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By Live Dr - Wed Feb 11, 3:04 am
|de Clerambault- Kadinsky complex||Delusion that someone from higher socio-economic status is in love with the patient|
|Othello syndrome||Delusion of infidelity|
|Capgrass syndrome||Delusion of doubles|
|Cotard’s syndrome/ Nihilism||Delusion that one has lost everything, including possessions, status, strength and body organs.|
|Fregoli’s delusions||Delusion that a persecutor is able to assume the appearance of others|
|Intermetamorphosis||Delusion that persons in the environment take on the appearance of tormentors|
|Parasitosis||Delusion that one is infested with parasites|
|Lycanthropy / Werewolfism||Delusion that one turns periodically into an animal|
|Heutoscopy/ doppelganger||Delusion that patient has a twin or second half|
|Incubus||Delusion that patient has a phantom or demon lover|
|Phantom boarder||Delusion that unwelcome guests are living in patient’s house|
|Dorian Gray||Delusion that others are aging, while the patient remains young|
|Illusion de Sorias||Delusion that one’s family has been replaced|
|Autochthonous delusions||Primary, de novo, can’t be explained on the basis of past experiences.|
|Amphitryon’s delusion||Delusion that one’s spouse has been replaced|
|Hypnopompic hallucinations||Hallucination while awakening|
|Hypnagogic||Hallucination while sleeping|
|Functional||External stimulus is necessary to produce hallucinations.
Normal perception and hallucination are in the same modality and experienced simultaneously.
|Reflex / Synaesthesia||Stimulus in one sensory modality produces hallucination in another sensory modality|
|Extracampine||Hallucinations are experienced outside the limits of the sensory field.|
*Visual hallucinations are characteristically seen in organic psychosis, whereas auditory hallucinations are more common in functional psychosis.
The greatest mistake in the treatment of diseases is that there are physicians for the body and physicians for the soul, although the two cannot be separated.- Plato
ELEVENTH HOUR PSYCHIATRY 174
|EUGEN BLEULER’S CARDINAL SYMPTOMS OF SCHIZOPHRENIA( FOUR A’S )|
Loosening of Association
|KURT SCHNEODER’S FIRST RANK SYMPTOMS OF SCHIZOPHRENIA|
|Hearing one’s thoughts aloud.
Auditory hallucinations commenting on one’s behaviour.
Thought withdrawal, insertion and broadcasting.
Somatic hallucinations or the experience of one’s thoughts as being controlled or influenced from outside.
TYPES OF SCHIZOPHRENIA
|Paranoid schizophrenia||Delusions of persecution
Late onset and progressive course.
|Hebephrenic schizophrenia||Marked thought disorder, severe loosening of association.
Progressively worse course.
|Catatonic schizophrenia||Acute onset in 2nd to 3rd decade.
Episodic and complete recovery.
Clinical features include-
Mutism, rigidity, negativism, posturing, stupor, echolalia, echopraxia, waxy flexibility, ambitendency, automatic obedience, verbigeration.
|Pseudo neurotic schizophrenia||Initially there are predominant neurotic symptoms. Three classical features are pan anxiety, pan neurosis, and pan sexuality|
|Oneiroid schizophrenia||Subtype of schizophrenia with acute onset, clouding of consciousness, disorientation, dream like state and perceptual disturbances with rapid shifting.|
|Van Gogh syndrome||Schizophrenia with self mutilation.|
|Propf syndrome||Schizophrenia with mental retardation.|
|Psychotic diseases||Neurotic diseases|
|Impaired reality testing||Reality testing is intact|
|Marked disturbance in personality||Personality and behaviour are preserved|
|Loss of insight||Insight present|
|Delusions and halluciantions are present||Delusions and halluciantions absent|
Men commit suicide three times more frequently than women do. But women attempt suicide two to three times more often than men.
