Affect and Mood
Describing affect: Type / quality, Range / variability, Degree / intensity, Stability / reactivity, Congruence, Appearance
Affect has three functions
Describing mood: Type / quality, Stability, Pattern of mood disturbance
Fungal laryngitis should be suspected in refractory cases.This is seen in immuno compromised as well as immuno competent cases.It mimics leucoplakia, or malignancy.
Affect and Mood
Describing affect: Type / quality, Range / variability, Degree / intensity, Stability / reactivity, Congruence, Appearance
Affect has three functions
Describing mood: Type / quality, Stability, Pattern of mood disturbance
Fungal laryngitis should be suspected in refractory cases.This is seen in immuno compromised as well as immuno competent cases.It mimics leucoplakia, or malignancy.
This presentation describes the concept of temporal plus syndrome, pseudotemporal epilepsy and paradoxical temporal lobe epilepsy and how to differentiate them from temporal lobe epilepsy.
Somatoform disorder include different entities. One of complex and difficult to treat ailment among the somatoform disorder is illness anxiety disorder, formerly known as hypochondriasis. My power point presentation is an attempt to simplify the mystery of this common psychiatric diagnosis. (Dr Satyajeet Singh, MD, Neuropsychiatrist, Aiims Patna)
This presentation describes the concept of temporal plus syndrome, pseudotemporal epilepsy and paradoxical temporal lobe epilepsy and how to differentiate them from temporal lobe epilepsy.
Somatoform disorder include different entities. One of complex and difficult to treat ailment among the somatoform disorder is illness anxiety disorder, formerly known as hypochondriasis. My power point presentation is an attempt to simplify the mystery of this common psychiatric diagnosis. (Dr Satyajeet Singh, MD, Neuropsychiatrist, Aiims Patna)
Schizophrenia is a significant mental disorder in which people interpret reality abnormally & it may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs daily functioning. Through this period Anti psychotic & Psycho social treatment improve the condition.
REPORT-CHILDREN WITH NEUROLOGICAL AND HEALTH PROBLEMS.pptxzarinaregalado2
PowerPoint presentation on children with neurological and health problems related to guidance and counseling. Contents range from nature, etiology, assessment, and prevalence of the disability.
Generalized anxiety disorder (GAD) is marked by excessive exaggerated anxiety and worry about every day life events for no obvious reason.People with GAD tend to always expect disaster and can't stop worrying about health,family,work or school.
This is a presentation done on 4/6/11 for the Grand Rounds at Wayne State university by Pallav Pareek M.D.
This presentation talks about the concept of prdrome as it is(if?) applicable to schizophrenia, and if schizophrenia is becoming more of a preventable illness as science progresses. If so what are the various ways and means in which we can accomplish this prevention.
Amidst so much controversy on the issue , whether there is a prodrome for this illness or not, here I have tried to present the recent advances in this field and the recent scientific literature in this regard.
Similar to Interface between Psychiatry and Otorhinolaryngology- Dr.Mahesh Desai (17)
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. A few firsts
? How many of you feel that Psychiatrists
can be of help in treating ENT problems
? How many of you feel that patients are
not ready to go to Psychiatrists and you
fear losing them
? How many of you feel that their
Psychiatric Patients are demanding and
time consuming and you do not want to
see them again
3. Justification of Subject
Interface : a point where two systems,
subjects, organizations, etc. meet and interact.
For e.g. if we see sign and symptoms of
anxiety and tinnitus both seem to be different
and patient would approach both differently.
But the interface lies in patho-physiology and
cause. It has normal structure but still has
defective functioning.
4. Need for its discussion
We haven’t invented anything . May be in far
future psyotorhinology is declared as a
specialization branch.
But the frequent presentation of sufferings of
human and some vacuum created as inability to
give complete cure. this led to the necessity and
gathered us here to achieve the cure.
‘Necessity is mother of invention’
5. Introduction
The link between ENT disorders and a
patient’s psychology is increasing rapidly due
to more awareness of diseases.
