Offer to discuss the concerns and name the involved persons of the family Offer information about medications before prescription  Discuss the information actively  The information should include the name , mechanism, effects and side effects of the medication Involve the patient in decisions Recognise and address the concerns of the patient as treatment progresses For schizophrenic patients, social and family support be ensured

Illness in the the patient needs treatment from the clinician in your environment   Illness related factors eg lack of insight Patient related factors eg personal beleifs about the illness Treatment related faactors like side effects or cost Clinician related factors eg ignoring patient's autonomy Environmental factors eg beleifs of the society 

I ACE I mpulsive A ntisocial  C old E gocentric 

PEN Psychoticism Extroversion Neuroticism

More PADS Mood disorders, (chronic) Medical conditions especially epilepsy Personality Disorder Alcohol abuse Drug  abuse (other), DSH past history Schizophrenia * DSH deliberate self harm

Predominant mood in grief is feelings of emptiness and loss , while in depression, one has a persistent low mood and anhedonia .  Mood in greif improves over days to weeks in waves , while it is persistent in case of depression. In greif there may be waves of positive feelings including humor as compared to depression where , there is only low mood.  The grieved person is preoccupied with memories of the deceased, depression on the other hand is characterised by the depressive cognitions of guilt, pessimism, hopelessness, worthlessness. 

Trust your Autonomy and Initiate the Industry , or your idenity will be isolated rather than self integrated . Trust versus mistrust  Autonomy versus shame and doubt Initiative versus shame and doubt Industry versus inferiority  Identity versus confusion Intimacy versus isolation   Generativity vs self absoption Integreity vs despair

Encoding can be enriched with the following techniques  MESI Motivation to remeber (should be high) Elaboration Self-referent (making the information self-refrent)  Imagery (create visual imagery of items you are memorizing) 

Mnemonic for Freud's Stages of Psychosexual Development The following sentence helps me remember the stages of psychosexual development in order.  O nions A nd P otatoes L ook G reat Oral Anal Phallic Latency  Genital 

VAP.  Vulnerable personality Availability of drugs, adverse social environment  Pharmacological factors 

moved

Breif CoPS Breif psychiatric rating scale BPRS Camberwell family interview  Positive and negative symptoms scale PANSS Schedule for the assement of positive symptoms SAPS, schedule for the assement of Negative symptoms SANS 

DPR Disorganization  Psychomotor poverty Reality disturbance

HIT GRAPE Hypnosis Individual and family therapy TF-CBT Group therapy Relaxation techniques  Anxiety management, art therapy Play therapy EMDR

Phing Persecutory  Hypochondriacal Impoverishment  Nihilistic  Guilt

JET-16 MAP C   JPI Jackson Personality Inventory  EPPS , Edwards Personal Preference Schedule, EPQ Eysenske Personality Questionaire TSCS Tennessee Self Concept Scale 16 -PF 16 personality factor MMPI (I and II) Minnesota Multi-phasic Personality Inventory , MCMI (I and II)  ACL Adjective Checklist  PSI Psychological Screening Inventory, PAI Personality Assessment Inventory  CPS Comrey Personality Scale 

COTCH-Q  Chlorpromazine  Olanzapine Trifluperazine Clozapine Haloperidol Quetiapine

DICHOP Dichotomous thinking Impulsivity Cognitive restriction Hopelessness Overgeneralised autobiographical memory Problem solving deficits

Worthwhile TEACHINGS Weight gain Tachycardia  Eneuresis Agranulocytosis Constipation Hypo/hypertension, hypersalivation Increased temperature Nausea GORD Seizures Clozapine Induced Gastric Hypomotility Previous data indicated that most severe cases of CIGH occur during the first four months of treatment (Palmer, McLean, Ellis, & Harrison-Woolrych, 2008; West, Rowbotham, Xiong, & Kenedi, 2017) However, a more recent study (Every-Palmer & Ellis, 2017) of clozapine-induced serious or fatal ‘slow gut’ adverse reactions revealed remarkably contrasting outcomes. This was the largest study to date on the problem and studied one-sixty accounts of serious CIGH out of about forty-three thousand patients exposed to clozapine. Fatalities occurred in at least twenty-nine patients. This sums to a prevalence of thirty-seven per ten-thousand and the case-fatality ratio of eighteen per cent. The duration of treatment when the serious cases occurred ranged from three da

Gamepil Excessive guilt Anorexia Morning worsening and distinct quality of mood Early morning waking Psychomotor retardation  Loss of interest Loss of libido

