PSYCHIATRY
——-
● PAGO PHAGOA = ICE
● GEOMELOPHAGIA = POTATO
● DE JA ETENDU = HEARING
● DE JA PENSE = THOUGHT
● LA BELLE INDIFFERENCE = PARIETAL LOBE, MS , CONVERSION DISORDER
● ENCOPRESIS = ELIMINATION DISORDER
THOUGHT DISORDERS
FORM CONTENT POSESSION STREAM
Loosening Assocn DELUSION Thought insertion Flight of Ideas
Neologism OBSESSION Thought withdrawal PROLIXITY
Word Salad Thought broadcast INHIBITION
Perseveration
Thought Block
Circumstantiality (?)
● HEALTHY THINKING =
CONSTANCY ORGANISATION CONTINUITY
Transitory thinking Privelling thinking Desultory thinking
- derailment , omission, substitution (Sudden ideas force their way)
Negative misidentification CAPGRAS
Positive misidentification FREGOLI
● FLIGHT OF IDEAS = MANIA, PRESSURISED SPEECH, CLANG ASSOCIATION
● PERSEVEREATION = ORGANIC MENTAL DISORDERS
● CLANG ASSOCIATION = MANIA
● VERBIGERATION = WORD SALAD
● VORBERDEN / PAST POINTING / APPROXIMATE ANSWERS = GANSER SYNDROME
● PROLIXITY = HYPOMANIA
REMOTE MEMORY
Implicit Explicit
Striatum, Amygdala , Cerebellum, Reflex pathways Episodic = hippocampus, medial temporal lobe,
Neocortex
Semantic = Prefrontal cortex, Temporal lobe
INSIGHT
Grade 1 COMPLETE DENIAL
2 Yes or No
3 Illness medical or external
4 Unknown in self
5 Intellectual
6 True emotional
SCHIZOPHRENIA
● AUTISM
● AFFECTIVE FLATTENING
● ASSOCIATION LOSS
● AMBIVALENCE
Ambivalence
1st described in SCHIZOPHRENIA
Mc seen in OCD
Core feature of OCD
● SOMATIC PASSIVITY ONLY IN PARANOID SCHIZOPHRENIA
Schizophrenia
ICD = 1MONTH MORE DSM = 6 MONTHS MORE ( 2/5 symptoms)
ICD <1m = ACUTE PSYCHOSIS DSM < 1 m = BRIEF PSYCHOTIC DISORDER
DSM <6m = SHIZOPHRENIFORM D/O
● ACUTE AND TRANSIENT PSYCHOSIS < 1 MONTH
● DSM 5 = NON AXIAL, DIMENSIONAL
SCHIZO
Gen populn 0.3 to 0.7 %
Non twin sibling 8%
One parent schizo 12%
Dizygotic twin 12%
Both parent schizo 40%
Monozygotic twins 47%
For S/D/M = 8/ 12 /47
Parents = 12/40
● most heritable = autism
● TYPE 1 SCHIZO = BETTER PROGNOSIS
Defences in Schizo Denial
Projection
Reaction formation
Defences in Phobia Displacement
Avoidance
Projection
Defences in OCD Isolation
Undoing
Reaction formation
● oral stage fixation
CATATONIC = BEST PROGNOSIS
● FRONTAL LOBE SYMPTOMS : GRIMACING + MANNERISMS ( IF NO MANNERISM ONLY GRIMACE,
HEBEPHRENIC)
● NO ANTIPSYCHOTICS
● MCC OF CATATONIA = DEPRESSION
● MANNERISM = GOAL DIRECTED REPETITIVE ACTIVITY
● RX = IV LORAZEPAM
PARANOID
● PERSONALITY IS INTACT
MARITAL SKEW = ONE PARENT MORE DOMINANT
Neurotransmitter in schizo
INCREASED DECREASED
DOPAMINE , SEROTONIN NE, ACH, GABA, GLUTAMATE
Neurotransmitter in DEPRESSION
INCREASED DECREASED
Ach, Glutamate (excitotoxicity ) Serotonin, NE, Dopamine , GABA
● increase in serotonin and decrease in NE CAUSES NEGATIVE SYMPTOMS
● Serotoninn = both +ve and neg symptoms
● Dopamine only +vve
PARAPHRENIA
● LATE ONSET
● FEMALES
● GOOD PROGNOSIS
● FAMILY HO OF SCHIZO
● MC IN PTS WITH SENSORY DEFICITS
