1) Huntington's disease is a progressive neurodegenerative disorder caused by a CAG repeat expansion in the huntingtin gene, resulting in chorea, cognitive decline, and psychiatric symptoms.
2) Movement symptoms include chorea, dystonia, and bradykinesia. Cognitive deficits involve executive dysfunction, memory impairment, and psychiatric symptoms include depression, anxiety, and psychosis.
3) Pathology involves selective degeneration of GABAergic medium spiny neurons in the striatum, leading to dysfunction of corticostriatal circuits and characteristic motor, cognitive, and behavioral changes.
Delirium is a neuropsychiatric syndrome characterized by acute onset of fluctuating cognitive impairment and changes in consciousness. It is common in medically ill patients and often misdiagnosed as psychiatric. Delirium is caused by underlying medical conditions and assessed using DSM criteria of disturbance in attention, cognition, and perception developing over short period. Treatment involves addressing underlying causes, managing symptoms like agitation, and preventing complications through reorientation and family support.
Depression is a mental disorder and has become most common in recent years. This slide or presentation deals with all types of aetiologies of depression, theories that are involved in development of depression, pathophysiology of drepression, various classes anti-depressant their pharmacology with the adverse events or effects. This also gives a brief note on difference between depression and sadness.
This document discusses neurocognitive disorders including delirium, major neurocognitive disorders such as dementia and amnestic syndrome, mild neurocognitive disorder, epilepsy, and traumatic brain injury. It provides details on the diagnostic criteria, clinical features, epidemiology, treatment, and prognosis of these conditions. Case studies are also presented to illustrate delirium and complex partial seizures.
The document provides information on antidepressants. It begins by defining depression and describing its various types. It then discusses the different classes of antidepressants, including SSRIs, SNRIs, TCAs, and MAOIs. For each class, it provides details on examples of drugs, their mechanisms of action, pharmacokinetics, therapeutic uses, and adverse effects. The document also discusses non-medication treatments for depression.
- Neurocognitive disorders include delirium, disorders due to Lewy bodies, Alzheimer's disease, frontotemporal disorders, vascular disorders, and traumatic brain injuries.
- Delirium involves an acute change in consciousness and cognition that fluctuates in severity. It is often caused by medical issues, medications, or substance withdrawal. Treatment focuses on resolving the underlying cause.
- Disorders like those due to Lewy bodies, Alzheimer's disease, and frontotemporal disorders cause progressive cognitive decline due to brain changes. Symptoms and severity vary by type. Management includes medications, environmental modifications, and supportive care.
- Vascular and traumatic brain injury disorders arise from disruptions to the brain's
Seminar on approach to schizophrenia.pptxfiraolgebisa
This document summarizes a seminar on the approach to schizophrenia. It begins with an outline of the topics to be covered, including introduction, definition, clinical diagnosis, and management principles. It then provides details on the introduction, definition, clinical manifestations, outcome, etiology, diagnosis, and management of schizophrenia. Key points include that schizophrenia is a chronic and disabling mental illness characterized by positive symptoms like hallucinations and delusions, negative symptoms, cognitive impairment, and mood symptoms. Treatment involves acute stabilization with antipsychotic medication followed by long-term management to prevent relapse.
I would do the following:
1. Assess for delirium by checking vital signs, mental status, and reviewing the medication list for any recent changes.
2. Taper and discontinue the ropinirole and alprazolam which can worsen hallucinations.
3. Consider reducing the levodopa dose gradually if hallucinations persist after stopping the other medications.
4. Initiate a trial of quetiapine or clozapine which are less likely to worsen parkinsonism compared to other antipsychotics. Start low and titrate slowly.
5. Reassure the patient and family that the hallucinations are likely due to Parkinson's disease progression and
Depression is a common mental disorder characterized by sadness, loss of interest or pleasure, and impaired functioning. It ranges from mild episodes of sadness to severe and persistent forms. Clinical depression involves changes in appetite, sleep, energy, concentration, self-esteem and thoughts of death or suicide. It has genetic, environmental, biochemical and hormonal causes. Treatments include antidepressant medications and psychotherapy.
Delirium is a neuropsychiatric syndrome characterized by acute onset of fluctuating cognitive impairment and changes in consciousness. It is common in medically ill patients and often misdiagnosed as psychiatric. Delirium is caused by underlying medical conditions and assessed using DSM criteria of disturbance in attention, cognition, and perception developing over short period. Treatment involves addressing underlying causes, managing symptoms like agitation, and preventing complications through reorientation and family support.
Depression is a mental disorder and has become most common in recent years. This slide or presentation deals with all types of aetiologies of depression, theories that are involved in development of depression, pathophysiology of drepression, various classes anti-depressant their pharmacology with the adverse events or effects. This also gives a brief note on difference between depression and sadness.
This document discusses neurocognitive disorders including delirium, major neurocognitive disorders such as dementia and amnestic syndrome, mild neurocognitive disorder, epilepsy, and traumatic brain injury. It provides details on the diagnostic criteria, clinical features, epidemiology, treatment, and prognosis of these conditions. Case studies are also presented to illustrate delirium and complex partial seizures.
The document provides information on antidepressants. It begins by defining depression and describing its various types. It then discusses the different classes of antidepressants, including SSRIs, SNRIs, TCAs, and MAOIs. For each class, it provides details on examples of drugs, their mechanisms of action, pharmacokinetics, therapeutic uses, and adverse effects. The document also discusses non-medication treatments for depression.
- Neurocognitive disorders include delirium, disorders due to Lewy bodies, Alzheimer's disease, frontotemporal disorders, vascular disorders, and traumatic brain injuries.
- Delirium involves an acute change in consciousness and cognition that fluctuates in severity. It is often caused by medical issues, medications, or substance withdrawal. Treatment focuses on resolving the underlying cause.
- Disorders like those due to Lewy bodies, Alzheimer's disease, and frontotemporal disorders cause progressive cognitive decline due to brain changes. Symptoms and severity vary by type. Management includes medications, environmental modifications, and supportive care.
- Vascular and traumatic brain injury disorders arise from disruptions to the brain's
Seminar on approach to schizophrenia.pptxfiraolgebisa
This document summarizes a seminar on the approach to schizophrenia. It begins with an outline of the topics to be covered, including introduction, definition, clinical diagnosis, and management principles. It then provides details on the introduction, definition, clinical manifestations, outcome, etiology, diagnosis, and management of schizophrenia. Key points include that schizophrenia is a chronic and disabling mental illness characterized by positive symptoms like hallucinations and delusions, negative symptoms, cognitive impairment, and mood symptoms. Treatment involves acute stabilization with antipsychotic medication followed by long-term management to prevent relapse.
