Indications Of Lithium

PALM
Prophylaxis of mood disorders
Augmentation in resistant depression
Learning disability (control of anger in)
Mania (acute treatment of) 

Aims Of Treatment Of Terminally ill Patient

White COPY
    * Wishes
    * Conflicts
    * Operate
    * Pain
    * Yeild control

- The patient should be relatively free from pain,
- should operate on as effective a level as possible,
- should recognize and resolve any remaining conflicts,
- should satisfy as far as possible their remaining wishes,
- and should be able to yield control to others in whom they have confidence

Risk Factors for NMS (Neuroleptic Malignant Syndrome)

P-HOARD
Psychosis, Parkinson's, polypharmacy (antipsychotic).
High potency antipsychotics.
Organic brain disease.
Agitation, alcoholism, anticholinergics.
Retardation (mental)
Dehydration, dose (rapid Increase or decrease)

Conditions That Can Cause Depression-Mnemonic

SANDICT mnemonic can help memorize and recall the conditions that can directly induce depression. 

SANDICT

• SLE 
• Addison's disease
• Neurological conditions eg. stroke. 
• Diabetes 
• Infections for example influenza virus infection. 
• Carcinoma, especially involving the brain directly or through metastasis. Breast carcinoma is an example. 
• Thyroid disorders especially hypothyroidism. 

Please see the Shorter Oxford Textbook of Psychiatry for more details.

Causes Of Dementia

A PRIME TOWN

    * Anoxia, Autoimmune

    * Primary neurodegenerative
    * Radiation
    * Infections, inflammation
    * Metabolic
    * Endocrine

    * Toxin, Trauma
    * Other causes
    * Vasculitides (W)
    * Neoplastic

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?

1. Cognitive therapy 
2. Fluoxetine
3. Imipramine
4. Amitriptyline 
5. 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 good outcome than either psychotherapy alone or combined treatment. However, not all studies agree on this point (Furukawa and Watanabe, 2006; van Apeldoorn et al., 2010).

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 degeneration: neuronal tau pathology shows wispy, fine-threaded tau incus. Magnetic resonance imaging may show asymmetric atrophy in the frontal and parietal lobes contralateral to the dominantly affected limbs. 

Treatment

We have limited treatment options for corticobasal degeneration, with only a minority of patients responding to L-dopa preparations given for parkinsonism. Myoclonus may respond to benzodiazepines, particularly clonazepam. No specific treatment for dementia is available, but it may not be cholinergic, suggesting that cholinesterase inhibitors are of limited value. Depression is common in corticobasal degeneration, but few data exist on treatment response. 

Clinical Manual of Neuropsychiatry, 2017