Psychiatry Diseases

"SCHIZOPHRENIA(SP).----
Fes.--Thought Alienation, Thought Insertion & Broadcasting, Suspiciousness, Conspire against him, Hallucination of VOICES, Paranoid Delusion, Passivity, Delusions in CLEAR CONSCIOUSNESS, Loss of insight occurs,-ve Symp.-Auditory H.,Visual H.,Delusions of persecution, Increased Psychomotor activity,AMBIVALENCE-seen,Personality deterioration seen, Delusion of Presentation, Delusions of Reference, Delusion of Control,waxy flexibility,Fes. of Affect seen, NIHILISTIC IDEAS seen,' FIRST RANK SYMP.--Thought Insertion, Delusion of Perception,Hallucination,Thought Alienation phenomenon, ass. with ASTHENIC personalities, SP.is a side-effect of Amphetamine, Incidence in India 5-10 per1000, Most common /Pathognomonic Hallucination--AUDITORY H., auditory H.-commanding the pt., Autism,Ass.Defect,Ambivalence,Cortisone,&ACTH-causes SP., Prognosis of SP.is improved by/Good prognosis is due to->ATYPICAL SYMP., Neurotransmittors involved are =PGE1,NorEpinephrine,5-HT, DOPAMINE is also found in increased quantity, Early SP.-resembles Anxiety neurosis, SP.is more common in low socioeconomic group/class, good prognosis is indicated by Early Onset, alsp good prognosis--is seen in Affective disorder, BLEULER'S Emphasis--is on Flattened affect, Loose associations, Ambivalence,
Rx of SP. ---DOC--FLUPHENAZINE,Rx of Auditory H.-CLOZAPINE,Rx of Chronic Resistant SP.-CLOZAPINE,
CATATONIC SP. --- Grimacing , Defect in Conation, First symp. to disappear after Rx/Symp. with Best prognosis--Auditory H., C.SP.-mostly occurs in Adolescents, Fes.--Mannerism, Increased Psychomotor activity ,Rigidity, Negativism, Waxy flexibility,Echolalia is also seen,
HEBEPHRENIC SP. --- has got BAD/WORST Prognosis, Grossly disorganised with severe deterioration,.. PARANOID SP. --- Caused by Amphetamine, GOOD PROGNOSIS & LATE ONSET, Psychosis due to chronic amphetamine intake-resembles->SP."-----------((47))

2) "DEPRESSION---most common D.-post partum psychosis, pseudodementia seen in D.,drugs causing--Methyldopa,Reserpine,O.C.pills,Propranolol,Rx of acute D.->ECT., Neurotransmittor Involved is =GABA & DOPAMINE,due to DEFICIENCY OF 5HT.,
MAJOR D.-- death of loved person,UNIPOLAR MAJOR D.--more common in females, Lithium carbonate -least likely to cause serious D.,
NEUROTIC D.-- commonest psychiatric illness in India, Ravenous appetite , INCREASED libido , common risk is-Fatigablity ,NIHILISTIC DELUSIONS & early morning Insomnia,
ENDOGENOUS D.---middle age 40-60 yrs.,sucidal tendecy most common,
Rx.of D.--Cognitive Theraphy ,DOC.-imipramine,DOC.for Rapid cyclers in Bipolar illness--valproic acid / Carbamazepine , DOC.for D.+CAD(coronary artery disease)--is-MIANSERIN."-------------((20))

3) "MOOD DISORDERS---seen in Schizoid state , MANIA---is a mood disorder, fes.--Mood Congruent delution, Delution of Grandeur, Neologism characteristic, Euphoria, Suicidal tendencies, pressure of Speech, Insomnia, Basic disturbance--ELATION, ass. With Good Humour, Physical Overactivity,
Rx of acute mania--is Lithium, drugs used--Haloperidol, Lithium,Carbamazepine,Chlorpromazine,"-------((13))

