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Showing posts from January, 2021

Psychosocial Issues Experienced in a Coronary Care Unit (CCU)

Psychosocial Issues Experienced in a Coronary Care Unit (CCU) Relating to the patient The suffering of others in the CCU Paraphernalia of tubes, machines, wires, etc Death of others. Possibility of having to witness a CPR etc. Relating to the Attendants Unsure of the progress Unaware of patients' perceptions and mental state. Watching a medley of news coming from inside for other attendants. Crying or wailing of other attendants. Doctors Dressed in white coats and scrubs walking about looking serious and pacing hurriedly creating a sense of emergency and danger.

Assessment and Management of Opioid Use Disorder, Withdrawal, and Intoxication Syndromes

Assessment and Management of Opioid Use Disorder, Withdrawal, and Intoxication Syndromes Neurobiology of Opioid Dependence and withdrawal Opioids act at specific opioid receptors in the central nervous system. Stimulation of these receptors suppresses the firing rate of noradrenergic neurons in the midbrain, thus causing CNS depression and reduction of anxiety. Euphoria is also because of the release of dopamine at nucleus coeruleus in the forebrain by dopaminergic neurons that originate in the ventral tegmental area in the midbrain. Opioid use causes reinforcement of the drug-taking behaviours because of these euphoric effects and the relief from anxiety. Repeated usage also causes neuroadaptive changes in these neurons, such that progressively less dopamine release in the nucleus coeruleus and less suppression of midbrain noradrenergic cells lead to reduced effects or increased doses being taken by the person (tolerance). When the person stops taking the drug, overexcited noradrenerg

Depressive Pseudodementia

Depressive Pseudodementia  Depressive pseudodementia is a term used for severe memory impairment that gives a dementia-like clinical profile, but depression causes which. It presents with memory impairment, slowness of responses, forgetfulness, disorientation, impaired attention, and concentration, diminished abstract thinking. Patients often omit details on drawing tasks. The patients are often aware of their problems. Frequently giving “I don't know responses” suggests depressive pseudodementia as well. No cortical signs are present in patients with pseudodementia.   Speech deficits in patients with pseudodementia: Frequent “I don't know responses.” Difficulty generating word lists, e.g., words beginning with “s” in 1 minute or lists of vegetables in one minute. Impaired comprehension of complex writing. Slow hypophonic speech Increased pause time in conversation Increased confusion at night is sometimes present in patients with dementia, but not in those with pseudodementia.

Mental Health ACT of 2001 Explanation

  Mental Health ACT of 2001 Explanation The following is a plain-language summary of the Mental Health Act (Ordinance) (2001). We made it to help make learning easy.  If a patient is suffering from a mental disorder for which he needs inpatient assessment to prevent harm to the patient himself or others, but he is not willing to get admitted, section 10 can be used to admit(detain) him against his will (i.e. involuntarily). First, an application must be written (context from section 17, general provisions) by the nearest relative of the patient. A psychiatrist or medical officer can also write the application but, they must inform the nearest relative as soon as possible when they write the application. Anyone who writes the application must also specify the reasons for his eligibility to write the application. This application (Section 10à) must be based on the recommendations of two practitioners (one must be a1 psychiatrist, one medical officer). These two practitioners will write d

Schizotypal Personality Disorder

 Schizotypal Personality Disorder  Scenario During an informal gathering, a teacher at a medical school discusses with you about a first-year student, who has just moved away from parents to a hostel. The teacher states that he behaves strangely and tries to avoid socialisation. He does not have any friends but passes his time with video games. He sometimes enjoys spiritual activities and shows interest in magic. When a colleague tried to make fun of him, he resented a lot and lodged a written complaint with the principal. The parents state he is like this since his former life and has always been "different" but a "good" child. His academic record varies from average to above average. What is the most likely diagnosis? What psychodynamic factors may have contributed? What are the risk factors for developing this disorder? Diagnosis  Schizotypal disorder/schizotypal personality disorder Risk factors This is more frequent among biological relatives of individuals wit

Summary of NICE Guidance for First-Episode Schizophrenia

Summary of NICE Guidance for First-Episode Schizophrenia > A complete assessment is mandatory before starting treatment For people with first-episode psychosis offer: ●        oral antipsychotic medication with ●        psychological interventions (family intervention and individual CBT.) Advise people who want to try psychological interventions alone that these therapies are more effective when delivered with antipsychotic medication. If the person still wants to try psychological interventions alone: offer family intervention and CBT agree a time (1 month or less) to review treatment options, including introducing antipsychotic medication     continue to monitor symptoms, distress, impairment, and level of functioning (including education, training, and employment) regularly. It is also mandatory to assess and monitor the physical health of the patients before commencing antipsychotics and during treatment. Especially Weight, BMI Blood pressure and pulse Serum li

Human Resources, Psychometric and Treatment Facilities you need to make the Forensic Evaluations

Human Resources, Psychometric and Treatment Facilities you need to make the Forensic Evaluations Scenario The local authorities have requested you to provide forensic psychiatry support for prison services in your area. What are the various human resources, psychometric, and treatment facilities that you would require to make the forensic evaluations? Human Resources Forensic psychiatrist Forensic psychologist Occupational therapist Social worker Trained nurses Psychometric Tools Historical clinical risk management-20  Violence risk appraisal guide Psychopathy checklist Revised Sexual violence risk 20 Stalking assessment and management Spousal assault risk assessment guide General Scales PANNS HAMD IPDE HADS CAGE/AUDIT COWS Coloured progressive matrices  Treatment Facilities Seclusion rooms Electroconvulsive therapy rooms

Establishing a Geriatric (old-age) Clinic; Medications and their Principles, Psychometric Tools, and Intake Performa

Establishing a Geriatric (old-age) Clinic; Medications and their Principles, Psychometric Tools, and Intake Performa Scenario: In view of increasing needs for elderly population requiring psychiatric help, your medical superintendent asked you to develop a senior citizens' clinic in your hospital.  Enlist and classify all medicines that you will need.  State the principles on which you base your choices. Enlist 8 psychometric tests/scales you will need? Which information do you think you will consider while developing an intake proforma? Principles Of Prescribing Medications in the Elderly Avoid drugs with long-half-lives (increased already in this population because of reduced renal and liver function, increased volume of distribution and relatively higher body fat content) Avoid drugs that worsen cognitive function, keeping in mind the rates of dementia in this population. Keep in mind the risk of fall and over sedation with central depressants and the propensity to side effects.

Postnatal Causes of Learning Disability (Intellectual Disability)

Postnatal Causes of Learning Disability (Intellectual Disability) Postnatal causes of learning or intellectual disability include head injury, infections, neurodegeneration, and toxicities. A study on the causes of developmental disability found bacterial meningitis, child battering, vehicle-related injuries, and otitis media as the most common causes. However, a developmental disability is a broader term which can include motor developmental disabilities too. The results still give us an idea as this overlap heavily with causes of pure intellectual disability. See Table 1. Table-1 Most Common Causes of Developmental Disability Bacterial meningitis 31% Child battering 15% Motor-vehicle- related injuries 11% Otitis media 11% Postnatal causes of developmental disabilities in children aged 3-10 years -- Atlanta, Georgia, 1991. MMWR Morb Mortal Wkly Rep 1996 Feb 16 45 13