The patients look for the information on the
disease on the Internet and become
apprehensive, confused and mentally
disturbed unnecessarily.
Several research studies have established a
strong connection between the interplay of
psychology and it’s manifestation of the ENT
diseases and vice versa.
6. The Conditions in the field between
otorhinolaryngology and psychiatry can be
classified into two :
Psychiatric conditions resulting
from ENT diseases
Interventions and those
expressing themselves as ENT
symptoms
Psychiatric conditions resulting
from ENT diseases
ENT diseases or interventions and
those expressing themselves as
ENT symptoms due to mental
ailment.
Example:
This includes hearing impairment,
dizziness, tinnitus, choked airway,
bad oral breath, stuffy nose,
traumatic interventions and
external nasal deformities.
Example:
This includes exaggerated and
diminished pharyngeal refl ex,
globus hystericus, speech
disorders, vasomotor rhinitis, nose
picking, choked feeling, dizziness
and headache.
7. Statistics
According to the statistics globally and
seen by me during my practice
approximately 30-40% of patients
presenting with ENT s/s have underlying
psychiatric illness.
Females out numbers males.
8. This is simple graph presenting the ratio of psychological
disorders among both genders
0
2
4
6
8
10
12
14
No.ofpatients
Psychological Disorders
Male
Female
9. ENT illnesses with psycho-somatic
co-morbidity
Ear illnesses
Tinnitus
Hyperacusis and Phonophobia
Psychogenic hearing disorder
Hardness of hearing and deafness
Morbus Menière
Vertigo
10. Upper respiratory diseases
Acute and recidiving infections/
acute rhinitis
Chronic and allergic rhinitis
Sick building syndrome
Disease of pharynx
Glossodynia/burning mouth syndrome
Globus pharyngeus
Dysphagia and phagophobia /oropharyngeal
swallowing disorder.
11. Diseases of Layrnx
Psychogenic dysphonia and aphonia
Laryngeal dysfunction- Laryngospasm
and Laryngismus
Bruxism and temporomandibular
dysfunction
Dysmorphophobia
Malign diseases of ENT region
12. Psychological implications of
deafness
Hard of hearing is usually accompanied by feeling like
isolation, mistrust, paranoid conditions, and depression
which are most pronounced in deaf people. Prevalence
rate being 15-60%.
Most of studies conclude that the prevalence of affective
disorders in hearing impaired children and adolescent Is
comparable with estimate of normal hearing people.
Studies suggested that deaf children show greater degree
of impulsivity.
Delusional disorder is more common in hearing impaired
people.
Patients who refuse to go for hearing aid, they have
underlying anxiety.
13. Tinnitus
Tinnitus, buzzing or ringing sounds perceived by the
patients in one or both ears causes a lot of anxiety and
emotional disturbances to the patient and sometimes
disturbs even sleep.
These patients should be investigated properly to rule
out any neurotological cause especially for unilateral
tinnitus.
Most of the time, no cause is found and it is termed as
idiopathic.
Instead of labeling them idiopathic we need to analyze
their history emotionally/socially. This somatic form of
presentation is highly prevalent with co-morbid
depression/anxiety. In that case what we need to treat is
emotional turmoil and not tinnitus.
14. According to an article published in international
archives of otorhinolaryngology, there is an
important relationship between tinnitus,
hallucinatory phenomena, and depression
based on persistent recall of facts/situations
leading to psychic distress.
The knowledge of such findings represents a
further step towards the need to adapt the
treatment of this particular subgroup of tinnitus
patients through interdisciplinary team work.
15. A sample of 53 male and female patients with
tinnitus between the age of 13 and 50 years
More numbers of female were there than males and
majority were in between 30-39 years.
Middle class and upper middle classes were most
affected.
Both married and unmarried people were equally.
The prevalence of psychiatric co-morbidity in these
tinnitus patients follows in descending order:
Major depressive disorder >>>Social Phobia>
Suicide> Panic disorder> Obsessive Compulsive
Disorder> Agoraphobia=Dysthymic disorder =
Generalized-anxiety.