4) "OBSESSIVE COMPULSIVE DISORDER/ NEUROSIS---characterised by Eleborate, checking, Repeated hand washing, Execessive Slowness, Irresistant Irrational behavior , Fixed at ANAL Stage, Persistance Irrational thought resisting the Data ,Mostcommon complication--is Depression,
DOC.-Clomipramine, Rx-Dugs+Behavior therapy, Rx of severe intractable OCN--is Cingulotomy, DOC.-Fluoxetine, DOC(OCN)--Imipramine" -------------((13))

5) "DELUSIONAL DISORDERS---/DELUSIONS---DEF.-firm false /unshakeable belief ,seen in schizophrenia, mania, delirium, psychosis,psychotic depression ,it is comprehensible, It is a Disorder of THINKING, MOOD CONGUENT DELUSIONS--MANIA & DEPRESSION ,DELUSION-OF-PERSECUTION---seen in schizophrenia.,"------------((12))

6) "HALLUCINATIONS---disorder of false perception, Visual hallucinations--seen in Alcoholism & Organic brain synd./lesion, Auditory H.--seen in Schizophrenia, Mania, Amphetamine toxicity, Hypnagogic H.--arises when a pt. is falling a sleep"------------((12))

7) "ALCOHOL---morbid jealously seen,ALCOHOL WITHDRAWAL SYND.---DOC.-chordiazepoxide,early morning drinking ,delirium,secretiveness about the amount taken,obessions,delusions,tremulousness,hallucination,hyperactive state,amnestic disorder,delirium tremens,epileptic seizures,ALCOHOL ADDICTION---direct evidence-withdrawal symptoms, ALCOHOLIC BLACK-OUTS---characterised by amnesia for events during drinking,ALCOHOLIC HALLUCINATIONS---occurs within 24hrs.of alcohol intake,ALCOHOLISM---auditory hallucinations,visual hallucinations,delirium ,&amnestic reaction."--------------((11))

8) "ECT / ELECTROCONVULSIVE THERAPY---CI--in Brain Tumour ,Pergnancy ,Absolutely CI-in-increased ICT.commonest side-effect--Amnesia,it is used in the Rx--of depression with sucidal tendencies, Req.>80Mvolts, memory disturbance-recovers in few days to few wks.,antegrade amnesia of short duration occurs after ECT.,ECT is not useful in Rx of acute & chronic Schizophrenia, Unilateral ECT--less memory disturbance , "--------------((11))

9) "LITHIUM---Prophylactic Rx-MDP(manic depressive psychosis),used for Rx of Mood disorders,used in prophylaxis-Bipolar MDP,commonest symp.of lithium toxicity --is POLYURIA,chronic use of lithium--> HYPOTHYROIDISM, side-effects--hypothyroidism,Leucocytosis,Polyuria, Organs affected in Lithium toxicity--are Brain,Heart,Kidney(but not liver), Serum Li2+ levels=0.7-1.2meq/l , Lithium induced tremors--Rx Propranolol , "--------------((11))

10) "DEMENTIA---head injury, alzheimer's,huntington's chorea, multiple infarctions,deficiency of Niacin, Fes.--impaired memory, loss of judgment, loss of learned function,, Reversible cause--post encephalitis,Common in old age >60yrs. SUBCORTICAL DEMENTIA---Tactile agnosia,causes-parkinsonism,wilson's disease ,huntington's chorea,"-------------((10))

11) "PHOBIAS---is a type of neurosis, AGORAPHOBIA--Fear of OPEN Places, Animal Phobia--occurs at 8yrs. Of age, SOCIAL Phobia--Fear of public/seniors, IRRATIONAL Fear of Normal Instances,
Mx--Systemic Desensitization, Rx--Behavioural Therapy & Flooding , "-------------((10))

12) "PSYCHOSIS---Acute<2wks., auditory Hallucination seen, Major Psychosis--Endogeneous depression, Acceptance of other persons delusion-is the characteristis fes., ORGANIC Psychosis--Disorientation in time ,place,&person, Clouding of consciousness, Hallucination, Itellectual Impairment, Loss of insight, Rx-drugs used--Chlorpromazine,PUERPERAL Psychosis---, PSYCHOTIC DISORDERS---Schizophrenia, Mania, Psychotic depression"---------------((10))