I would do the following:
1. Assess for delirium by checking vital signs, mental status, and reviewing the medication list for any recent changes.
2. Taper and discontinue the ropinirole and alprazolam which can worsen hallucinations.
3. Consider reducing the levodopa dose gradually if hallucinations persist after stopping the other medications.
4. Initiate a trial of quetiapine or clozapine which are less likely to worsen parkinsonism compared to other antipsychotics. Start low and titrate slowly.
5. Reassure the patient and family that the hallucinations are likely due to Parkinson's disease progression and
Depression is a common mental disorder characterized by sadness, loss of interest or pleasure, and impaired functioning. It ranges from mild episodes of sadness to severe and persistent forms. Clinical depression involves changes in appetite, sleep, energy, concentration, self-esteem and thoughts of death or suicide. It has genetic, environmental, biochemical and hormonal causes. Treatments include antidepressant medications and psychotherapy.
The document discusses several neurocognitive disorders including delirium, neurocognitive disorder due to Lewy bodies, neurocognitive disorder due to Alzheimer's disease, frontotemporal neurocognitive disorder, vascular neurocognitive disorder, and neurocognitive disorder due to traumatic brain injury. It provides details on the causes, symptoms, risk factors, and treatment options for each disorder. The disorders are characterized by impairments in cognitive functioning and mental abilities caused by underlying conditions that damage brain cells or their connections.
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.
Depression is underrecognized and undertreated in older adults. It is not a normal part of aging and can worsen medical illnesses. Symptoms include depressed mood, loss of interest, changes in appetite, insomnia, fatigue, guilt, and suicidal thoughts. Depression is diagnosed if five or more symptoms are present for two weeks. Treatment involves pharmacotherapy such as SSRIs or SNRIs for at least six months, psychotherapy like CBT, and other somatic therapies for severe cases. Untreated depression can have serious consequences so screening and treatment is important for older adults.
Antipsychotic : Dr Rahul Kunkulol's Power point preparationsRahul Kunkulol
This document discusses the treatment of psychosis and schizophrenia with a focus on antipsychotic drugs. It begins by classifying psychiatric disorders and defining psychosis. Schizophrenia is described as a particular type of psychosis characterized by disturbances in thinking. The dopamine theory of schizophrenia is explained, which posits that psychosis is related to increased dopamine activity in the brain. Older antipsychotics are dopamine antagonists that can cause neurological side effects like tardive dyskinesia. Atypical antipsychotics have fewer side effects. Lithium is discussed as the drug of choice for treating mania in bipolar disorder.
- Affective disorders include persistent mood disorders like depression that cause socio-occupational dysfunction. Depression is the most common mental disorder.
- The document outlines depression and bipolar affective disorder, their diagnostic criteria, clinical features, management, and when to refer patients. Depression is a leading cause of disability and its early identification and treatment improves outcomes. Bipolar disorder involves episodes of mania or hypomania with or without depression.
This document provides an overview of depression, including its definition, types, epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, investigations, and treatment. Depression is a common mental disorder characterized by depressed mood and loss of interest or pleasure. It affects over 350 million people globally and is the leading cause of disability for those aged 15-44 in the U.S. Depression has genetic, environmental, biochemical, and physical illness-related causes and is treated through antidepressants, psychotherapy, lifestyle changes, and in severe cases, electroconvulsive therapy. The document covers various antidepressant classes and their mechanisms of action and side effects.
This document provides an overview of depression, including its definition, types, epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, investigations, and treatment. Depression is defined as a common mental disorder characterized by depressed mood, loss of interest, feelings of guilt, sleep disturbances, low energy, and poor concentration. Major types include major depressive disorder, bipolar disorder, dysthymic disorder, and situational depression. Depression affects over 350 million people globally and is a leading cause of disability. Causes may include genetic, environmental, biochemical and neurological factors. Treatment involves antidepressant medications like SSRIs, TCAs, and MAOIs as well as psychotherapy and other non-pharmacological approaches.
Delirium is an acute disturbance in attention and awareness that develops over a short period of time and fluctuates in severity. It is common in older adults due to age-related physiological changes and multiple medical conditions or medications. Delirium is diagnosed based on impairment in attention, cognition, and perception, as well as changes in psychomotor behavior. It requires identification and treatment of underlying causes, along with non-pharmacological and pharmacological interventions as needed to manage symptoms. Delirium is associated with poor outcomes, so prevention through risk factor modification is important.
Parkinsons Disease Psychosis (PDP) is a multifactorial, progressive disease that presents in the late stages of Parkinsons Disease. Its hallmark features include visual hallucinations and delusions. There are factors related to Parkinsons medications (i.e. L-DOPA, anticholinergics) as well as intrinsic disease-related factors that contribute to the psychosis.
Antipsychotic drugs, also called neuroleptics or major tranquilizers, are primarily used to treat schizophrenia and other psychotic states by decreasing the intensity of hallucinations, delusions, and permitting patients to function better. These drugs work by blocking dopamine receptors in the brain and have side effects like extrapyramidal symptoms and metabolic issues. Antipsychotics are classified based on their generation (first or second), chemical structure, and pharmacological properties.
Elderly individuals are at risk of psychiatric problems like dementia and depression. Dementia affects 5-7% of those over 65 and 40% over 85, with Alzheimer's disease being the most common type. Depression is also common in the elderly. Treatment involves identifying the precise condition, using drugs like acetylcholinesterase inhibitors for dementia or antidepressants for depression, and providing psychosocial support. Psychiatric disorders in the elderly like schizophrenia require careful use of antipsychotic drugs and family psychoeducation.
Depression is a common mental disorder characterized by depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, and poor concentration. There are several types of depression including major depressive disorder, dysthymic disorder, postpartum depression, and seasonal affective disorder. Symptoms include feelings of sadness, changes in appetite and sleep, fatigue, anxiety, and thoughts of death or suicide. Depression is caused by genetic, environmental, biochemical and physiological factors and can be effectively treated with antidepressant medication, psychotherapy like CBT or IPT, and lifestyle changes to reduce stress and improve sleep and social support.
This document provides information on psychopharmacology and psychiatric disorders. It defines key terms like psychotropic agents and delusions. It describes brain areas involved in mental function and personalities prone to psychiatric disorders. It discusses psychosis and neurosis, comparing their characteristics. It provides details on schizophrenia including causes, symptoms, and treatment with antipsychotic drugs. It explains mechanisms of action, effects, and side effects of typical and atypical antipsychotics. Finally, it discusses treatment of anxiety disorders and lists common anxiolytic drug classes including benzodiazepines, azapirones, antidepressants, and antihistamines.