Long POSTMOn Long duration of the illness P ersonality disorder O vervalued ideas about obsessions S evere symptoms T ic-related symptoms  M ale gender On set in childhood  The prognosis is better when there has been a precipitating event, social and occupational adjustment is good, and the symptoms are episodic. Reference: Zohar 2009

Thes concepts of normality fall into four functional perspectives. Normality as health: physicain equates normality with health and consider health as a universal phenomenon. Behaviour is considered normal when there is no psychopthology. Normality as utopia: optimal blending of the diverse elements of the mental apparatus that result in optimal functioning Normality as average Normality as a process

3 FIRM HELLs 1 n in 3000 Facial asymetry Irritability Microcepahlly, mild to moderate MR Hyperactivity Ears being low set Upper Lip deformity

Sickle cell trait. When the oxygen tension falls below a certain level (about 60%), it induces sickling. Therefore, during ECT it should be ensured that oxygen tension does not fall too low.  Diabetic patients taking insulin.  Old age

PAST Prematurity   Factors leading to poor attachment to parents Separation from mother during early years of life  Temperamentally difficult child  

SensoPreConForm Sensorimotor stage Preoperational stage Concrete operational stage Formal operational stage

Detailed history and physical examination Decision to give ECT and whether unilateral or bilateral Informational care followed by consent Keep the patient NBM for at least 5 hours Just before Administring, check the patient's identity, their medication list, and consent. Check vitals Any evidence of Drug allergy or reaction to anesthesia or any contraindication for ECT

Iodine deficiency  Severe maternal malnutrition 

The preveious beleif was that these two rates are not correlated. However, later studies revealed that the higher the average level of consumption of alcohol in the community, the higher the rates of alcohol use disorder. The resultant plot is a logarithmic normal curve. 

Humor Sublimation Supression 

MEND CLEFTH Metabolic disorders Endocrinopathies Neurosyphilis  Dementia Cerebral vasculitidies Limbic encephalopathies Focal basal ganglia lesions Temporal lobe disorders Huntigtons disease SLE

DRIP Uric Acid Displacement, dissociation Repression, rationalization, reaction formation Isolation of affect Passive aggression Undoing Acting out

Serile Social networks (expanding)  Education about schizophrenia  Reducing number of hours of daily contact Improving communication  Lowering expressed emotions Expectations (adjusting) 

Metocloperamide Paroxetine (acute dystonia) Domperidone 

BISEP Bipolar course of the illness Incomplete symptomatic remission Comorbid substance abuse and/or personality disorder Early age of onset Poor physical health and/or social support, previous history 

PSD Projection Splitting Denial

VEAP Ventillation of emotions Evaluating the problem (to see what can be changed and change it and accept whatever can not be changed)  Avoidance of the problem (by refusing to think about it) Positive reappraisal of the problem (that it has led to some good)

SOFT Sexual exploitation of patients Imposing your Own values and beleifs on the patients Financial exploitation of the patients Putting the interests of third parties before that of the patient 

BRIS Blocking Regression Introjection Somatization 

GAS Good working relationships among staff and between staff and patients  Adequate number of well trained staff, Agreed policies for observation and review of patients Safe environment in the ward 

Spacier Social isolation Poor parenting skills, psychiatric disorders Age being young  Criminal record Intelligence being low Exposure as a child to physical abuse Relationship breakdown with partner

10-30% risk of further severe injury Increased risk of physical disorders Delayed development  Learning disbalities Increased rates of behavioral and emotional problems in adolescence 

Being competent in academics Sociability Having the abilitity to establish relationship with an adult outside the home 

HENP HIV Encephalitis  Neurosyphilis Prion

Dynamism Optimization  Personal contentment Socially responsible  Occupationally effective Economically emancipated  Relieved from pain and discomfort  Homeostasis

FAIRED     Flashbacks      Anxiety (persistent), Avoidance of reminders,      Irritability, insomnia, interest (loss of)     Recall (of stressful events is difficult),      Emotional numbing     Detachment, Dreams (distressing)

VILD A bague account of the way in which the injuries came about Inconsitent acount of the injury (it's extent and nature)  Lack of concern (apparent) about the child's injuries Defensive or suspicious 

E ach A nd every DPR is C ontroversial  Express empathy Avoid arguing and don't be judgemental Detect and role with resistance Point out discrepancies in history Raise awareness about the contrast between the substance users aims and behavior 

