Late onset mania is a kind of Psychiatric illness in which Manic symptoms develops for the first time after the age of 60 years or the continuation of recurrent bipolar illness.
Negative symptoms in schizophrenia can be primary or secondary. Primary negative symptoms are intrinsic to schizophrenia while secondary symptoms are caused by other factors like positive symptoms or medication side effects. Persistent primary negative symptoms present for over 6 months may indicate the deficit syndrome. Several rating scales exist to measure negative symptoms, including the Scale for Assessment of Negative Symptoms (SANS) and Positive and Negative Syndrome Scale (PANSS). Treatment involves addressing secondary causes and then using second generation antipsychotics like low-dose amisulpride or adjunctive antidepressants for primary symptoms.
Major depression (MD) is an illness that affects mood, body, and thoughts. It impacts sleep, appetite, feelings of self-worth, and how one thinks. MD cannot be willed away and without treatment, symptoms can last for weeks, months or years. Treatment such as antidepressants and psychotherapy can help most people with MD. Physical and genetic factors along with life stressors can contribute to the development of MD.
Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder, is characterized by two or more distinct personalities that take control of a person. Psychotherapy is the primary treatment, involving establishing trust and safety, mapping alters and trauma history, processing trauma memories, and integrating alters. Integration aims to unite alters into a single identity, while resolution stabilizes alter cooperation. Relapse is common, requiring ongoing treatment to solidify gains and prevent dissociative coping.
The document summarizes a presentation on thought and thought disorders. It defines thought, describes different types of thinking (fantasy, imaginative, rational), and characteristics of healthy thinking. It then discusses thought disorders, formal thought disorders, and specific disorders like flight of ideas, poverty of speech, circumstantiality, and loose associations. Research on thought disorders in schizophrenia is mentioned, focusing on structural brain abnormalities and biomarkers.
This document defines and describes organic mental disorders and organic mental syndromes. It discusses disorders, syndromes, and organic mental syndrome. Organic mental disorders result from changes in the brain due to various causes like toxicity, tumors, infections, or metabolic changes. The document outlines classifications of organic mental disorders in ICD-10 and DSM-IV and describes specific disorders like dementia, delirium, and amnestic syndromes. It discusses causes, risk factors, types, and features of organic mental disorders and provides detailed descriptions of delirium and dementia.
This document provides an overview of Acute and Transient Psychotic Disorder (ATPD). It discusses the history and evolution of ATPD from early descriptions in the late 19th century to its inclusion as a diagnostic category in ICD-10 in 1992. The document outlines the ICD-10 diagnostic criteria for ATPD and reviews several landmark studies that helped establish ATPD as a separate diagnostic category from schizophrenia and affective disorders. It also discusses cultural variants of brief psychotic episodes and debates around classifying certain culture-bound syndromes as ATPD.
This document provides an overview of long-acting injectable antipsychotics (LAIs). It discusses the benefits of LAIs including consistent drug delivery and improved compliance. It then describes the pharmacology of first-generation LAIs such as fluphenazine, haloperidol, and zuclopenthixol. Second-generation LAIs including risperidone, paliperidone, and olanzapine are also reviewed in terms of their absorption, metabolism, and indications. The advantages and disadvantages of different LAIs are compared.
Negative symptoms in schizophrenia can be primary or secondary. Primary negative symptoms are intrinsic to schizophrenia while secondary symptoms are caused by other factors like positive symptoms or medication side effects. Persistent primary negative symptoms present for over 6 months may indicate the deficit syndrome. Several rating scales exist to measure negative symptoms, including the Scale for Assessment of Negative Symptoms (SANS) and Positive and Negative Syndrome Scale (PANSS). Treatment involves addressing secondary causes and then using second generation antipsychotics like low-dose amisulpride or adjunctive antidepressants for primary symptoms.
Major depression (MD) is an illness that affects mood, body, and thoughts. It impacts sleep, appetite, feelings of self-worth, and how one thinks. MD cannot be willed away and without treatment, symptoms can last for weeks, months or years. Treatment such as antidepressants and psychotherapy can help most people with MD. Physical and genetic factors along with life stressors can contribute to the development of MD.
Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder, is characterized by two or more distinct personalities that take control of a person. Psychotherapy is the primary treatment, involving establishing trust and safety, mapping alters and trauma history, processing trauma memories, and integrating alters. Integration aims to unite alters into a single identity, while resolution stabilizes alter cooperation. Relapse is common, requiring ongoing treatment to solidify gains and prevent dissociative coping.
The document summarizes a presentation on thought and thought disorders. It defines thought, describes different types of thinking (fantasy, imaginative, rational), and characteristics of healthy thinking. It then discusses thought disorders, formal thought disorders, and specific disorders like flight of ideas, poverty of speech, circumstantiality, and loose associations. Research on thought disorders in schizophrenia is mentioned, focusing on structural brain abnormalities and biomarkers.
This document defines and describes organic mental disorders and organic mental syndromes. It discusses disorders, syndromes, and organic mental syndrome. Organic mental disorders result from changes in the brain due to various causes like toxicity, tumors, infections, or metabolic changes. The document outlines classifications of organic mental disorders in ICD-10 and DSM-IV and describes specific disorders like dementia, delirium, and amnestic syndromes. It discusses causes, risk factors, types, and features of organic mental disorders and provides detailed descriptions of delirium and dementia.
This document provides an overview of Acute and Transient Psychotic Disorder (ATPD). It discusses the history and evolution of ATPD from early descriptions in the late 19th century to its inclusion as a diagnostic category in ICD-10 in 1992. The document outlines the ICD-10 diagnostic criteria for ATPD and reviews several landmark studies that helped establish ATPD as a separate diagnostic category from schizophrenia and affective disorders. It also discusses cultural variants of brief psychotic episodes and debates around classifying certain culture-bound syndromes as ATPD.
This document provides an overview of long-acting injectable antipsychotics (LAIs). It discusses the benefits of LAIs including consistent drug delivery and improved compliance. It then describes the pharmacology of first-generation LAIs such as fluphenazine, haloperidol, and zuclopenthixol. Second-generation LAIs including risperidone, paliperidone, and olanzapine are also reviewed in terms of their absorption, metabolism, and indications. The advantages and disadvantages of different LAIs are compared.
