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Showing posts from 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 

Difference between Grief Reaction and Depression

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. 

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) 

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 

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 da

Poor prognostic factors for OCD

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

What are the different functional perspectives of normality ?

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

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

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)

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. 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

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

Psychiatric Disorders Associated with Alchoholism

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 

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

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 

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 are the differentiating features of vascular dementia ?

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

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.  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

What affects Lithium levles ?

Which one of the following may affect blood levels of lithium? A. NSAIDS B. ACE inhibitors C. Thiazide diuretics D. Dehydration E. All of the above   The following drugs increase the lithium levels by a pharmakokinetic interaction. DNA D IURETICS, fursemide being the safest one N SAIDs, sulindac and aspirin being safest ones A CEIs,  A RBs,  A ntipsychotics The following drugs reduce lithium levels (also a pharmakokinetic interaction). Sodium bicarbonate Theophylline Lithium is reabsorbed in competition with sodium from the kidney tubule. If the reabsoption of sodium increases, that of lithium decreases, and if the reabsoption of sodium decreases, that of lithium increases. Thiazide diuretics cause sodium diuresis i.e.decreased reabsoption. In this way, thiazides lead to increase lithium levels. Lithium reabsoption is also dependent on water reabsoption. It moves parallel with water. That is, if the reabsoption of water increases, lithium reabsoption also increases and vi

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

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 w

Risk and Protective Factors For Alzheimer's Dementia

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

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.

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. 

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

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 no

Delirium; Acute Confusional State

Delirium What is Delirium? Here is the definition of delirium from the shorter oxford textbook of psychiatry. It says “delirium is a global impairment (couding) of consciousness resulting in a reduced level of alertness, attention, perception of the environment, and thence cognitive performance”.  There are several terms used in this definition that can make it difficult to understand at first. It begins with a clouding of consciousness , that they say results in reduced alertness, attention, and perception, and these are cognitive or lets up it simple, mental abilities so the overall mental abilities or cognitive performance is reduced. Now, let me quickly explain these and some other terms so you can fully comprehend this definition and the other signs and symptoms of delirium that we will be discussing.  Terminology Perception Perception occurs when the brain processes the raw sensory stimuli from the environment to generate meaningful information. For example, the light packets