16. Vertigo
Studies suggest 50% of person who present to
clinics for dizziness have anxiety and reactive
depression with anxiety.
A review of prevalence of panic was published
by Simon other in ‘98 . They document
prevalence varying 3-41% in dizziness
specialty clinic.
Psychogenic dizziness or vertigo consists of a
sensation of motion(spinning, rocking, tilting,
levitating disorder. That can be reasonably
attributed to psychiatric disorder. e.g., anxiety,
depression, somatic disease.
17. Simon and associates (1998) reviewed three
explanatory models (hypotheses) regarding the known
association between anxiety (panic) and dizziness
Psychosomatic model Somatopsychic model Network alarm model
a primary psychiatric
disturbance causes dizziness
(psychiatric chicken causes
dizziness egg)
a primary inner ear
disturbance causes anxiety.
(dizziness egg produces
psychiatric chicken which
produces more dizziness
eggs)
renamed variant of
somatopsychic model
Hyperventilation and
hyperarrousal increased
vestibular sensitivity.
Signals from the inner ear are
misinterpreted as signifying
immediate danger, which
increases anxiety. Increased
anxiety increases
misinterpretation.
Conditioning makes it
persistent.
Panic is triggered by a "false
alarm" via afferents to the
locus ceruleus (an area in the
brain), which then triggers a
"neuronal network", including
limbic, midbrain and
prefrontal areas. This
explanation seems to us to
be the "somatopsychic"
model, renamed and
attached to a specific brain
localization
18. Panic Syndrome:
Situational pattern is major factor that
helps in diagnosis of anxiety.
Examples:
Vertigo disappears on vacation .
Mother in law comes and the complain
starts.
19. Differentiation
PPV(phobic postural vertigo) CSD( chronic subjective dizziness)
Triggered Constant
Without any signs Without any medical conditions
E.g., fear of falling without any real fall Lack of other explanation
Persistent > 3 month
Chronic motion sensitivity
Exacerbation with use of vision
PPPD (Persistent Post Perceptual Dizziness) is the replacement acronym for CSD.
20. Headache
This symptom has many causes including various
ENT diseases.
It is commonly known that patient’s psychology and
mental factors play an important part in its genesis
and progress and migrainous headache is classical
example.
Headache is considered as non-specific syndrome
illustrating the concept of pain as an emotion.
Just as the ‘brain’ can not easily be separated from
the ‘mind’, so as to believe that some pain is
‘physical’ and some ‘emotional’ is a distortion.
21. External nose deformity
Minor external nasal deformities and
illusion of non existing nasal deformities
especially in young males is used as
scapegoat for underlying mental
disturbance.
The surgeon should assess and evaluate
psychological, socio-cultural perspective
along with physical manifestations.
The late stage of cocaine abuse can result
in perforation of nasal septum and difficulty
in breathing.
22. Dysmorphophobia
It is defined as preoccupation with an imagined defect in
ones physical appearance.
For example time consuming rituals such as mirror gazing
or constant comparing.
There was a man named Wolfman who had
preoccupation of imagined defects on his nose.
There is frequent co-morbidity in BDD especially in
depression, social phobia, OCD and delusional disorder.
So the doctors need to go through thorough case history
to rule out this in order to avoid irrational surgeries.
23. Acute and Recidiving Infections/
Acute Rhinitis
Whether as a doctor or as a patient, we are all
aware of the phenomenon that we catch an
infection a lot quicker when we are under stress
(night watch!). Stress can lead to an increased
occurrence of respiratory.
24. Chronic and Allergic Rhinitis
Chronic Rhinitis is a common illness. Characteristics
symptoms are a blocked nose, runny nose and frequent
sneezing.
At first glance, allergic and psychosomatic reactions seem
to have nothing in common.
Studies into psycho-immunology have shown that allergic
reaction can be curbed with hypnotic suggestion.
Experimental studies furthermore found out that plasma
histamine concentration rises under pressure.