This presentation is about geriatric Psychiatry awareness. it contains basic information about what is geriatric psychiatry, which are the main psychiatry disorder found in elderly and how to manage them?. it contains some detailed information about late life depression, delirium and dementia in geriatric population.
The document provides an overview of mood stabilizers, including their definition, classification, mechanisms of action, and side effects. It defines mood stabilizers as medications that decrease vulnerability to manic or depressive episodes without exacerbating current symptoms. Common mood stabilizers are lithium, anticonvulsants like valproate and carbamazepine, and atypical antipsychotics. These medications impact neurotransmitter systems and signaling pathways in the brain to achieve their mood stabilizing effects, but can also cause side effects like tremors, weight gain, thyroid and kidney issues.
This document summarizes dissociative disorders, including their causes, symptoms, and types. Dissociative disorders often develop as a coping mechanism for childhood trauma and result in a disturbance of identity and memory. The main types discussed are dissociative amnesia, characterized by memory loss; dissociative fugue, involving sudden travel away from one's surroundings; and dissociative identity disorder, previously called multiple personality disorder, defined by switching between alternate identities. Biological and neurological factors as well as family dynamics can contribute to dissociative disorders developing in response to trauma.
This document discusses the treatment of psychiatric disorders through pharmacotherapy, psychotherapy, and somatic treatments. It focuses on the role of medications in treating various conditions like mood disorders, schizophrenia, anxiety, sleep disorders, substance use disorders, and others. It provides details on specific drug classes and examples used to treat each condition. It also covers electroconvulsive therapy (ECT) and discusses what it is, how it works, when it may be used, potential side effects, and the ECT administration and recovery process. Psychotherapies are also mentioned as important treatment options.
Bipolar disorder causes extreme shifts in mood from mania to depression. It is a chronic illness often diagnosed in adolescence that has high rates of suicide. While the causes are unknown, genetic and environmental factors likely contribute. Diagnosis involves meeting DSM-5 criteria for manic or hypomanic episodes. Treatment includes medication, psychotherapy, and lifestyle changes. Lithium and anticonvulsants are commonly used to stabilize moods, while antidepressants may be used for depression but carry risk for inducing mania. Long-term management focuses on preventing recurrences through medication adherence and monitoring for risky behaviors.
1) Amnestic disorders involve memory disturbances, especially amnesia, caused by organic brain damage or disease.
2) There are several types of amnestic disorders including those due to alcoholism (Wernicke-Korsakoff syndrome), head trauma, viral infections, and transient global amnesia.
3) The disorders are characterized by difficulties forming new memories (anterograde amnesia) and sometimes retrieving old memories (retrograde amnesia) due to lesions in areas like the hippocampus and mammillary bodies. People may also experience confabulation.
Schizoaffective disorder is a chronic mental health condition characterized by symptoms of both schizophrenia and mood disorders like mania or depression. It affects a person's thoughts, emotions, and potentially their actions. It is considered a disorder of both the mind and emotions. Schizoaffective disorder can be of the bipolar, depressive, or mixed type depending on the symptoms present. Treatment involves medications like antipsychotics and mood stabilizers as well as psychotherapy and life skills training. Nursing care focuses on ensuring safety, promoting functioning, and supporting treatment compliance.
THERE ARE LOTS OF DISORDERS IN MENTAL HEALTH ASPECT.THIS PRESENTATION'S FOCUS IS ON PANIC DISORDER AND ITS MANAGEMENT.THIS CLASS IS IN ASPECT OF PSYCHIATRIC NURSING STUDENTS.
The STAR*D trial aimed to identify effective next-step treatments for patients who did not respond to initial antidepressants. However, the study misrepresented data to claim higher remission rates. The actual remission rate was only around 3%, rather than the reported 40%. Investigators inappropriately changed outcome measures and excluded dropouts to inflate results. They also underreported treatment-emergent suicidal ideation. The study investigators had conflicts of interest that may have biased their analysis and presentation of the data. In reality, the study showed antidepressants have only marginal efficacy compared to placebo.
Neuropsychiatric aspects of traumatic brain injuryAzfer Ibrahim
1) Traumatic brain injury (TBI) can cause various neuropsychiatric issues including mood disorders, cognitive deficits, and behavioral changes.
2) Common mood disorders after TBI include depression in 25-50% of patients in the first year, as well as increased risks of mania/hypomania and anxiety disorders.
3) Frequent cognitive deficits involve problems with memory, attention, concentration, language, and executive functioning that can cause long-term impairment.
The document discusses the history and evolution of somatic symptom and related disorders. It describes how concepts like hysteria, hypochondriasis, and psychosomatic disorders developed before being categorized under somatic symptom disorder, illness anxiety disorder, conversion disorder, and other diagnoses in DSM-5. It provides details on the characteristic symptoms, thresholds, and specifiers for each DSM-5 disorder category. Theories on the causes of related conditions like pseudocyesis are also summarized.
Neuro-Psychiatric aspect of Diabetes MellitusDr.Jeet Nadpara
- The document discusses the neuro-psychiatric aspects of diabetes mellitus, including the links between diabetes and conditions like depression. It notes that as early as the 17th century, diabetes was thought to be caused by sadness or emotional distress.
- Managing diabetes requires significant patient self-care and support systems, but psychiatric illnesses can interfere with self-management behaviors. Conditions like depression may also impact diabetes through neurohormonal changes.
- The document examines topics like cognitive effects of diabetes, links between diabetes and depression, eating disorders and diabetes, and the impacts on patients, families, and development.
Major Depressive Disorder is characterized by at least five symptoms of depression lasting at least two weeks. The document discusses the various types of depression like major depression, dysthymia, seasonal affective disorder, atypical depression, bipolar disorder, and others. It also discusses the causes of depression including genetic, environmental, medical factors. Treatment involves medication, psychotherapy, and social support depending on the severity and type of depression.