13) "DISSOCIATIVE DISORDER---loss of Memory of all modalities , DISSOCIATION---seen in Fugue,Multiple personalities , Hysterical conversion, Somnabulism, dissociation hysteria leads to Amnesia , "----------((7))

14) "HYSTERIA---commonest symp.--motor or sensory phenomenon, Fixation of Hysteria--occurs at Phallic stage, uncommon symp.-Palpitation, Hysterical Somatization--Hemiplegia, Blindness, Fugue, Normal Intelligence, Rx--Psychoanalysis ,HYSTERICAL FITS---diff.fromm that of Epileptic Fits --Hyst.Fits occurs when people are Wachting , Incontinence of urine occurs,"--------------((7))

15) "TCA---ANTIDEPRESSANTS---TCA overdose-Rx-amitryptilline,safest TCA in HTN-Fluoxetine, TCA are CI. in angle closure glaucoma, Indications-gastric ulcer,depression,anxiety,…TCA adversly interact with Trnaylcypromine , TCA-causing Tardive dyskinesia-is-AMOXAPINE, side effects of TCA--metallic taste,dry mouth,epigastric discomfort,"-------------((6))

1) "ANXIETY---anxiety is usually viewed as repressed or forgotten -fear ,features--hyperventilation,cold extremities,palpitations,pupillary dilatation,…..ANXIETY NEUROSIS---acute restlessness & fear of impending doom , anti -anxiety effect--chlorpromazine,TCA,BZD.,"------------((5))

2) "COCAINE---coined by FREUD.,jet black pigmentation of tongue with tactile hallucination ,creeping sensation,COCAINE-BUGS---sensation of bugs crawling all over the body"-----------((5))

3) "DELIRIUM---illusions with loss of consciousness,acute delerium-impaired consciousness, visual hallucination, hyperactivity& Fragmentary Delusions,"-------------((5))

4) "FREUD---introduced ---Cocaine , Psychoanalysis , concept of ""SUPER-EGO"" , free association , "" OEDIPUS COMPLEX""--by sigmund freund"----------((5))

5) "ANOREXIA NERVOSA---amenorroea-100%,phobic avoidance of normal wt.,wt.loss seen,over perception of body image,self induced vomiting ,excessive exercise,evident psychosis,least characteristic--decreased physical activity,false-decreased appetite,"-----------((4))

6) "CANNABIS---medical purposes/uses-in-Epilepsy ,glaucoma,nausea,Flash black phenomenon,.CANNABIS ADDICTION---symptomatic,Rx not req.,JHAGNAN phenomenon seen,"-------------((4))

7) "DEFENSE MECHANISIMS---MATURE defense mech.-->Projection & Altruism,IMP.defense mech.-->Repression,RATIONALIZATION-->drinks due to quarrel with wife ,"------------((4))

8) "DELIRIUM TREMENS---altered cons. ,tremors & visual hallucinations ,DOC.-diazepam."---------((4))

9) "EGO---works on realitiy principle , EGO DEFENSE MECHANISMS---""undoing""-seen in--OCN, Picasso synd.--Sublimation, Projection , Conversion,Reaction formation, "-----------((4))

10) "FUGUE---& DISOCIATIVE FUGUE--- seen in Schizophrenia , hysteria,epilepsy,wandering purposefully with some amnesia, "-----------((4))

11) "KORSAKOFF'S PSYCHOSIS---long term memory loss ,fes.--loss of Intellectual function but preservation of memory, lack of insight, unable to understand the disability, it is a REVERSIBLE state, CONFABULATION seen,Rx--VIT.B1(THIAMINE)"-------------((4))

12) "MENTAL RETARDATION---commonest cause--Birth Asphyxia ( Intellectual deficiency ),MENTALLY ILL---commonest mental illness in Chlidren --Neuroses,"------------((4))

13) "NEUROSIS---defective childhood experiences & adjustments & mild mental disorder , NEUROTIC DISORDERS---Anxiety, Hysteria, Phobia, OCN, "-------------((4))

14) "BULIMIA NERVOSA---episodes of excessive&uncontrolled eating , carries teeth , inducing vomiting,"----------((3))