This document defines and describes acute confusional state (also known as delirium). It notes that delirium is a transient disorder involving impaired attention and cognition, caused by a medical condition, substance use, or medications. The document outlines the pathophysiology, causes, presentation, diagnosis, treatment, and management of delirium. It compares delirium to other conditions like dementia and acute functional psychosis.
This document summarizes psychiatric disorders and their pharmacotherapy. It discusses anxiety disorders, obsessive compulsive disorder, depression, bipolar disorder, and mania. For each disorder, it covers definitions, types, biological mechanisms, and common drug treatments. The key drugs discussed are benzodiazepines, SSRIs, SNRIs, and atypical antipsychotics for anxiety, OCD, and mood disorders.
This document discusses post-stroke psychiatric disorders. It describes five frontosubcortical circuits that are involved in cognition, behavior and movement. Common post-stroke psychiatric conditions include depression, anxiety, apathy, psychosis and pathological laughing/crying. Lesion location can impact the type of psychiatric disorder, such as left anterior lesions increasing risk of depression. Treatment involves pharmacotherapy, such as antidepressants, and psychotherapy. Screening and ongoing monitoring of symptoms is important after a stroke to identify and manage post-stroke psychiatric complications.
There are three main points covered in the document:
1. Psychosis is a thought disorder characterized by disturbances in reality, perception, cognition, and affect. It encompasses several mental disorders including schizophrenia.
2. Schizophrenia is a type of psychosis characterized by severe personality changes and thought disorders. It has an onset in late teens to early twenties and has both genetic and environmental risk factors.
3. Antipsychotic drugs treat psychosis by blocking dopamine D2 receptors in the brain. Older "typical" antipsychotics are more likely to cause extrapyramidal side effects while newer "atypical" antipsychotics have fewer neurological side effects.
There are three main points covered in the document:
1. Psychosis is a thought disorder characterized by disturbances in reality, perception, cognition, and affect. It encompasses several mental disorders including schizophrenia.
2. Schizophrenia is a type of psychosis characterized by severe personality changes and thought disorders. It has an onset in late teens to early twenties and has both genetic and environmental risk factors.
3. Antipsychotic drugs treat psychosis by blocking dopamine D2 receptors in the brain. Older "typical" antipsychotics are more likely to cause extrapyramidal side effects while newer "atypical" antipsychotics have fewer neurological side effects.
Antipsychotics, also known as neuroleptics,[1] are a class of psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia but also in a range of other psychotic disorders.[2][3] They are also the mainstay together with mood stabilizers in the treatment of bipolar disorder.[4]
Antipsychotic
Drug class
Zyprexa.PNG
Olanzapine, an example of a second-generation (atypical) antipsychotic
Class identifiers
Synonyms
Neuroleptics, major tranquilizers[1]
Use
Principally: Schizophrenia, Schizoaffective disorder, Dementia, Tourette syndrome, Bipolar disorder, irritability in autism spectrum disorder
Clinical data
Drugs.com
Drug Classes
External links
MeSH
D014150
In Wikidata
Prior research has shown that use of any antipsychotic is associated with smaller brain tissue volumes,[5][6] including white matter reduction[7] and that this brain shrinkage is dose dependent and time dependent.[5][6] A more recent controlled trial suggests that second generation antipsychotics[8] combined with intensive psychosocial therapy[9] may potentially prevent pallidal brain volume loss in first episode psychosis.[10][7]
The use of antipsychotics may result in many unwanted side effects such as involuntary movement disorders, gynecomastia, impotence, weight gain and metabolic syndrome. Long-term use can produce adverse effects such as tardive dyskinesia, tardive dystonia, and tardive akathisia.
Prevention of these adverse effects is possible through concomitant medication strategies including use of beta-blockers. Currently, treatments for tardive diseases are not well established.
First-generation antipsychotics (e.g. chlorpromazine), known as typical antipsychotics, were first introduced in the 1950s, and others were developed until the early 1970s.[11] Second-generation antipsychotics, known as atypical antipsychotics, were introduced firstly with clozapine in the early 1970s followed by others (e.g. risperidone).[12] Both generations of medication block receptors in the brain for dopamine, but atypicals tend to act on serotonin receptors as well. Neuroleptic, originating from Greek: νεῦρον (neuron) and λαμβάνω (take hold of)—thus meaning "which takes the nerve"—refers to both common neurological effects and side
Degenerative disorders are conditions that involve the progressive deterioration of cells or tissues over time due to normal aging or lifestyle factors. Examples include Parkinson's disease, Alzheimer's disease, Huntington's disease, and multiple sclerosis. Parkinson's disease causes movement problems and is linked to the death of dopamine-producing neurons in the brain. Alzheimer's disease causes memory loss and cognitive decline due to the buildup of plaques and tangles in the brain that kill neurons. Both Parkinson's and Alzheimer's worsen over time and can be treated with drugs, though currently there is no cure. Huntington's disease is inherited and involves the degeneration of nerve cells in the brain.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
The document discusses several neurocognitive disorders including delirium, neurocognitive disorder due to Lewy bodies, neurocognitive disorder due to Alzheimer's disease, frontotemporal neurocognitive disorder, vascular neurocognitive disorder, and neurocognitive disorder due to traumatic brain injury. It provides details on the causes, symptoms, risk factors, and treatment options for each disorder. The disorders are characterized by impairments in cognitive functioning and mental abilities caused by underlying conditions that damage brain cells or their connections.
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.
Depression is underrecognized and undertreated in older adults. It is not a normal part of aging and can worsen medical illnesses. Symptoms include depressed mood, loss of interest, changes in appetite, insomnia, fatigue, guilt, and suicidal thoughts. Depression is diagnosed if five or more symptoms are present for two weeks. Treatment involves pharmacotherapy such as SSRIs or SNRIs for at least six months, psychotherapy like CBT, and other somatic therapies for severe cases. Untreated depression can have serious consequences so screening and treatment is important for older adults.
Antipsychotic : Dr Rahul Kunkulol's Power point preparationsRahul Kunkulol
This document discusses the treatment of psychosis and schizophrenia with a focus on antipsychotic drugs. It begins by classifying psychiatric disorders and defining psychosis. Schizophrenia is described as a particular type of psychosis characterized by disturbances in thinking. The dopamine theory of schizophrenia is explained, which posits that psychosis is related to increased dopamine activity in the brain. Older antipsychotics are dopamine antagonists that can cause neurological side effects like tardive dyskinesia. Atypical antipsychotics have fewer side effects. Lithium is discussed as the drug of choice for treating mania in bipolar disorder.
- Affective disorders include persistent mood disorders like depression that cause socio-occupational dysfunction. Depression is the most common mental disorder.
