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Depression for Medical Students

Transcript: Phenomenology What is it like? Epidemiology risk factors for depression & suicide Etiology Genes and environment Diagnosis DSM-IV criteria for Major depressive episode and Depressive Disorder Pathophysiology Where and how in the brain Depression Diagnosis 3 Mental Status Examination Depression: What you need to learn Depression: Epidemiology 3 Risk Factors Major Depressive Disorder (Single or Recurrent) Dysthymia Bipolar Disorder-depressed Depressive Disorder Due to Medical Condition Substance-induced Depressive Disorder Adjustment Disorder with Depressed Mood Depressive Disorder NOS Self Rating Scales Anatomy of Melancholy Depression Diagnosis 2 SIG: E. CAPS Pervasive, sustained feeling tone Internal experience Influences behavior and perception Like the “climate” Depression: Diagnosis 1 MDD – highest lifetime prevalence of any psychiatric disorder = 16.9% (National Comorbidity Survey) Females 20.2% Males 13.2% Cohort (generations) 18-29 16% 30-44 19.3% 45-59 20.1% 60+ 10.7% MDD – yearly incidence = 1.6% If a transmitter depolarizes the post-synaptic neuron, it is said to be excitatory If a transmitter hyperpolarizes the post-synaptic neuron, it is said to be inhibitory Whether a transmitter is excitatory or inhibitory depends on its receptor Ten leading causes of burden of disease, world, 2004 and 2030 Melancholy by Edward Munch, 1891 Nearly all depressed patients have considerable anxiety Anxiety may lead patients to suicide Patients may drink to calm anxiety Important to treat anxiety Comorbid anxiety disorders common (i.e. social phobia, panic) The Noradrenaline Pathways Types of Depressive Disorders Neurotransmitters Norepinephrine, Serotonin, Dopamine Second messengers Hormonal regulation HPA, Thyroid, GH, Prolactin Immunological disturbances Quote from a patient: “Depression is the worst of all diseases because when you are sick you want to get better; but when you are depressed you want to die…” Epidemiology Origins: Substancia Nigra “Probably more unpleasant than any physical disease except rabies” “There is constant mental pain” Physicians often shy away because it is so difficult to be with these patient’s feelings. Depressed patients make us feel helpless. Post partum depression versus “Baby Blues” DALYs Erick Messias, MD, PhD Phenomenology Excitatory and inhibitory neurotransmitters Differential Diagnosis Origins: Locus Ceruleus Carcinoid tumors Carcinomas (pancreas) Cerebrovascular disease (stroke) Collagen-vascular disease Endocrinopathies (thyroid, adrenal) Cardiac disease (common post MI) Pernicious anemia Neurological – stroke, brain injury, Parkinson’s Disease Grief and Bereavement Depression may be caused by medical treatments Beck Depression Inventory 1 and 2 PHQ 2/9 % Ischaemic heart disease 12.2 Cerebrovascular disease 9.7 Lower respiratory infections 7.1 COPD 5.1 Diarrhoeal diseases 3.7 HIV/AIDS 3.5 Tuberculosis 2.5 Trachea, bronchus, lung cancers 2.3 Road traffic accidents 2.2 Prematurity, low birth weight 2.0 Don’t MISS the DEPRESSION if the patient has physical complaints and/or medical illness Don’t MISS the Medical problems if the patient complaint is DEPRESSION Defining terms 1: Mood vs. Affect Depression: Epidemiology 1 Depression Depression and Medical Comorbidities Hamilton Rating Scale for Depression HAM-D Montgomery-Asberg Depression Rating Scale MADRS What for? For the test For your clerkship For your practice (whatever specialty) For your career in psychiatry For life External expression of mood Observed Like the “weather” Quote from Darkness Visible Appearance – posture, psychomotor retardation, tearfulness, hand wringing Mood- 50% deny depressed mood Speech – decreased rate & volume Delusions, Hallucinations –mood congruent Thoughts- negative, ruminations Memory- 50-75% impaired Insight / Judgment - impaired Antibiotics Antihypertensives Benzodiazepines Barbiturates Corticosteroids Chemotherapeutic agents Cimetidine Interferon Opioid Analgesics Monoamines: Overlapping Functions “Bad Mood” Sadness Grief Demoralization Depressed The Serotonin Pathways Goya’s Dark Paintings 5 or more for at least 2 weeks Essential Symptoms 1. Depressed mood 2. Anhedonia Physical Symptoms (VEGETATIVE SX) 3. Changes in sleep 4. Change in appetite or weight 5. Fatigue 6. Change in psychomotor activity Psychological symptoms 7. Feelings of guilt, worthlessness, hopelessness 8. Difficulty in thinking, concentrating, or making decisions 9. Recurrent thoughts of death and/or suicidal plans or attempts Adapted from DSM-IV History and FH Are there symptoms of a medical condition (cold intolerance, neuro changes?, etc) Medical conditions may mimic some symptoms of depression (energy, weight) Late onset more suggestive of medical cause Check Medication list Thyroid testing, B12 level Urine drug screen Brain imaging? Depression With psychotic features Delusions & Hallucination With catatonic features Mutism, immobility or motor overactivity, posturing, echolalia With Atypical features Increase