Dementia can sometimes be caused by reversible conditions. This document discusses several potential reversible causes of dementia, including thyroid disorders, vitamin deficiencies, infections, and side effects of medications like steroids. It provides details on specific disorders and how treatment of the underlying condition may resolve cognitive and behavioral symptoms. Reversible dementias are estimated to account for 18% of cases under 65 but only 5% of those over 65. While treatment can sometimes improve symptoms, complete reversion of cognitive impairment is unclear for certain conditions like Cushing's syndrome.
This document provides an overview of delirium, including its introduction, history, epidemiology, etiology, neuropathology, diagnosis, differential diagnosis, course, prevention and management. Delirium is characterized by an acute change in mental status and cognition that fluctuates over the course of a day. It has a prevalence of 5-55% among elderly hospitalized patients and is associated with increased mortality, longer hospital stays and higher healthcare costs. The pathophysiology involves multiple neurotransmitter systems and risk factors include predisposing patient factors and precipitating insults like infection, medication side effects or metabolic disturbances. Prevention focuses on reducing risk factors and early diagnosis and treatment can improve outcomes.
This document discusses drug-induced movement disorders caused by antipsychotic medications. It covers the classification of both acute and chronic movement disorders including dystonia, parkinsonism, akathisia, and tardive dyskinesia. It discusses the pathophysiology, risk factors, signs and symptoms, time of onset, scales used for assessment, management, and prevention of these medication-induced movement disorders. It also lists other medications that can cause movement disorders and the DSM-5 diagnostic categories for medication-induced movement disorders.
Psychopharmacology and Cardiovascular Disease - psycho cardiologymagdy elmasry
Psychopharmacology andCardiovascular Disease.Your Heart And Mind Are Connected.Psychiatric Disorders and Cardiovascular System .Cardiac response to acute stress .Heart disease and depression are closely linkedCardiovascular Side Effects of Psychotropic Drugs
.
Bipolar disorder is a brain disorder that causes unusual shifts in mood and energy levels. It is characterized by periods of depression and periods of mania or hypomania. There are four main types of bipolar disorder defined by the severity and length of mood episodes. Bipolar disorder is caused by biological and genetic factors that impact brain chemistry. Effective treatments include mood stabilizing medications, antipsychotic medications, psychotherapy, and electroconvulsive therapy in severe cases.
Bipolar disorder is a mental illness characterized by periods of depression and periods of mania or hypomania. It is a lifelong condition that affects about 2% of the global population. The exact causes are unknown but include genetic and environmental factors. Treatment involves lifestyle changes and lifelong medication with mood stabilizers, antipsychotics, or antidepressants to reduce symptoms and prevent recurrence. Left untreated, bipolar disorder can lead to substance abuse, legal and financial problems, relationship issues, and increased risk of suicide.
This presentation deals with the various medicines used in the treatment of depression and mania. The drugs used include MAO inhibitors, tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin and noradrenaline reuptake inhibtors and atypical antidepressants with a brief mention of Lithium at the end
This presentation is about geriatric Psychiatry awareness. it contains basic information about what is geriatric psychiatry, which are the main psychiatry disorder found in elderly and how to manage them?. it contains some detailed information about late life depression, delirium and dementia in geriatric population.
The document provides an overview of mood stabilizers, including their definition, classification, mechanisms of action, and side effects. It defines mood stabilizers as medications that decrease vulnerability to manic or depressive episodes without exacerbating current symptoms. Common mood stabilizers are lithium, anticonvulsants like valproate and carbamazepine, and atypical antipsychotics. These medications impact neurotransmitter systems and signaling pathways in the brain to achieve their mood stabilizing effects, but can also cause side effects like tremors, weight gain, thyroid and kidney issues.
This document summarizes dissociative disorders, including their causes, symptoms, and types. Dissociative disorders often develop as a coping mechanism for childhood trauma and result in a disturbance of identity and memory. The main types discussed are dissociative amnesia, characterized by memory loss; dissociative fugue, involving sudden travel away from one's surroundings; and dissociative identity disorder, previously called multiple personality disorder, defined by switching between alternate identities. Biological and neurological factors as well as family dynamics can contribute to dissociative disorders developing in response to trauma.
This document discusses the treatment of psychiatric disorders through pharmacotherapy, psychotherapy, and somatic treatments. It focuses on the role of medications in treating various conditions like mood disorders, schizophrenia, anxiety, sleep disorders, substance use disorders, and others. It provides details on specific drug classes and examples used to treat each condition. It also covers electroconvulsive therapy (ECT) and discusses what it is, how it works, when it may be used, potential side effects, and the ECT administration and recovery process. Psychotherapies are also mentioned as important treatment options.
Bipolar disorder causes extreme shifts in mood from mania to depression. It is a chronic illness often diagnosed in adolescence that has high rates of suicide. While the causes are unknown, genetic and environmental factors likely contribute. Diagnosis involves meeting DSM-5 criteria for manic or hypomanic episodes. Treatment includes medication, psychotherapy, and lifestyle changes. Lithium and anticonvulsants are commonly used to stabilize moods, while antidepressants may be used for depression but carry risk for inducing mania. Long-term management focuses on preventing recurrences through medication adherence and monitoring for risky behaviors.
1) Amnestic disorders involve memory disturbances, especially amnesia, caused by organic brain damage or disease.
2) There are several types of amnestic disorders including those due to alcoholism (Wernicke-Korsakoff syndrome), head trauma, viral infections, and transient global amnesia.
3) The disorders are characterized by difficulties forming new memories (anterograde amnesia) and sometimes retrieving old memories (retrograde amnesia) due to lesions in areas like the hippocampus and mammillary bodies. People may also experience confabulation.
Schizoaffective disorder is a chronic mental health condition characterized by symptoms of both schizophrenia and mood disorders like mania or depression. It affects a person's thoughts, emotions, and potentially their actions. It is considered a disorder of both the mind and emotions. Schizoaffective disorder can be of the bipolar, depressive, or mixed type depending on the symptoms present. Treatment involves medications like antipsychotics and mood stabilizers as well as psychotherapy and life skills training. Nursing care focuses on ensuring safety, promoting functioning, and supporting treatment compliance.