Allergies can develop from auto-suggestion and strong
feelings of anxiety let skin react more sensitivity to
potential allergies.
25.
26. Relation between Rhinitis and
Depression
Despite stark differences in methodologies, the majority of
published studies indicate some type of indistinct relationship
between allergies and anxiety and mood disorders.
The strength of these associations is difficult to discern,
given the present data.
There may be a number of allergy-related mediating
variables, such as alterations in immunity/cytokines, the
effect of nasal obstruction on sleep, disturbed cognitive
functioning and genetic overlap.
Regardless, current evidence indicated that individuals with
allergies appear to be at a higher risk, of an unknown
degree, for developing various types of anxiety and/or
syndromes.
27. Globus Pharyngeus
Patients suffer from a lump or foreign body sensation
in the throat, sometimes in combination with
increased mucous production and the feeling of
having to clear throat.
Therapy should start with an instructive talk following
a careful ear, nose and throat examination. If the
symptoms are recent, improvement can often
already be reached quickly.
Psychosomatic aspects and a conversion disorder
often play a role in oropharyngeal swallowing
disorders, especially if no organic cause could be
found. Women with anxious –hypochondriac
behavior patterns are mostly affected.
28. Hysterical Aphonia – Sudden,
dramatic loss of speech. One simple
test to clinch the diagnosis is to ask
the patient to write –If she/he can
write easily it is aphonia.
29. Malignancy
The malignancy growth occurs in ear, nose , throat.
More commonly in throat cancer, if the patient is found to
refuse the treatment. We need to rule out the fears. Fears
like fear of chemotherapy, surgery, any deformity caused.
So basically psychiatric intervention could ease the case
for further management.
The other group of patients is one who don’t have cancer
actually but do have profound fear of cancer.
So they keep hoping from doctors to doctors.
We need to educate them about anxiety and further
psychiatric treatment if required.
30. When you should suspect psychiatric
illness or psychological problem?
ALL YOUR ENT EXAMINATION –WNL FIRST AND FORMOST
Illness longer than 3 months?
If you ask anything else, co-morbid many physical complain as
we Asians somatize.
Sleep/appetite disturbance
Terminal insomnia.
Doctor shopping.
Diffusely specific but specifically vague.
History of response to anxiolytics and poor response to
conventional treatments.
Repeat visits. Not happy or satisfied with response.
NO OBJECTIVE LESION
31. Do’s
Reassurance and proper scientific explanation like using models like
chemical imbalance or sympathetic, parasmpathetic system.
How I explain the phenomenon.
Learning use of SSRI and anxiolytics.
Dispersible clonazepam
Life style changes.
Explain the difference between structural damage and functional
etiology .
I have examined your ear, nose and throat thoroughly. I do not find
any structural damage and there are chances that this is disorder of
function rather than any damage to structure.’
32. Dont’s
Please don’t tell them that it is all in your mind. Then giving
long list of medicines.
Please don’t threaten them that if you don’t behave then I will
send you to psychiatrist.‘
Writing in illegible words at the corner of a case papers in small
letters ‘Reference to Psychiatrist’. And giving them a long list of
investigations, that is unfair.
Avoid extensive, costly investigation to rule out rare disorders
and if at all you want to do it, explain the purpose.
Leaving things to your subordinates giving them printed
instructions rather than that explain the vestibular exercise,
demonstrate them .
33.
34.
35.
36.