15) "CATATONIA---FES.-automatic obedience,cataplexy,negativism,is seen in Schizophrenia,CATATONIA STUPOROUS---waxy flexibility is characteristic."---------((3))

16) "CONFABULATION---making stories to fill up gaps in memory loss , seen in alcoholism ,korsakoff psychosis"--------((3))

17) "FLASH BACK PHENOMENON---seen in Cannabis , Psilocybin , LSD.,"---------((3))

18) "HYPERKINETIC DISORDER---LOW I.Q., low Attention SPAN, poor impulse control, increase in Anger outburst, DOC-AMPHETAMINE.,"------------((3))

19) "LSD--Flash Blacks & Bad Trips , LSD Intoxication--> panic,confusion,Hyperreflexia, "------------((3))

20) "NOCTURNAL ENURESIS---DOC.-Imipramine, occurs in Stage IV sleep , "------------((3))

21) "OPIOID WITHDRAWAL---Rx nonaddicting drug -->Clonidine is used, OPIUM WTHDRAWAL---fes.-Lacrimation"---------((3))

22) "ORGANIC BRAIN SYND.---Visual Hallucination, Disorientation seen , bender gestalt test"---------((3))

23) "PANIC DISORDERS---DOC.--Diazepam, sudden attacks of anxiety with fear"-----------((3))

24) "PSYCHOANALYSIS---coined by Freud , this Tech. Used in Hypnosis,"-------------((3))

25) "SUICIDAL TENDENCIES---least in married person, Due to Withdrawal from Cocaine,Amphetamine,Alcohol, SUICIDE---most prone among -Adolecscent Girls,"------------((3))

·         If one parent has a mood disorder, a child's risk of a mood disorder is 10% to 25%; if both parents are affected, the risk roughly doubles.

·         The gate control theory proposes that there is a structure in the dorsal horn of the spinal cord that acts as a gate for increasing or decreasing nerve impulse flow from the peripheral fibers to the central nervous system. This allows sensory input to be reviewed and modified at the gate before it evokes pain.

Sensory input is increased or decreased by the activity of large diameter fibers (A fibers), small diameter fibers (A and C fibers), and descending fibers from the brain.

Impulses from the large fibers can close the gate, inhibiting transmission, while activity from the small fibers can open the gate to enhance transmission. Efferent impulses from the brain provide further influence and the access route for the psychological processes of anxiety, depression, attention, and past experience to alter the gate and thus directly influence the pain perception process.

·         Hippocampal formation and the limbic cortex that surround it are involved in learning and memory, rather than emotional behavior. However, the remaining sections of the limbic system are responsible for emotions, feelings, moods, and motivation.

·         Progressive muscle relaxation, or a reasonable variation, can serve as a powerful therapeutic technique for treating generalized anxiety, insomnia, headaches, neck tension, and mild forms of agitated depression. It has also effectively been used to reduce pain, the side effects of cancer chemotherapy, nausea, and mild hypertension, preferably before pharmacologic intervention. Relaxation therapy is based on the premise and observation that muscle tension is a physiologic response to anxiety and stress. There is a significant reduction in experienced anxiety if tense muscles can be relaxed. Muscle relaxation also can change the physiologic activation process. The Jacobson relaxation procedure involves tensing selected muscles for about 10 seconds, and then completely relaxing them and noticing the difference in sensation. Eventually, the patient is able to relax particular muscle groups from their present level of tension. Other effective methods of relaxation include systematic deep breathing, transcendental meditation, and yoga.

·         Different kinds of stressors elicit different physiologic responses. Vigilant inaction is a condition in which one is facing stressors for which there is no apparent coping strategy or opportunity for defense. In that case there is increased blood pressure and peripheral blood flow resistance, vagus nerve–mediated bradycardia, decreased cardiac output, increased secretion of corticotropin (ACTH) and cortisol, and decreased levels of brain norepinephrine. When active coping is pursued or becomes an option, adrenal medullary secretion of epinephrine and hypothalamic-pituitary-adrenocortical activity decrease.

·         Catecholamine hypothesis of mood disorders in which a functional deficiency of NE results in a depressed mood.