THERE ARE LOTS OF DISORDERS IN MENTAL HEALTH ASPECT.THIS PRESENTATION'S FOCUS IS ON PANIC DISORDER AND ITS MANAGEMENT.THIS CLASS IS IN ASPECT OF PSYCHIATRIC NURSING STUDENTS.
The STAR*D trial aimed to identify effective next-step treatments for patients who did not respond to initial antidepressants. However, the study misrepresented data to claim higher remission rates. The actual remission rate was only around 3%, rather than the reported 40%. Investigators inappropriately changed outcome measures and excluded dropouts to inflate results. They also underreported treatment-emergent suicidal ideation. The study investigators had conflicts of interest that may have biased their analysis and presentation of the data. In reality, the study showed antidepressants have only marginal efficacy compared to placebo.
Neuropsychiatric aspects of traumatic brain injuryAzfer Ibrahim
1) Traumatic brain injury (TBI) can cause various neuropsychiatric issues including mood disorders, cognitive deficits, and behavioral changes.
2) Common mood disorders after TBI include depression in 25-50% of patients in the first year, as well as increased risks of mania/hypomania and anxiety disorders.
3) Frequent cognitive deficits involve problems with memory, attention, concentration, language, and executive functioning that can cause long-term impairment.
The document discusses the history and evolution of somatic symptom and related disorders. It describes how concepts like hysteria, hypochondriasis, and psychosomatic disorders developed before being categorized under somatic symptom disorder, illness anxiety disorder, conversion disorder, and other diagnoses in DSM-5. It provides details on the characteristic symptoms, thresholds, and specifiers for each DSM-5 disorder category. Theories on the causes of related conditions like pseudocyesis are also summarized.
Neuro-Psychiatric aspect of Diabetes MellitusDr.Jeet Nadpara
- The document discusses the neuro-psychiatric aspects of diabetes mellitus, including the links between diabetes and conditions like depression. It notes that as early as the 17th century, diabetes was thought to be caused by sadness or emotional distress.
- Managing diabetes requires significant patient self-care and support systems, but psychiatric illnesses can interfere with self-management behaviors. Conditions like depression may also impact diabetes through neurohormonal changes.
- The document examines topics like cognitive effects of diabetes, links between diabetes and depression, eating disorders and diabetes, and the impacts on patients, families, and development.
Major Depressive Disorder is characterized by at least five symptoms of depression lasting at least two weeks. The document discusses the various types of depression like major depression, dysthymia, seasonal affective disorder, atypical depression, bipolar disorder, and others. It also discusses the causes of depression including genetic, environmental, medical factors. Treatment involves medication, psychotherapy, and social support depending on the severity and type of depression.
Dementia can sometimes be caused by reversible conditions. This document discusses several potential reversible causes of dementia, including thyroid disorders, vitamin deficiencies, infections, and side effects of medications like steroids. It provides details on specific disorders and how treatment of the underlying condition may resolve cognitive and behavioral symptoms. Reversible dementias are estimated to account for 18% of cases under 65 but only 5% of those over 65. While treatment can sometimes improve symptoms, complete reversion of cognitive impairment is unclear for certain conditions like Cushing's syndrome.
This document provides an overview of delirium, including its introduction, history, epidemiology, etiology, neuropathology, diagnosis, differential diagnosis, course, prevention and management. Delirium is characterized by an acute change in mental status and cognition that fluctuates over the course of a day. It has a prevalence of 5-55% among elderly hospitalized patients and is associated with increased mortality, longer hospital stays and higher healthcare costs. The pathophysiology involves multiple neurotransmitter systems and risk factors include predisposing patient factors and precipitating insults like infection, medication side effects or metabolic disturbances. Prevention focuses on reducing risk factors and early diagnosis and treatment can improve outcomes.
This document discusses drug-induced movement disorders caused by antipsychotic medications. It covers the classification of both acute and chronic movement disorders including dystonia, parkinsonism, akathisia, and tardive dyskinesia. It discusses the pathophysiology, risk factors, signs and symptoms, time of onset, scales used for assessment, management, and prevention of these medication-induced movement disorders. It also lists other medications that can cause movement disorders and the DSM-5 diagnostic categories for medication-induced movement disorders.
Psychopharmacology and Cardiovascular Disease - psycho cardiologymagdy elmasry
Psychopharmacology andCardiovascular Disease.Your Heart And Mind Are Connected.Psychiatric Disorders and Cardiovascular System .Cardiac response to acute stress .Heart disease and depression are closely linkedCardiovascular Side Effects of Psychotropic Drugs
.
Bipolar disorder is a brain disorder that causes unusual shifts in mood and energy levels. It is characterized by periods of depression and periods of mania or hypomania. There are four main types of bipolar disorder defined by the severity and length of mood episodes. Bipolar disorder is caused by biological and genetic factors that impact brain chemistry. Effective treatments include mood stabilizing medications, antipsychotic medications, psychotherapy, and electroconvulsive therapy in severe cases.
Bipolar disorder is a mental illness characterized by periods of depression and periods of mania or hypomania. It is a lifelong condition that affects about 2% of the global population. The exact causes are unknown but include genetic and environmental factors. Treatment involves lifestyle changes and lifelong medication with mood stabilizers, antipsychotics, or antidepressants to reduce symptoms and prevent recurrence. Left untreated, bipolar disorder can lead to substance abuse, legal and financial problems, relationship issues, and increased risk of suicide.
This presentation deals with the various medicines used in the treatment of depression and mania. The drugs used include MAO inhibitors, tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin and noradrenaline reuptake inhibtors and atypical antidepressants with a brief mention of Lithium at the end
This document provides a case study on bipolar disorder. It begins with objectives to define bipolar disorder, discuss concepts of nursing care, examine the brain's anatomy and physiology related to neurotransmitters, understand pharmacological treatments, and apply assessments and interventions. It then provides background on bipolar disorder prevalence and characteristics. The rationale for choosing this case and significance of studying it are discussed. The scope focuses on nursing and pharmacological management, with limitations due to confidentiality. Dorothea Orem's Self-Care Model is identified as the conceptual framework. Literature on the history and classifications of bipolar disorder is reviewed. The clinical summary provides demographic data and applies developmental theories to the case.