- The document outlines depression and bipolar affective disorder, their diagnostic criteria, clinical features, management, and when to refer patients. Depression is a leading cause of disability and its early identification and treatment improves outcomes. Bipolar disorder involves episodes of mania or hypomania with or without depression.
This document provides an overview of depression, including its definition, types, epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, investigations, and treatment. Depression is a common mental disorder characterized by depressed mood and loss of interest or pleasure. It affects over 350 million people globally and is the leading cause of disability for those aged 15-44 in the U.S. Depression has genetic, environmental, biochemical, and physical illness-related causes and is treated through antidepressants, psychotherapy, lifestyle changes, and in severe cases, electroconvulsive therapy. The document covers various antidepressant classes and their mechanisms of action and side effects.
This document provides an overview of depression, including its definition, types, epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, investigations, and treatment. Depression is defined as a common mental disorder characterized by depressed mood, loss of interest, feelings of guilt, sleep disturbances, low energy, and poor concentration. Major types include major depressive disorder, bipolar disorder, dysthymic disorder, and situational depression. Depression affects over 350 million people globally and is a leading cause of disability. Causes may include genetic, environmental, biochemical and neurological factors. Treatment involves antidepressant medications like SSRIs, TCAs, and MAOIs as well as psychotherapy and other non-pharmacological approaches.
Delirium is an acute disturbance in attention and awareness that develops over a short period of time and fluctuates in severity. It is common in older adults due to age-related physiological changes and multiple medical conditions or medications. Delirium is diagnosed based on impairment in attention, cognition, and perception, as well as changes in psychomotor behavior. It requires identification and treatment of underlying causes, along with non-pharmacological and pharmacological interventions as needed to manage symptoms. Delirium is associated with poor outcomes, so prevention through risk factor modification is important.
Parkinsons Disease Psychosis (PDP) is a multifactorial, progressive disease that presents in the late stages of Parkinsons Disease. Its hallmark features include visual hallucinations and delusions. There are factors related to Parkinsons medications (i.e. L-DOPA, anticholinergics) as well as intrinsic disease-related factors that contribute to the psychosis.
Antipsychotic drugs, also called neuroleptics or major tranquilizers, are primarily used to treat schizophrenia and other psychotic states by decreasing the intensity of hallucinations, delusions, and permitting patients to function better. These drugs work by blocking dopamine receptors in the brain and have side effects like extrapyramidal symptoms and metabolic issues. Antipsychotics are classified based on their generation (first or second), chemical structure, and pharmacological properties.
Elderly individuals are at risk of psychiatric problems like dementia and depression. Dementia affects 5-7% of those over 65 and 40% over 85, with Alzheimer's disease being the most common type. Depression is also common in the elderly. Treatment involves identifying the precise condition, using drugs like acetylcholinesterase inhibitors for dementia or antidepressants for depression, and providing psychosocial support. Psychiatric disorders in the elderly like schizophrenia require careful use of antipsychotic drugs and family psychoeducation.
Depression is a common mental disorder characterized by depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, and poor concentration. There are several types of depression including major depressive disorder, dysthymic disorder, postpartum depression, and seasonal affective disorder. Symptoms include feelings of sadness, changes in appetite and sleep, fatigue, anxiety, and thoughts of death or suicide. Depression is caused by genetic, environmental, biochemical and physiological factors and can be effectively treated with antidepressant medication, psychotherapy like CBT or IPT, and lifestyle changes to reduce stress and improve sleep and social support.
This document provides information on psychopharmacology and psychiatric disorders. It defines key terms like psychotropic agents and delusions. It describes brain areas involved in mental function and personalities prone to psychiatric disorders. It discusses psychosis and neurosis, comparing their characteristics. It provides details on schizophrenia including causes, symptoms, and treatment with antipsychotic drugs. It explains mechanisms of action, effects, and side effects of typical and atypical antipsychotics. Finally, it discusses treatment of anxiety disorders and lists common anxiolytic drug classes including benzodiazepines, azapirones, antidepressants, and antihistamines.
This document defines and describes acute confusional state (also known as delirium). It notes that delirium is a transient disorder involving impaired attention and cognition, caused by a medical condition, substance use, or medications. The document outlines the pathophysiology, causes, presentation, diagnosis, treatment, and management of delirium. It compares delirium to other conditions like dementia and acute functional psychosis.
This document summarizes psychiatric disorders and their pharmacotherapy. It discusses anxiety disorders, obsessive compulsive disorder, depression, bipolar disorder, and mania. For each disorder, it covers definitions, types, biological mechanisms, and common drug treatments. The key drugs discussed are benzodiazepines, SSRIs, SNRIs, and atypical antipsychotics for anxiety, OCD, and mood disorders.
This document discusses post-stroke psychiatric disorders. It describes five frontosubcortical circuits that are involved in cognition, behavior and movement. Common post-stroke psychiatric conditions include depression, anxiety, apathy, psychosis and pathological laughing/crying. Lesion location can impact the type of psychiatric disorder, such as left anterior lesions increasing risk of depression. Treatment involves pharmacotherapy, such as antidepressants, and psychotherapy. Screening and ongoing monitoring of symptoms is important after a stroke to identify and manage post-stroke psychiatric complications.
There are three main points covered in the document:
1. Psychosis is a thought disorder characterized by disturbances in reality, perception, cognition, and affect. It encompasses several mental disorders including schizophrenia.
2. Schizophrenia is a type of psychosis characterized by severe personality changes and thought disorders. It has an onset in late teens to early twenties and has both genetic and environmental risk factors.
3. Antipsychotic drugs treat psychosis by blocking dopamine D2 receptors in the brain. Older "typical" antipsychotics are more likely to cause extrapyramidal side effects while newer "atypical" antipsychotics have fewer neurological side effects.
There are three main points covered in the document:
1. Psychosis is a thought disorder characterized by disturbances in reality, perception, cognition, and affect. It encompasses several mental disorders including schizophrenia.
2. Schizophrenia is a type of psychosis characterized by severe personality changes and thought disorders. It has an onset in late teens to early twenties and has both genetic and environmental risk factors.
3. Antipsychotic drugs treat psychosis by blocking dopamine D2 receptors in the brain. Older "typical" antipsychotics are more likely to cause extrapyramidal side effects while newer "atypical" antipsychotics have fewer neurological side effects.