·         GABA is an amine acid neurotransmitter that is associated with a modulating effect on anxiety. It is bound to brain receptors, and when GABA neurons fire, they dampen excitement generated in the central nervous system (CNS). When GABA receptors are blocked, the excitability in the brain increases, sometimes leading to seizures. When the postsynaptic receptors are bound with GABA, the chlorine channels open and the influx of chlorine negative ions hyperpolarizes the cell membrane, thus decreasing the likelihood of firing.

·         Acetylcholine is a neurotransmitter that is essential for memory. Persons given an anticholinergic drug that blocks acetylcholine acquire a memory deficit. When this is counteracted by another drug, memory is restored.

·         HERETIBILITY

·         General cognitive ability – 80%

·         Interpersonal skills, intellectual abilities, and domestic skills - 50%.

·         body weight and obesity - 70%

·         blood pressure and heart rate - 50%

·         alcoholism exists - 40% in first-degree male relatives and about 20% in female relatives

·         smoking-  75% of identical twin cases and 63% of fraternal twin cases

·         ADHD – 70%

·         self-perceived competence - 50%.

·         Schizophrenia Heritability:

1.       One percent in population;

2.       first-degree relatives,10% (whether reared together or apart);

3.       fraternal twins, 17%;

4.       identical twins, 48%;

5.       may be linked to chromosome 6.

·         Positive symptoms (Type I)

i. What schizophrenic persons have that normals do not, e.g.,delusions, hallucinations, bizarre behavior

ii. Associated with dopamine receptors

·         Negative symptoms (Type II)

i. What normals have,that schizophrenics do not, e.g.,flat affect, motor retardation, apathy, mutism

ii. Associated with muscarinic receptors

·         Ethology was developed by Konrad Lorenz and Nicholaas Tinbergen  by conducting comparative studies of unlearned behavior with special emphasis on its mechanisms, ontogeny, and evolution.

Innate behavior is a relatively complex sequence of responses, called a fixed action pattern, which is triggered by a sign stimulus or releaser. A fixed action pattern, somewhat like a reflex, does not require previous learning for its expression.

·         Down syndrome was originally named trisomy 21 because, at the time, the trisomy was thought to involve the next to the smallest autosome (number 21 by the Denver system of enumeration). It is now known that the smallest autosome is the one in triplicate. Even though Down's syndrome should really be called trisomy 22, the error is so firmly entrenched in the literature that it is still referred to as involving chromosome 21.

·         The Bender-Gestalt Test consists of nine test figures that a subject is asked to copy; difficulties in this easy task often are indicative of brain dysfunction.

The Thematic Apperception Test (TAT), which consists of a series of 30 ambiguous pictures about which subjects are asked to construct a story, is most useful in assessing motivational variables. It provides a case-study exploration of a person's personality.

The Halstead-Reitan Battery of neurologic tests was developed in the early 1940s to determine the location and effects of specific brain lesions.

The Wechsler Adult Intelligence Scale (WAIS) is the best standardized test of intelligence in use today.

·         Compliance with chemotherapy for cancer is very high—better than 90%. Medication treatment for hypertension, glaucoma, coronary heart disease, and diabetes achieves from 40 to 70% compliance from the patient.

·         A person with a passive-aggressive personality disorder demonstrates covert noncompliance, especially with authority. The bookkeeper's forgetting, procrastinating, and arriving late can be a passive way to express aggression in response to anger and frustration. Psychotherapy is the treatment of choice

·         Biofeedback techniques have allowed the average person to learn to control physiologic responses. When we receive feedback or information concerning the response we have just made, we can then make appropriate adjustments.

·         Contingency management is the technical term often used for positive reinforcement or stepping. It involves the process of changing the frequency of a behavior by controlling the consequences of that behavior with positive reinforcement to encourage or discourage a particular behavior.

·         Repeated instances of noncontingent behavior and outcome can result in learned helplessness, with a person learning and expecting that most events are not controllable or will not be successful.

