A 16-year-old girl presents with multiple unconsciousness. These started about six months ago and have become progressively worse. During the episodes, there is the jerky movement of the body but no urinary or faecal incontinence. These symptoms last for a few minutes and are followed by drowsiness. Neurological examination is normal. What differential diagnoses would you consider in this case? What other information would you enquire from the family about the episodes? Which specific investigations would you like to order? Differential Diagnosis Conversion disorder (F44.5 Dissociative convulsions) suggested by the episodes of unconsciousness and lack of findings on neurological examination and absence of incontinence. Epilepsy suggested by the recurrent brief episodes of unconsciousness, accompanied by jerky movements and followed by drowsiness Vasovagal syncope suggested by the brief episodes of unconsciousness, jerky movements (may occur) and normal physical examination Paroxysmal a

INSOMNIA COMORBID WITH MAJOR DEPRESSIVE DISORDER Management Approaches ___ Amit Chopra, MD, DFAPA.   INTRODUCTION Insomnia is defined as  a predominant dissatisfaction with sleep quantity or quality, associated with one or more specific symptoms including difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening with inability to return to sleep.   Based on DSM-5 criteria, the sleep difficulty should occur at least 3 times per week for 3 months or more, despite adequate opportunity for sleep for establishing a diagnosis of insomnia disorder. Insomnia is  the most common sleep complaint with trouble initiating sleep (initial insomnia), disrupted sleep (middle insomnia), early morning awakenings (terminal insomnia), and/or non-restorative sleep during acute major depressive episodes. Evidence suggests that insomnia   correlates strongly with a significantly increased risk of developing depression . Given substantial evidence that ea

Psychosocial Issues Experienced in a Coronary Care Unit (CCU) Relating to the patient The suffering of others in the CCU Paraphernalia of tubes, machines, wires, etc Death of others. Possibility of having to witness a CPR etc. Relating to the Attendants Unsure of the progress Unaware of patients' perceptions and mental state. Watching a medley of news coming from inside for other attendants. Crying or wailing of other attendants. Doctors Dressed in white coats and scrubs walking about looking serious and pacing hurriedly creating a sense of emergency and danger.

Assessment and Management of Opioid Use Disorder, Withdrawal, and Intoxication Syndromes Neurobiology of Opioid Dependence and withdrawal Opioids act at specific opioid receptors in the central nervous system. Stimulation of these receptors suppresses the firing rate of noradrenergic neurons in the midbrain, thus causing CNS depression and reduction of anxiety. Euphoria is also because of the release of dopamine at nucleus coeruleus in the forebrain by dopaminergic neurons that originate in the ventral tegmental area in the midbrain. Opioid use causes reinforcement of the drug-taking behaviours because of these euphoric effects and the relief from anxiety. Repeated usage also causes neuroadaptive changes in these neurons, such that progressively less dopamine release in the nucleus coeruleus and less suppression of midbrain noradrenergic cells lead to reduced effects or increased doses being taken by the person (tolerance). When the person stops taking the drug, overexcited noradrenerg

Depressive Pseudodementia Introduction: Depressive pseudodementia is a condition that has been described as having cognitive impairment, memory loss, and other symptoms that mimic those of dementia, but are caused by depression instead of a degenerative brain disease. In this article, we will explore the current understanding of depressive pseudodementia, including its diagnosis, symptoms, and treatment. Diagnosis: Depressive pseudodementia is not a recognized diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the standard diagnostic manual for mental health conditions. However, some experts believe that it is a useful concept for understanding the relationship between depression and cognitive impairment (1). To be diagnosed with depressive pseudodementia, a patient must have symptoms that resemble those of dementia, but the symptoms must be caused by depression rather than a degenerative brain disease (2). Symptoms: The symptoms of depressive pseu