09/22/2017

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By Live Dr - Wed Feb 11, 3:04 am

Psychiatry

Delusions

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

HALLUCINATIONS

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.

QUOTE CORNER

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 )
Blunted Affect

Loosening of Association

Ambivalence

Autism

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.

Emotional disturbances.

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

TRIVIAL TRUTH

Men commit suicide three times more frequently than women do. But women attempt suicide two to three times more often than men.

ELEVENTH HOUR    PSYCHIATRY                                                                                                        175

DRUGS OF CHOICE OF PSYCHIATRIC DISORDERS

DISEASE DRUGS OF CHOICE
Generalized anxiety Benzodiazepines
Panic attack Fluoxetine
Nocturnal enuresis Imipramine
Opioid withdrawal Methadone → 2nd DOC → Clonidine
Opioid intoxication Naloxone / Naltrexone
Alcohol withdrawal Chlordiazepoxide → 2nd DOC→ Diazepam
Alcohol abstinence Disulfiram
Benzodiazepines intoxication Flumazenil
Obsessive compulsive disorder Clomipramine→ 2nd DOC→ Fluoxetine.
Attention deficit hyperactivity disorder Amphetamine→ 2nd DOC→ Methylphenidate
Tic disorder Haloperidol
Bulimia nervosa Fluoxetine
Alcoholic hallucinations Diazepam
Neuroleptic induced urinary retention Bethanecol
Neuroleptic induced hyperprolactinoma Amantadine
Akathisia Propranolol

*No withdrawal syndrome is seen with LSD

EEG WAVES AND SLEEP CYCLES

SLEEP / AWAKE STAGE E.E.G. FEATURES
Awake and alert

β  waves

Awake , restful, eyes closed

α

NREM- 1

θ

NREM-2

θ

NREM-3

δ

NREM-4

δ

REM

β

WAVES FREQUENCY

Hz

BRAIN REGION CONDITION

β

14-80

Parietal / Frontal Tension, excitation, hypnotic over dosage

α

8-13

Occipital Awake, at rest with eyes closed.

θ

4-7

Parietal Temporal Hippocampus. Disappointment, frustration,

organic, functional degenerative, brain disorders

δ

3-5

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.

QUOTE CORNER

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

PERSONALITY TYPES

Personality type Characteristics
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.

TRIVIAL TRUTH

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.

QUOTE CORNER

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

Side effects

>2  mEq / L

Life threatening toxicity

>3.5  mEq / L

Alcoholism

Alpha Milieu limited
Beta Male limited
Gamma Malignant alcoholism
Epsilon Spree drinking

*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.

TRIVIAL TRUTH

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.

Management-

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.

Much safer

*Klein-Levin syndrome

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.

QUOTE CORNER

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.

TRIVIAL TRUTH

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

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