The document discusses desktop virtualization and remote desktop services. It explains that with these services, the desktop workload is centralized on a virtual machine in the datacenter while the presentation of the UI is managed remotely via protocols like RDP. It also discusses mobility options that allow Lync to work across devices like PCs, Macs, smartphones and tablets through different applications. Finally, it provides a table comparing Lync support and requirements for various Windows Phone models.
This document discusses various halogens including fluorine, bromine, chlorine, and iodine. It lists atomic numbers and masses for isotopes of bromine-35, bromine-81, chlorine-35, chlorine-37, and iodine-127. The document also mentions fluorine-19 and iodine-53.
The document provides instructions for a quiz and game involving groups of students. The quiz includes 5 questions about market structures, fixed and variable costs, ways to increase total revenue, and diminishing marginal returns. The game involves groups flipping coins marked with Xs and Os to earn or lose points depending on the combination of flips. Students are then instructed to get into groups of 7 and play the game.
This IDC Country Brief cover India, where the amount of data created, replicated, and consumed each year will grow an amazing 23-fold through the end of the decade, according to the 2012 EMC-IDC Digital Universe study.
Here are the answers to the bellringer quiz questions:
1. Examples of FC for this widget firm: Rent on factory building, equipment/machinery, insurance
2. Examples of VC for this widget firm: Materials/supplies, labor, electricity
3. This firm could increase its TR by increasing the quantity of widgets produced and sold, or by raising the price of each widget
4. An example of diminishing marginal returns for this widget firm would be if the marginal cost of each additional widget produced started to increase after a certain level of production, such as due to workers getting tired or supplies running low
Countering Cyber Threats By Monitoring “Normal” Website BehaviorEMC
Have you considered using big data to protect against cyber threats? Savvy CSOs are doing just that-leveraging hoards of web traffic data to model normal online behavior and then use that insight to counter attempts at business-logic abuse. Check out this informative technology dossier to explore the ins and outs of using big data analysis and web-user profiling to protect your company against cyber threats.
This document summarizes a presentation about scale-out converged solutions for analytics. The presentation covers the history of analytic infrastructure, why scale-out converged solutions are beneficial, an analytic workflow enabled by EMC Isilon storage and Hadoop, test results showing performance benefits, customer use cases, and next steps. It includes an agenda, diagrams demonstrating analytic workflows, performance comparisons, and descriptions of enterprise features provided by using EMC Isilon with Hadoop.
The document discusses the economy of Zimbabwe and provides background information to advise the President on improving the economy. It notes that many Zimbabweans cannot afford food and goods due to high prices set by businesses. Local Zimbabwean businesses also struggle with imports from other countries. The document suggests redistributing farmland owned by white farmers to native Africans, as 98% of farmland is owned by white farmers but 90% of the population is black. It also notes that the Zimbabwe dollar is a strong currency but the central bank does not print much money, so people lack money to buy food.
PostNL is bij de Client Awards uit 593 deelnemende organisaties verkozen tot beste zzp-opdrachtgever van Nederland. De kwaliteit van deelnemende organisaties is gemeten op basis van de referenties van meer dan 19.000 zzp’ers met communicatie, tarief en overeenkomst als belangrijkste criteria.
Uit onderzoek van ZZP Barometer blijkt dat communicatie, tarief, overeenkomst, betalingstermijn en werksfeer de vijf belangrijkste criteria zijn van ‘Goed Opdrachtgeverschap’. Deze criteria zijn aan zzp’ers voorgelegd, naast vragen over algemene tevredenheid, de waarschijnlijkheid tot aanbeveling en suggesties tot verbetering. PostNL scoort gemiddeld een 7,6 bij zzp’ers en een Net Promoter Score (NPS) van 77. Hiermee eindigt PostNL twee posities hoger dan vorig jaar, net voor Aegon, Evita Zorg, Stedin en ING.
De top 10 van de Client Awards ziet er als volgt uit:
1. PostNL
2. Aegon
3. Evita Zorg
4. Stedin
5. ING
6. Domijn
7. ABN AMRO
8. KPN Consulting
9. Tele2
10. Rijkswaterstaat
Opportunities for students in the New World of Cloud and Big DataEMC
Cloud Transforms IT ……. Big Data Transforms Business
At this intersection, the way we consume or deliver IT has changed. Some of the technologies which we talk about today are no longer relevant in this new world. This session will help you in the following ways –
- New World with Cloud and Big Data
- Understand some of the new technologies and roles in the new world
- Forums to connect
This document outlines a pitch for a new rock/indie music magazine. The target audience is younger adults aged 16+ who enjoy reading about their favorite bands, concert locations, festivals, and new artists. The magazine will focus on exclusive content like posters and interviews to stand out from competitors like Kerrang and NME. Some potential masthead names are proposed, with "Bullet" being the top choice as it reflects the attitude of rock music. Sample cover story ideas and layout concepts are presented, with an emphasis on using models and locations that suit the rock genre.
O documento descreve um acidente de carro. O veículo saiu da estrada e colidiu com uma árvore. O motorista sofreu ferimentos leves e foi levado para o hospital para exames.
Bipolar disorders in geriatric populations (rwanda)AphrodisARIMUBE
This document discusses the diagnosis and treatment of bipolar disorder in late life. Some key points include:
- Bipolar disorder in older adults is heterogeneous and requires careful differential diagnosis from other conditions. Medical assessment is essential.
- Cognitive impairment often accompanies bipolar disorder in older patients.
- Data on pharmacotherapy is limited, but lithium, divalproex, and atypical antipsychotics are used to treat mania, while lithium, lamotrigine, and some antidepressants are used for bipolar depression.
- Special considerations are needed for pharmacokinetics, drug interactions, tolerability and adherence in treating geriatric bipolar patients.
This document summarizes key aspects of bipolar disorder, including:
1) Bipolar disorder is characterized by recurring manic or hypomanic episodes that alternate with depressive episodes. It exists on a spectrum from bipolar I to bipolar II disorder.
2) Bipolar disorder has a lifetime prevalence of around 2.4% worldwide and is associated with significant disability. However, it often goes undiagnosed for around 10 years.
