Thursday, 30 June 2016

Strategies to Improve Medication Adherence

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

Causes of Medication Non-adherence Mnemonic

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 

Psychoticism (Components Of) Mnemonic














I ACE



  • Impulsive

  • Antisocial 

  • Cold

  • Egocentric 

Eysenck's High Order Traits of Personality

PEN

  • Psychoticism

  • Extroversion

  • Neuroticism

Individual psychiatric and medical factors that increase the risk of suicide

More PADS


  • Mood disorders, (chronic) Medical conditions especially epilepsy

  • Personality Disorder

  • Alcohol abuse

  • Drug abuse (other), DSH past history

  • Schizophrenia


* DSH deliberate self harm

Wednesday, 29 June 2016

Difference between Grief Reaction and Depression


  1. Predominant mood in grief is feelings of emptiness and loss, while in depression, one has a persistent low mood and anhedonia

  2. Mood in greif improves over days to weeks in waves, while it is persistent in case of depression.

  3. In greif there may be waves of positive feelings including humor as compared to depression where , there is only low mood. 

  4. 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. 

Erikson's stages of personality development Beautiful Mnemonic

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

How to Enrich Memory Encoding

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) 

Tuesday, 28 June 2016

Mnemonic for Freud's Stages of Psychosexual Development

Mnemonic for Freud's Stages of Psychosexual Development

The following sentence helps me remember the stages of psychosexual development in order. 

Onions And Potatoes Look Great

  1. Oral
  2. Anal
  3. Phallic
  4. Latency 
  5. Genital 

What are the main causes of drug misuse?

VAP. 

  • Vulnerable personality

  • Availability of drugs, adverse social environment 

  • Pharmacological factors 

Principal Features of OCD Mnemonic

moved

Scales Used for Schizophrenia Mnemomic

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 

Monday, 27 June 2016

Three clinical subsyndromes of schizophrenia Liddle

DPR

  • Disorganization 

  • Psychomotor poverty

  • Reality disturbance

Non Pharmacological treatment options for PTSD

HIT GRAPE

  • Hypnosis

  • Individual and family therapy

  • TF-CBT

  • Group therapy

  • Relaxation techniques 

  • Anxiety management, art therapy

  • Play therapy

  • EMDR

Mood Congruent Delusions Which May be Found in Psychotic Depression

Phing

  • Persecutory 

  • Hypochondriacal

  • Impoverishment 

  • Nihilistic 

  • Guilt

Objective Scales for Personality Assessment

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 

Key Cognitive Processes in OCD

Differential Diagnosis of OCD Mnemonic


Sunday, 26 June 2016

Antipsychotics That Are Relatively Safe During Pregnancy Mnemonic

COTCH-Q 

  • Chlorpromazine 

  • Olanzapine

  • Trifluperazine

  • Clozapine

  • Haloperidol

  • Quetiapine

Psychological Risk Factors For Suicide

DICHOP

  • Dichotomous thinking

  • Impulsivity

  • Cognitive restriction

  • Hopelessness

  • Overgeneralised autobiographical memory

  • Problem solving deficits

Saturday, 25 June 2016

Adverse effects of Clozapine Mnemonic

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 days to eighteen years with a median of two-and-a-half years. However, the median duration of onset was over four years in cases with a fatal outcome and two years in those with a nonfatal or unknown outcome. The odds ratio of fatal outcomes rose by twenty-one percent every two years. Thus, serious CIGH can occur during the treatment, and the cases presenting later may be at higher risk of death.

Factors associated with risk of repetition of attempted suicide

PC VAULTS

  • Previous attempt , Personality disorder  

  • Criminal record

  • History of violence

  • Alcohol or drug abuse, Age 25–54 years 

  • Unemployment  

  • Lower social class  

  • Previous psychiatric treatment

  • Single, divorced, or separated

Friday, 24 June 2016

Melancholic features of depression Mnemonic

Gamepil

  • Excessive guilt

  • Anorexia

  • Morning worsening and distinct quality of mood

  • Early morning waking

  • Psychomotor retardation 

  • Loss of interest

  • Loss of libido

Poor prognostic factors for OCD

Long POSTMOn

  • Long duration of the illness

  • Personality disorder

  • Overvalued ideas about obsessions

  • Severe symptoms

  • Tic-related symptoms 

  • Male gender

  • Onset 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

What are the different functional perspectives of normality ?

