Causes of Poor Response to Treatment in Patients with Schizophrenia There can be several reasons for poor response to treatment in schizophrenia and may be related to illness, patient and their environment, treatment or clinician. Patients started on treatment at a relatively later stage in the course of their illness and/or patients having slow onset schizophrenia respond poorly to treatment. Likewise, disorganised/hebephrenic schizophrenia carries a poor prognosis. Poor compliance, subtherapeutic doses and (sometimes) plasma concentrations may also be reasons for inadequate response, just as comorbid substance or alcohol abuse is. Patients who use medications periodically, upon worsening, become less likely to respond to treatment.  Related to the Illness Slow onset schizophrenia  Hebephrenic subtype Predominantly negative symptoms Related to the Patients and their Environment Comorbid substance/alcohol use Poor compliance with treatment High-expressed emotions (positive

Clock Drawing Test: A Neuropsychological Assessment Tool Introduction The Clock Drawing Test (CDT) is a simple and quick neuropsychological assessment tool that can help identify cognitive impairments in patients with conditions such as dementia, stroke, and brain injury. The test has been used for over 50 years as a quick and easy way to assess various aspects of cognitive function, including visuospatial ability, executive function, and language skills. How does the CDT work? The test is conducted by asking the patient to draw a simple clock face on a blank piece of paper and place the numbers in the correct order. The patient is then asked to place the hands on the clock to indicate a specific time, such as 10 after 11. The clock drawing can be scored based on specific criteria, including the presence of numbers and the placement of the hands. What does the CDT measure? The CDT is used to assess several aspects of cognitive function, including visuospatial ability, executive functio

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