opinion which go beyond the facts before the court and are individual views of the author

Whatever is to be decided by the application of statutory rules or principles of law

A judges decision to dismiss a civil action as a matter of law because there is no genuine issue of material fact

decision to hear a case requires the agreement of 4 justices

'May you have the body.' The primary function of a writ is to release someone from unlawful imprisonment. It does not address guilt or innocence, but whether a person is properly restrained

Reasonable belief that a person has committed a crime; less than 50%

Freedom of speech

Freedom from unreasonable serach and seizure

Grant due process.
5th: Federal defendants
14th: state defendants

Right to counsel

Proscription of cruel and unusual punishment

To determine what due process is required:
1. private interest affected by gov actions
2. risk of erroneous deprivation of such interest vs benefit
3. gov's interest

- In re Richardson
- Addington v Texas
- Parham v JL and JR
- Ake v OK
- Santosky v Kramer
- Washington v Harper

- Lessard v Schmidt
- Oconnor v Donaldson
- Rogers v Commissioner
- Estelle v Gamble

False

- False imprisonment
- Violate civil rights
- Sex w patients
- Defamation of character

negligence, bx which caused an unreasonable risk of harm

- Duty
- Dereliction
- Direct cause
- Damages

Command to appear with records

a defendant 'should be aware of a justifiable and substantial risk but INADVERTANTLY fails to take into account that risk, as would a reasonable person

- Purposely
- Knowingly

- Purposely
- Knowingly
- Recklessly

85-90%

- justifiable
- necessity
- honest and reasonable belief that death or seriously bodily injury is imminent

- self defense
- duress
- insanity
- automatism
- entrapment
- necessity

to rehabilitate

8th Amendment: cruel and unusual

dismissal for insufficient cause of action

Set standard of evidence for civil commitment as clear and convincing

Parental commitment of a child requires a neutral fact finders' determination that admission requirements are satisfied

Required that transfer f incarcerated prisoner to mental hospital requires written notice and a hearing

14th

Taking something vs taking something with force

- malice aforethought
- premeditation
- deliberation
- specific intent

- intent to kill
- intend to do grievous bodily harm
- wanton disregard
- kill in commission of specific felonies

- In hot blood, crime of passion

- Intentional or reckless act
- extreme and outrageous
- Causation of emotional distress

Free speech clause of 1st amendment can serve as a defense in state tort suits for the intentional infliction of emotional distress

Person must be physically impacted. No recovery can be had for injuries sustained by fright occasioned by the negligence of another where there is no IMMEDIATE personal injury.

Foreseeability test: plaintiff located near the scene, direct emotional impact, plaintiff and victim closely related

Zone of danger test for negligent infliction of emotional distress

- Contributory negligence
- Assumption of risk
- Fellow servant (at fault) not emplyer

- Emotional disabilities are compensable whether the cause of such emotional disability is a direct physical injury, a mental shock or sustained pressure

- Person with a pre-existing condition that may have increased the likelihood that they could be harmed but the harm was nevertheless caused by the alleged insult

- Preexisting condition of such severity that they would have ultimately experienced the harm, even without an intervening insult

MMPI2
SIMS
SIRS
MFAST
Atypical presentation scale

- childhood abuse
- parental poverty
- unstable family during childhood
- behavior disorder
- poor self confidence before age 15

- anxiety
- sleeping problems
- headaches
- fatigue
- dizziness

strong possibility

- magnitude
- likelihood
- imminence
- frequency

- delusions
- hallucinations
- disorganization
- grandiosity
- suspiciousness

- blunted affect
- emotional withdrawal
- poor rapport
- apathy
- lack of spontaneity
- poor abstract thinking

- uncooperativeness
- poor insight
- poor judgment
- violence in the week prior to admission

- hallucination- related delusion
- familiar voice
- feelings of personal superiority
- act will benefit hallucinator

- persecutory
- systematized
- assoc w fear, anger, anxiety
- acted on before
- coupled w/ substance abuse
- infidelity

Violates 5 th Am to introduce at a capital sentence proceeding psych eval that was conducted without informed consent

It is ok to use hypothetical questions posed to psychiatrists on dangerousness related to the defendant.

Hypothetical questions were found to be an acceptable basis for psychiatric testimony

Victim impact statements admissable

Executions of the mentally retarded are prohibited under the 8th am

Judges determining aggravating factors for increased sentencing violates the 6th Am

State courts must provide procedures for a competency to be executed hearing

8th Am prohibits a state from carrying out a sentence of death upon a prisoner who is insane. Comptence to be executed requires at lease 'rational awareness' of reasons for execution.

Deliberate indifference by prison personnel to a prisoners serious medical illness or injury constitutes cruel and unusual punishment

A prison official may be found liable if he knows of and disregards an excessive risk to inmate health and safety; the official must be aware of the facts from which an inference could be drawn that a serious risk of harm exists

Prisoners must be granted a jury review of their civil commitment in order to be held beyond their sentence, a violation of 14th Am.

Sexual Abuse Treatment Program serves a penological purpose. It does not violate the 5th Am.

Title II of the ADA applies to state prisons

Pts have right to treatment if being held NGRI

State Mental Hospital must provide:
1. Humane environment
2. Qualified staff in numbers sufficient to administer tx
3. Indiviualized treatment plans

DD / MR patients have a right to freedom from restraint and treament

HMO must review decisions as applicable under state law; ERISA does not pre-empt; 514

A civil action may be brought by a participant to recover benefits.

Decisions by MCOs about what kind of care to pay for must be regarded as eligibility decisions, not treament decisions

ERISA premepts state laws against malpractice for HMOs and prevents recovery for emotional distress

Mixed treatment and eligibility decisions are not fiduciary decicions

1. Capacity to express choice
2. Capacity to understand relevant information
3.Capacity to understand current situation
4. Capacity to manipulate (reason) rationally

Comptence inlcudes the ability to properly assist counsel, possess a rational understanding of the proceedings

Amensia per se does not equal incompetence

Standard of proof for competency is 51% (prepondenrance of the evidence)

Def cannot be held longer than it takes to determine he is incompetent, since he will not respond to treatment. (MR)

To force medication in prisoners, state must show:
- no less intrusive alternatives
- meds medically appropriate
- essential for safety

Four factors necessary for involuntary meds:
- Govt interest
- Invol meds must further state interests (meds have to be likely to render person competent)
- Invol meds are necessary and no less intrusive means avail
- Meds must be in patients best interest

- Knowing
- Intelligent
- Voluntary

A person who is competent to stand trial is also competent to plead guilty
- Clinicians should ask about comptence to wave rights in a plea bargain

Comptence to represent self: State may limit a pt from representing himself.

Involuntary confession must inlcude police coercion