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Showing posts from July, 2016

Morphine paradoxically prolongs neuropathic pain in rats by amplifying spinal NLRP3 inflammasome activation

Opioid use for pain management has dramatically increased, with little assessment of potential pathophysiological consequences for the primary pain condition. Here, a short course of morphine, starting 10 d after injury in male rats, paradoxically and remarkably doubled the duration of chronic constriction injury (CCI)-allodynia, months after morphine ceased. No such effect of opioids on neuropathic pain has previously been reported. Using pharmacologic and genetic approaches, we discovered that the initiation and maintenance of this multimonth prolongation of neuropathic pain was mediated by a previously unidentified mechanism for spinal cord and pain-namely, morphine-induced spinal NOD-like receptor protein 3 (NLRP3) inflammasomes and associated release of interleukin-1β (IL-1β). As spinal dorsal horn microglia expressed this signaling platform, these cells were selectively inhibited in vivo after transfection with a novel Designer Receptor Exclusively Activated by Designer Drugs (DR

Report- Clinico-pathological Conference on Liaison Psychiatry

The Institute of Psychiatry, Benazir Bhutto Hospital, World Health Organization Collaboration Centre, organised a Clinico-Pathological Conference (CPC), on the theme of Liaison Psychiatry, at the New Teaching Block, Rawalpindi Medical College, on the 27th of July 2016. The CPC sought to appraise the medical students, psychologists, and various physicians and surgeons in attendance, about the intricate relationship between the various disciplines of health care. The proceedings ensued, with Dr Yousaf Raza reciting from the Holy Qur’an and welcoming the attendees on behalf of the Institute. He introduced the audience to the layout of the presentations and the theme at hand. Dr Sundus Fatima, Academic Registrar at the Institute, then took the stage to present the first case history. She gave a detailed history of a 13-year-old girl who developed psychiatric complications as part of post-encephalitic sequelae; depressive and dissociative symptoms. In addition, she also had pica. She’d had

Most Common Cause of Excessive Daytime Sleepiness

Most Common Cause of Excessive Daytime Sleepiness What is the most common cause of excessive daytime sleepiness? Sleep deprivation Narcolepsy Drug effects Depression Comments: If u mean "Jet lag" from sleep deprivation, then the common cause is narcolepsy. It really depends on age. In children the most common cause is nightmares, in young people it can both be a psychiatric disorder or a manifestation of their daytime routine, in middle age and elderly it is mostly Obstructive Sleep Apnea Syndrome. Correct Answer:  Sleep deprivation

Alcoholics may have impaired performance on cognitive tasks:

Alcoholics may have impaired performance on cognitive tasks especially (name the cognitive domain) ?   Comments: Salma Sultan; Euphoria Abbas Sepah; Memory Samra Kyinat; Attention n concentration,perception Sheikh Anzi; Executive functioning planning reasoning decision making judgment all associated with pre frontal lobe Correct Answer: executive functioning is the correct answer.

Parents with Low intelligence has higher risk of abusing their child:

Parents with low intelligence have a higher risk of abusing their child? True or false Comments: Afshan Malik; True,,,,it also depends on families background and culture...families with upper class can also abuse their children... Mehdi Intisar; False it more relay on environmental circumstances Abbas Sepah; True but a few of them has proved to be very caring if social support is present otherwise your statement is True Correct Answer: Ok yes it true. Please note that risk factor is just a risk factor. It does CAUSE ANYTHING. it increases the chance, just that

Incidence of down syndrome decreased:

Why has the incidence of down syndrome decreased ? Comments: Sanam Munir; It has..coz of perinatal tests available to detect it.. n early termination of pregnancy Immo Mani; Yes,prenatal tests during pregnancy Correct Amswer: Correct detection through amniocentesis and then subsequent termination of pregnancy and its 1 in 650 live births.