● PARANOID SYMPTOMS
SCHIZOAFFECTIVE DISORDER
● BIPOLAR + SCHIZO
● MOOD STABILIZERS ALONG WITH ANTIPSYCHOTICS
ATYPICAL ANTIPSYCHOTICS ALSO BLOCK SEROTONIN RECEPTOR SO BETTER IN NEGATIVE SYMPTOMS
● CLOZAPINE LOWERS SEIZURE THRESHOLD ( DOSE DEPENDENT )
● LEAST METABOLIC SE = ARIPIPRAZOLE (PINES>dines >ole)
DELUSIONAL DISORDER
● DSM = 1 MONTH , ICD = 3 MONTHS
DURATION TO DIAGNOSE =
HYPOMANIA = 4 DAYS
MANIA = 1 WEEK
DEPRESSION = 2 WEEK
SEASONAL AFFECTIVE DISORDER, DYSTHYMIA , CYCLOTHYMIA = 2 YEARS
● BPAD 2 = HYPOMANIA (NEVER MANIA)
* RAPID CYCLER = 4 EPISODE IN 1 YEAR
* ULTR RAPID = 4 IN 1 MONTH
* ULTRARIAN = 4 IN 1 DAY
SCHIZO AND BIPOLAR = MALES AND FEMALES EQUALLY AFFECTED
Cognitive distortions in depression
OVERGENERALISATION/ MAGNIFICATION
SELECTIVE ABSTRACTION
ARBITARY INFERENCE
PERSONALISATION
MINIMISATION
DEPRESSION
Endogeneous Exogeneous
MELANCHOLIC DEPRESSION
No stress factor With a stress factor
● INVOLUTIONAL MELANCHOLIA = MAX SUICIDE
● ANACLITIC DEPRESSION = HOPITALISM , SEEN IN INFANTS (RENE SPITZ DESCRIBED IT)
ATYPICAL DEPRESSION = HYSTEROID DYSPHORIA
● LEADEN PARALYSIS
● CARB CRAVING, INCR SLEEP, WEIGHT GAIN
● INTERPERSONAL REJECTION SENSITIVITY
● DOC = SSRI
● TCA IS CONTRAINDICATED
PMDD
● RELATIONSHIP PROBLEMS
● SOCIOOCCUPATIONAL IMPAIRMENT
● LATE LUTEAL PHASE DEFECT
POSTPARTM DEPRESSION
● WITHIN 4 WEEKS
● THOUGHTS OF HARMING BABY +
● HELPSEEKING BEHAVIOUR
● RX = SSRI + CBT
PP PSYCHOSIS
● MAX RECURRENCE
● WITHIN 2 WEEKS
● EX= ANTIPSYCHOTICS + ANTIDEPRESSANTS
Scales in depression HAM D
BDI
MADRS
Zung
Raskin
● IN SUICIDALPATIENTS , DECREASED 5HIAA
● MC SIDE EFFECT OF FLUOXETINE = NAUSEA > PARADOXICAL ANXIETY
● FLUOXAMINE = MAXIMUM DRUG INTERACTION, SHORTEST T1/2
● SERTRALINE = MAX SAFE IN DM PT
● PAROXETINE= MAX ANTICHOLINERGIC EFFECT
Bupropion uses
MAJOR DEPRESSION
SMOKING CESSATION
ADHD
HYPOACTIVE SEX DRIVE
CAFFEINE INTOXICATION
NaSSA Mirtazapine
NARI Reboxetine
VAGAL NERVE STIMULATOR
● LEFT VAGUS STIMULATED
ECT
● MINIMUM = 25ms
● MAXIMUM = 180ms
● Unilateral = place on NON DOMINANT SIDE
● MC = RETROGRADE AMNESIA
● CLOZAPINE NOT FDA APPROVED FOR MANIA
● BIPOLAR DEPRESSION MOOD STABILISER OF CHOICE = LAMOTRIGINE
● LITHIUM ADR = LEUKOCYTOSIS
● THERAPEUTIC LEVEL = 0.6 to 1.2 meq/L
● ANTIDOTE FOR TCA TOXICITY = SODIUM BICARBONATE
● MOST COMMON PHOBIA = ANIMALS
● TOKOPHOBIA = PREGNANCY
● AILUROPHOBIA = CATS
● BLOOD PHOBIA CAUSES BRADYCARDIA
● DOC FOR PHOBIA = SSRI
Scale = YBOCS FOR OCD
ACUTE 6STRESS DISORDER ADJUSTMENT DISORDER
Onset within 6 m of stress Within 1 m of stress (ICD) , 3 m of stress (DSM)
PTSD = INTRUSIVENESS IS MOST CONSISTENT SYMPTOM
PTSD INTRUSIVENESS
HYPERAROUSAL
AVOIDANCE
EMOTIONAL NUMBING
● FIRST RX TO START IN PTSD = PHARMACOTHERAPY
● PRAZOSIN DECREASES NIGHTMARES
● PSYCHOTHERAPY OF CHOICE = SUPPORTIVE PSYCHOTHERAPY( ENHANCING COPING SKILLS)
GRIEF
● IF SYMPTOMS LAST LESS THAN 2 MONTHS = BEREAVEMENT REACTION
Bereavement <2months