LOQ Lurasidone  Olanzapine Quetiapine 

Bloody GMC Blood alcohol concentration  GGT MCV Carbohydrate defecient transferrin

BAH TIA Systemic Bacterial endocarditis  Accidental overdose Hepatitis B and C, HIV Local  Thrombosis (veinous) Infection of injection site Artery damage

FEIST Feelings of emptiness Efforts to avoid abandonement Intense and unstable relationships Self image (disturbed) Threats/acts of self harm

MASTR-B Multiple bruising Abrasions Subdural hemorrhage Torn upper lip Retinal hemorrhage  Bites, bone fractures

MASTR-B Multiple bruising Abrasions Subdural hemorrhage Torn upper lip Retinal hemorrhage  Bites, bone fractures

Hypochondriacal Disorder A 34-year-old operating room assistant has presented you in the outpatient department; his physician— to whom he reported ninth time in last three months with a dread that he has human immune virus infection—sent him to you for psychiatric assessment and management. The physician notes he requested him to examine and re-test him for AIDS. He explained that his roommate in the mess recently confessed to having homosexual relationships with multiple partners. The patient never had a homosexual contact nor carries a factor for human immune virus infection. He had anankastic traits; remains worried about his health, however, he has no depression or disturbed biological functions. What will be the differential diagnosis in this case? What is the most likely diagnosis? Justify. How would you manage this case? Differential Diagnosis Hypochondriasis/Illness Anxiety Disorder Obsessive-compulsive disorder, these could be intrusive thoughts, but this is less likely. Monos

Economic control i.e. price. Increase in priced reduces the consumption and vice versa Formal control e.g. Law. It has little effect on average consupmtion though Informal controls e.g. Customs and moral beleifs. 

Psychological form of treatment. D-CRIMe Difficult to treat CBT is more effective than clinical management or psychodynamic psychotherapy Repeated reassurance is unhelpful Investigations must be limited to those that are necessary and not to satisfy the patient Misinterpretation of normal bodily sensations must be corrected

More VIDS Maladaptiveness Violations of social standards Irrationality and unpredictability  Dangerousness  Statistical deviancy, social discomfort (causing), suffering *None is sufficient or necessary 

VIRAL CO Visouconstructive abilities Information  Recall Attention, Ability to follow commands Language Calculation Orientation 

Large PRAISe Liaison with the medical and nursing staff Psychiatric Consultation for LUDO Long-Standing Problems Uncooperative/Uncommunicative patients Depression  Other Psychiatric Symptoms (esp., Delirium with paranoid symptoms) Reduce Symptoms (breathlessness, pain, confusion) Adjust (help the patient to) Inform (staff and relatives) about all that the patient has been told Support Relatives, Special Services (take help of)

White COPY Wishes Conflicts Operate Pain Yeild control - The patient should be relatively free from pain ,  - should operate on as effective a level as possible,  - should recognize and resolve any remaining conflicts ,  - should satisfy as far as possible their remaining wishes ,  - and should be able to yield control to others in whom they have confidence

MH ADVICES Memory impairment  Hallucinations  Apathy, anxiety, ataxia Delusions Volitional movements reduced Irritability Chorea, clumsiness, concentration reduced Eating, speaking, swallowing difficulty 

ChloroQueLidone Chlorpromazine  Quetiapine  Illoperidone, risperidone, palliperidone

HALTS Haloperidol  Aripiprazole, Asenapine, Amisulpiride  Lurasidone Trifluphenazine Sulperide

The mortality of ECT is about 3-4 per 100,000. The causes are attributable to general anaesthesia. Most common causes of death are Ventricular fibrillation and Myocardial Infarction. 

Anger is CRIME Anger management  Cognitive restructuring  Recall of images of the events Information about about stress response Monitoring (self) of symptoms  Exposure

The following are the non-pharmacological options for the treatment of depression Counselling Cognitive behavioral therapy Interpersonal therapy Couple therapy/marital Psychodynamic psychotherapy Bright light therapy ECT

Some people suggest that diagnostic lables such as ADHD, Depression etc. are stigmatizing and if these are removed, stigma will be reduce. However, the basis of stigma is "fear" and not a lable. People have been stigmatizing mentally ill people long before diagnostic classifications and have been using thier own lables for them. 