·          Classical conditioning is a basic form of learning. It was first described by Ivan Pavlov working on the conditioned reflex. He was able to take an automatic reflex (e.g., salivation to food) that was thought to be unconditioned and demonstrated that it could be conditioned to respond to a new stimulus (e.g., a bell) if the new stimulus was presented along with or prior to the unconditioned stimulus (food). After a number of such presentations the new stimulus (bell) would elicit the automatic unconditioned response. The automatic response had, in effect, learned to respond to the new stimulus (i.e., a learned association or connection between the two stimuli had occurred). Pavlov called this learned association stimulus substitution.

Operant conditioning, sometimes called instrumental conditioning, was formulated by Edward Thorndike and later developed by B. F. Skinner. In operant conditioning a new behavioral response is learned, as compared with classical conditioning in which a new stimulus is conditioned (learned) to elicit the same response or behavior. In operant conditioning reinforcement becomes the key stimulus that increases the liklihood that the desired behavior will be repeated or strengthened.

Shaping is a reinforcement and learning process wherein a series of successive responses that approximate the desired response are reinforced until the desired response is learned. It is basically an operant conditioning procedure and was originally developed using the bar-pressing response of rats as the act to be learned.

Contact desensitization is a variation of sytematic desensitization that combines modeling and guided participation procedures. The procedure is based on extinction rather than depending on relaxation to inhibit the anxiety.

·         A variable ratio reinforcement is best illustrated by a slot machine player, who may be rewarded after 6 lever pulls, again after only 3 pulls, but next after 20 pulls. The person is motivated to continue to play and at an increased number of pulls. A variable ratio schedule is most resistant to extinction.

·         The most crucial element in the physician-patient relationship is the nature of role expectations that each has and the congruence and mutuality of such expectations.

·         Modeling—observation and imitation—is a very effective method of learning the practice of medicine and most other skills.

·         The nature of an adolescent boy's relationship with his parents is the single factor most predictive of juvenile delinquency.

·         Conduct disorder is the more serious disorder in that it is diagnosed when the child's behaviors violate the rights of others (e.g., assault) or are in conflict with major societal norms (e.g., stealing, truancy, setting fires). Children with conduct disorder are at risk for developing the antisocial personality disorder seen in adults.

Oppositional defiant disorder is characterized by recurrent negative and defiant behaviors toward authority figures.

·         Shared Psychotic Disorder (Folie à Deux):

A delusion that develops in one person (the secondary case) who is involved in a close relationship with another person (the primary case) who has a preexisting delusion. Usually, the primary case is dominant in the relationship and chronically ill (e.g., schizophrenia). The secondary case is typically more gullible and passive. The relationship may involve more than two people and has been reported in families (folie à famille).

·         The Von Domarus principle states that the schizophrenic identifies subjects by identifying different predicates. The subject loses his immutability in the sentence. The subject changes with the change of its predicate: the relationship between subject and predicate is internal, intense, and no purely logical or structural. In this way, if a tree appears to us as a dog in the verge of flying because both (tree and dog) raise their extremities to the sky (and the eye's shortcomings during nocturnal vision makes the tree's features into those of the dog), then that tree is a dog in the verge of flying. Schizophrenic thinking is transgressive, it breaks the laws of thought grounded in the identity of the subject. In light of Von Domarus principle the schizophrenic identifies different subjects in virtue of what is predicated of them, the subject is exchangeable.

·         Four of five criteria are needed for the diagnosis of panic disorder: PANIC = Palpitations, Abdominal pain, Nausea, Increased perspiration, and Chest pain, Chills, or Choking

·         Anaclitic depression: Depression in an infant owing to continued separation from caregiver––can result in failure to thrive. Infant becomes withdrawn and unresponsive.

·         The prevalence of tic disorder is higher in younger children and in males and is associated with school dysfunction, obsessive-compulsive disorder, and attention-deficit/hyperactivity disorder. In addition, separation anxiety, overanxious disorder, simple phobia, social phobia, agoraphobia, mania, major depression, and oppositional defiant disorder were found to be significantly more common in children with tics.

·         Anniversary reaction: As the anniversary of the death of a spouse, relative, or close friend approaches, the survivor may experience depressed mood or undefined somatic symptoms. An anniversary reaction may also occur after any significant loss such as that of a job, limb, or health or divorce.