Antipsychotics, also known as neuroleptics,[1] are a class of psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia but also in a range of other psychotic disorders.[2][3] They are also the mainstay together with mood stabilizers in the treatment of bipolar disorder.[4]
Antipsychotic
Drug class
Zyprexa.PNG
Olanzapine, an example of a second-generation (atypical) antipsychotic
Class identifiers
Synonyms
Neuroleptics, major tranquilizers[1]
Use
Principally: Schizophrenia, Schizoaffective disorder, Dementia, Tourette syndrome, Bipolar disorder, irritability in autism spectrum disorder
Clinical data
Drugs.com
Drug Classes
External links
MeSH
D014150
In Wikidata
Prior research has shown that use of any antipsychotic is associated with smaller brain tissue volumes,[5][6] including white matter reduction[7] and that this brain shrinkage is dose dependent and time dependent.[5][6] A more recent controlled trial suggests that second generation antipsychotics[8] combined with intensive psychosocial therapy[9] may potentially prevent pallidal brain volume loss in first episode psychosis.[10][7]
The use of antipsychotics may result in many unwanted side effects such as involuntary movement disorders, gynecomastia, impotence, weight gain and metabolic syndrome. Long-term use can produce adverse effects such as tardive dyskinesia, tardive dystonia, and tardive akathisia.
Prevention of these adverse effects is possible through concomitant medication strategies including use of beta-blockers. Currently, treatments for tardive diseases are not well established.
First-generation antipsychotics (e.g. chlorpromazine), known as typical antipsychotics, were first introduced in the 1950s, and others were developed until the early 1970s.[11] Second-generation antipsychotics, known as atypical antipsychotics, were introduced firstly with clozapine in the early 1970s followed by others (e.g. risperidone).[12] Both generations of medication block receptors in the brain for dopamine, but atypicals tend to act on serotonin receptors as well. Neuroleptic, originating from Greek: νεῦρον (neuron) and λαμβάνω (take hold of)—thus meaning "which takes the nerve"—refers to both common neurological effects and side
Degenerative disorders are conditions that involve the progressive deterioration of cells or tissues over time due to normal aging or lifestyle factors. Examples include Parkinson's disease, Alzheimer's disease, Huntington's disease, and multiple sclerosis. Parkinson's disease causes movement problems and is linked to the death of dopamine-producing neurons in the brain. Alzheimer's disease causes memory loss and cognitive decline due to the buildup of plaques and tangles in the brain that kill neurons. Both Parkinson's and Alzheimer's worsen over time and can be treated with drugs, though currently there is no cure. Huntington's disease is inherited and involves the degeneration of nerve cells in the brain.
Similar to Movement Disorders- M_Saidi- 21_01_20.pptx (20)
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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2. Introduction:
• Involuntary movements: tremor, dystonia, chorea, myoclonus, tics, and stereotypies
• Movement disorders: neurological syndromes presenting with excessive or diminished voluntary movements
not related to weakness or spasticity
• Most movement disorders are progressive and ultimately lead to significant morbidity and incapacitation
• High prevalence of comorbid psychiatric symptoms like depression, anxiety, OCD, hallucinations, delusions,
impulsivity, sleep disorders, apathy and cognitive impairment regarded as neuropsychiatric diseases
• Considerable implications for patient and caregiver stress, compliance with medications, and prognosis
• Major movement disorders (such as Parkinson's disease, Huntington's disease, and Gilles de la Tourette's
syndrome) have important psychiatric dimensions, often the primary determinants of quality of life
• Many psychotropic agents conventionally used to treat them can have harmful effects on motor function
3.
4. • Table 1 Hypokinetic Signs in Movement Disorders
5. • Table 2. Hyperkinetic Signs in Movement Disorders
6.
7.
8.
9. Parkinson’s Disease
• Loss of pigmented dopamine neurons in the Substantia Nigra resulting tremor, rigidity,
and bradykinesia
• Levodopa relieves symptoms, especially in the initial stages of illness, by providing
replacement of dopamine
• “Parkinsonian syndrome“: tremor, bradykinesia, rigidity, and postural instability
• Found in Parkinson's disease (PD), Dementia with Lewy bodies (DLB), and Parkinson's
disease dementia (PDD), and many other conditions such as Parkinson Plus Syndrome
• Drug-induced ("pseudo-parkinsonism"): Antipsychotics, Lithium, Metoclopramide,
MDMA addiction, Tetrabenazine, …
10.
11.
12.
13.
14. • Depression:
• Diagnosis complicated due to masqueraded body language including a sad expressionless
anxious face, a hang dog appearance, slow movement and monotonous speech
• Common in Parkinson's disease (PD), with a prevalence of about 50%
• Occur at any stage of the disease, and occasionally may precede the onset of motor
symptoms by a few years
• More commonly develop with increasing disease severity and disability
• More prone to have anxiety disorders, psychotic symptoms or dementia
• PD is associated with pathology in all the brainstem monoaminergic nuclei, causing
profound reductions in 5-HT and noradrenaline (norepinephrine) concentrations
• Ongoing low mood, anhedonia, sleep disturbance, and a failure to feel better despite
objective motor improvement are all potential pointers of depression
15. • Remarkably few trials of antidepressant strategies in PD
• Tricyclics are best avoided in patients with cognitive impairment
• Selective serotonin and selective noradrenaline reuptake inhibitors (SSRIs and SNRIs) are
generally well tolerated and effective
• SSRI sertraline (50–100 mg at night) also weakly dopaminergic; the SNRI venlafaxine (37.5–75 mg
twice daily) better tolerated
• Psychological approaches, such as cognitive behavioural therapy, may also have a place
• Motor condition fluctuates widely with distressing swings in their mental state (For example, “off”
periods) intense feelings of doom or dread, naturally respond to this by over-medicating and
dyskinetic state
• Again SSRIs or SNRIs may be a very helpful adjunct to the normal strategies for managing
fluctuations or dyskinesia
16. • Anxiety:
• Up to 30% of people with PD may experience symptoms of anxiety
• Ranging from a generalised anxiety disorder to social phobia, panic disorders and obsessive
compulsive disorders
• Contribute to impaired quality of life and increased severity of motor symptoms such as on/off
fluctuations or freezing episodes
• Generalised anxiety and panic attacks associated with “off” periods are common
• Social phobia seems to be particularly under recognised
• Responding either to drugs (as above) or psychological therapy (for example, through a PD
specialist nurse) with dramatic improvements in quality of life
• Support from the local group of the Parkinson's Disease Society invaluable
17. • Psychosis:
• Hallucinations or delusions occur in approximately 50% of people with PD over the course of the illness and
may be sign of dementia beginning
• From minor hallucinations – "sense of passage" (something quickly passing beside the person) or "sense of
presence" (the perception of something/someone standing just to the side or behind the person) – to full
blown vivid, formed visual hallucinations and paranoid ideation
