Epidemiology/ Ethics/ Psychiatry Flashcards
Sensitivity
A/ (A+C)
TP/ (TP+FN)
Positive test of disease/ Total disease
Specificity
D/ (B+D)
TN/ (TN+FP)
Negative test of no disease/ total no disease
Prevalence
Positive test/ total population
TP+FN/ Total
PPV
A/ (A+B)
TP/(TP+FP)
True positive/ (All positives)
The higher the disease prevalence that higher the PPV
NPV
D/ (C+D)
TN/(FN+TN)
True negatives/ All negatives
Likelihood ratio (LR)
+LR= sensitivity / (1-specificity)
NNT
NNT= 1/ absolute risk reduction
Odds ratio
OR= (A/C)/ (B/D)
OR= AD/ BC
Relative risk
RR= [A/(A+B)]/ [C/(C+D)]
Risk of developing disease in those exposed divided by risk of disease in unexposed
Absolute risk reduction
ARR= [C/C+D] -[A/(A+B)]
The difference in risk attributable to the intervention compared to the control
Cohort
Exposure —> disease
Case control
Diseased and non-diseased into two group trying to find exposure
Odds ratio
Type I (alpha) error
Concluding there is a difference when there is not
False positive
Rejecting the null hypothesis when it should not be rejected
Type II (beta) error
No difference when there is
False negative
P value
estimate of the probability that differences in treatment effects in a study could have happened by chance alone
P < 0.05 statistically significant
Reject null hypothesis which states no correlation
Power
What increased power?
Probability that a study will find a statistically significant difference when one is truly there
Increase number of subjects increases power
Power= 1 - type II error (beta)
Live vaccines
MMR Polio (Sabin) Yellow fever Influenza (nasal) Varicella
Inactivated vaccines
Cholera HAV Polio (Salk) Rabies Influenza (injection)
Toxoid vaccines
Diphtheria
Tetanus
Informed consent
BRAIN
Benefits Risk Alternatives Indications Nature
Absence of living will
SPOUSE CHIPS in For the patient
SPOUSE CHIldren Parent Sibling Friend
Distribution in 95%
Mean 230
SD 10 mg/dL
2 SD from mean
210 - 250
Stand deviation distribution
68% (middle)= 1 standard deviation
95%= 2 SD
99.7 (outside)= 3 SD
Inquire about possible risk factors and outcomes at a specific point in time (snap shot)
Cross-sectional study
Type of observational study
Ascertainment (sampling) bias
Study population differs from target population due to nonrandom selection methods
Berkson bias
Disease studied using only hospital based patients may lead to results not applicable to target population
Neyman bias
Prevalence bias
Exposures that happen long before disease assessment can cause study to miss diseased patients that die early or recover
Move from point B to A
Change on sensitivity
Sensitive will increase
Fewer FN
Confounding bias vs effect modification
Effect modification
- results when an extraneous variable (modifer) changes the direction or strength of an association
Modifier is associated with disease but not the risk factor
Confounding bias
- extraneous factor associated with both exposure and disease
Tourette syndrome Tx
First line: aripiprazole
Tetrabenazine (dopamine depleting agents)
MRI of schizophrenia
Enlarged ventricles
Decreased cortical volume
SE Haloperidol
QTc prolongation
EPS
QTc prolongation
Haloperidol
Ziprasidone
Clozapine SE
Agranulocytosis
EPS
4 and A
4 hrs: Acute dystonia
4 days: Akinesia
4 weeks: Akathisia
4 months: Tardive dyskinesia
ADAPT Hours to days: Acute Dystonia (Muscle spasm, stiffness, oculogyric grisis) (prolonged involuntary gaze upward) - Benztropine - Diphenhydramine
Days to months: Akathiasia, Parkinsonism (restlessness, bradykinesia) - Beta blockers - Benzodiazepine (lorazepam) - Benztropine --- -Benztropine - Amantadine
Months to years: Tardive dyskinesia
(orofacial chorea)
- Valbenazine
- Deutetrabenazine
Prolonged painful tonic muscle contractions or spasm
Acute dystonia
Hours
Tx: Benztropine (anticholinergics)