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DRUGS OF CHOICE OF PSYCHIATRIC DISORDERS
|DISEASE||DRUGS OF CHOICE|
|Opioid withdrawal||Methadone → 2nd DOC → Clonidine|
|Opioid intoxication||Naloxone / Naltrexone|
|Alcohol withdrawal||Chlordiazepoxide → 2nd DOC→ Diazepam|
|Obsessive compulsive disorder||Clomipramine→ 2nd DOC→ Fluoxetine.|
|Attention deficit hyperactivity disorder||Amphetamine→ 2nd DOC→ Methylphenidate|
|Neuroleptic induced urinary retention||Bethanecol|
|Neuroleptic induced hyperprolactinoma||Amantadine|
*No withdrawal syndrome is seen with LSD
EEG WAVES AND SLEEP CYCLES
|SLEEP / AWAKE STAGE||E.E.G. FEATURES|
|Awake and alert||
|Awake , restful, eyes closed||
|Parietal / Frontal||Tension, excitation, hypnotic over dosage|
|Occipital||Awake, at rest with eyes closed.|
|Parietal Temporal Hippocampus.||Disappointment, frustration,
organic, functional degenerative, brain disorders
|Parietal, Temporal, Hippocampus,||Very deep sleep, organic, functional degenerative, brain disorders|
|REM stage of sleep||Nightmares.|
|NREM- 4 stage of sleep||Somnambulism, Night-terror, bedwetting, Bruxism, sleep talking.|
Cured yesterday of my disease, I died last night of my physician. – Matthew Prior
ELEVENTH HOUR PSYCHIATRY 176
TYPES OF PHOBIAS
|Acrophobia||Fear of high places|
|Zoophobia||Fear of animals|
|Xenophobia||Fear of strangers|
|Algophobia||Fear of pain|
|Claustrophobia||Fear of closed spaces|
|Thanatophobia||Fear of death|
|Sitophobia||Fear of eating|
|Schizoid personality type||Introverted, withdrawn, solitary and distant.|
|Paranoid personality||Interprets the action of others as deliberately threatening. Untrusting, unforgiving, guarded, and prone to aggression. Perceive others as jealous, deceitful and condescending.|
|Schizotypal personality disorder||Odd and eccentric manners of dressing and speaking. Strange, paranoid beliefs. Have difficulties forming relations and extreme anxiety in social situations. Display sign of magical thinking.|
|Antisocial personality disorder||Impulsive, irresponsible, callous and aggressive. No respect for others and no remorse. High risk for alcohol and substance abuse|
|Borderline personality disorder||Abrupt and extreme mood changes. Unstable and fluctuating self image. Unpredictable and self destructive. Fears of abandonment. Excessive dependency, self mutilation or recurrent suicidal gestures. Impulsive, chronic feeling of boredom, bouts of intense anger.|
|Narcissistic personality||Exaggerated senses of self importance, fantasies of unlimited success, seek constant attention, oversensitive to failure, and complains of multiple somatic symptoms, extreme mood swings, between self admiration and insecurity.|
|Avoidant personality disorder||Hypersensitive to rejection, excessive social discomfort, timidity, fear of criticism, avoidance of social work|
|Dependant personality disorder||Dependant and submissive behavior, feel fear of rejection, lack self confidence.|
|Compulsive personality disorder||Compulsive personalities, high levels of aspirations, strive for perfection, never satisfied with achievements .Reliable, dependable, orderly, methodical and highly cautious.|
|Histrionic personality||Self dramatization, exaggerated expressions, suggestibility, attention seeking attitude. Seductiveness, concerned with physical appearance.|
Hippopotomonstrosesquippedaliophobia is the fear of long words.
ELEVENTH HOUR PSYCHIATRY 177
|Id||Selfish, primitive, childish and pleasure oriented part of the personality with no ability to delay gratification.|
|Superego||Internalised societal and parental standards of good, bad, right and wrong behaviour.|
|Ego||Moderator between the Id and Superego which compromises to pasify both.|
Anna Freud’s types of ego defense mechanisms
|Compensation||Takes up one behaviour because one cannot accomplish another behaviour.|
|Denial||Refuses to perceive the more unpleasant aspects of external reality.|
|Displacement||Redirects emotions from a dangerous object to a safe object. Shifts sexual or aggressive impulses to a more acceptable or less threatening target.|
|Intellectualization/ isolation||Concentrating on the intellectual components of the situations as to distance oneself from the anxiety provoking emotions associated with these situations.|
|Projection||Attributing to others, one’s own unacceptable or unwanted thoughts and/or emotions. Projection reduces anxiety in the way that it allows the expression of the impulse or desire without letting the ego recognise it.|
|Rationalization||The process of constructing a logical justification for a decision that was originally arrived at through a different mental process.|
|Reaction formation||The conversion of unconscious wishes or impulses that are perceived to be dangerous into their opposites.|
|Regression||The reversion to an earlier stage of development in the face of unacceptable impulses.|
|Repression||The process of pulling thoughts into the unconscious and preventing painful or dangerous thoughts from entering consciousness.|
|Sublimation||Rechanneling of psychic energy away from negative outlets to more positive outlets. It is the process of transforming libido into ‘socially useful’ achievements, mainly art. Psychoanalysts often refer to sublimation as the only truly successful defence mechanism.|
|Undoing||A person tries to ‘undo’ a negative or threatening thought by their actions.|
|Suppression||The conscious process of pushing thoughts into the preconscious.|
|Dissociation||Separation or postponement of a feeling that normally would accompany a situation or thought.|
A hypochondriac is one who has a pill for everything except what ails him. Mignon McLaughlin, The Second Neurotic’s Notebook, 1966
ELEVENTH HOUR PSYCHIATRY 178
Anna Freud’s types of ego defense mechanisms CONTINUED…
|Humor||Refocuses attention on the somewhat comical side of the situation as to relieve negative tension.|
|Idealization||Form of denial in which the object of attention is presented as “all good” masking true negative feelings towards the other.|
|Identification||The unconscious modeling of one’s self upon another person’s behavior.|
|Introjection||Identifying with some idea or object so deeply that it becomes a part of that person.|
|Inversion||Refocusing of aggression or emotions evoked from an external force onto one’s self.|
|Somatisation||Manifestation of emotional anxiety into physical symptoms.|
|Splitting||A person sees external objects or people as either “all good” or “all bad.”|
|Substitution||When a person replaces one feeling or emotion for another.|
|Therapeutic level of blood lithium||
0.8-1.2 mEq / L
|Prophylactic blood lithium||
0.6-1.2 mEq / L
>2 mEq / L
|Life threatening toxicity||
>3.5 mEq / L
*Alcoholics anonymous-Self-help society of recovered and recovering alcoholics.