Inflammation on Contrast enhanced CT:

Inflammation on Contrast enhanced CT appears White Black Comment: Sarmad Mushtaq;   Black Correct Answer: Contrast agents enter areas of inflammation or tumors well. more quantity of contrast agent means more quantity of radiation being absorbed, which in turn make areas of inflammation bright appearing on CT scan.

MRI pulses create images similar to CT:

Which MRI pulses create images similar to CT T1 T2 Correct Answer: T1 images is the correct answer. T1 pulses are brief and the data is collected for brief amount of time. Areas with high hydrogen in hydrophillic environment appear Dark. e.g. CSF. Fat tissue on the other hand appear dark. T1 is also the only MRI technology that can be enhanced by contrast agent Gadolinium.

Difference between Flight of ideas & Pressure of thoughts:

What is the difference between flight of ideas and pressure of thoughts.  C o mments: Abbas Sepah; This usually is used in the same context but I think Flight of ideas is related with abnormality of thoughts while the other is abnormality of speech Sanam Munir; flight of ideas as seen in mania.. there is a continuous stream of thoughts or ideas going from one to another.. while pressure of thoughts I believe is that the person can not say everything thy want to..  Correct answer:   Pressure of thoughts is considered a disorder of stream of thoughts. Ideas passing through the mind quickly and in abundance. If the patient speaks them as they come, it is then known as pressure of speech. Flight of ideas is considered a disorder of form of thought. The basic error is that patient is jumping from topic to topic, which are connected to each other.

Tourette Syndrome

Tourette Syndrome Clinical features >> Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Multiple vocal and motor tics  Starting before the age of 18 and  Persisting for a duration of at least one year We have excluded other causes of tics. LOSE Learning difficulties  Overactivity  Social problems  Emotional disturbances Maudsley Prescribing Guidelines (13th Edition)  They recommend  alpha-2 agonists  such as Clonidine or Guanfacine as the first-line pharmacological treatment for Tics and Tourette Syndrome  American Family Physicians and Canadian Guidelines Antipsychotics possess a variety of serious adverse effects (Pringsheim et al., 2012) and even though the evidence base for them is strong, we use them in cases not responding to alpha-2 agonists. References Taylor, D. (2018). The Maudsley Prescribing Guidelines. The Maudsley Prescribing Guidelines.  Kenney, C., Kuo, S.-H., & Jimenez-Shahed, J. (2008). Tourette’s syndro

Cognitive Deficits in Multiple Sclerosis

Impairment of learning, abstraction, memory, and problem-solving occur in patients with multiple sclerosis. These impairments are present in 40% of patients with multiple sclerosis in the community. Sometimes, it is an early manifestation.  Mostly the impairments are seen later in the course. The impairments are mild and progress slowly.  Well-practiced verbal skills are often preserved.  Cognitive impairment correlates with total lesion load and degree of callosal atrophy on brain imaging.  LAMP L earning A bstraction M emory P roblem-solving

Clinical features of complex partial sezires, Mnemonic

"P ardon DJ H ell, you are P roducing GAS that is AFFE Cting A ll the F earful TEDS, C o ST ing them M aDness"  P erceptual: D istorted perceptions, D eja Vu J amais Vu H allucinations  P sychomotor G rimacing and other body movements  A utomatisms S tereotyped behaviors A ffective F ear and anxiety E uphoric or ecstatic states A utonomic and visceral  F lushing T achycrdia  E pigastric aura D izziness Other bodily S ensations C ognitive S peech disturbances T hought disturbances M emory disturbances D epersonalization, d erealization 

Better imaging study for the assement of change in behavior

Patient has change in behavior. Would it be preferable to use CT with contrast or without contrast for assessment ?LikeShow more reactions Comments Sarmad Mushtaq Ct withcontrast  Immo Mani With contrast Valeed Ahmed Yess with contrast,,, inflammation and tumors etc can create change in behavior that can be better viewed by contrast enhanced CT, contrast agents can not enter the BB barrier except in arease of inflamation where the barrier is damages ir tumor where it is not formed,,,so the contrast enters there very well, making the area distinct due to more absroption of radiation