Thes concepts of normality fall into four functional perspectives.

  1. Normality as health: physicain equates normality with health and consider health as a universal phenomenon. Behaviour is considered normal when there is no psychopthology.

  2. Normality as utopia: optimal blending of the diverse elements of the mental apparatus that result in optimal functioning

  3. Normality as average

  4. Normality as a process

Fetal Alcohol Syndrome (Mnemonic)

3 FIRM HELLs

  • 1 n in 3000

  • Facial asymetry

  • Irritability

  • Microcepahlly, mild to moderate MR

  • Hyperactivity

  • Ears being low set

  • Upper Lip deformity

Conditions in which ECT has a high risk of adverse outcome


  • 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

Features of children that may increase their risk of being abused.

PAST

  • Prematurity 

  • Factors leading to poor attachment to parents

  • Separation from mother during early years of life 

  • Temperamentally difficult child  

Stages of Piaget's theory of cognitive development

SensoPreConForm

  • Sensorimotor stage

  • Preoperational stage

  • Concrete operational stage

  • Formal operational stage

What are the steps to be taken before the administration of ECT?


  • 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

Nutritional causes of learning disability in the mother


  • Iodine deficiency 

  • Severe maternal malnutrition 

Is there any correlation between general level of alcohol consumption in the society and the rates of alcohol use disorders ?

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. 

Thursday, 23 June 2016

Mature defense mechanisms


  • Humor

  • Sublimation

  • Supression 

Medical and neurological condtions that can cause paychotic symptoms

MEND CLEFTH

  • Metabolic disorders

  • Endocrinopathies

  • Neurosyphilis 

  • Dementia

  • Cerebral vasculitidies

  • Limbic encephalopathies

  • Focal basal ganglia lesions

  • Temporal lobe disorders

  • Huntigtons disease

  • SLE

Anxiety Defenses

DRIP Uric Acid

  • Displacement, dissociation

  • Repression, rationalization, reaction formation

  • Isolation of affect

  • Passive aggression

  • Undoing

  • Acting out

Elements of family intervention in schizophrenia

Serile

  • Social networks (expanding) 

  • Education about schizophrenia 

  • Reducing number of hours of daily contact

  • Improving communication 

  • Lowering expressed emotions

  • Expectations (adjusting) 

Non-neuroleptics that can cause Extra-Pyramidal Symptoms?


  • Metocloperamide

  • Paroxetine (acute dystonia)

  • Domperidone 

Prognostic factors of mood disorders

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 

Narcissistic Defence Mechanisms

PSD

  • Projection

  • Splitting

  • Denial

Emotion Reducing Coping Strategies

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)

Ways in whoch doctor patient relationship can be abused

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 

Immature Defense Mechanisms

BRIS

  • Blocking

  • Regression

  • Introjection

  • Somatization 

Management of Suicide in ward, General Requirements

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 

Tuesday, 21 June 2016

What are features of parents that increase the risk of child physical abuse ?

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

What are the complications of child physical abuse ?


  1. 10-30% risk of further severe injury

  2. Increased risk of physical disorders

  3. Delayed development 

  4. Learning disbalities

  5. Increased rates of behavioral and emotional problems in adolescence 

What are the good prognostic factors for child physical abuse ?


  • Being competent in academics

  • Sociability

  • Having the abilitity to establish relationship with an adult outside the home 

What are the infections that may cause dementia ?

HENP

  • HIV

  • Encephalitis 

  • Neurosyphilis

  • Prion

What are the parameters of normalcy ?