Psychiatric Disorders Associated with Alcoholism I use the following mnemonic to remember the disorders associated with alcoholism. BADS Bipolar affective disorders Anxiety disorders especially panic and social phobia Depressive disorders, the delusion of infidelity  Schizophrenia and sexual dysfunction 

The basis of stigma is the fear that people with mental illness may act or behave in threatening or unpredictable ways. Therefore people keep away from them. Stigma is reduced when people know about the low incidence of violence in mentally ill people

PLeaSuRiNG Peptic ulcer disease Liver disease Seizures Repeated accidents  Neuropathy Gastritis

SAC Steroids Alcohol, Amphetamines Cannabis, cocaine

SANDICT SLE Addison's Neurological Diabetes  Infections Carcinoma Thyroid

ADICOSE HoMe A Autism Spectrum, Affective, AIDS, AIP, Antipsychotics  D Disulfiram, Drug Withdrawal  I Infarcts (cingulate, temporal, parietal) C CJD, Cushing's Conversion, Corticosteroids  O OCD S SLE, Schizophrenia  E Encephalitis, Epilepsy H Hepatitis, HIV M Metoclopramide, MDMA

RTSP Ready availability of weapons Threats to people to whome patient has access Substance abuse Previous history of violence to others, Psychotic symptoms, Planning of violence

Freuds psychonalytical theories Jung's analytical psychology Adler's individual psychology 

MoCKuP AfGHaniSTan Mucopolysccahridoses(except hurler's) Cystic Fibrosis Kartagener syndrome  PKU Albinism, AR-PKD Glycogen storage diseases Hemochromatosis  Sickle cell anemia, Sphingolipidoses except fabrys disease Thalassemia 

A number of abnormalities may predate the development of alcoholism.  Cognitive impairments especially of executive function  Abnormally evoked visual P300 responses Being less sensitive to large quantities of alcohol

Family aggregation present Higher concordance in MZ twins 50% estimated heritability Higher risk of alcohol misue in adopted away sons Mutation in gene that codes for aldehyde dehydrogenase prevets against alcoholism GABA receptor and dopamine D4 receptor genes are other candidates (inonsistent results of studies regarding these) 

The risk of alcoholism is higher in people whose parent(s) were drinker(s). However, learning through modeling (ie parents acting as models) do not appear to be involved. Risk of drinking is in children is not increased if the parent(s) are currently drinking (sher et al, 2005) Sher KJ, Grekin ER and Williams NA ( 2005). The development of alcohol use disorders Annual Review of Clinical Psychology, 1, 493–523.

Two mechanisms are suggested Alcohol decreases anxiety and elevates mood. These act as reinforcer to increase the behaviour the lead to it i.e. Drinking Alcohol Alcohol causes the release of dopamine which increases motivational behaviour that lead to its release. 

NISAR Novelty seeking Inferiority Self-indulgent tendencies Antisocial Risk taking

2 GEMS Genetic (is strongly) Early age of onset (it has) Males (predominantly occurs in Sociopathy and criminality (is highly associated with these in both biological and adoptee father) 

LAMISTER Listening Advice and guidance Morale (restoration of) Information (providing of) Suggestion Therapeutic relationship Emotions (release of )  Rationale (providing of)

SUGARI Socialization Universality Group cohesion Altruism Recapatulation of the family problems Imitation, Interpersonal learning

RPM (Ravens Progressive Matrices) Cattle Culture Free test

Feature s of vascular dementia All of the following feaures suggest a diagnosis of vascular dementia (against other types of dementias) History of strokes Patchy psychological defecits Localizing nerological signs Relative preservation of personality Physical signs of hypertension and arteriolosclerosis Psuedobulbar palsy Rigidity Akinesia Brisk reflexes

Subtypes of vascular dementia: BELC Binwangers disease Etate lacunaire Leucocariosis CADASIL

Very few therapies have been evaluated scientifically for the treatment of borderline personality disorder. Two of these are DBT (dialectical behavior therapy) and Psychoanalytically oriented mentalization day treatment. The results for DBT were encouraging in a study (6-9)but the effects were lost on follow up. Also the effects were not studied directly on personality disorder but on features such as self-harming behaviour. Mentalization treatment on the other hand has been evaulauted with two randomised onctrolled trials (1-5) and the effects were significant and sustained. The refrence studies are given below.  Bateman A and Fonagy P ( 1999). Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial . American Journal of Psychiatry, 156, 1563–9. Bateman A and Fonagy P (2001). Treatment of borderlinepersonality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up . American Journ

Stress that leads to release of stress hormones and ultimately poor glycemic control Poor adherence to treatment may also affect glycemic control

