Age Disorientation in Schizophrenia Age-disoriented patients are cognitively more impaired than their age-oriented counterparts. Whether the cognitive impairment is present to a greater degree premorbid among these patients, studies have not yet established this, but some data support this. Others have reported that rated school performance and grade-level do not distinguish age-disoriented from age-oriented subjects. Some have suggested that marked cognitive decline occurs following the first break.  Harvey et al. reported that age-related decline in mini-mental state examination scores is dramatically greater among age-disoriented schizophrenia patients than age-oriented subjects, consistent with more rapid deterioration. Examination of the specific PANSS items revealed that the age-disoriented group was consistently more delusional and more conceptually disorganized and showed increased stereotyped thinking, motor retardation, unusual thought content, disorientation, and poor attent

What are the advantages of open-ended questions? During the clinical assessment, open-ended questions are always preferred to close-ended questions. there are several advantages to the open-ended questions.  If you still don't know What are Open-Ended Questions? Open-ended questions allow patients to start talking about themselves and puts them at ease as they have the floor.  Allows you time to think and plan areas of questioning as you assess their style and content of the response. Allows a period of non-verbal response from interviewer; listening and facilitating.  >> Just slight info: To Have the floor means to have the right or opportunity to speak in a group, especially at a formal event or gathering.  Please, Dr. Dunstaple, your colleague has the floor. You'll have the opportunity to reply when he has finished speaking. 

Clinical Vignette: Management of a Patient with Treatment-Refractory Depression Mr X is a known case of depressive illness for the last 1 year. He has stopped responding after two different groups of antidepressants were tried and has been labelled as a patient of treatment-resistant depression.  How will you assess the cause of this resistance? Write the treatment algorithm that you will follow for his management? If you had to start lithium in this case, what protocol would you follow to start it and how will you monitor it? Treatment Options for Refractory Depression

A 33-year-old man who is a driver-by-profession presented to you with decreased appetite, loss of sleep, and irritability for the last three months. There is no past or family history of psychiatric conditions. He is the only earning member of his family and must go to work every day to make a living. On physical examination, his pulse is 90 beats per minute with an irregular rhythm. a) Outline your assessment and management plans. b) What precautions you will take while prescribing psychotropic medications in this case? c) Enumerate all possible differential diagnoses in this case.

  Assessment of Treatment Resistance   Reconsider the diagnosis, especially considering bipolar depression and hypothyroidism.   Identify comorbidities.   Ensure that adequate dosages for adequate durations have been given   Confirm adherence to treatment   Evaluate for maintaining factors and repeated experiences of stressful circumstances.

(Mnemonic: GINPH) ● Delusions of Guilt ● Delusions of Impoverishment (can also be considered as a type of nihilistic delusion. ● Nihilistic delusions, including Cotard syndrome ● Persecutory delusions* ● Hypochondriacal delusions Patients with Psychotic depression  consider these thoughts well-deserved unlike in schizophrenia where patients feel remorse towards them and mania where patients consider them a response to the great position they have earned.  When these delusions occur against a background of depressed mood, they are mood-congruent and favor the diagnosis of psychotic depression. When patients with depression have delusions of grandeur or even neutral delusions e.g. delusions of reference, they are mood-incongruent delusions" and favor the diagnosis of schizophrenia (ICD-10).

Psychosis Versus Neurosis What is psychosis? A psychiatric disorder in which the thoughts, affective-response, ability to recognize reality, and ability to communicate and relate to others shows impairment sufficient to interfere grossly with the capacity to deal with reality. The classic characteristics of psychosis are. Impaired reality testing Hallucinations Delusions Disorganization. Psychosis Insight is absent in patients with psychosis.  In patients with psychosis, there is an impairment in judgment and reasoning.  They lose contact with reality. For example, they believe in the voices they hear.  Delusions are often present. Delusions are psychotic features and are never normal (if a belief meets any criteria of normality, it's not a delusion).  True hallucinations are present, even though hallucinations, especially hypnagogic and hypnopompic hallucinations, also occur in normal people.   Patients with psychosis may exhibit changes in personality, especially patients with sc