Normal GRIEF <6months
Dealyed Grief >2WEEKS only starts
Prolonged grief Last >6months
Hypertrophic Grief <1 year but SEVERE
Purposeful wandering Dissociative fugue
Purposeless wandering Psychosis
● DE PERSONALISATION / DE REALISATION = AS IF PHENOMENON
● ATLEAST 6M TO DIAGNOSE SOMATOFORM DISORDERS
● BLOCQʼS DISEASE = ABSTACIA/ABASIA (ABNORMAL GAIT) IN CONVERSION DISORDER
● HOOVERʼS TEST = PSEUDOSEIZURE
● FACTITIOUS = NO GOAL MOTIVE = MUCHHAUSSEN
● CONDUCT D/O = PHYSICALLY ABUSIVE, VIOLATES RIGHTS
● HALLMARK FEATURE OF ANOREXIA = PECULIAR FOOD HANDLING BEHAVIOUR
● LANUGO HAIR + IN ANOREXIA NERVOSA
● CORTISOL, PROLACTIN, TSH INCREASED. REST DECREASED
● SCOFF QUESTIONAIRE FOR FEEDING DISORDERS
NARCOLEPSY
● CORE FTR = CATAPLEXY
● HLA DR 2
● DECREASED OREXIN
● ( SUVOREXANT USED TO RX INSOMNIA NOT NARCOLEPSY)
*ORGASMIC PHASE D/O = PREMATURE EJACULN
*RESOLUTION PHASE D/O = PRIAPISM ( EXPECTED Q) NOT EXCITEMENT PHASE
● Gender realised by 3 years
● 3-6 yrs = PHALLIC PHASE
ADHD <12yrs
6 symptoms
ATLEAST 2 environments
● ADULT ADHD = UTAH CRITERIA
● CONNER RATING SCALE = ADHD
● DOC FOR ADHD = METHYLPHENIDATE
● ADHD ADULT = ATOMOXETINE ( SNRI )
● DOC FOR TOURETTE SX = CLONIDINE
AUTISM
● M- CHAT = CHECKLIST FOR RX OF AUTISM IN TODDLER
● ABNORMAL FINGERPRINT IN AUTISM
● MR IN 30% CASES ONLY
● DEMENTIA INFANTALIS = CHILDHOOD DISINTEGRATIVE D/O = HELLERS
● HELLERS = BOWEL / BLADDER COMPLAINTS
● RETT = XLD (READ MORE ABT RETT)
● DRUG FOR AUTISM TO CONTROL BEHAVIOUR = RISPERIDONE
Personality
Schizoid Fantasy thinking
Schizotypal Magical thinking ( also OCD)
● SEDUCTIVE, EMOTIONAL LABILITY = HISTRIONIC
● SUICIDAL = BORDERLINE
● BORDERLINE O.D = AMBULATORY SCHIZOPHRENIA/ PSEUDONEUROTIC SCHIZO
As if phenomenon Depersonalisation/ De realisation
As if personality Borderline Pd
● mc dissociative disorder = AMNESIA (DISSOCIATIVE/ PSCHOGENIC AMNESIA)
PERSONALITY
Type A CAD PRONE
Type B Relaxed
Type C CANCER PRONE
Type D Depression / Cardiac
Type H Hardiness personality
● REMOTE MEMORY NORMAL IN DELIRIUM
● GENERALISED SLOWING ON EEG = DELIRIUM
● DEMENTIA = 6 MONTHS NEEDED
Cortical Subcortical
ALZHEIMERS HUNTINGTON
BINSWANGER DS
HIV DEMENTIA
● GLUTAMATE INCREASED IN HIPPOCAMPUS IN ALZHEIMERS
● ICD = GAMING DISORDER
● DSM = GAMBLING DISORDER
● NICOTINE WITHDRAWAL = WEIGHT GAIN, BRADYCARDIA
●
● COCAINE, AMPHETAMINE WITHDRAWAL = DEPRESSION
Amphetamine acute use Paranoid schizo
Amphetamine chronic use Tactile hallucination
● BUPROPION DECREASES SEIZURE THRESHOLD
ALCOHOL WITHDRAWAL
1st day Tremor, nightmare
2nd day SEIZURES ( GTCS ONLY)
3rd day Delirium tremens
● ALICE IN WONDERLAND = SSPE
Mind
TOPOGRAPHIC MODEL STRUCTURAL MODEL
CONSCIOUS ,PRECONSCIOUS,UNCONSCIOUS ID , EGO, SUPER EGO
ASCIETISM Turning spiritual ( mnemonic = spirit ingestion causes
ASCITES)
ALTURISM Giving charity
● MOST MATURE = SUBLIMATION
Oral phase SCHIZO, ALCOHOL
Anal OCD, OCPD
Phallic HYSTERIA
Latency Neurosis
Genital Neurosis