3) People with bipolar disorder have high risks of suicide, psychiatric comorbidities, and medical comorbidities. They also face impairments in education, work and development due to the disorder.
This document discusses recent advances in the diagnosis and treatment of schizophrenia and Alzheimer's/dementia. It provides definitions of schizophrenia and Alzheimer's disease, describing them as neurological disorders. The causes, diagnoses, and treatments of each are discussed, along with limitations in current treatments and prospects for future treatment improvements. Biochemical and molecular analyses of both conditions are also reviewed.
Prognosis of epilepsy disease definition, mortality, relapse risks explainedsahil136
pilepsy is a neurological disorder marked by recurrent sudden episodes of convulsions, sensory disturbances, loss of consciousness correlated with abnormal electrical activity in the brain.
This document provides an overview of neurocognitive disorders including delirium and dementia. It begins with an introduction noting the aging population and prevalence of these conditions. It then discusses delirium as an acute decline in consciousness and cognition often caused by medical conditions or substances. Dementia is defined as progressive cognitive decline without altered consciousness. Common causes of dementia like Alzheimer's and vascular dementia are explained. The document provides details on assessing, diagnosing, treating and managing delirium and dementia. It concludes with take home messages about the importance of recognizing these conditions in elderly patients.
This document discusses bipolar disorder, including its prevalence, risk factors, clinical features, differential diagnosis, and neurobiology. Some key points:
- Bipolar disorder affects 1-3% of the population worldwide and has a strong hereditary component.
- It is associated with high rates of relapse, chronicity, cognitive impairment, and functional disability. Patients also have an increased risk of medical comorbidities.
- While genetic factors are important, environmental triggers like stressful life events can influence recurrence.
- Neurobiological studies have found abnormalities in monoaminergic neurotransmitter systems, but these have not fully explained the episodic nature and progression of bipolar disorder. It likely arises from complex gene-
An acute medical condition.
Common in UK critical care patients.
Serious adverse outcomes.
Bedside diagnosis.
Maybe the first sign of a new infection.
Pathological, not psychological.
Neuropsychiatric manifestations of endocrine disordersDheeraj kumar
This is a subject seminar of neuropsychiatric manifesations of endocrine disorders.It took a lot of time to prepare,it helps fellow residents of Gen medicine to download and present as it is.
Bipolar disorder is a mood disorder characterized by episodes of mania and depression. It can cause shifts in mood, energy levels, and ability to function. The document discusses the diagnostic criteria for bipolar disorder according to the DSM-V, including symptoms of mania, hypomania, psychosis and depression. It also covers the prevalence of bipolar disorder, potential causes, evaluation process, treatment options including mood stabilizers, psychotherapy and alternatives if monotherapy fails. Treatment trends are discussed for children, adolescents, and the elderly population.
Schizophrenia is a disease that affects thoughts, emotions, and actions. It was first described in the 19th century and given its current name in 1911. There are various biological, psychological, and social factors involved in its etiology. Genetics plays a major role, with risk increasing if a family member has schizophrenia. Symptoms include positive symptoms like delusions and hallucinations as well as negative symptoms such as apathy. It is diagnosed based on symptoms and differential diagnosis is needed to rule out other conditions. Outcomes vary but many experience impairment. Management involves antipsychotic medication, psychosocial support, and addressing any substance abuse or medical issues.
The document discusses substance abuse in bipolar patients. It notes that the dominance of substance abuse disorders is higher in bipolar patients than any other psychiatric illness. Bipolar patients often use substances like alcohol to help control symptoms of anxiety and sleep disorders. Those with both a substance use disorder and bipolar disorder are at a higher risk of developing antidepressant-induced mania or mood instability.
This document provides information on the nursing management of clients with mania. It begins with definitions of mood and affect. It then discusses the classification and diagnosis of bipolar disorder and mania. The clinical manifestations of mania include elevated mood, decreased need for sleep, racing thoughts, and hyperactivity. Treatment involves hospitalization if needed for safety, along with pharmacotherapy including lithium, valproate, carbamazepine, benzodiazepines, and antipsychotics to reduce manic symptoms and prevent relapse. Close monitoring of the client and medication levels is important.
Bipolar disorder and alcohol abuse commonly co-occur, with around 30-60% of bipolar patients also having issues with substance abuse. This comorbidity makes diagnosis and treatment more difficult as alcohol use can worsen bipolar symptoms. Patients also sometimes use substances like alcohol to self-medicate and cope with bipolar symptoms. Integrated treatment that addresses both the mental health and substance abuse issues simultaneously tends to be the most effective approach for dual diagnosis patients.
Schizophrenia is a mental disorder characterized by hallucinations and delusions. The exact cause is unknown but there are several hypotheses including a dopamine imbalance in the brain. Symptoms include changes in behavior, speech abnormalities, hallucinations, and delusions. Treatment involves antipsychotic medications which work by blocking dopamine receptors in the brain. While medications can help control symptoms, schizophrenia has no cure and often becomes a chronic condition.
This document discusses reversible causes of dementia and delirium. It begins by defining major neurocognitive disorder and reversible dementias. Common reversible causes of dementia include central nervous system infections, normal pressure hydrocephalus, nutritional deficiencies, drugs, endocrine disorders, depression, and sleep apnea. Delirium is then discussed, including risk factors, pathophysiology, clinical subtypes, DSM-5 criteria, assessment scales, differential diagnosis, course, prevention, and management. Reversible dementias are estimated to account for 8-40% of dementia cases. Early diagnosis and treatment of the underlying cause can improve cognitive functioning.
Major depression is characterized by depressed mood and loss of interest or pleasure that lasts at least two weeks. About 15% of people experience major depression in their lifetime. Females experience depression twice as often as males. Depression has genetic, biological, psychological, and social causes. Treatment involves psychotherapy, antidepressant medication, electroconvulsive therapy, or light therapy. Nursing care focuses on safety, support, and education to prevent suicide and promote recovery.