Stressors impact on health & well-being

According to richard lazarus, what kind of stressors are having most impact on health and well being ? Comments: Inam Ul Haque Masood; Are we talking about the Lazarus or Kanner. I believe that Lazarus theory was based on the Primary Appraisal leading to Positive , Dangerous and Indifferent Threats leading to Secondary Appraisals and stress in which the Dangerous Threats were perceived to produce the stress and in Kanner hypothesis Daily Hassles had the role. Need a little elaboration Correct Answer: The everyday hassles rather than the big events like earthquakes, floods,,,and other disasters

Social Readjustment Scale:

On social readjustment scale, the most stressful event is ? a) Death of spouse b) Death of child c) Death of parent d) Death of sibling e) Marriage  Comments: Isha Mughal: All Saqib Siddique: Death of a spouse have 100 points Nanny Marry: Death of spouse but mostly for women... Immo Mani: Although all events are stressful but I think number one is the right answer Ruby Malik: Death of child Kira Awan: I think it varies from situation to situation... in case of children... its death of parents..in case of couple... its death of spouse...in my case its marriage !!! Correct Answer: death of spouse is the right answer. T he scale talks about the overall situation not about individuals. Remember this scale is based on research from real people from general population like you and me. So overall people find the death of spouse to be most difficult life change to adjust to.

Components and Principles of management of schizophrenia Mnemonic

What are the components and principles of management of schizophrenia ?  Answer: MENOMONIC -> CONFIATE CBT , c ognitive remediation, c lozapine, c risis resolution teams. O utreach teams  N eeds assessment  F amily intervention I ntegrated treatment for comorbid substance abuse A ntipsychotics T herapeutic realtionship  E arly intervention 

Memory Cues

f LO xetine has the LO ngest half life among all SSRIs Hunting 4 CAGs . The gene for Hunting ton lies on chromosome 4p and codes for the protein hunting tin and mutations causes CAG repetitions (36+)  Ant O n syndrome occurs in O ccipital lobe syndrome  T-t W o. Areas with Water appear brighter on T2 weighted MRI images e.g. CSF, tumors, inflammation. Hypna Go gic hallucinations occur when you are GO ing to sleep.  Catale PSY is associated with the PSY chiatric disorder rather than narcole PSY which is unfortunately associated with cataplexy.  LEFT hippocampal damage causes VERBAL memory deficits, the SPEECH area (Broca's area) also lies on the LEFT usually.  So now, right hippocampal damage causes non verbal memory loss.  PRA der WILLI patients are WILLING to PREY for food. (Insatiable appetite leading to obesity).  Type I error or alpha error is what drug companies tend to commit. Drug does not work but they report it works. That is to reject the null hypo

Terror Management Theory:

Every human is aware of the inevitable nature of death; yet people don't feel as terrified of death as expected even at old age. What mechanism reduces this terror ? correct answer: "One theory that explains this is terror management theory" According to this theory, it is the culture that prevents this fear. People either keep themselves unaware of this reality or those who are aware of it most of the time ; they would be pursuing their cultural goals. In this way they would also be increasing their self esteem. These two (high self esteem, and cultural world view being defended, reduce the fear or anxiety of the inevitability of death.  For example , Muslims would become more religious in old age and that would also elevate their self esteem and give a purpose to their lives so their death related anxiety would reduce . I think, if i am not wrong, there is a Hadith related to this as well, that we should remind ourselves about death every now and then "remind often

Explicit consent

Explicit consent is Oral and written Written only Oral only Comments          Answe       r       :  Oral and verbal  both are explicit consent  