Restlessness that is perceived as being distressing
Akathasia
Day
Tx: Betablockers (propranolol)
Pseudoparkinsonism
EPS
Dyskinesia
Benztropine (anticholinergics) or dopamine agonist (amantadine)
Involuntary, painless oral facial movements
Tardive dyskinesia
Switch neurolepic to clozapien or risperidone
Dont mix with Buspirione
MAOIs
Tx Social anxiety disorder
Beta blockers
OCD Tx
SSRI
Or Clomipramine (TCA)
TX PTSD
CBT
SSRI, SNRI
Prazosin (alpha blocker) for nightmares
Alzheimers tx
Cholinesterase inhibitors
- Donepezil
- Rivastigmine
- Galantamine
Moderate to severe
- Add Memantine (NMDA antagonist)
SIG E CAPS
Sleep Interest Guilt Energy Concentration Appetite Psychomotor agitation Suicidal ideation
TCA toxicity
Tri-Cs
Convulsions
Coma
Cardiac arrhythmias
Paroxetine
SSRI
Avoided in pregnancy
- Cardiac defects
- pulmonary Htn
Mirtazapine
WG
MAOIs
MAO Take Pride In Shanghai
Tranylcycpromine
Phenelzine
Isocarboxazid
Selegilline
SE: HTN crisis
DIG FAST
Distractibility Insomnia Grandiosity Flight of ideas Activites Sexual indiscretion Talkative/ pressure speech
Mania
> 1 week
Mania 1st line tx
Lithium
Lithium toxicity
Ataxia
Dysarthria
Delirium
Acute renal failure
Naltrexone
first line tx for craving of alcohol
Blocks u opioid receptor
SE TCAs
Orthostatic Hypotension
High QTC
470 or 480
Antipsychotic to give if over weight
Abilify (arippiprazole)
Physiology of schizophrenia
Increased DA in mesolimbic
Decreased DA in mesocortical
Mental status changes (not psychosis)
- delirium
Muscle rigidity +/- tremor (lead pipe rigidity)
Hyperthermia
Rhabdomyolysis
Autonomic instability
- tachycardia, high blood pressure, tachypnea, diaphoresis
Due to
Tx
Neuroleptic malignant syndrome
Due to antipsychotics
Tx: Dantrolene
Bromocriptine
Elevated creatinine phosphokinase
Which antipsychotic is most closely associated iwth an increased risk of diabetes
Olanzapine
SNRI for fibromyalgia
Milnacipran
Chronic pain tx
Duloxetine
SNRI
Fibromyalgia tx
MIlnacipran (SNRI)
Amitriptyline (TCA)
Tx neuropathic pain
Amitriptyline
Antidepressant the causes appetite stimulant and weight gain
Mirtrazapine
Serotonin syndrome signs
Hyperreflexia and clonus
Hyperthermia
Autonomic instability
- Cardiovascular collapse, mental status changes
Bulimina nervosa labs
Hypokalemic
Hypochloremic
Metabolic alkalosis
Non-anion gap metabolic alkalosis w/ respiratory compensation
Metabolic acidosis (laxative abuse)
Elevated bicarbonate
Incrased BUn
Hypernatremia
Increased amylase
Fixation
partially remaining at childish level of development
Reaction formation
Taking unacceptable thoughts and attempting to over exaggerate in opposite action
Projection
Taking unacceptable thoughts and believing that someone else has those thoughts
Displacement
Substitutes new aim/ object for something that is undesirable
man yells at family for bad day at work
Sublimation
unacceptable impulses or feelings transformed into socially acceptable actions
Suppression
Voluntarily choosing to not think about something
Opioid withdrawal symptoms
Sweating Dilated pupils piloerection yawning Rhinorrhea Flu like
Tx:
Moderate: Clonidine (autonomic signs)
Severe: Methadone, suboxone
Reversal agent for benzo
Flumazenil
- blockade of GABAergic neurotransmission
Can cause seizure
Reversal agent for opioids
Naloxone
Naltrexone
Severe depression, HA, fatigue, insomnia/ hypersomnia, hunger
Cocaine and amphetamine withdrawal
Pinpoint pupils
N/V
Seizures
Opioid overdose
Belligerence, impulsivness, nystagmus, homicidal ideation, psychosis
PCP intoxication
Anxiety, piloerection, yawning, fever, rhinorhea, nausea, diarrhea
opioid withdrawal
Identification
Acting like the person you have positive thoughts towards (changing where you wear sthetoscope
Intellectualization
using logic or fact to emotionally distance onself from stressful situation