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Showing posts from 2019

Factors that Improve Effective Communication with Patients

What are the factors known to improve effective communication? The following is a list of the factors that contribute to effective communication with patients during clinical assessment.  Use Minimal Prompts Interrupting your patient during a clinical assessment prohibits them from explaining their concerns. Points that are important for you as a clinician are often less important for the patient.  Knowing whatever is important to the patients and addressing their concerns is immensely important from a holistic and biopsychosocial model of health care. Using minimal prompts helps patients to communicate their concerns so you can address them.  Sit squarely in relation to the patient Open body position in relation to the patient Leaning slightly towards the client Eye contact maintained Relax while listening Listen to the message content Listen for feelings Respond to feelings Note all non-verbal cues

Development in the first year of life summarised

Development in the first year of life summarised Smiling starts at 3 weeks.  Selective smiling starts at 6 months.  Fear of strangers starts at 8 months, while separation anxiety starts later to that.  At the end of the first year, children also learn a few simple words like mama, dada, etc.  Weaning starts at around 6 months and should have completed by the end of the year.  An ordered sleep-wake cycle has also got established, Children learn to point at objects in the first year of life.

Types of Personality Disorder

It is classified into three clusters as: Suspicious: which include Antisocial Paranoid Schizoid Schizotypal Emotional and impulsive: Borderline Histrionic Narcissitic Anxious: Avoidant Dependent Obsessive compulsive Another way to classify them is Mad, Bad and Sad respectively for the suspicious, impulsive and anxious clusters. Remember there are no clusters in ICD11 anymore, The individual personality disorders have been eliminated from ICD11.

What is Neuroleptic malignant syndrome (NMS) ?

How do we define NMS? It is an acute disorder of thermoregulation and neuromotor control that occurs because of exposure to dopaminergic drugs. What drugs or medications can cause NMS? Antipsychotics, especially the ones with high anti-dopaminergic potency. But also dopaminergic agonist withdrawal e.g. withdrawal from levodopa.

The Gene associated with antisocial behaviour

Criminal behavior, lack of guilt, and irritability are typical features of antisocial personality disorder. Evidence suggests that a low-activity variant of the MAO-A gene predisposes to adult antisocial behavior in men, especially in those who faced early adversity 1–4 . Catechol-O-methyltransferase enzyme metabolizes dopamine and other monoamines. Its gene, the COMT-gene, occurs in two forms: a high-activity form and a low-activity form. They associate these variants with differential abilities of the prefrontal cortex, especially working memory. People with low-activity form may have a more efficient prefrontal cortex, likely because of the greater dopamine level in the synaptic space 5,6 . We have associated serotonin transporter gene variants with neuroticism and a predisposition to depression. The variants may also influence individual response to SSRIs8. APOE4 gene is a risk factor for Alzheimer’s disease (compared to APOE2 and APOE3).
 COLLEGE OF PHYSICIANS & SURGEONS PAKISTAN 27th February 2019 MCPS UBJECT: PSYCHIATRY ANSWER ALL QUESTIONS (TOTAL QUESTIONS: 10) USE SEPARATE ANSWER BOOK FOR EACH QUESTION PAPER: TIME ALLOWED 3 HOURS 2.4 A young unmarried male of 25-year was diagnosed as a case of schizophrenia. There is family history of psychiatric illness in the family. He developed the disease acutely with prominent positive features. He taq responded to treatment within two months and was well supported by his family, however, his family is still very cautious, inquisitive and worried excessively as the patient has adopted a lonely lifestyle. a) What are the factors ointing towards good and bad prognosis in this patient? b) What are the characteristic features of "high expressed emotions family?stilette 1481 ellipse, c) What family interventions can be done in patients with schizophrenia? CHA Q.5 A 31-year-old male presents with history of episodes of sudden onset of palpitation, trembling of body and fea

Opioid Epidemiology in Pakistan

Opioid Epidemiology in Pakistan Nationwide, one per cent of the population –over one million people– were estimated to be regular opiate (heroin or opium) users. The majority (80 per cent) use heroin, while one-third (33 per cent) use opium. Opium users were slightly older (mean age 38.2, standard deviation 10.1 years) than heroin users (mean age 33.8, standard deviation 9.4 years), and more likely to live in rural environments whereas heroin users live in cities. Two-thirds of opium users and one- third of heroin users were married, and while opium users mostly live in a home (84 per cent), nearly forty per cent of heroin users living in a park/road, shrine, or a location other than a home. A daily heroin habit in Pakistan is estimated to cost between 1.50 and 3.00 USD, yet only 6.5 per cent of heroin users are employed full time. To earn money, one-third report donating/selling blood, and forty per cent report exchanging sex for drugs or money. Opiate users also often beg for money