Consent by a diabetic patient who appears incompetent

A 55-year old woman with diabetes is diagnosed to have gangrene on both feet. She was brought to the hospital. She told the doctor the she is feeling fine and she has no medical problems. Can she give consent for the amputation of both legs? Comments Anam Najam no  Hajira Mehboob No she needs psychological treatment... Valeed Ahmed The patient appears incompetent as she says she is fine and there is nothing wrong with her, so her consent is not acceptable

Hospitalizing autism patient who is not resisting

You are working in the UK as a consultant psychiatrist. A 20 year old Patient is suffering from autism. You think he should be admitted to autism treatment center. Guardians are not willing to hospitalize him although the patient himself is not actively refusing to be hospitalized. What is the most appropriate step to take ? Admit him to the hospital Treat on out patient basis Refer to best interests assessor Comments Bournewood Gap An adult patient who was suffering from autism was admitted to bounwood hospital because he by himself was not resisting to be admitted although his carers were not willing for this. This case indicated a “gap” in the law i.e. Failure to protect an individual’s liberty if he can not resist. Deprivation of liberty safeguards Bournewood case lead to deprivation of liberty safeguards act in 2007, according to which such patients will be asses by a ‘best interests assessor’ before such action is taken to make sure it is in the best interest of the patient. The

Down's Syndrome Original Name

Down syndrome was originally known as ? Comments Sanam Munir Trisomy 21 Valeed Ahmed Not trisomy 21,,,trisomy was discovered much later than down syndrome itslef,,,,, Immo Mani Than what? Valeed Ahmed Mongolism Immo Mani Yes,right

Exception to the rule of consent to treatment

Which of the following cannot be considered as an exception to direct informed consent? A. Waiver B. Detention under mental health act C. Emergencies where full information cannot be given D. Incompetent patient E. Passively compliant patient Comments Valeed Ahmed The answer is E, passive compliance is not an exception, rather an implied consent is. The situations in which explicit consent is not required are : Implied consent given Necessity (harm likely, competency doubted) Emergency 

What is Waiver

A competent adult patient who is suffering from malignant cancer does not want to know about his prognosis. What is this known as ? \Comments Valeed Ahmed This is known as waiver in legal terms. 

Consent for pregnancy by adolescent

A 15-year old girl recently becomes pregnant. She went to a doctor for abortion. She told the doctor not to tell her parents about this pregnancy. What is the nest appropriate step in management ? Inform the parents for the consent Do not inform the parents and deal with abortion per local laws Obtain a court order for the abortion Deny abortion and don't inform the patient Comments Anam Najam Inform the parents for the consent Anam Najam correct ans please Valeed Ahmed? Valeed Ahmed The correct answer is b. In such cases as pregnancy, if the adolescent does not want their parents to know then do not inform them, termination of pregnancy or abortion is then subject to local laws Anam Najam Does the same rule apply in our country as well? Inam Ul Haque Masood Local laws may be adhered

A Vignette for Discussion

An 18 year old man comes with presenting complaints of irritability, severe headache, increased religious orientation, frequent cleaning of clothes, auditory hallucinations, and delusions of persecution. These symptoms started almost six weeks ago but aggression, irritability and loss of interest in daily activities were prevalent since one year.  What could be the possible diagnosis of this case? Excluded Hypomania does not have psychotic features.  Could be. Ocd wd psychotic features. MDD with psychotic features comorbid with OCD. This patient should be explored for psychosis first as it a year-long illness with delusions and hallucinations and social dysfunction. If you can rule out psychosis then it can be mood disorder or other. Obsessional symptoms may be part of psychosis. The patient needs detailed history and serial MSE to confirm the diagnosis But if you see the history. Hallucination and delusions started off later. Initially, the patient exhibited symptoms of depression. He

