Neurobiology of Panic Disorder "There is most evidence for changes in Gamma-aminobutyric acid , with lowered cortical Gamma-aminobutyric acid type  levels measured by magnetic resonance spectroscopy, and diminished benzodiazepine -receptor binding in the parietotemporal regions in unmedicated patients with panic disorder (Hasler et al., 2008)." This happens in panic disorder. Gamma-aminobutyric acid is the major  inhibitory  neurotransmitter in the brain. Benzodiazepine also binds to Gamma-aminobutyric acid type A receptors and increases its firing rate, thus resulting in hyperpolarisation of the cell because of increased chloride influx. So, specific regions in the brain are hyperexcitable in patients with panic disorder. Summary of Hasler et al.  Context Studies have implicated the benzodiazepine receptor system in the pathophysiologic mechanism of panic disorder  by indirect evidence from pharmacological challenge studies and by direct evidence from single-photon emission

APRIL 2017 Previous (solved) Paper IMM Q11 A 45-year male patient with several years history of mental illness was seen replying to some person abusing him when nobody was around. At the same time, he also reports that he can see a young girl skipping a rope behind his back. During the conversation, he recalled events related to his father's accidental death & burial that occurred two months back but was mostly smiling while mentioning it. He was convinced that his wife is not faithful to him and is having an illicit relationship with one of his friends, although no evidence suggesting, this is available. During his assessment, he was found constantly imitating the actions performed by his doctor and believed that a cart carrying armed personnel will land in his room by making a hole in the roof and will take away all his valuables to another planet. Name the psychological disturbances present in phenomenological terms. Q12 Outline the neurobiology of neglect and abuse in child

Physical illness (most common)  Anxiety and depression  Deliberately kept home by parents  Truancy Miserable conditions at school e.g. Bullying 

Summary of Treatment Guidelines   for ADHD       AAP Treatment Recommendations Nov 2019         First-line    Second line    Preschool children (4-5 years)    Behaviour therapy    Methylphenidate        Methylphenidate, if no significant improvement and moderate-to- severe functional impairment    Elementary school (6–11 years)    Behaviour therapy or medication, preferably both .     Evidence      stimulants > atomoxetine > guanfacine ER > Clonidine ER    Summary, NICE Treatment Recommendations 2018        First-line    Second line    Children under 5 years    Discussion    Group parent-training program    (ADHD-Focused)    Medication     (Only a specialist can start)    Start medications only after seeking advice from ADHD specialist services    Children over 5 years    Discussion and ADHD-focused Support     Medication    Support     Offer a minimum of 1 or 2 sessions of support, can be    group-based        education on the causes and impact of ADHD    advice on parenting