  • Dynamism

  • Optimization 

  • Personal contentment

  • Socially responsible 

  • Occupationally effective

  • Economically emancipated 

  • Relieved from pain and discomfort 

  • Homeostasis

What are The Principal Symptoms Of Post-Traumatic Stress Disorder

FAIRED

  •     Flashbacks 

  •     Anxiety (persistent), Avoidance of reminders, 

  •     Irritability, insomnia, interest (loss of)

  •     Recall (of stressful events is difficult), 

  •     Emotional numbing

  •     Detachment, Dreams (distressing)

What points in the history may raise suspicion of child abuse ?

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 

Sunday, 19 June 2016

What are the components of motivational interviewing ?

Each And every DPR is Controversial 

  • 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 

What are the drugs used for bipolar depression in children ?

LOQ

  • Lurasidone 

  • Olanzapine

  • Quetiapine 

What laboratory tests are used for alcohol dependence ?

Bloody GMC

  • Blood alcohol concentration 

  • GGT

  • MCV

  • Carbohydrate defecient transferrin

What are the consequences of IV Drug abuse ?

BAH TIA

Systemic

  • Bacterial endocarditis 

  • Accidental overdose

  • Hepatitis B and C, HIV


Local 

  • Thrombosis (veinous)

  • Infection of injection site

  • Artery damage

What are the features of borderline type emotionally unstable personality disorder ?

FEIST

  • Feelings of emptiness

  • Efforts to avoid abandonement

  • Intense and unstable relationships

  • Self image (disturbed)

  • Threats/acts of self harm

What are the most common forms of injury due to child physical abuse ?

MASTR-B

  • Multiple bruising

  • Abrasions

  • Subdural hemorrhage

  • Torn upper lip

  • Retinal hemorrhage 

  • Bites, bone fractures

What are the most common forms of injury due to child physical abuse ?

MASTR-B

  • Multiple bruising

  • Abrasions

  • Subdural hemorrhage

  • Torn upper lip

  • Retinal hemorrhage 

  • Bites, bone fractures

Hypochondriacal Disorder

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.

  1. What will be the differential diagnosis in this case?
  2. What is the most likely diagnosis? Justify.
  3. How would you manage this case?

Differential Diagnosis

  1. Hypochondriasis/Illness Anxiety Disorder
  2. Obsessive-compulsive disorder, these could be intrusive thoughts, but this is less likely.
  3. Monosymptomatic hypochondriacal delusional disorder
  4. Somatization disorder (but few physical symptoms stated in the stem)

Justification

He has a strong preoccupation with the possibility of having AIDS

Does not have risk factors for or evidence of AIDS

His physician can not reassure him as this is his 9th time

Young age

Medical help-seeking behaviour e.g. repeatedly requests investigations

Obsessional-traits

Prominent anxiety and fear

He only has a fear of having AIDS, therefore requests testing and examination and NOT a belief (delusion)

There is no evidence other psychiatric disorder e.g. depression where also such preoccupations may occur.

Unlike somatization disorder, it does not preoccupy him with symptoms but with fear of having a disease. Unlike this patient, those who have somatization disorder request for treatment of symptoms, not investigations. Similarly, the patient does not have any evidence of drug use, as in patients with somatization disorder.

Differentiate between somatization disorder, conversion, hypochondriasis, and psychosomatic disorder. Give an example of each in the patient's language (verbatim) to highlight the difference between the conditions.

Somatization Vs Hypochondriasis

  1. Patients with somatization disorders put the emphasis on the symptoms themselves and their individual effects, patients with the hypochondriacal disorder, direct attention more to the underlying progressive and serious disease process and its consequences.
  2. In hypochondriacal disorder, the patient asks for investigations to determine or confirm the nature of the underlying disease, whereas the patient with somatization disorder asks for a treatment to remove the symptoms. 
  3. Patients with somatization disorder misuse drugs and may show noncompliance over extended periods. Patients with hypochondriacal disorder fear drugs and their side-effects and seek reassurance by frequent visits to different physicians.