Recurrent episodes of hypoglycemia Cerebral arteriolosclerosis

There are two types of sexual dysfunctions that may occur in diabteic men.  Psychogenic impotence (just like the general population)  Organic impotence ( due to pelvic autonomic neuropathy and vasculopthay) 

SHRIMPED BANGS Sadnees,weeping, waves of greif Restlessness  Illusions, vivid imagery Memories of deceased(being preoccupied with) Poor sleep Experience of a presence Decreased appetite  Blame Anger Guilt Social withdrawal 

BAR De FAR Body-image Disturbance Apraxia (limb) Right-to-Left hemineglect Dyscalculia Finger agnosia Agraphia Receptive dysphasia

Klaus Lieb, Birgit Völlm, Gerta Rücker, Antje Timmer, Jutta M. StoffersThe British Journal of Psychiatry Dec 2009, 196 (1) 4-12; DOI: 10.1192/bjp.bp.108.062984 Twenty-seven trials were included in which first- and second-generation antipsychotics, mood stabilisers, antidepressants and omega-3 fatty acids were tested. Most beneficial effects were found for the mood stabilisers topiramate, lamotrigine and valproate semisodium, and the second-generation antipsychotics aripiprazole and olanzapine. However, the robustness of findings is low, since they are based mostly on single, small studies. Selective serotonin reuptake inhibitors so far lack high-level evidence of effectiveness. The current evidence from randomised controlled trials suggests that drug treatment, especially with mood stabilisers and second-generation antipsychotics, may be effective for treating a number of core symptoms and associated psychopathology, but the evidence does not currently support effectiveness for overall

Lithium plus valproate combination therapy versus monotherapy for relapse prevention in bipolar I disorder (BALANCE): a randomised open-label trial. BACKGROUND : Lithium carbonate and valproate semisodium are both recommended as monotherapy for prevention of relapse in bipolar disorder, but are not individually fully effective in many patients. If combination therapy with both agents is better than monotherapy, many relapses and consequent disability could be avoided. We aimed to establish whether lithium plus valproate was better than monotherapy with either drug alone for relapse prevention in bipolar I disorder. METHODS : 330 patients aged 16 years and older with bipolar I disorder from 41 sites in the UK, France, USA, and Italy were randomly allocated to open-label lithium monotherapy (plasma concentration 0.4-1.0 mmol/L, n=110), valproate monotherapy (750-1250 mg, n=110), or both agents in combination (n=110), after an active run-in of 4-8 weeks on the combination. Randomisation w

he removed the SHell AND Fully POACHED the egss Protective Factors  S tatins H RT, Use of hormone replacement therapy (HRT) A ctivity, cognitive and physical activity in Midlife N SAIDs D eit, Mideterranian Risk Factors F amily history P olymorhisms, genetic O besity A POE4 C erebrovascular disease H SV, homocysteine high levels, head injury E ducational level being low D iabetes, depression, down syndrome

While you start educating a patient about his condition, he refuses to know about it and asks you to give whatever treatment you want to give him. He has full capacity to make decisions otherwise. What should you do next? Give treatment that is best for him Decide with his relatives Inform him against his will Try to find the reasons why he does not wish to know Inform him that it is still important that he learns about all the options Answer : If an adult has capacity, no one else can make decisions on behalf of him/her. If the patient wants you to make decision for them or leaves it to a relative, friend etc., you should explain that it is still important for them to learn about the available options. If they do not want this information, you should then try to find the reasons.In case of any questions, please write down your comment below. Reference:  http://www.gmc-uk.org/guidance/ethical_guidance/confidentiality.asp

Which of these side effects of antipsychotics occur earlier than the others? A.  Tardive  dyskinesia B.  Akathisia C.  Parkinsonism D.  Hypothyroidism E.  Weight  gain   Answer : Acute dystonia can occur within hours of starting antipsychotics (minutes if the IM or IV route is used) Tardive dystonia occurs after months to years of antipsychotic treatment. Acute akathisia occurs within hours to weeks of starting antipsychotics or increasing the dose. Tardive akathisia takes longer to develop and can persist after antipsychotics have been withdrawn. Tardive dyskinesia occurs in months to years. Weight gain may start early but it may not be evident for few weeks. Parkinsonism may take days to weeks after antipsychotic drugs are started or the dose is increased. Reference:  The Maudsley Prescribing Guidelines in Psychiatry 12th Edition.