·         STEROID PSYCHOSIS: Corticosteroid use is frequently associated with changes in mood (euphoria, dysphoria, or emotional lability), sleep pattern (insomnia, weird dreams, nightmares), and appetite (usually increased). Corticosteroids also can have important effects on behavior and thought processes, inducing frank psychosis in persons without a history of psychiatric disturbance or decompensation in known psychotics.

·         AIMS test: Abnormal Involuntary Movement Scale: to Dx Tardive Dyskinesia

·         Partial response to antidepressant therapy is common and such patient is a good candidate for augmenting the response by the addition of another drug. The most common drugs used for this purpose are lithium and bupropion.

·         Alcohol abuse is defined as a maladaptive pattern of alcohol use leading to clinically significant impairment or distress, manifested in a 12-month period by one or more of the following problems: (1) failure to fulfill role obligations at work, school, or home; (2) recurrent use of alcohol in hazardous situations; (3) legal problems related to alcohol; and (4) continued use despite alcohol-related social problems. Alcohol dependence is manifested by a maladaptive pattern of use over a 12month period that includes three or more of the following problems: (1) physiologic tolerance, characterized either by an increase in the amount of alcohol consumed or by a decrease in the effects of the amount of alcohol customarily consumed; (2) symptoms of withdrawal; (3) use of greater amounts of alcohol over a longer period than intended; (4) a persistent desire or unsuccessful attempts to control use; (5) a great deal of time spent obtaining alcohol, using alcohol, or recovering from use; (6) reducing important social, occupational, and recreational activities; and (7) continued use despite knowledge of physical or psychological problems.

·         All addictive drugs share the property of activating a subcortical brain circuit that normally functions to motivate the pursuit of goals with positive survival value, such as obtaining food and sexual partners. This circuit extends from the ventral tegmental area (VTA) of the midbrain to the nucleus accumbens (NAc), which is the ventral portion of the striatum and uses dopamine as its neurotransmitter. The opiates mimic endogenous opioid neurotransmitters (e.g., enkephalins), which disinhibit the VTA, leading to dopamine release, but can also act directly on the NAc, thus bypassing dopamine release.

·         Schizotypal personality disorder shares some of the clinical characteristics of schizophrenia, such as social and physical anhedonia, suspiciousness, magical thinking, blunting of affect and emotional experience, and poor functioning. However, schizotypal patients do not experience overt and persistent psychotic symptoms, although rare and brief psychotic symptoms may occur. In a patient with persistent psychosis, the differential diagnosis consists mainly of affective disorders with psychosis, substance abuse, and delusional disorders. Psychosis that coincides with depression is typically associated with such affective features as delusions of poverty or accusatory voices. Similarly, delusions of grandeur are common during manic episodes. Psychotic symptoms in affective disorders typically follow the emergence of depression or mania and fade once the affective symptoms recede. The history and toxicology screen can rule out psychosis caused by drug abuse, such as use of PCP or long-term abuse of steroids. Delusional disorder is diagnosed on the basis of nonbizarre, persistent, and circumscribed delusions in the absence of the other characteristics of schizophrenia. Rarely, neurologic conditions such as brain tumor or temporal lobe epilepsy may be misdiagnosed as schizophrenia. When such conditions are suspected, MRI and EEG can help with the diagnosis.

·         The defining characteristic of GAD is persistent excessive and uncontrollable worry about everyday situations. GAD can be highly debilitating and may predispose to the development of other anxiety or mood disorders. GAD is the most common anxiety disorder seen in primary care settings; patients often present with sleep disturbance or somatic symptoms such as muscle aches and tension headaches. GAD is similar to other anxiety disorders in that it often goes undiagnosed and untreated. Venlafaxine is considered by most experts to be the first-line treatment. SSRIs have been found efficacious, and benzodiazepines have also been used to treat GAD. However, these drugs are generally not used as first-line treatments. Although cognitive-behavioral psychotherapy for GAD has been less studied than for other anxiety disorders, this approach appears promising.

·         Dentists have the highest suicide rate of any profession

·         Highest "on-the-job" mortality: taxi drivers

·         Suicide threats are the clearest reason to hospitalize someone for psychiatric reasons.