Insomnia is defined as repeated difficulty initiating or maintaining sleep that impairs daytime functioning. Approximately one third of adults experience some insomnia symptoms, while 6-10% meet diagnostic criteria. Insomnia is more common in women, older adults, shift workers, and those with medical/psychiatric conditions. Chronic insomnia lasting over 1 month can have numerous health consequences and is associated with impaired daily life and increased healthcare costs. Evaluation involves assessing sleep history, habits, and impairment through diaries and interviews to determine if insomnia is primary, comorbid, or secondary to another condition.
Psychological and social factors affecting aging womanRavi Soni
The document discusses various social and psychological factors affecting aging women. It begins by defining aging and noting that aging is different for women than men due to hormonal changes, diseases, and changes in bodily appearance. It then discusses maintaining stability and accepting changes as a key psychological factor. Social factors include role changes, marriage and widowhood, retirement, and involvement in extended families and groups. The document outlines developmental milestones in old age such as integrating one's life, developing wisdom, conducting life reviews, retirement, grandparenthood, and facing mortality. It concludes by noting benefits of growing old such as a happier outlook and wisdom.
Traumatic Brain Injury to temporal lobe and cognitive rehabilitationRavi Soni
This presentation briefs you about temporal lobe basic anatomy, Structures, functions, Mechanisms of Temporal lobe Injury and Cognitive rehabilitation strategies for temporal lobe deficits
Alzheimer's disease: Clinical Assessment and ManagementRavi Soni
This PPT is a seminar on the Alzheimer's disease which was prepared for sensitizing post graduate psychiatry students on the day of World Alzheimer's Day.
Evidence based treatment approaches for prevention of dementiaRavi Soni
This presentation reviews all the available treatment which have been used for prevention of dementia. The evidences were taken from the Cochrane reviews and library.
Relationship of Metabolic syndrome and cognitive impairment has been discussed. Metabolic causes of Dementia and their reversibility has been discussed.
This PPT contains all the important guidelines that are needed to manage a patient of Dementia. It involves diagnosis, psychosocial treatment, non-pharmacological management and pharmacological management. This PPT is prepared from NICE, APA and SIGN guidelines.
This presentation describes various movement disorders and its management strategies with particular focus of management of parkinson's disease. It gives basic overview of the drugs also.
Aging is a natural process that occurs gradually over time and involves changes in biological, psychological, and social domains. Biologically, aging is associated with declines in cognitive abilities like processing speed and working memory due to changes in the brain and decreases in immune function. The heart and blood vessels also undergo structural and functional changes with aging like thickening of arteries and a slower heart rate. While aging impacts many systems and abilities, there is significant variability between individuals.
This ppt describes various movement disorders found commonly in elderly persons. It also describes hyper and hypokinetic disorder categorization with cause and pathophysiology of movement disorders.
1. The document discusses the genetics of several cognitive disorders in elderly individuals, including Alzheimer's disease, frontotemporal lobar degeneration, Lewy body disease, vascular dementia, and Huntington's disease.
2. For Alzheimer's disease, mutations in the APP, PSEN1, and PSEN2 genes are associated with early-onset familial Alzheimer's, while the APOE ε4 allele is a major genetic risk factor for late-onset Alzheimer's.
3. For frontotemporal lobar degeneration, mutations in the PGRN and MAPT genes are most common, while other genes like C9ORF72 and VCP have also been linked. Genetic causes
Suicidal tendencies in late life depressionRavi Soni
This document discusses suicidal tendencies and prevention in the elderly. It provides statistics on elderly suicide rates globally and in India. Key points include that nearly 10% of Indian suicides are among those aged 65+, though the rate is lower than other countries due to family support of elders. Common risk factors for elderly suicide are depression, physical illness, social isolation and loss of spouse. Treatment of depression and pain are important for prevention, though SSRIs may increase short-term risk which decreases after the initial period. Goals for prevention include raising awareness of suicide and depression.
The patient is a 65-year-old retired male teacher presenting with a 4-year history of progressive cognitive and behavioral decline. He has been diagnosed with bipolar affective disorder for over 35 years. Over the last 4 years, his family has reported increasing forgetfulness, irritability, suspiciousness, sleep disturbances, and difficulties with activities of daily living. His cognitive evaluation shows impairments in attention, memory, visuospatial abilities, and executive function. Brain imaging reveals diffuse cerebral atrophy. Based on the clinical presentation and investigations, the provisional diagnosis is late-onset Alzheimer's disease with behavioral and psychological symptoms of dementia. Other considerations include mixed Alzheimer's and vascular dementia or vascular dementia. The patient is being treated with
This document discusses social issues and factors in old age. It covers topics like aging concepts, ageism, loneliness, social isolation, retirement, and marriage/widowhood. Regarding loneliness, it describes three types (situational, developmental, internal), risk factors, impacts on health, and potential interventions. Social isolation is also discussed in depth, including its prevalence, attributes, and negative health consequences. Interventions for social isolation focus on convening regular social groups. The relationship between retirement and mental health is complex, with involuntary retirement increasing mental health risks. Marriage provides benefits in old age, but many older women live alone due to higher male mortality rates.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Late Life mania
1. Late onset Mania
DR. RAVI SONI
DM SR III
DEPT. OF GERIATRIC MENTAL HEALTH
KGMU, LKO
1
2. Highlights
Bipolarity in the elderly is heterogeneous and
require careful differential diagnosis
Medical assessment is essential
Mania runs atypical course in elderly
Cognitive impairment is a frequent
concomitant of bipolar disorders in the elderly
2
3. Mania in elderly: Considerations
Whether late-onset manic episodes represent a different entity or they
should or should not be considered differently for treatment
Why detailed evaluation of the first episode Mania in elderly is necessary?
There is higher rate of Secondary Mania in elderly population
Higher mortality rates of mania
Relationship between affective disorders and dementia
There are differences in treatment approaches
According to currently accepted definition,
Cases over 50 years of age are considered as “late-onset”, and
Cases over 60 years of age are considered as “very late-onset” manic disorders
Major confusion is with delirium
The risk of dementia may increase in patients with geriatric mania
Severe derangement may be detected in the cognitive functions of
patients during a manic episode.