Which of these side effects of antipsychotics occur earlier than the others? A.  Tardive  dyskinesia B.  Akathisia C.  Parkinsonism D.  Hypothyroidism E.  Weight  gain Answer :  Acute dystonia can occur within hours of starting antipsychotics (minutes if the IM or IV route is used) Tardive dystonia occurs after months to years of antipsychotic treatment.  Acute akathisia occurs within hours to weeks of starting antipsychotics or increasing the dose. Tardive akathisia takes longer to develop and can persist after antipsychotics have been withdrawn. Tardive dyskinesia occurs in months to years. Weight gain may start early but it may not be evident for few weeks. Parkinsonism may take days to weeks after antipsychotic drugs are started or the dose is increased. Reference: The Maudsley Prescribing Guidelines in Psychiatry 12th Edition. 

While you start educating a patient about his condition, he refuses to know about it and asks you to give whatever treatment you want to give him. He has full capacity to make decisions otherwise. What should you do next? Give treatment that is best for him Decide with his relatives Inform him against his will Try to find the reasons why he does not wish to know Inform him that it is still important that he learns about all the options Answer : If an adult has capacity, no one else can make decisions on behalf of him/her. If the patient wants you to make decision for them or leaves it to a relative, friend etc., you should explain that it is still important for them to learn about the available options. If they do not want this information, you should then try to find the reasons. Reference: http://www.gmc-uk.org/guidance/ethical_guidance/confidentiality.asp

Risk Factors for Post-Traumatic Stress Disorder The following description of risk factors also answers QID:919472837474 The best answer would be d) her intelligence quotient. The patient has developed symptoms of post-traumatic stress disorder, including the most specific “intrusive symptoms.” These have occurred after the life-threatening event she went through. Both the international classification of diseases and the diagnostic and statistical manual require such a precipitating factor for making the diagnosis. It is an event that is life-threatening, or according to the diagnostic and statistical manual, one that threatens body-integrity (e.g. rape). One may either be a bystander or directly threatened by the event. However, this factor interacts with other predisposing or vulnerability factors in an individual to trigger the condition. Genetic factors account for about one-third of the vulnerability , according to a study conducted on twins working in the U.S. military. Other no

Meri CHANDI Memory impairment  Concentration reduced  Hallucinations  Anxiety  Nightmares Depression, delusions, depersonalization Insomnia

PALM Prophylaxis of mood disorders Augmentation in resistant depression Learning disability (control of anger in) Mania (acute treatment of) 

White COPY     * Wishes     * Conflicts     * Operate     * Pain     * Yeild control - The patient should be relatively free from pain , - should operate on as effective a level as possible, - should recognize and resolve any remaining conflicts , - should satisfy as far as possible their remaining wishes , - and should be able to yield control to others in whom they have confidence

P-HOARD Psychosis, Parkinson's, polypharmacy (antipsychotic). High potency antipsychotics. Organic brain disease. Agitation, alcoholism, anticholinergics. Retardation (mental) Dehydration, dose (rapid Increase or decrease)

Conditions That Can Cause Depression-Mnemonic SANDICT mnemonic can help memorize and recall the conditions that can directly induce depression.  SANDICT SLE  Addison's disease Neurological conditions eg. stroke.  Diabetes  Infections for example influenza virus infection.  Carcinoma, especially involving the brain directly or through metastasis. Breast carcinoma is an example.  Thyroid disorders especially hypothyroidism.  Please see the Shorter Oxford Textbook of Psychiatry for more details.

A PRIME TOWN     * Anoxia, Autoimmune     * Primary neurodegenerative     * Radiation     * Infections, inflammation     * Metabolic     * Endocrine     * Toxin, Trauma     * Other causes     * Vasculitides (W)     * Neoplastic

Vignette: Most Effective Treatment for a Man with Sudden Episodes of Anxiety A 30-year-old man presented with episodes of sudden anxiety, palpitations, chest tightness, and a feeling of impending doom. These episodes occur about 4-5 times per month for the last 7 months and last about 10 minutes on average. They have carried his physical examination and laboratory evaluation out, which is inconclusive about biological causation for his condition.  What would be the most effective treatment option? Cognitive therapy  Fluoxetine Imipramine Amitriptyline  Cognitive Behavior Therapy Controlled studies have shown that cognitive therapy is at least as effective as antidepressant medication in the treatment of the panic disorder (Mitte, 2005). Combined treatment with medication and psychotherapy may cause a better response in the acute phase than either treatment modality given alone, but probably not in the longer term. In the longer-term medication alone may have a less good outcome th