37. Anxiolytics
Drug (generic name) Trade Name Equivalent Potency Dosage Range/Day (in mg
oral)
Benzodiazepines
Chlordiazepoxide Librium Long 20 to 100
Equillibrium Long
Diazepam Paxum Long 2 to 60
Vallium Long
Calm doze Long
Calmode Long
Oxazepam Serepax Short 30-120
Alprazolam Zolax Short .5 to 6
Alprax Short
Alzolam Short
Zenex Short
Lorazepalm Larpose Short 5 to 10
Ativan Short
Trapex Short
Clonazeplam Klonopin Long .5 to 10
Nitrazeplam Nitravet Short 5 to 10
Nirosun Short
38. Drug (generic name) Trade Name Equivalent Potency Dosage Range/Day
(in mg oral)
Flupenthixol Fluanxol Long .5 to 3
Risperidone Long .5 to 1
Olanzepine Oliza Long .5 to 5
Trifluperanil Esporine Long 1 to 2.5
39. Summary of therapeutic
method
Pharmacological Interventions
Relaxation methods
Autogenic training
Progressive muscle relaxation
Biofeedback
Yoga, Qi Gong and Tai Chi
Hypnosis
Talks as part of psychosomatic- primary health care
Behavioral therapy
40. Advice to Doctors
Right at the starting of the first consultation doctor
should ask about acute or chronic stress.
Besides offering organic forms of treatment,
encouraging patients to learn relaxation methods is
also a sensible approach.
It’s important for the doctor to empathically
understand the situation, which is seen as
existentially threatening by patient.
The doctor should immediately clarify the
psychological factor and advise interdisciplinary
treatment to prevent the disorder from becoming
chronic.
41. As Otorhinolaryngologists which possibilities
are open to us for diagnosing psychosomatic
disorders ?
What seems to be the trouble?
When did the symptoms first arise, what caused the
trouble , and what coincide with trouble?
Have there been any drastic changes in your life
recently? Have you had any bad experiences?
Have you had problems with your ears/ nose before?
What steps have you taken so far?
How do you picture your treatment?
42. We psychiatrists are poor cousins of medical
fraternity, divorced from medicine so patients would
rather die, than come to us
In this situation all my esteemed ENT surgeons must learn to
manage the population, other wise the likely scenario would be:
1) Patients going to alternative system of medicine , faith
healers , sooth Sayers and giving our allopathic system
bad name.
2) Repeated unnecessary admission , unnecessary medical
workup, are a burden to health care delivery system , taking
us away from attending more deserving seriously ill patients.
3) Poorly treated or half heartedly treated depression
becoming resistant depression just like resistant T.B.
43. 4) Use of short acting Benzodiazepine sold by chemist
without prescription creating iatrogenic drug
dependence.
5) Undiagnosed or ignored co - morbid psychiatric
illness in surgical patients leading to delayed
recovery ,out of proportion expectations and
sometimes even a medico legal case.
6) Poor communication leading to doctor shopping.
7) Secondary complication of hospitalization like
hospital infection.
44. Prognosis and Outlook: Psychosomatic Disorder
Prognosis of a psychosomatic disorder depends crucially
on the duration of illness and on the number of already
administered and mostly unsuccessful attempts at
treatment. A psychiatrist co -morbidity such as anxiety or
depression is mostly accompanied by an increased
severity of the disorder and worse prognosis.
On the part of the otolaryngologist, it is the organ medic’s
opportunity that many patients first come to them with
organic complaints and psychosomatic disorders.
This gives them the chance to help patients using a
psychosomatic therapy approach and thereby avoid
letting the troubles become chronic.
45. References
Savistino M, Marioni G, Aita M., ENT Journal
Simon N M, Pollack M H., Tuby K. S, Stern T A., Dizziness and panic disorder: a review of association
between vestibular dysfunction and anxiety, Annals Clin Psych
Clouse RE, Lustman PJ, Psychiatric illness and contraction abnormalities of the esophagus. N Engl J
Med. 1983;309:1337-1342
Decot E., Therapeutic methods for psychosomatic disorders in oto-rhino-laryngology,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3200998/
Warninghoff J C, Bayer O, Ferrai U, Strabue A, Co-morbidities of vertiginous diseases, BMC
Neurology, DOI: 10.1186/1471-2377/9/29
Bisdorff A, Bosser G, Gueguen R, Pernn P, The epidemology of vertigo, dizziness and unsteadiness
and its link to co-morbidities, Frontiers in Neurology, 2013;Vol 04; Article 29
Indian Journal of Otolaryngology