·         IMPORTANT: Suicide often occurs when a person is feeling better after coming out of a deep depressive episode (more likely just after admission to hospital for psychiatric reasons).

·         The basic addiction pathway in the brain is a dopamine pathway. Activation of this pathway accounts for the "positive reinforcement" feeling and makes us want to repeat the action that triggered that feeling.

Medial forebrain bundle (MFB) → Nucleus accumbens (NAC) →Ventral tegmental area (VTA)

·         Fetal alcohol syndrome (FAS): The leading known cause of mental retardation (Down syndrome is second) ; Characterized by developmental and mental retardation, craniofacial abnormalities, limb dislocation; Consumption of large quantities of alcohol needed to produce FAS

·         One major prospective study has shown that the Type A behavior pattern is associated with a twofold increase in incidence of coronary heart disease, even after controlling for the major risk factors (systolic blood pressure, cigarette smoking, cholesterol). Following a first heart attack, Type As who survived had a lower chance of a second attack than did Type Bs.

·         Holmes and Rahe scale used to quantify stressful life events. The death of a spouse is weighed as the most stressful event.

·         Commonly used IQ tests

1. Wechsler Adult Intelligence Scale,Revised (WAIS-R) is for adults, aged 17 and older.
2. WechslerIntelligence Scalefor Children, Revised (WISC-R) is for children aged 6 to 17.
3. Wechsler Preschool and Primary Scale of Intelligence (WPPSI) is for children aged 4 to 6.
4. Stanford-Binet Scale is the first formal IQ test (1905) and is used for children aged 2 to 18. Today,it's most useful with children younger than 6, the impaired, or the very bright.

·         The IQ has a mean of 100 and a standard deviation of 15. IQ is very stable from age 5 onward and is measured with an error of +-5points.

·         Both mental age and deviation from norms methods can be used to compute IQ.

·         Objective tests use simple stimuli, limited response sets, and can be machine scored. Objective test can be scored as either norm referenced (comparing with others) or criterion referenced (comparing to a preset standard).

·         Projective tests use ambiguous stimuli, allow a wide range of responses and must be scored by a skilled clinician.

·         Important neuropsychologic tests include Halsted-Reitan Battery, Luria Nebraska Battery, Bender Visual Motor Gestalt Test, Benton Visual Retention Test, and Wechsler Memory Scale.

·         Heritability index: (MZ - DZ)/(1O0- DZ) = proportion of conditions due to genetic factors

·         Pathways of known psychiatric importance:

i.         Nigrostriatal pathway in substantia nigra (movement disorders) . Dopamine blockade via neuroleptics or destruction of dopaminergic. cells in Parkinson disease

. Leads to Parkinson symptoms (tremors, muscle rigidity, bradykinesia)

ii. Meso-limbic-cortico pathway (psychosis) . Postsynaptic dopamine blockade produces antipsychotic symptoms

. Neuroleptic medications have an antidopaminergic effectand reduce the positive symptoms of schizophrenia (hallucinations, delusions).

. Dopamine levels are also lower in depression and slightly higher in mania.

. Amphetamines cause the release of dopantine and NE and block their re-uptake, thus aggravating psychotic symptoms.

. Tourette's syndrome is also a disorder of a hyperactive dopamine system, for which haloperidol is sometimes effective.

iii. Tuberoinfundibular system

. Dopamine is a prolactin-inhibiting factor. . Prolactin levels can serve as rough indicators of overall dopamine activity.

iv. Nucleus accumbens (NAC) pathway

. Positive reinforcement occurs here.

. The "addiction pathway"

·         Behavioral therapy techniques

Classic conditioning techniques

Systematic desensitization: relaxation with gradual presentation of feared stimulus

Exposure: maintaining stimulus until fear extinguishes

Aversive conditioning: change the original stimulus to produce and aversive response

Operant conditioning techniques

Shaping: successive approximations toward desired behavior

Extinction: identify and remove reinforcing agent."Timeout"

Stimulus control: avoiding stimuli producing unwanted behavior

Biofeedback: trial and error conditioning to change internal physiology using external feeedback

Fading: gradually removing the active ingredient while still maintaining behavior

(Taken from Internet Blog)