Disorders Which Must be Excluded to Diagnose Hypochondriasis
To diagnose hypochondriasis, one must exclude Panic Disorder and Delusional Disorder by the conventions of ICD-10.

Panic disorder
Delusional disorder

What factors determine the average level of consumption of alcohol in the society ?


  1. Economic control i.e. price. Increase in priced reduces the consumption and vice versa

  2. Formal control e.g. Law. It has little effect on average consupmtion though

  3. Informal controls e.g. Customs and moral beleifs. 

What is the most suitable form of treatment for hypochnodriasis?

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

What is the Criteria for abnormality ?

More VIDS

  • Maladaptiveness

  • Violations of social standards

  • Irrationality and unpredictability 

  • Dangerousness 

  • Statistical deviancy, social discomfort (causing), suffering


*None is sufficient or necessary 

Saturday, 18 June 2016

What areas of cognitive functions are tested in MMSE ?

VIRAL CO

  • Visouconstructive abilities

  • Information 

  • Recall

  • Attention, Ability to follow commands

  • Language

  • Calculation

  • Orientation 

Management of Terminally ill patient

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)

Aims Of Treatment Of Terminally ill Patient

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

What are the clinical features of Huntingtons Disease ?

MH ADVICES

  • Memory impairment 

  • Hallucinations 

  • Apathy, anxiety, ataxia

  • Delusions

  • Volitional movements reduced

  • Irritability

  • Chorea, clumsiness, concentration reduced

  • Eating, speaking, swallowing difficulty 

Antipsychotics that have moderate risk of weight gain

ChloroQueLidone

  • Chlorpromazine 

  • Quetiapine 

  • Illoperidone, risperidone, palliperidone

Which Antipsychotics have lowest risk of weight gain ?

HALTS

  • Haloperidol 

  • Aripiprazole, Asenapine, Amisulpiride 

  • Lurasidone

  • Trifluphenazine

  • Sulperide

What is the mortality of ECT

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. 

Components of CBT for PTSD

Anger is CRIME

  • Anger management 

  • Cognitive restructuring 

  • Recall of images of the events

  • Information about about stress response

  • Monitoring (self) of symptoms 

  • Exposure

Friday, 17 June 2016

What are the non-pharmacological treatment options for depression ?

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

What is the role of a diagnostic lable in Stigma of Mental Health ?

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 Alchoholism

Psychiatric Disorders Associated with Alcoholism

I use the following mnemonic to remember the disorders associated with alcoholism.

BADS

  1. Bipolar affective disorders
  2. Anxiety disorders especially panic and social phobia
  3. Depressive disorders, the delusion of infidelity 
  4. Schizophrenia and sexual dysfunction 

What is the basis of stigma in mental health ?

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

What are the conditions that may suggest alcoholism as the underlying cause

PLeaSuRiNG

  • Peptic ulcer disease

  • Liver disease

  • Seizures

  • Repeated accidents 

  • Neuropathy

  • Gastritis

What substances (of abuse) can cause psychosis ?

SAC

  • Steroids

  • Alcohol, Amphetamines

  • Cannabis, cocaine

What are the medical conditions that can cause depression?

SANDICT

  • SLE

  • Addison's

  • Neurological

  • Diabetes 

  • Infections

  • Carcinoma

  • Thyroid

What are the causes of catatonia ?

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

What are the most significant factors associated with violence ?

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

Psychodynamic theories


  • Freuds psychonalytical theories

  • Jung's analytical psychology

  • Adler's individual psychology 

Autosomal recessive disorders


  • 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 

Other than genetic factors, what biological factors are involed in causing alcoholim ?

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

What are the genetic basis of alcoholism?


  • 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) 

Do children learn to drink alcohol from their parents ?

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.

What is the role of reward dependence in causing alcoholism?

Two mechanisms are suggested

  1. Alcohol decreases anxiety and elevates mood. These act as reinforcer to increase the behaviour the lead to it i.e. Drinking Alcohol

  2. Alcohol causes the release of dopamine which increases motivational behaviour that lead to its release. 

What personality factors are associated with alcoholism?

