Capgras Syndrome The patient believes that someone else has replaced a familiar person. Both have a close resemblance. For example, an unknown person replaces the daughter. The patient may attack the familiar person. The original name was ‘delusion des sosies’ a delusion and not a syndrome an example of reduplicative paramnesia.. the most common cause is schizophrenia. other causes include Lewy body dementia and other neuropsychiatric disorders. Always assess the risk of violence to the family person.         

Organic Amnestic Syndrome and Korsakoff Psychosis Dr Waleed Ahmad Vignette A 30-year-old woman is brought to you with memory deficits and rigid behaviour. On examination, she appears lean and weak, dishevelled, is disoriented to time, has a flat affect, registration is 3/3, short-term memory is 0/3 and long-term memory appears intact. She does not have any difficulty naming objects. On physical examination, her weight is 42Kg and her height 152 cm. The lady says, there is nothing wrong with her, while her father says she is speaking too many lies these days. The rest of the clinical evaluation is insignificant except for chronic diarrhoea and recent episodes of vomiting.  What finding will you look for on MRI? Diagnosis The clinical picture, in this case, is consistent with organic amnestic syndrome, specifically Korsakoff Psychosis. The most common cause of organic amnestic syndrome is thiamine deficiency.(1) Magnetic Resonance Imaging Increased signal (ie, hyperintensity) in midline

You received a call from the medical department who requested you to see a 31-year-old lady who has been an in-patient for over two weeks. During her admission, she underwent investigations for persistent pain in her upper abdomen. She has been experiencing pain for the last two months. The physicians originally believed this was gastric or duodenal, but endoscopy was negative. After a comprehensive debate on the case, the medical team has opted to get a psychiatric opinion. Upon evaluation, you found that she has visited multiple clinics and has experienced wide-ranging manifestations and pains over the last two years. However, physicians have identified no source of her symptoms so far. She is worried about her physical symptoms but does not consider them as a warning sign of any serious underlying disease. On mental state examination, she has a low mood, hopelessness, sleeplessness, and reduced appetite. These mental state findings have been present for the last two months.    How w

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