IMPORTANT MOOD DISORDER TOPICS LEARN FOR THE FCPS-2 EXAM Learn the differential diagnosis of depression, dysthymia, stupor,   psychotic depression.   Outline the assessment and treatment of these conditions.   Assess treatment resistance   Enlist or identify risk factors (dysthymia, depression)   Investigate stupor, depression with organic findings Treatment options for refractory depression   Use of lithium in depression   Relevant guidelines, recommendations for depression Patient education about depression and antidepressants Antidepressant response   Association of depression with medical conditions Depression in pregnancy   Lithium (extensively tested from several aspects including risks and benefits used in pregnancy and lactation, predictors of response, efficacy in various conditions, mechanisms/causes of loss of efficacy in the long-term, etc. Take-home message >> wherever you see a line, a para, a topic about lithium READ IT)    (Postnatal) manic episode managemen


Behavioural Treatments For PTSD  Prolonged Exposure  Introduction Prolonged exposure is a manual-guided CBT comprising ten, sixty-to-ninety-minute weekly individual therapy sessions. We can explain the central therapeutic component of prolonged exposure on "Pavlovian learning theory."  Approach The treatment involves repeatedly presenting a conditioned stimulus (e.g., a trauma reminder) in the absence of an unconditioned stimulus (e.g., the traumatic event). They do this through imaginal exposure during therapy sessions and through in vivo exposure in the environment.  Evidence On average, prolonged exposure proves robust symptom severity improvement.  Cognitive Processing  Introduction Another manual-guided cognitive behavioural modality that has received strong empirical support to treat PTSD is cognitive processing therapy.  Approach Cognitive processing therapy comprises twelve weekly, 60-minute individual sessions.   This therapy involves  Imagining and reviewing written

Protocol for Lithium

Step 1: First obtain a complete history (to confirm that lithium is indicated and suitable, there is no contraindication, identify whether the patient is taking any medications that interact with lithium, likely to adhere to treatment and the protocol) Step 2: Physical examination especially blood pressure, pulse, weight, BMI, and thyroid examination Step 3: Laboratory investigations especially TFTs, eGFR, ECG if needed, and in women of childbearing age, a pregnancy test. Serum calcium is also desirable. Step 4: Education of the patient about the effects, side effects, the need for strict adherence, the risk of toxicity, signs of toxicity, and conditions that increase the risk of toxicity (in a way that generates a realistic and balanced view of the risks and advantages). Provide written materials Step 5: Start lithium OD200mg or 400mg. Aim for a plasma level of 0.4 to 0.8 mmol/L initially. Step 6: Check plasma level after a week, then every two weeks until the plasma level is sta

ICD 10 Multiaxial System

In multi-axial diagnosis, a patient’s problems are viewed within a broader context, which includes clinical diagnosis, assessment of disability, and psychosocial factors. In ICD-10, multi-axial diagnoses are made along three axes, as follows: Axis I: clinical diagnoses This includes all disorders, both psychiatric and physical, including learning disability and personality disorders.  Axis II: disabilities Conceptualized in line with WHO definitions of impairments, disabilities, and handicaps, this covers a number of specific areas of functioning that are rated on a scale of 0–5 (‘no disability’ to ‘gross disability’): Personal care: personal hygiene, dressing, feeding, etc. Occupation: expected functioning in paid activities, studying, homemaking, etc. Family and household: participation in family life. Functioning in a broader social context: participation in the wider community, including contact with friends, leisure, and other social activities.  Axis III: contextual factors The

Neurotransmitters Involved in the Aetiology of Depression

Neurotransmitters Impairments in Depression Depression involves impairments in the following neurotransmitters: Serotonin:  It has reduced levels in synaptic space. Glutamate: it has decreased levels in the anterior brain region. Dopamine: there are complex changes in dopaminergic neurotransmitters; we may say it impairs dopaminergic neurotransmitters.  What does the Monoamine Hypothesis of Depression posit? It posits an imbalance in the monoamine neurotransmitters causes depression.  What kind of monoamine neurotransmitter imbalance causes depression? A decrease What are the monoamine neurotransmitters impairments in patients with depression? Nor-adrenaline, serotonin, dopamine What was noticed in the 1950s? Drugs that decreased monoamine neurotransmitters caused symptoms like depressive disorder What are the characteristics associated with nor-adrenaline? Sleeping, energy, motivation, emotion Characteristics of serotonin? Mood control, sleeping, hunger What other job does serotonin