Step 1: First obtain a complete history (to confirm that lithium is indicated and suitable, there is no contraindication, identify whether the patient is taking any medications that interact with lithium, likely to adhere to treatment and the protocol) Step 2: Physical examination especially blood pressure, pulse, weight, BMI, and thyroid examination Step 3: Laboratory investigations especially TFTs, eGFR, ECG if needed, and in women of childbearing age, a pregnancy test. Serum calcium is also desirable. Step 4: Education of the patient about the effects, side effects, the need for strict adherence, the risk of toxicity, signs of toxicity, and conditions that increase the risk of toxicity (in a way that generates a realistic and balanced view of the risks and advantages). Provide written materials Step 5: Start lithium OD200mg or 400mg. Aim for a plasma level of 0.4 to 0.8 mmol/L initially. Step 6: Check plasma level after a week, then every two weeks until the plasma level is sta

In multi-axial diagnosis, a patient’s problems are viewed within a broader context, which includes clinical diagnosis, assessment of disability, and psychosocial factors. In ICD-10, multi-axial diagnoses are made along three axes, as follows: Axis I: clinical diagnoses This includes all disorders, both psychiatric and physical, including learning disability and personality disorders.  Axis II: disabilities Conceptualized in line with WHO definitions of impairments, disabilities, and handicaps, this covers a number of specific areas of functioning that are rated on a scale of 0–5 (‘no disability’ to ‘gross disability’): Personal care: personal hygiene, dressing, feeding, etc. Occupation: expected functioning in paid activities, studying, homemaking, etc. Family and household: participation in family life. Functioning in a broader social context: participation in the wider community, including contact with friends, leisure, and other social activities.  Axis III: contextual factors The

Neurotransmitters Impairments in Depression Depression involves impairments in the following neurotransmitters: Serotonin:  It has reduced levels in synaptic space. Glutamate: it has decreased levels in the anterior brain region. Dopamine: there are complex changes in dopaminergic neurotransmitters; we may say it impairs dopaminergic neurotransmitters.  What does the Monoamine Hypothesis of Depression posit? It posits an imbalance in the monoamine neurotransmitters causes depression.  What kind of monoamine neurotransmitter imbalance causes depression? A decrease What are the monoamine neurotransmitters impairments in patients with depression? Nor-adrenaline, serotonin, dopamine What was noticed in the 1950s? Drugs that decreased monoamine neurotransmitters caused symptoms like depressive disorder What are the characteristics associated with nor-adrenaline? Sleeping, energy, motivation, emotion Characteristics of serotonin? Mood control, sleeping, hunger What other job does serotonin

Mnemonic for Types of Stress Here is a silly but worthwhile mnemonic to remember the major types of stress  Change  of pressure created the conflict , which frustrated everyone.

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Q.1 A 21-year old lady with history of chaotic Interpersonal relationships presented with history of several self-inflicted cut marks on her wrist. Her psychologist describes that she alternates between periods in which she idealises the therapist and periods of anger when she is convinced that therapist is unhelpful and the therapeutic work is worthless. What is the likely provisional diagnosis? Define the defense mechanisms she is using. What is type of psychotherapy is recommended in this case and what are the different modules steps in this particular psychotherapy? 1. Personality disorder, borderline pattern (ICD11) 6D11.5 Borderline pattern Parent: 6D11 Prominent personality traits or patterns 6D10 Personality disorder 2. Splitting: the person sees everyone in a black and white pattern. Someone can either be good or bad. There is no inbetween. At different times, this image of someone changes. Splitting (also called black-and-white thinking or all-or-nothing thinkin

1. Problem solving counselling 2. Antipsychotics and mood stabilisers (improvement in affective instability, impulsive behavioural dyscontrol, cognitive perceptual symptoms). Only for the short term. 3. Dynamic psychotherapy- difficult 4. Expressive psychotherapy- excellent results in clinical trials 5. Dialectical behavioural therapy- Reduces self haRM, very demanding, effects last for long 5. Group therapy, transference reactions are spread across the group 6. Psychoanalytically oriented psychodynamic psychotherapy, two trials, favourable