PowerPoint Game Templates

Transcript: Example of a Jeopardy Template By: Laken Feeser and Rachel Chapman When creating without a template... http://www.edtechnetwork.com/powerpoint.html https://www.thebalance.com/free-family-feud-powerpoint-templates-1358184 Example of a Deal or No Deal Template PowerPoint Game Templates There are free templates for games such as jeopardy, wheel of fortune, and cash cab that can be downloaded online. However, some templates may cost more money depending on the complexity of the game. Classroom Games that Make Test Review and Memorization Fun! (n.d.). Retrieved February 17, 2017, from http://people.uncw.edu/ertzbergerj/msgames.htm Fisher, S. (n.d.). Customize a PowerPoint Game for Your Class with These Free Templates. Retrieved February 17, 2017, from https://www.thebalance.com/free-powerpoint-games-for-teachers-1358169 1. Users will begin with a lot of slides all with the same basic graphic design. 2. The, decide and create a series of questions that are to be asked during the game. 3. By hyper linking certain answers to different slides, the game jumps from slide to slide while playing the game. 4. This kind of setup is normally seen as a simple quiz show game. Example of a Wheel of Fortune Template https://www.teacherspayteachers.com/Product/Wheel-of-Riches-PowerPoint-Template-Plays-Just-Like-Wheel-of-Fortune-383606 Games can be made in order to make a fun and easy way to learn. Popular game templates include: Family Feud Millionaire Jeopardy and other quiz shows. http://www.free-power-point-templates.com/deal-powerpoint-template/ Quick video on template "Millionaire" PowerPoint Games Some games are easier to make compared to others If users are unsure whether or not downloading certain templates is safe, you can actually make your own game by just simply using PowerPoint. add logo here References Example of a Family Feud Template PowerPoint Games are a great way to introduce new concepts and ideas You can create a fun, competitive atmosphere with the use of different templates You can change and rearrange information to correlate with the topic or idea being discussed. Great with students, workers, family, etc. For example: With games like Jeopardy and Family Feud, players can pick practically any answers. The person who is running the game will have to have all of the answers in order to determine if players are correct or not. However, with a game like Who Wants to be a Millionaire, the players only have a choice between answers, A, B, C, or D. Therefore, when the player decides their answer, the person running the game clicks it, and the game will tell them whether they are right or wrong.

Medical powerpoint

Transcript: Characteristics Earn a doctor of medicine (M.D) 4 years of medical school 3 years of general pediatric training (intern or resident) Going into the medical field is going to be a difficult challenge but with determination I will achieve my goal. With some of the experience I already have it will give me a jump start into the medical field. Pediatrician: I am 16 years old my favorite sport is swimming I want to get into a prestigious medical school some of my strengths are: I am very ambitious and this program would be a great opportunity for me. I am a team player and i am happy to work with other people on a project I am very hard working. I put a lot of efforts into what I do and I do my best Master's degree Bachelor's degree in nursing 1-2 years of experience Class of 2017 Health Career Academy Exploration Education plan Registered nurse University of Irvine Salary: $70,590 yearly $33.94 hourly Claudia Lopez period 1 Who am I? My future Skill set Work well with others I know my medical terminology words I know my vital signs Medical abbreviations i am very sociable Want to go straight to a 4 year university I am CPR certified I have completed my 100 hours of externship I have experience in a clinic Nurse practitioner a nurse who is qualified to treat certain medical conditions without the direct supervision of a doctor. $96,460 yearly $46.37 hourly Registered nurse: Education Plan My future Earn a bachelor's of science in nursing (BSN) 4 years at a university 2-3 years to achieve pathway Lesson learned Claudia Lopez Nurse practitioner: Pediatrics Enjoy working with kids $173,000 yearly $74.00 hourly Health Career Academy