• Most commonly a form of complex visual hallucinations, typically of recognisable living things, which may
talk to the patient
• Hallucinations are most common neuropsychiatric feature of PD, Auditory hallucinations occurring in the
absence of visual hallucination are rare
• High incidence and prevalence over time, affecting more than 70% of patients in a 20-year follow-up period,
May be accompanying paranoid ideation
• In younger PD psychosis usually drug induced or secondary to depression
• In older PD early hallucinations associated with progression to cognitive impairment, or may be secondary to
depression
18. • In either age group it is traditional to reduce or withdraw drugs that may be causing or
exacerbating the psychosis
• Trihexyphenidyl (or other anticholinergics) is a particular culprit in older patients and should be
slowly withdrawn first, followed by drugs like Levodopa, Selegeline, Amantadine and dopamine
agonists
• Return of tremor or dyskinesia as the price for an improvement in mental state, gradual dose
reduction may relieve the psychosis at the expense of a worsening of PD
• In younger patients the dopamine agonists are usually the problem, it may then be possible to
retrieve by moving towards Apomorphine (the dopamine agonist with the least tendency to cause
psychosis)
• Suppress psychosis with an atypical neuroleptic (works best in younger patients who are
cognitively intact)
• Clozapine is the best evidence base medication, requires haematological monitoring
19. • Quetiapine seems to be less potent, certainly more convenient, not usually help until large doses for
example 200 mg bd
• Olanzapine can also be helpful but carries greater risk of EPSE or causing confusion (Not NICE supported)
• Sulpiride almost always causes some deterioration of Parkinsonism
• In patients with cognitive impairment use cholinesterase inhibitors, licensed and endorsed by NICE
• Clinical experience suggests that Rivastigmine, Donepezil, and Galantamine may all have useful antipsychotic
effects in people with PD who have cognitive impairment
• Rivastigmine (1.5 mg twice daily increasing slowly to 6 mg twice daily), Donepezil (5 mg once daily increasing
to 10 mg once daily) has the simplest titration
• SE of diarrhoea is rarely a problem in PD, but agitation and motor restlessness may occur as SE
• Recent study demonstrated that Pimavanserin (FDA approved), a selective 5-HT2A inverse agonist, may be
able to address this unmet need
20. • Dementia:
• The most serious neuropsychiatric complication of PD, affecting about 30% of patients, usually after the age
of 65 years
• Psychosis, especially visual hallucination, is often the initial presenting symptom
• Cognitive function may fluctuate and accompanied by periods of frank confusion and poor episodic memory
• Frontal lobe function (MCI) is abnormal in many non-demented people with PD declines further
• The most common cognitive deficit is executive dysfunction: problems with planning, cognitive flexibility,
abstract thinking, inhibiting inappropriate actions, initiating appropriate actions, difficulties with shifting,
sequencing, or maintaining behavioural set in the face of interfering stimuli, and control of attention
• Dysfunction of frontal cortico-striatal circuits, due to loss of dopamine innervation of frontal cortex, or to
loss of the normal basal ganglia output to frontal cortex (via thalamus), or combination
• Other cognitive difficulties slowed cognitive processing speed, impaired recall and impaired perception and
estimation of time, increase in apathy and inertia
• Visuospatial function also declines early on (detected by clock drawing)
21. • Showed an increased error rate as they performed successive trials, but not an increased time to switch
between tasks
• Intact dopamine neurotransmission is required to sustain cognitive and motor processes over prolonged
time periods
• PDD is not primarily due to nigrostriatal dopamine loss, but is due to other mechanisms: including coexistent
Alzheimer’s disease, multi-system atrophy with loss of other subcortical nuclei, or diffuse Lewy body disease
• An inverse relationship between performance on visual or verbal memory tasks and hippocampal volume
• No relationship between performance on spatial working memory or set-shifting tasks and hippocampal
volume
• Large numbers of cortical Lewy bodies and primitive senile plaques, although some cases have pathology
typical of Alzheimer disease (with tau-containing neurofibrillary tangles and neurotic plaques)
• Distinction between dementia in PD and dementia with Lewy bodies is semantic rather than biological
• A person with PD has two to six times the risk of dementia compared to the general population
22. • The dopamine dysregulation syndrome:
• Dysfunction of the reward system observed in some individuals taking dopaminergic medications for an
extended length of time, leading to over usage – is a rare complication of levodopa
• Increases drug intake lead to loss of dopaminergic receptors in the striatum which enhance sensitisation to
dopamine therapy
• Symptom of craving for dopaminergic medication is an intense impulse to obtain medication even in the
absence of symptoms
• Different impulse control disorders including: gambling, compulsive shopping, eating disorders and hyper
sexuality
• Hypomania, manifesting with feelings of euphoria, omnipotence, or grandiosity
• Behavioural disturbances, most commonly aggressive tendencies, Psychosis is also common
• First choice management is dopaminergic drug dosage reduction, if this decrease is maintained,
dysregulation syndrome features soon decrease
• Antipsychotic may be of use in the presence of psychosis, aggression, gambling or hyper sexuality
23. Huntington's disease:
•The prevalence of HD ranges from 4–10 per 100,000, average prevalence for the UK was 12.3
per 100,000
• Recent studies revealed the prevalence in the UK is considerably underestimate (hot spots?)
• About 10% of patients have onset of symptoms before the age of 20 (juvenile Huntington’s disease) and
10% have onset after the age of 60
• The average survival time after diagnosis is about 15-20 years,
• Autosomal dominant disorder, destruction of the head of the caudate nucleus
• Symptoms usually begin between 30 and 50 years of age, about 8-10% start before the age of 20 years
and typically more similar to Parkinson's disease symptoms
• HD is a CAG repeat expansion disorder where sufferers will have a repeat size of 36 or more, CAG
repeats in the huntingtin gene associated with progressive chorea
• Other trinnucleotide repeat disorders include a variety of spinocerebellar ataxias, fragile X syndrome
(CGG), Friedrich’s ataxia (GAA) and myotonic dystrophy (CTG)
24.
25. • HD is typically inherited, although up to 10% of cases are due to a new mutation
• 5-10% of people doing genetic test (predictive)
• Anticipation: earlier symptoms onset with each generation
• Future generations more likely to be affected if the genetic transmission is paternal in origin where expansion can take place in the
process of spermatogenesis
• The genetic results could be:
• normal under 26
• 'intermediate allele': normal in the 27–35 range
• "incomplete penetrance': abnormal in the 36–39 range
• unequivocally abnormal (over 40)
• Strong inverse correlation between the CAG repeat number and the age of onset
• Number of repeats over 60 is usually associated with juvenile HD
• Juvenile onset HD can present with a different clinical picture known as the Westphal variant, rapid deterioration, rigidity and seizures.