NISAR

  • Novelty seeking

  • Inferiority

  • Self-indulgent tendencies

  • Antisocial

  • Risk taking

What are the features of type 2 alcoholism ?

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) 

What are the common therapeutic factors in all forms psychotherapies ?

LAMISTER

  • Listening

  • Advice and guidance

  • Morale (restoration of)

  • Information (providing of)

  • Suggestion

  • Therapeutic relationship

  • Emotions (release of ) 

  • Rationale (providing of)

What are the common therapeutic factors in group therapy ?

SUGARI

  • Socialization

  • Universality

  • Group cohesion

  • Altruism

  • Recapatulation of the family problems

  • Imitation, Interpersonal learning

Which IQ tests are culture fare ?


  • RPM (Ravens Progressive Matrices)

  • Cattle Culture Free test

What are the differentiating features of vascular dementia ?

Features 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

What are the subtypes of vascular dementia

Subtypes of vascular dementia:


BELC



  • Binwangers disease

  • Etate lacunaire

  • Leucocariosis

  • CADASIL

Thursday, 16 June 2016

What is the most effective therapy for borderline personality disorder based on evidence ?

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. 

  1. 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.

  2. Bateman A and Fonagy P (2001). Treatment of borderlinepersonality disorder with psychoanalytically oriented partial
    hospitalization: an 18-month follow-up . American Journal of Psychiatry, 158, 36–42.

  3. Bateman A and Fonagy P (2004). Psychotherapy for Borderline Personality Disorder: mentalisation-based treatment. Oxford University Press, Oxford. 

  4. Bateman A and Fonagy P (2008). Eight-year follow-up of patients treated for borderline personality disorder: mentalizationbased treatment versus treatment as usual . American Journal of Psychiatry, 165, 631–8. 

  5. Bateman A and Tyrer P (2002). Effective Management of Partial Personality Disorder. National Institute for Mental Health in England, London.

  6. Linehan MM ( 1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford, New York . 

  7. Linehan MM et al. ( 1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients . Archives of General Psychiatry, 48, 1060–64. 

  8. Linehan MM et al. ( 2002). Dialectical behaviour therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder . Drug and Alcohol Dependence,67, 13–26. 

  9. Linehan MM et al. ( 1994). Interpersonal outcome of cognitive behavioural treatment for chronically suicidal borderlinepatients. American Journal of Psychiatry, 151, 1771–6.

What psychological factors may affect diabetic control ?


  1. Stress that leads to release of stress hormones and ultimately poor glycemic control

  2. Poor adherence to treatment may also affect glycemic control

What is the cause of cognitive dysfunction in Diabetic patients?


  1. Recurrent episodes of hypoglycemia

  2. Cerebral arteriolosclerosis

What kind of sexual problems may occur in Diabteic patients ?

There are two types of sexual dysfunctions that may occur in diabteic men. 

  1. Psychogenic impotence (just like the general population) 

  2. Organic impotence ( due to pelvic autonomic neuropathy and vasculopthay) 

What are the features of second stage of greif ?

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 

What are the features of Dmoninat parietal lobe dysfunction ?

BAR De FAR

  • Body-image Disturbance

  • Apraxia (limb)

  • Right-to-Left hemineglect

  • Dyscalculia

  • Finger agnosia

  • Agraphia

  • Receptive dysphasia

Wednesday, 15 June 2016

Pharmacotherapy for borderline personality disorder: Cochrane systematic review of randomised trials.

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 severity of borderline personality disorder. There is some evidence that olanzapine may increase self-harming behaviour. Pharmacotherapy should therefore be targeted at specific symptoms. 

Tuesday, 14 June 2016

Lithium plus valproate combination therapy versus monotherapy for relapse prevention in bipolar I disorder (BALANCE): a randomised open-label trial.

