The following are the models of breaking bad news SPIKES P-SPIKES SAD NEWS BREAKS ABCDE PEWTER Kays Model

GB-PTV G ingko Biloba B enzodiazepines P ropranolol T etrabenazine V itamine E

Tourette Syndrome Clinical features >> Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Multiple vocal and motor tics  Starting before the age of 18 and  Persisting for a duration of at least one year We have excluded other causes of tics. LOSE Learning difficulties  Overactivity  Social problems  Emotional disturbances Maudsley Prescribing Guidelines (13th Edition)  They recommend  alpha-2 agonists  such as Clonidine or Guanfacine as the first-line pharmacological treatment for Tics and Tourette Syndrome  American Family Physicians and Canadian Guidelines Antipsychotics possess a variety of serious adverse effects (Pringsheim et al., 2012) and even though the evidence base for them is strong, we use them in cases not responding to alpha-2 agonists. References Taylor, D. (2018). The Maudsley Prescribing Guidelines. The Maudsley Prescribing Guidelines.  Kenney, C., Kuo, S.-H., & Jimenez-Shahed, J. (2008). Tourette’s syndro

Impairment of learning, abstraction, memory, and problem-solving occur in patients with multiple sclerosis. These impairments are present in 40% of patients with multiple sclerosis in the community. Sometimes, it is an early manifestation.  Mostly the impairments are seen later in the course. The impairments are mild and progress slowly.  Well-practiced verbal skills are often preserved.  Cognitive impairment correlates with total lesion load and degree of callosal atrophy on brain imaging.  LAMP L earning A bstraction M emory P roblem-solving

DAILE D detached A aloof I introspective  L lacking enjoyment  E emotionally cold 

"P ardon DJ H ell, you are P roducing GAS that is AFFE Cting A ll the F earful TEDS, C o ST ing them M aDness"  P erceptual: D istorted perceptions, D eja Vu J amais Vu H allucinations  P sychomotor G rimacing and other body movements  A utomatisms S tereotyped behaviors A ffective F ear and anxiety E uphoric or ecstatic states A utonomic and visceral  F lushing T achycrdia  E pigastric aura D izziness Other bodily S ensations C ognitive S peech disturbances T hought disturbances M emory disturbances D epersonalization, d erealization 

MAID M indfulness   A nger control I nterpersonal skills Ways of tolerating D istress

MAC-D Mi ndfulness A phorisms  D ialectical ways of thinking C ognitive and behavioral techniques 

These abnormal beleifs of the people form the basis of psychiatric stigma:  DUFIT These people are Dangerous They are Unpredictable  They  Feel different from the rest of us They are Incurable Psychiatric patients can't be Talked to or related to

To clear the concept, these two are the major Differentiating points b/w Negative reinforcement and Punishment1) Negative reinforcement strengthen a response while punishment weaken/decreases a response. 2) Negative reinforcement involves removal of unpleasant stimulus while punishment is presentation of an unpleasant stimulus.