3
4. 4Differential Diagnosis of Mania
in elderlies
The differential diagnosis is broad and includes:
• Bipolar manic and mixed states
• Delirium
• BPSD
• Schizophrenia and schizophrenia like Psychosis
• Schizoaffective disorder- Bipolar type
• Drug intoxication, and
• Mood disorder due to medical disorders
Phenomenology is not the same as Adults always
So, differential diagnosis is very important
6. Geriatric Mania or Late onset
Mania
Late onset Mania:
Early age at onset (recurrent mood disorder with
manic episode in later age)
Late age of onset (first episode of Mania after 60
years of age)
Mood disorders may be related to underlying
medical or neurological condition, substance use or
psychotropic drugs (particularly antidepressant
induced manic switch)
6
7. 7Some Medical Causes of Mania
Related Disorders/Substances
Neurologic
Dementia
Head injury
CNS tumor
Multiple sclerosis
Stroke
Epilepsy
Wilson’s disease
Sleep apnea
Vitamin B12 deficiency
Endocrine
Hypo- or hyperthyroidism
Hypercortisolemia
Infectious
HIV
Syphilis
Lyme disease
Viral encephalitis
Toxic
Substances
Medications
(corticosteroids,
amphetamines, and other
sympathomimetics, L-
DOPA)
Forester et al. 2004
8. 8Assessment
Psychiatric, medical/neurological, treatment
history;
Mental status examination;
Physical/neurological examination;
Clinical laboratory tests
Include TSH, folate, B12
ECG
Neuroimaging, when indicated e.g.,
neurological signs/symptoms, late onset,
different presentation from prior episodes,
presence of vascular risk factors
9. 9Epidemiology
5-18 % among geropsychiatric admissions
Prevalence of Bipolar disorder is around 0.1 to 0.5%
among individuals 65 years and older
Persons age 60 years and older constitute about 25% of
the population with bipolar disorder
6–8% of all new cases of bipolar disorder developing in
persons age 60 years and older
The incidence of mania at age greater than 75 years is
around 2 per 100000 persons
The distributions of the subtypes of a single depressive
episode or mania/bipolar disorder are remarkably similar
for male and female patients aged over 65 years
Kessing LV. 2006, Azorin et al. 2010, Benedetti et al. 2008, Dhonju et al. 2014
10. Clinical Characteristics of Late
onset Mania
Is different
Studies have suggested that mania in old age is less
severe and manifests with more irritability, confusion,
psychosis, and mixed features
higher levels of premorbid psychosocial functioning
Family history of Bipolar illness is less common
Comorbid medical illness is more common
Persecutory delusion are more common in elderlies
Typical flight of ideas is rare and inconsistent with the
patient’s mood
The euphoria in elderly manic patients is not contagious
Hostility is more prominent
Ipekcioglu et al. 2015
10
11. Differences between Early and
Late onset mania
Lower rate of positive family history and prior psychiatric history
Higher rate of association with cerebral organic disorder and
neurological comorbidities
Higher rates and longer duration of hospitalization
Slower improvement
Higher rates of anxiety
Azorin et al. reported Late-onset bipolar illness as
Secondary disorder,
Expression of a lower vulnerability to the disease,
Subform of pseudodementia,
Risk factor for developing dementia, and
Bipolar type VI (bipolarity in the context of dementia – like
processes)
Ipekcioglu et al. 2015, Azorin et al. 2010
11
12. Late onset Mania as a secondary
Mania
Concept was elaborated by Krauthammer and Klerman to
describe Subform of bipolar illness associated with wide
variety of organic factors
Neurological illness (mostly cerebrovascular disorders) was
found twice as frequent
Diagnosis of dementia is associated with increased risk of
manic episodes at follow up.
Brain injury, epilepsy, brain tumors, encephalitis, and various
forms of cerebral infection are found be associated with it
Neuroimaging: lesions in late onset mania
Subcortical hyperintensities,
Decreased cerebral blood flow, and
Silent cerebral infarcts
Azorin et al. 2010
12
13. Late onset Bipolar illness (LOBI) as
a “Bipolar Type VI”
Recently proposed to include LOBI into the bipolar
spectrum under the “bipolar type VI” category
Could represent the various forms of LOBI, including
Secondary disorders
Bipolar liability revealed by dementing process
Bipolar pseudodementia (the clinical picture may be close to
that of mixed or agitated depression)
Created to address the commonalities in the
pathophysiological processes of bipolarity and dementia
Azorin et al. 2010
13
14. Treatment
Cautious use of drugs while treating elderly because
Pharmacokinetic and pharmacodynamic changes that occur
with ageing,
Frequent concomitant medical illnesses and their treatments,
Increase the risk of adverse events and drug interactions
Management starts with thorough assessment for
medical/neurological illnesses that may be associated with
manic symptoms
Valproate is better tolerated than lithium
Lithium requires lower serum levels like 0.4-0.7 mEq/L
Azorin et al. 2010
14
15. Valproate and atypical antipsychotics can be the first
choice
Carbamazepine causes more drug interactions
Typical antipsychotics should be avoided
For maintenance therapy, use same drug with same dose
which demonstrated efficacy in management of acute
episode
ECT may be useful in patients who are refractory to drug
treatment and in those who need rapid resolution of
symptoms
Treatment
Azorin et al. 2010
15
18. 18Treatment Recommendations for
Manic/Mixed States in Late Life
1st line: monotherapy - divalproex or lithium
Partial responders - add atypical antipsychotic
medication - risperidone, quetiapine, olanzapine,
possibly aripiprazole
For “treatment resistant” episode – consider
clozapine or ECT
No evidence-based guidance on duration of
treatment, time to wait before augmentation, or use
of other mood stabilizing anticonvulsants
Young et al 2004
19. 19Take Home message
Manic illness in old age is heterogeneous.
Older manic patients frequently have vascular
and neurological comorbidities, and are at risk
for poor outcomes.
Management typically focuses on
pharmacotherapy with mood stabilizers, and use
of simplest possible regimen.
Pharmacokinetic changes can alter drug dosing.
Cognitive impairment may reduce tolerability of
treatment.
20. King George’s Medical University UP, LucknowKing George’s Medical University UP, Lucknow
INDIAINDIA 20