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Showing posts from February, 2021

Capgras Syndrome (Delusion)

Capgras Syndrome The patient believes that a familiar person has been replaced by someone else.  Both have a close resemblance For example, daughter replaced by an unknown person. The patient may attack the familiar person. The original name was ‘delusion des sosies’ a delusion and not a syndrome an example of reduplicative paramnesia a most common cause is schizophrenia  other causes include Lewy body dementia and other neuropsychiatric disorders. Always assess the risk of violence to the family person   ________________________________________        

Organic Amnestic Syndrome and Korsakov Psychosis

Organic Amnestic Syndrome Vignette A 30-year-old woman is brought to you with memory deficits and rigid behaviour. On examination, she appears lean and weak, dishevelled, is disoriented to time, has a flat affect, registration is 3/3, short term memory is 0/3 and long term memory appears intact. She does not have any difficulty naming objects. On physical examination, her weight is  42Kg and height 152 cm. The lady says, there is nothing wrong with her, while her father says she is speaking too many lies these days. The rest of the clinical evaluation is insignificant except for chronic diarrhoea and recent episodes of vomiting.  What finding will you look for, on MRI? Increased signal in midline structures Hippocampal atrophy Periventricular signal change Diagnosis  Organic amnestic syndrome The most common cause of organic amnestic syndrome is thiamine deficiency.  Magnetic resonance imaging sign Increased signal in midline structures Lab test Red cell transketolase activity Other ca

Somatization Disorder CASC Station

You received a call from the medical department who requested you to see a 31-year-old lady who has been an in-patient for over two weeks. During her admission, she underwent investigations for persistent pain in her upper abdomen. She has been experiencing pain for the last two months. The physicians originally believed this was gastric or duodenal, but endoscopy was negative. After a comprehensive debate on the case, the medical team has opted to get a psychiatric opinion. Upon evaluation, you found that she has visited multiple clinics and has experienced wide-ranging manifestations and pains over the last two years. However, physicians have identified no source of her symptoms so far. She is worried about her physical symptoms but does not consider them as a warning sign of any serious underlying disease. On mental state examination, she has a low mood, hopelessness, sleeplessness, and reduced appetite. These mental state findings have been present for the last two months.    How w

Conversion Disorder

A 16-year-old girl presents with multiple unconsciousness. These started about six months ago and have become progressively worse. During the episodes, there is the jerky movement of the body but no urinary or faecal incontinence. These symptoms last for a few minutes and are followed by drowsiness. Neurological examination is normal. What differential diagnoses would you consider in this case? What other information would you enquire from the family about the episodes? Which specific investigations would you like to order? Differential Diagnosis Conversion disorder (F44.5 Dissociative convulsions) suggested by the episodes of unconsciousness and lack of findings on neurological examination and absence of incontinence. Epilepsy suggested by the recurrent brief episodes of unconsciousness, accompanied by jerky movements and followed by drowsiness Vasovagal syncope suggested by the brief episodes of unconsciousness, jerky movements (may occur) and normal physical examination Paroxysmal a

INSOMNIA COMORBID WITH MAJOR DEPRESSIVE DISORDER

INSOMNIA COMORBID WITH MAJOR DEPRESSIVE DISORDER Management Approaches ___ Amit Chopra, MD, DFAPA.   INTRODUCTION Insomnia is defined as  a predominant dissatisfaction with sleep quantity or quality, associated with one or more specific symptoms including difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening with inability to return to sleep.   Based on DSM-5 criteria, the sleep difficulty should occur at least 3 times per week for 3 months or more, despite adequate opportunity for sleep for establishing a diagnosis of insomnia disorder. Insomnia is  the most common sleep complaint with trouble initiating sleep (initial insomnia), disrupted sleep (middle insomnia), early morning awakenings (terminal insomnia), and/or non-restorative sleep during acute major depressive episodes. Evidence suggests that insomnia   correlates strongly with a significantly increased risk of developing depression . Given substantial evidence that ea