Scholarships for Medical Students

Transcript: Scholarships & More Got scholarships? Learn more Overview & Types Scholarship Universe External Scholarships COM-T Scholarships Tips & Stats External Scholarships Search & apply External Scholarships National Scholarships National American Medical Association (AMA) Physicians of Tomorrow Underrepresented in Medicine National Medical Fellowships (NMF) AAMC & Darrell G. Kirch, MD Emergency fund National Hispanic Health Foundation (NHHF) Hispanic Health Professional Student Scholarship Women in Medicine Scholarships (WIM) Leadership Scholarship Tillman Scholarship AAMC Herbert W. Nickens Tylenol® Future Care Scholarship Local & Tribal Scholarships Community & Tribal Arizona Community Foundation Guinn B. Burton Scholarship Jim Troxel Foundation Arizona Latin-American Medical Association (ALMA) Scholars and Leaders of Tomorrow American Indian Graduate College (AIGC) Cobell Scholarship American Indian Education Fund Other chapter funding Service Scholarships Service National Health Service Corps (NHSC) Indian Health Service (IHS) Military Health Professions Scholarship Program (HPSP) NIH Scholarship & other loan repayment programs COM-T Scholarships COM-T General Scholarships State grant Donor endowments & gifts Renewable & Non-renewable Need-based & only 2 Merit Admissions application serves as scholarship application One-time review process COM-T Service & Partnership Programs COM-T Service Scholarships Primary Care Physicians (PCP) Scholarship Family medicine, general internal medicine, geriatric medicine, general pediatrics, psychiatry and OB/GYN Covers tuition for AZ resident Minimum of 2 years & Max of 4 years Practice in undeserved areas of AZ Navajo Nation Future Physicians Scholarship COM-T & ONNSFA cover tuition Minimum of 2 years & Max of 4 years Practice in Navajo community Scholarship Universe Scholarship Universe https://financialaid.arizona.edu/scholarshipuniverse Explore & Find Types Office of Scholarships and Financial Aid (OSFA) Departmental Outside & many more Quick Stats Stats Class of 2019 Debt: Average med= $198,552 Average ed= $218,85 2019-2020 MS1 Cost of Attendance: $60,518 19-20AY Scholarships & QTR 19-20AY %s MS1-MS4 =8% received an external scholarship Incoming class COM-T general: 22% received a scholarship 13% renewable / 9% non-renewable Average award = $19K MS1-MS4 QTR = 10% received either spouse or dependent tuition reduction benefit 19-20AY Scholarships Service #s Service scholars: 3 NHSC 10 HPSP 4 FPS 21 PCPSP Scholarships to Loans %s 2018, FASR Important Dates & Reminders Tips January -May is the peak application season FAFSA priority date is March 1st COM-T scholarship offers begin in February for each current accepted admission rounds Application Tips Tips Increase your odds, apply to all eligible scholarships Focus on eligibility criterion Avoid vague responses Highlight your unique qualities Complete both broad and narrow searches Resources Resources Scholarship Universe financial-aid.medicine.arizona.edu Arizona Community Foundation AAMC FIRST Fastweb