26. • Pathology:
• The production of the abnormal protein, mutant Huntingtin, is the pathological
mechanism in HD
• Animal studies suggest in healthy individuals, Huntingtin has a role in apoptosis,
preventing programmed cell death,
• It is proposed that this causes glutamate-mediated excitoxicity, with resultant cell
death?!
• The atrophy and astrogliosis of the caudate and putamen are the most obvious
abnormalities, with enlarged lateral ventricles, reduction in subcortical white
matter
• Caudate atrophy is the result of selective loss of inhibitory GABA-minergic
neurones that project from the striatum to the Globus Pallidus
• The loss of this inhibition causes increased activity in the thalamus and
consequently the motor cortex
27.
28. Fig. 1
Symmetrical partial atrophy of head of caudate nucleus, gross atrophy of putamen.
(a) Axial T1W and (b) Axial T2W images of the patient at the level of basal ganglia.
29. • Clinical features:
• 5 stages of HD (prodromal, early, moderate, advanced and end of life)
• Subtle cognitive or emotional problems may often precede motor symptoms
• Motor symptoms:
• The most characteristic initial physical symptoms are jerky, random, and uncontrollable movements called chorea
• Disruptive daily movement, may lead to fall
• Difficulties to maintaining position, lack of hand coordination
• Prior to full-blown chorea may present: restlessness and fidgeting, abnormal ocular movements (including nystagmus and
slow saccadic movement), dysarthria, hyperreflexia, clumsiness, inability to sustain voluntary contraction
• As the disease progresses extrapyramidal symptoms emerge: dystonia and hyper-rigidity, bradykinesia and dysphagia
• The clear appearance of symptoms such as rigidity, writhing motions or abnormal posturing appear as the disorder
progresses
• Other causes of chorea include:
• Wilson’s disease, Sydenham’s chorea, basal ganglia stroke/hypoxia, neuroa-canthocytosis, cerebral palsy and benign
hereditary chorea
30. • Cognitive symptoms:
• Often cited as a typical 'subcortical' dementing illness, present with the pronounced
cognitive slowing, poor attention and concentration
• Also impairments in a wide range of functions traditionally described as 'cortical', i.e.
dysexecutive syndrome and memory impairments
• Memory is often enhanced with prompting or multiple choice cueing, contrasting with
the deficits commonly seen in Alzheimer’s disease
• HD more frequently presents with working and procedural memory impairments when
compared to AD
• Inefficient memory in HD relates to retrieval rather than registration (benefit from
cueing)
• Loss of mental flexibilities and repeat word listing test
• Perseveration or being fixed on a specific issue is also common
31. • Relatives may comment that HD sufferers have become inflexible and stubborn,
reflecting increasing cognitive rigidity and difficulty in empathic reasoning
• May struggle more with judging distances between themselves and surrounding objects
while they may still be able to make fairly accurate judgements on distances between
items not related to their personal space
• Affects on executive functions: planning, cognitive flexibility, abstract thinking, initiation
of appropriate actions, and inhibition of inappropriate actions
• Most HD patients unaware of their involuntary movements probably have a form of
Anosognosia
• Organic denial patients may either not accept the diagnosis or deny that they have any
form of disability
• This can potentially maintain people’s motivation to some degree, but equally it could
lead to them taking unnecessary risks
32. • Common to see cognitive disturbances before development of abnormal physical signs in
HD
• Motor abnormalities below the neurological exam threshold may precede these
cognitive abnormalities
• HD Neuropsychiatric symptoms including: depression, anxiety, psychosis, OCD, and a
frontal lobe syndrome with either disinhibition, impulsivity, and aggression or apathy and
self-neglect, mood swings, impaired judgment, loss of empathy
• Neuropsychiatric presentation lead to difficulties and a breakdown in interpersonal
relationships, major source of both patient and caregiver distress
• Initial treatment of these symptoms may involve a neuroleptic, suppresses chorea and
makes diagnosis difficult
• Not recognising other people's negative expressions observed, neuroimaging studies
correlated with damage to the ventral putamen and atrophy of the anterior insula
33. • Mood Disorder:
• The prevalence of depression in HD may be as high as 50%
• Suicide is approximately five times more common in HD than the general
population
• Suicide remains a major concern in HD, both because of its neuropsychiatric
manifestations (depression and impulsivity), their family history of their future
• Psychological support, from genetic counsellors, specialist multidisciplinary HD
clinics, and the Huntington's Disease Association, is vital
• Caudate pathology seem to correlate with depression
• SSRIs and mirtazapine are commonly used as first line for depression treatment
• Apathy, appetite disturbance, sleep problems and social withdrawal
34. • Anxiety, depression, reduced display of emotions (blunted affect),
egocentrism, aggression, and compulsive behaviour, the latter of which can
cause or worsen addictions, including alcoholism, gambling, and hyper
sexuality
• Apathy sometimes treated with dopamine agonists such as bromocriptine
but its use is limited in HD by the frequency with which individuals develop
worsening chorea, agitation
• Anxiety is also common, both as a comorbid presentation with other
psychiatric disturbance and as a more discrete problem, occurring in up to
50% of individuals
• Antidepressants most commonly prescribed drugs in HD clinics, SSRI
helpful in treating anxiety or OCD (or both); occasionally exacerbate chorea
35. • Disinhibition and irritability are commonly seen in HD but more florid
episodes of mania-like symptoms are not well described
• Emotional recognition deficits in patients with HD may modulate some of
aggressive behaviour
• Irritability is often treated with SSRIs, antipsychotics, benzodiazepines
and/or carbamazepine
• Although irritability and impulse control problems could benefit from
medical treatment approach, non-pharmacological approaches can be
more effective
• Although HD patients can display obsessive ruminations and
preoccupations, obsessive-compulsive disorder is not common in HD
36. • Psychotic disorders:
• Schizophrenia-like illness, positive symptoms of psychosis such as
delusions and hallucinations are frequently reported
• Atypical antipsychotics such as Olanzapine and Aripiprazole (helping
for chorea as well)
• Using neuroleptics accelerate tendency of natural switch from chorea
to parkinsonism and dystonia
• Atypical neuroleptics allow psychosis to be treated with fewer motor
complications
37. • Juvenile HD:
• Generally progresses faster and chorea is exhibited briefly
• Epilepsy is much more common in juvenile than late onset HD
• Could also present with myoclonus, rigidity, motor and vocal tics
38. • Non CNS symptoms:
• Speech (slow and dyarthric)
• Swallowing (quick putting food into mouth)
• Weight loss
• Muscle atrophy
• Heart problem
• Thyroid gland problem and Glucose change Fragile bone
• Bone thinning
• Sleep disturbance
• Cause of death?