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 was by computer program, and investigators and participants were informed of treatment allocation. All outcome events were considered by the trial management team, who were masked to treatment assignment. Participants were followed up for up to 24 months. The primary outcome was initiation of new intervention for an emergent mood episode, which was compared between groups by Cox regression. Analysis was by intention to treat. This study is registered, number ISRCTN 55261332.
FINDINGS:
59 (54%) of 110 people in the combination therapy group, 65 (59%) of 110 in the lithium group, and 76 (69%) of 110 in the valproate group had a primary outcome event during follow-up. Hazard ratios for the primary outcome were 0.59 (95% CI 0.42-0.83, p=0.0023) for combination therapy versus valproate, 0.82 (0.58-1.17, p=0.27) for combination therapy versus lithium, and 0.71 (0.51-1.00, p=0.0472) for lithium versus valproate. 16 participants had serious adverse events after randomisation: seven receiving valproate monotherapy (three deaths); five lithium monotherapy (two deaths); and four combination therapy (one death).

INTERPRETATION:
For people with bipolar I disorder, for whom long-term therapy is clinically indicated, both combination therapy with lithium plus valproate and lithium monotherapy are more likely to prevent relapse than is valproate monotherapy. This benefit seems to be irrespective of baseline severity of illness and is maintained for up to 2 years. BALANCE could neither reliably confirm nor refute a benefit of combination therapy compared with lithium monotherapy.
FUNDING:
Stanley Medical Research Institute; Sanofi-Aventis.

Copyright 2010 Elsevier Ltd. All rights reserved.

Full Text

Risk and Protective Factors For Alzheimer's Dementia

he removed the SHell AND Fully POACHED the egss

Protective Factors 

  • Statins

  • HRT, Use of hormone replacement therapy (HRT)

  • Activity, cognitive and physical activity in Midlife

  • NSAIDs

  • Deit, Mideterranian


Risk Factors

  • Family history

  • Polymorhisms, genetic

  • Obesity

  • APOE4

  • Cerebrovascular disease

  • HSV, homocysteine high levels, head injury

  • Educational level being low

  • Diabetes, depression, down syndrome

Reasons For Not Sharing Information With Patients

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

Side Effects of Antipsychotics in Chronological Order

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.

Monday, 13 June 2016

Side Effects of Antipsychotics in Chronological Order

Which of these side effects of antipsychotics occur earlier than the others?
A.  Tardive  dyskinesia
B.  Akathisia
C.  Parkinsonism
D.  Hypothyroidism
E.  Weight  gain


AnswerAcute 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. 

Reasons For Not Sharing Information With Patients

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

Sunday, 12 June 2016

Symptoms of OCD (Obsessive Compulsive Disorder)


Risk Factors for PTSD (Post-Traumatic Stress Disorder)

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 notable predisposing factors include female gender, a history of anxiety or depression, lower levels of intelligence, neurotic traits, a history of trauma, and lower social support. Her gender, her history of depression, of experiencing a similar event, and her personality, may all have predisposed her to develop post-traumatic stress disorder. Low and not an elevated level of intelligence predisposes to post-traumatic stress disorder. Thus, her elevated level of intelligence may not have added to her risk.

FAINTS

  •      Female Gender, Family History of Psychiatric Illness
  •      Anxiety/mood disorder (history of)
  •      Intelligence (low)
  •      Neuroticism
  •      Trauma, history of
  •      Social support (poor)

Symptoms Of Benzodiazepine Withdrawal

Meri CHANDI


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

Indications Of Lithium

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

Aims Of Treatment Of Terminally ill Patient

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

Risk Factors for NMS (Neuroleptic Malignant Syndrome)

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

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.

Causes Of Dementia

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

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?
  1. Cognitive therapy 
  2. Fluoxetine
  3. Imipramine
  4. Amitriptyline 
  5. 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 than either psychotherapy alone or combined treatment. However, not all studies agree on this point (Furukawa and Watanabe, 2006; van Apeldoorn et al., 2010).



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