SCD for medical students

Transcript: Definition: What is Sickle Cell Disease? 3 months- 5 years Acute crisis: -Vaso-occlusive -Visceral sequestration -Aplastic -Haemolytic Bony Infarcts :( "Cod-fish" vertebrae Long bone involvement *humerus *tibia *femur Dactylitis or "hand-foot" syndrome 1. Review etiology and pathophysiology of sickle cell anemia 2. Discuss acute presentations and management 3. Discuss recommended long-term management of patients 4. Recognise poor prognostic factors 5. Discuss tips for parents or caregivers The SCD child Available from: http://www.sicklecellontario.org/_/rsrc/1314475848220/sickle-cell-101/a-history-of-sickle-cell-disease/sickle-cell-540x380.jpg Renal Remember the vasa recta? Kinney TR, Ware RE, Schultz WH, et al. Long-term management of splenic sequestration in children with sickle cell disease. J Pediatr 1990;117:194-9. Pop Quiz Is it serious? The physical examination: *Jaundice in the neonate. *Protuberant abdomen +/- umbilical hernia *Cardiac systolic flow murmur *Overbite or frontal bossing *Short stature + delay sexual development Folic acid: 1mg po od Transient Red Cell Aplasia *Direct toxicity of parvovirus B19 on erythrocyte precursors Priapism Average age of onset: 12yrs Advice: Onset: Drink fluids, urinate, take analgesics >2hrs- seek medical attention: IV hydration and analgesics Lungs Acute chest syndrome: *fever *dyspnoea *CXR infiltrate Management: 1. Oxygen 2. Transfusion 3. Analgesia and incentive spirometry 4. IV Antibiotics Brain Ischemic stroke 1. CT scan 2. IV hydration 3. exchange transfusion to reduce Hb S to <30% 4. chronic transfusion Haemorrhage 1. surgery Immunization Routine Special *Influenza *PCV7 *PPV23 -Meningococcal Etiology of HbS Sickle Cell Disease Visceral Sequestration Presented by: Ornella Humphrey RaeAnna Dilbar Rhea Solomon Poor prognosis -dactylitis <12mnths -Hb <7g/dl at age 2 -WBC >13.7 <10 years Foundation Presentation Falletta JM, Woods RM, Verter JI, et al. Discontinuing penicillin prophylaxis in children with sickle cell anemia. J Pediatr 1995;127:685-90. References: Hoffbrand AV, Moss PAH. Essential Haematology. 6th Edition, Wiley-Blackwell Publication 2011. Management of Sickle Cell Disease. National Heart, Lung, and Blood Institute: Division of Blood Diseases and Resources. 4th edition, National Institutes of Health 2002 [revised]. Publication no. 02-2117. Miller ST, Sleeper LA, Pegelow CH, et al. Prediction of adverse outcomes in children with sickle cell disease. N Engl J Med 2000;342:83-9 what is this? which is cod fish? Available from: http://www.physics.ohio-state.edu/~wilkins/writing/Samples/shortmed/nelson/sickle_fig1.jpg Lessons 1. common physical findings 2. laboratory values 3. administer painkillers and antibiotics 4. how to palpate the spleen. Permissions 1. Encourage self-esteem fostering activites. 2. Schoolwork 3. Exercise in a SELF-LIMITED BASIS. 4. Warm clothes in cold weather 5. No swimming in cold water 6. Air travel in pressurized environment. Objectives- To: Fever without focus *blood, urine, CSF, throat culture *CBC + ret count *CXR + broad spectrum IV antibiotics Expanding our knowledge... of sickle cell disease Testing Routine: *CBC + reticulocyte count *RFT + LFT *SPO2 Special: Brain: Transcranial doppler ultrasound Lungs: lung function tests Eyes: dilated eye exams Types: HbSS HbSBo HbSC HbSB+ Clinical severity Pain! Management: 1. Begin hydration 2. Determine cause of pain 3. Assess severity* *Morphine 0.15mg/kg IV q3-4 4. Reassess at 15-30mins 5. Start by-the-clock dosing Parents crisis Maintaining health Acute splenic sequestration complication (ASSC) *enlarging spleen *decrease in Hb by 2g/dl *increase in reticulocyte count Signs -> pallor, tachycardia, tachypnoea, Symptoms -> weakness -> abdominal fullness Acute management: *Transfusion Long-term management: *Splenectomy Aplastic Crisis Vaso-occlusive Antibiotics Penicillin VK: 125 mg po bd <3 years of age 250 mg po bd >3 yrs Erythromycin: 10mg/kg po bd 2mnths- 5years* A functional and structural haemoglobinopathy whereby the sickle beta chain is inherited. Valine replaces glutamic acid in the 6th position of the beta chain thereby causingthe beta globin abnormality.

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