Somatic Symptom (Somatization) Disorder Vignette The medical team requested you to see a 31-year-old woman in a medical ward who has been an in-patient for 2 weeks undergoing investigations for constant pain in her upper abdomen for the last 2 months. We initially thought this to be gastric or duodenal, but endoscopy was negative. Recently, it has been informed by her husband that she has presented to several hospitals over the past 2 years complaining about a wide variety of symptoms and different pains for which they had identified no physical cause despite multiple investigations. In addition, she is concerned about her physical symptoms but does not consider them as a warning sign of any serious underlying disease. After a detailed discussion about the case, the medical team has a psychiatric opinion.  What is the most likely diagnosis? Enlist the differential diagnosis in this case.  What information in history supports the most likely diagnosis? How will you manage this patient?

Catatonia; Presentation, Assessment, Diagnosis and Management INTRODUCTION Catatonia is a neuropsychiatric syndrome characterized by a variety of motor, behavioural, emotional, and autonomic abnormalities Karl Ludwig Kahlbaum in 1874 first described catatonia; he was a German psychiatrist. It is an important condition in psychiatry though it can also have medical causes. Causes General medical, neurological, and psychiatric disorders medications and drugs of abuse. Onset Catatonia presents acutely, and we often see it in emergency departments and hospitalised patients. Sometimes it may have a sub-acute onset and a chronic course. Cardinal Signs Studies have identified forty signs of catatonia but are mutism, catalepsy/posturing, stupor, rigidity, waxy flexibility, stereotypies/mannerisms, and echophenomena are its cardinal ones Cardinal Signs of Catatonia Mutism Catalepsy Posturing Stupor Rigidity Waxy flexibility

Night Eating Syndrome Recurrent episodes of night eating, as manifested by  Eating after awakening from sleep or  Excessive food consumption after the evening meal AND Awareness and recall of eating the next morning. Associations (High-risk individuals) Obesity Psychiatric disorders,  Endocrine and metabolic disturbances,  Sleep problems. Screening High-risk individuals >  Night Eating Questionnaire (NEQ) Pharmaceutical treatment options   SSRIs Melatonergic medications. e.g agomelatine Psychological interventions CBT Behavioural interventions Relaxation exercises Allison KC, Tarves EP. Treatment of night eating syndrome. Psychiatr Clin North Am. 2011;34(4):785-796. doi:10.1016/j.psc.2011.08.002

Wilson's Disease >> Hepatolenticular Degeneration Wilson's Disease is a rare autosomal recessive disorder that results in a copper build up in the brain and liver. There are both neuropsychiatric and GI/hepatic signs and symptoms. Onset is usually in the second or third decade, with dystonia, parkinsonism, or cerebellar ataxia. Patients also may have dysarthria: dysphagia, hypophonia, or seizures. We may detect chronic hepatitis or haemolytic anaemia. Kayser-Fleischer rings comprise brown or green discolouration near the limbus of the cornea and are present in all patients with neurological signs. Prevalence Wilson's disease occurs in about 1 in 30,000 people. Symptoms usually begin between the ages of 5 and 35 years. Males and females are equally affected. Symptoms Neuropsychiatric Manifestations Psychiatric symptoms because of Wilson's disease are present in about 15% of patients. It may present with schizophrenia-like changes, depression, or manic-depressive st

Anorexia Nervosa History Anorexia was first described by Luis Vitore marce in 1860, who however, did not name it. Later, in 1873, Charles league named the condition de l’anorexie hysterique. The name anorexia nervosa was suggested by William gull in 1874.  Historical names in anorexia nervosa Epidemiology Onset Anorexia Nervosa often has its onset during adolescence or early adulthood (i.e., between the ages of 10 and 24), typically following a stressful life event. Early onset Anorexia Nervosa (before puberty) and late-onset Anorexia Nervosa (after age 40) are relatively rare. Incidence Incidence, which means the number of new cases in a specified time, ranges from 0.4 for studies conducted in the united states, to 4 in Swedish studies. In developing countries like Pakistan, anorexia nervosa are exceedingly rare. But, we may expect to see more cases in future under the influence of media and western cultures. Reported incidence is increasing in recent years everywhere. The cult of thi