Vignette: Most Effective Treatment for a Man with Sudden Episodes of Anxiety A 30-year-old man presented with episodes of sudden anxiety, palpitations, chest tightness, and a feeling of impending doom. These episodes occur about 4-5 times per month for the last 7 months and last about 10 minutes on average. They have carried his physical examination and laboratory evaluation out, which is inconclusive about biological causation for his condition.  What would be the most effective treatment option? Cognitive therapy  Fluoxetine Imipramine Amitriptyline  Cognitive Behavior Therapy Controlled studies have shown that cognitive therapy is at least as effective as antidepressant medication in the treatment of the panic disorder (Mitte, 2005). Combined treatment with medication and psychotherapy may cause a better response in the acute phase than either treatment modality given alone, but probably not in the longer term. In the longer-term medication alone may have a less g...

Corticobasal Degeneration Corticobasal ganglionic degeneration present with asymmetric basal ganglia (akinesia, rigidity, dystonia) and cerebral cortical (apraxia, cortical sensory loss, alien limb) manifestations. We see the alien limb with parietal lobe, medial frontal lobe, and corpus callosum pathology. Dementia is a variable but may be the presenting symptom.  Oculomotor involvement like that in progressive supranuclear palsy may occur. But the major difference between PSP and corticobasal degeneration is that the latter is with limb coordination problems, and the former is with balance and walking problems.  Prognosis Survival ranges from 2.5 to 12 years, with a median of about 8 years.  Neuropathology Corticobasal degeneration pathology shows abundant ballooned, achromatic neurons, and focal cortical atrophy predominating in medial frontal and parietal lobes, plus degeneration of the substantia nigra. We also see astrocytic plaques in the cortex. corticobasal degen...

Schizophrenia as a Disorder of Disorganized Focus of Attention ONLY.  Schizophrenia is THE psychiatric condition with variable manifestations involving all the major areas of a mental state examination, appearance and behaviour, thoughts and speech, cognitions, perceptions, mood, and most commonly, insight or reality-testing. Studies have long proposed schizophrenia being related to impaired regulation of attention; we propose a model explaining the entire range of manifestations as the result of a disorganized focus of attention.  Explaining delusions The cognitive model of depression proposes that patients with dysfunctional beliefs maintain these because of their selective attention to evidence that confirms these beliefs and their tendency to ignore the evidence against it. In the most severe cases, these dysfunctional beliefs may progress to delusions in which case they absolutely do not attend to evidence against their delusional beliefs and are preoccupied with the evid...

FCPS-2 October 2014, College of Physicians and Surgeons Pakistan Q.4 A student of BSc diagnosed with borderline personality disorder presented in an emergency after attempting self-harm following a quarrel with a boyfriend. What signs and symptoms require urgent medical treatment? What care we should take in managing this patient in the ward What psychosocial support you will activate Give instructions on discharge regarding follow-ups. Q.5 What are the various points that differentiate between the various anxiety disorders in terms of their prevalence and clinical features? Q.6 A 39-year-old woman is diagnosed with severe depression years after the death of her husband. She is suicidal and has active suicidal ideations and symptoms of psychosis and is not responding to treatment with antidepressants. The psychiatrist plans ECT on this patient.  What are the other indications to start ECT in severe depressive disorder What are the indications for ECT other than severe depressio...

So, I have been asked by your GP to have a chat with you because you are having some difficulties in judging. So, as far as I know, you have, you were in an accident. A few months ago and since then you've been having some difficulties. But if it's okay, I'll let you explain what led you to come in here already. Yeah, I just had an accident about six months ago. And ever since then, I just can't get out of my head. was it was a serious accident? Yeah, it was it could have been, you know, the car was all messed up in a way you know to sort of concussion to split a whiplash room in the car was really hard. I can see where you're getting a bit anxious even talking about it. If you find questions difficult to answer It's okay, we can move on. And you can take your time, too, if you're feeling anxious. So you had this unfortunate accident you said that, although you will not seriously injure the car was quite badly damaged, and you make the most depending on how ...