Alanon / Alateen- For relatives and friends of alcoholics.
Similarly there are Narcotics anonymous and Naranon for substance abusers.
*Traditional neuroleptics are most effective in treating positive symptoms of schizophrenia
Most common side effect of neuroleptic drugs (haloperidol) is drowsiness.
Tardive dyskinesia is the most common delayed complication of antipsychotic medication, characterized by purposeless, involuntary facial and lip movement.
Most common extrapyramidal side effect is Akathisia, which is treated with Propranolol and Clonazepam.
A heavy cigar smoker, Freud endured more than 30 operations during his life due to mouth cancer. In September 1939 he prevailed on his doctor and friend Max Schur to assist him in suicide. After reading Balzac’s La Peau de chagrin in a single sitting he said, “My dear Schur, you certainly remember our first talk. You promised me then not to forsake me when my time comes. Now it is nothing but torture and makes no sense any more.” Schur administered three doses of morphine over many hours that resulted in Freud’s death on September 23, 1939.
ELEVENTH HOUR PSYCHIATRY 179
*Neuroleptic malignant syndrome
Muscle rigidity, autonomic dysregulation and hyperthermia.
Idiosyncratic reaction to inhibition of central dopamine receptors that results in increased heat production and failure of heat dissipation.
Rapid physical cooling.
Administration of an antipyretic or actainophenbromocriptine and Dantrolene.
*Major depression with suicidal risk is the first and the most important indication of electroconvulsive therapy
In unilateral ECT, the electrodes are placed on the non-dominant side.
Recurrent episode of hypersomnia and hyperphagia, each lasting 1-3 weeks.
*Mythomania (Pseudologia fantastica or Pathological lying) is a condition involving compulsive lying by a person with no obvious motivation. The affected person might believe their lies to be truth, and may have to create elaborate myths to reconcile them with other facts.
*Munchausen’s syndrome is a disorder in which those affected feign disease, illness, or psychological trauma in order to draw attention or sympathy to themselves. It is also sometimes known as Hospital addiction syndrome.
*Diogenes syndrome is a behavioral disorder characterized by extreme self-neglect. It usually affects the elderly who live alone. Its symptoms include body odor and other signs of severe hygienic neglect. Physical diseases relating to bodily neglect usually accompany the syndrome.
*Heutoscopy is a term used in psychiatry for the reduplicative hallucination of “seeing one’s own body at a distance”
* Media Induced Post-traumatic Stress Disorder (MIPTSD). is a manifestation of Post-traumatic stress disorder type; symptoms specifically due to exposure to entertainment media that focuses excessively on violence.
*Retired husband syndrome is a psychosomatic, stress related illness It is a condition where a woman begins to exhibit signs of physical illness and depression as their husband reaches, or approaches retirement.
The only difference between psychiatrists and their patients is that the patients have a chance of getting better.-Anonymous.
ELEVENTH HOUR PSYCHIATRY 180
*Medical student syndrome is a type of literary self-imposed hypochondria. It typically starts as a person reads or learns about an illness or disorder and begins to believe they have it.
*Cryptomnesia, or “concealed recollection,” is a phenomenon involving suppressed or ‘forgotten’ memories. It refers to cases where a person believes that he is creating or inventing something new, such as a story, poem, artwork, or joke, but is actually recalling a similar or identical work which he or she has previously encountered.
*Ringxiety / Phantom ring effect / Fauxcellarm.
the sensation and the false belief that one can hear his or her mobile phone ringing or feel it vibrating, when in fact the telephone is not doing so.
Hitler was mostly vegetarian because of stomach problems, but he continued to eat pigs’ knuckles. He was also known to eat up to 2 lbs of chocolate per day. His diet was unbalanced because he ate too many carbohydrates, resulting in depression that was treated with drugs.
He is claimed to have relations with three women all of whom attempted suicide during their relationship with him, leading to speculation that Hitler may have had unusual sexual fetishes, such as urolagnia. Some claim he was asexual or homosexual.
On 30 April 1945, Hitler committed suicide, shooting himself while simultaneously biting into a cyanide capsule. Hitler’s body and that of Eva Braun (whom he had married the day before) were put in a bomb crater, doused in gasoline, and set alight. Hitler also had his dog Blondi poisoned before his suicide to test the poison he and Eva Braun were going to take.
ELEVENTH HOUR PSYCHIATRY 181