39. • Management:
• Only initiated if particular symptom causing problems, such as: suffering during mealtimes, being unable to
feed themselves with subsequent nutritional decline, choreic movements causing accidents and falls or
social embarrassment
• Environmental manipulation and adaptations can sometimes maximising patients safety without need for
pharmacological treatment (use atypical antipsychotics)
• Importance of nutrition and therapy in early and moderated stage
• Tetrabenazine (monoamine-depleting agent) in longer term increase risk of depression and insomnia (SE is
dose dependent)
• Depokote has good evidence for impulsivity, irritability, labile mood and chorea
• Where Parkinsonism symptoms dominate (dystonia, rigidity and bradykinesia), treatment with dopamine
agonists (Amantadine)
• Anticholinergics improving Parkinsonian features, but increase risk of confusion and/or delirium
• Benzodiazepines useful in the treatment of rigidity and low doses are usually well tolerated, However,
motor coordination can deteriorate leading to falls and problems with swallowing may be compounded with
the risk of aspiration
40. • The multidisciplinary team consist of:
• a physiotherapist
• an occupational therapist
• a dentist/dental hygienist
• a dietician
• a speech/language therapist
• a neuropsychologist
• a clinical psychologist
• a counsellor
• a social worker
• a neuropsychiatrist
• a community nurse specialist
• a non-cancer palliative care nurse
• a Huntington’s Disease Association (HDA) specialist HD advisor
41. Tourette's syndrome:
• As part of a spectrum of tic disorders, includes provisional, transient and persistent (chronic) tics
• A complex disorder with onset in childhood, multiple fluctuating motor and phonic tics lasting for more than
1 year
• Involve abnormal connectivity between the basal ganglia and prefrontal cortex
• Alteration of basal ganglia function within the corticostriatal-thalamocortical circuitry and involvement of
the dopaminergic nigrostriatal pathway suggested by various imaging and post mortem studies
42. • Frequently accompanied by a wide range of psychiatric comorbidities, including obsessive-compulsive
disorder (OCD), attention deficit hyperactivity disorder (ADHD), and depression
• Tics neither decreased with onset of PD nor worsened with Dopamimetic treatment
• Tics are not exclusively due to functional over activity of the dopamine system, but must involve other
systems as well
• TS+OCD has more substantial comorbidity than either diagnosis alone
• OCD and TS may share a common biological substrate, accompanying OCD is often the principal source of
disability
• First degree relatives of TS patients may have isolated OCD without a movement disorder
• The phenomenology of OCD in TS is very similar to that of isolated OCD, with complex rituals and complex
checking
• Repetitive hand washing is less common in TS+OCD
• There is a paucity of evidence-based data regarding the efficacy of different medications in the treatment of
Tourette syndrome
43. • Medications:
• Alpha agonists
• Clonidine 0.05-0.5 mg
• Guanfacine 0.5-4 mg
• Antipsychotics
• Haloperidol* 0.5-20 mg
• Fluphenazine 0.5-20 mg
• Pimozide* 0.5-10 mg
• Risperidone 0.5-16 mg
• Dopamine depletor
• Tetrabenazine 12.5-100 mg
• Centrally acting α2 adrenergic agonists such as clonidine are usually used as first-line treatment and can help
improve comorbid ADHD
• The most commonly prescribed drugs for moderate to severe tics are dopamine antagonists, such as typical
(e.g., Haloperidol, Pimozide) and atypical (e.g., Risperidone, Aripiprazole)
• Given the high frequency of coexistent OCD and tics, when a partial response occurs consider the addition of
a SSRI and behavioural therapy
44. • CBIT is an evidence-based type of behavioural therapy for TS and chronic tic
disorders, includes habit reversal in addition to other strategies, including
education about tics and relaxation techniques
• In CBIT, a therapist to better understand the types of tics the person is having and
to understand the situations in which the tics are at their worst
• Changes to the surroundings may be made, if possible
• Helps to decrease how often the tic occurs by doing a new behaviour (like putting
his or her hands on his or her knees when an urge to perform the tic happens)
• DBS suggested as a potential therapy for severe and disabling tics, regarded as an
invasive, experimental procedure, unlikely to become widespread, involving
thalamic stimulation, some patients can achieve substantial benefit
45.
46. Parkinson Plus syndrome:
• Features of Parkinson's disease (tremor, rigidity, akinesia/bradykinesia, and postural instability)
with additional features that distinguish them from simple idiopathic Parkinson's disease (PD)
• Parkinson-plus syndromes are either inherited genetically or occur sporadically
• Include: multiple system atrophy (MSA), progressive supra nuclear palsy (PSP), and cortico-basal
degeneration (CBD)
• Synucleinopathies and Tauopathies may coexist
• Clinical features that distinguish Parkinson-plus syndromes from idiopathic PD include
symmetrical onset, a lack of or irregular resting tremor, and a reduced response to dopaminergic
drugs (including levodopa)
• Additional features include bradykinesia, early-onset postural instability, increased rigidity in axial
muscles, dysautonomia, alien limb syndrome, supranuclear gaze palsy, apraxia, involvement of
the cerebellum including the pyramidal cells, and in some instances significant cognitive
impairment
47. • PSP:
• Supranuclear ophthalmoplegia, vertical gaze paralysis, backward falls, neck
dystonia, Parkinsonism, Pseudobulbar palsy (swallowing difficulties), imbalance
and walking difficulty
• While Levodopa treatment may initially improve symptoms in Parkinson's
disease, patients with PSP may not benefit
• No treatment has yet been identified that stops the progression of PSP
• Commonly presented with behavioural and cognitive impairment
• MSA:
• Autonomic dysfunction, parkinsonism (muscle rigidity +/ tremor and slow
movement) and ataxia (Poor coordination /unsteady walking)
48. • CBD:
• Involved the cerebral cortex and the basal ganglia
• Typically shows posterior parietal and frontal cortical atrophy with unequal representation in
corresponding sides
• Atrophy has been noted in the corpus callosum
• Symptoms typically begin in people from 50 to 70 years of age
• Average disease duration is six years
• Marked disorders in movement and cognitive dysfunction, Frontotemporal dementia can be an
early feature
• Parkinsonism, Alien hand syndrome, Apraxia (ideomotor apraxia and limb-kinetic apraxia),
Aphasia
• Prominent psychiatric and cognitive conditions cited in individuals include dementia, depression,
and irritability, Dementia forming a key feature that sometimes leads to the misdiagnosis of CBD
as another cognitive disorder such as Alzheimer's disease (AD)