Establishing a Geriatric (old-age) Clinic; Medications and their Principles, Psychometric Tools, and Intake Performa Scenario: In view of increasing needs for elderly population requiring psychiatric help, your medical superintendent asked you to develop a senior citizens' clinic in your hospital.  Enlist and classify all medicines that you will need.  State the principles on which you base your choices. Enlist 8 psychometric tests/scales you will need? Which information do you think you will consider while developing an intake proforma? Principles Of Prescribing Medications in the Elderly Avoid drugs with long-half-lives (increased already in this population because of reduced renal and liver function, increased volume of distribution and relatively higher body fat content) Avoid drugs that worsen cognitive function, keeping in mind the rates of dementia in this population. Keep in mind the risk of fall and over sedation with central depressants and the propensity to side effects.

Postnatal Causes of Learning Disability (Intellectual Disability) Postnatal causes of learning or intellectual disability include head injury, infections, neurodegeneration, and toxicities. A study on the causes of developmental disability found bacterial meningitis, child battering, vehicle-related injuries, and otitis media as the most common causes. However, a developmental disability is a broader term that can include motor developmental disabilities too. The results still give us an idea as this overlap heavily with causes of pure intellectual disability. See Table 1. Table 1: Most Common Causes of Developmental Disability Bacterial meningitis 31% Child battering 15% Motor-vehicle- related injuries 11% Otitis media 11% Postnatal causes of developmental disabilities in children aged 3-10 years -- Atlanta, Georgia, 1991. MMWR Morb Mortal Wkly Rep 1996 Feb 16 45 13

Interventions for Mental Health Promotion in The Community The World Health Organization has enlisted two types of interventions to promote mental health in the community; macro-interventions and micro-interventions.  Macro Interventions  Improving nutrition Improving housing Improving access to education Strengthening community networks Reducing the misuse of addictive substances Intervening after disasters Preventing violence Micro interventions Preschool educational and psychosocial interventions Reducing violence and improving the emotional well-being in the school setting Effective school-based interventions for mental health Improving the school ecology Multicomponent programs Reducing the strain of unemployment  Stress prevention programs at the workplace Improving the mental health of the elderly Interventions for Low-Income Settings Advocacy Empowerment Social support e.g. improving maternal health will improve mother-child attachment/bonding and outcomes for the child. 

Spotting the Study Design We can work the type of study by looking at three issues: Assigning exposures Will you “assign” exposures?  If you assign exposure—which might be an intervention, like an antidepressant, a placebo, or a therapy, for example—you are doing an experimental (intervention before observation) study.  Observational (no intervention involved)  Experimental designs  Will there be a control group? Controlled study. Will there be an active comparator or placebo?  Some trials use an active comparator, and we call it active comparator trial. if you want to you a placebo, your study design is a placebo-control trial.  will the allocation be random?   yes > randomised no > non-randomised/quasi-experimental    Will the allocation be swapped from time to time? Yes -> cross-over, No ->  parallel Who will know about the allocation of the treatment?           Everyone -> open-label          All except patients > single-blinded          Neither patients nor asse

A young lady of twenty-eight, came to the psychiatric outpatient department with an irresistible urge to overeat followed by feelings of guilt and self-induced vomiting. She also uses laxatives to compensate for overeating. She wants to know if this is a normal pattern of behaviour or an illness?   How will you respond to her?  What is the likely diagnosis?  Outline management steps for this patient according to the NICE stepped-care approach.     It is likely you are suffering from an eating disorder, in which people repeatedly experience an irresistible urge to eat an enormous amount of food in a brief time. The associated feelings of guilt and efforts to counteract the resultant We would like to carry out a detailed assessment to confirm the diagnosis. But that you are cannot control the episodes implies that the behaviour may not be normal.   Diagnosis  Bulimia nervosa   If there was evidence of BMI being lower than 17.5, or recent severe weight loss, we would diagnose anorexia ner