Psychotherapy session is ending abruptly

pllz give your ideas Read the following case scenario carefully Khalid came to Mr. Jamil, a counselor working in a local hospital, with the presenting complaints of  having anger, difficulty in maintaining relationships, feeling of being alone and lack of interest in daily activities. Khalid also reported himself to be restricting in his social activities since the death of his wife. Counselor developed a management plan for Kahlid for six sessions in which he used different behavioral and cognitive techniques. On the sixth session (the last session) with Khalid the counselor told him that today he will terminate the counseling however he can come for the follow up sessions. But Khalid told the counselor that still he does not find himself able enough to quit counseling sessions. However counselor was of the view that six sessions were more than enough to get out of his problem and now he should practice what he had learned during the course of counseling. Now answer the following ques

Types of learning theories in this case

Comments   Valeed Ahmed Apart from observational learning theory,is there any other theory applicable here   Rabia Jihan Classical Conditioning Sanam Munir Operant learning Precious Faimii opernt conditionning, *punishment   Valeed Ahmed Operant? Punishment is not a reinforcer   Precious Faimii 4 types of reinforcemnt,, negative reinforcer, positive reinforcer, punishment and extinction.,,,    if i m not wrong   Valeed Ahmed Yep u r right   Noor Noor Classical conditioning Angel's Dua Classical conditioning,    first of all its important to evaluate the problem of the child before applying any technique, i.e to see what is the cause of his this beh,,,   then according to the problem solve the issue,,,,  u may apply positive reinforcement to encourage the positive beh and negative reinforcement to reduce negative beh   Brothers Doll Operant therapy as well as observation is too much important... bcoz through observation we know better those factors which disturb

Pathological jealousy; a symptom or syndrome ?

Pathological jealousy is a paranoid symptom or syndrome ? Comments Inam Ul Haque Masood I believe it is a syndrome as it is a constellation of symptoms which gives uniqueness to the syndrome Abbas Sepah The other name is Othello's syndrome, so it's a syndrome Valeed Ahmed Yeah othello s :D,    Have heard this name dozens of times.  ok it is a syndrome as there is a group of systematized symptoms consitent with the central theme of the delusion and not just the delusion

Mentally ill patient needs medical treatment

An adult patient is severely depressed refuses get treated for HCV infection. How should this patient be dealt with ? First treat depression and then for HCV Treat for HCV and depression without consent Obtain a court order to treat for both Comments Anam Najam First treat depression and then for HCV Waleed   Ahmed When a mentally ill patient refuses consent to medical treatment, the steps are Step 1 treat the psychiatric condition Step 2 treat the medical condition If psychiatric condition can not be treated, consider legal action e.g. Court order or consent from relative Angel's Dua agreed

Mechanism of Dementia in Downs Syndrome

Which of the following is responsible for dementia seen in adults with Down’s syndrome? A. Loss of genetic material in chromosome 21 B. Extra genetic material in chromosome 21 C. Genetic material lost from chromosome 14 D. Loss of genetic material corresponding to presenilin -1 E. Loss of genetic material corresponding to Apoe4 Ok extra genetic material is the correct answer. The gene that codes for b amyloid is located on chromosome 21. Since down syndrome is due to trisomy 21 so there is increased amount of genetic material that production of its product proteins. Product protein of the APP gene located on chromosome 21 is beta amyloid that is central to the aetiology of alzheimers

Implied consent

You are about to check a patients Blood pressure. As you Reach the bedside and open your BP apparatus, the patient extends her arm to let you check her BP although you have not asked for a consent yet. What is the best next step Take verbal consent Check her BP without asking Comments   Asma Zafar A    Immo Mani Check without asking   Sarmad Mushtaq A   Nazia Tanveer B    Salma Sultan Obviously without asking   Valeed Ahmed Extending her arm when she sees a bp apparatus is implicit consent which obviates the need for an explicit consent. The other exceptions for explicit consent are emergency and neccessity (harm likely, competency in doubt)   Misbah Mustafa Means explicit consent should still be taken right?    Valeed Ahmed No. It is not needed.   Inam Ul Haque Masood Her extending the arm so that you can take blood pressure is a sign of consent and I believe that taking verbal consent is not mandatory