This document discusses various neurotic, stress-related and somatoform disorders including anxiety disorders, obsessive-compulsive disorder, dissociative disorders, and conversion disorder. It provides information on the symptoms, etiology, risk factors, and treatment options for these conditions. Key topics covered include the definition of anxiety and its various subtypes, the involvement of the serotonin system in OCD pathogenesis, the 5 stages of acceptance in bereavement, and that conversion disorder is more common in females and young patients.
HIV and Psychiatry , Neuropsychiatric aspects of HIV , AIDS , Breaking bad news in HIV , Psychiatric intervention in HIV , Neuropsychiatric complications of HIV and AIDS
A presentation about depressive disorder. The presentation composed of the definition, causes, types, clinical feature, diagnosis, prognosis, treatment and prevention of depression
somatoform disorders are characterized by persistent requests for medical attention because of physical complaints that cannot be sufficiently explained by medical causes.
PSYCHOSES REVISION NOTES IN PSYCHIATRY TONY SCARIA
SCHIZOPHRENIA
FIRST RANK SYMPTOMS OF SCHNEIDER
ETIOLOGY OF SCHIZOPHRENIA
PATHOGENESIS
PSYCHIATRY REVISION NOTES BASED ON LECTURE NOTES AND HIGH YIELD FACTS BASED ON PREVIOUS YEAR QUESTIONS
Mood disorders PSYCHIATRY REVISION NOTES TONY SCARIA
DEPRESSSION
MANIA
REVISION NOTES
BASIC PSYCHIATRY REVISION NOTES BASED ON LECTURE NOTES AND HIGH YIELD POINTS
BASED ON PREVIOUS YEAR QUESTIONS
FOR NEET AIIMS PG PREPARATION
HIV and Psychiatry , Neuropsychiatric aspects of HIV , AIDS , Breaking bad news in HIV , Psychiatric intervention in HIV , Neuropsychiatric complications of HIV and AIDS
A presentation about depressive disorder. The presentation composed of the definition, causes, types, clinical feature, diagnosis, prognosis, treatment and prevention of depression
somatoform disorders are characterized by persistent requests for medical attention because of physical complaints that cannot be sufficiently explained by medical causes.
PSYCHOSES REVISION NOTES IN PSYCHIATRY TONY SCARIA
SCHIZOPHRENIA
FIRST RANK SYMPTOMS OF SCHNEIDER
ETIOLOGY OF SCHIZOPHRENIA
PATHOGENESIS
PSYCHIATRY REVISION NOTES BASED ON LECTURE NOTES AND HIGH YIELD FACTS BASED ON PREVIOUS YEAR QUESTIONS
Mood disorders PSYCHIATRY REVISION NOTES TONY SCARIA
DEPRESSSION
MANIA
REVISION NOTES
BASIC PSYCHIATRY REVISION NOTES BASED ON LECTURE NOTES AND HIGH YIELD POINTS
BASED ON PREVIOUS YEAR QUESTIONS
FOR NEET AIIMS PG PREPARATION
mental status examination
mini mental status exmination
mood affect
coprolalia
echopraxia
psychoanalytic theory
psychosis
neurosis
basics of psychiatry revision notes based on lecture notes and previous year questions
Sexual disorders ELECTROCONVULSIVE THERAPY PSYCHOTHERAPY MISCELLANEOUS PSYCHI...TONY SCARIA
PSYCHIATRY REVISION NOTES BASED ON LECTURE NOTES AND HIGH YIELD TOPICS
FOR LAST MINUTE REVISION NOTES
PREMATURE EJACULATION
GENDER IDENTITY DISORDER
PARAPHILIA
FETCHISM
ELECTRO CONVULSIVE THERAPY
DEMENTIA
DELIRIUM
BULIMIA
ANOREXIA
EATING DISORDER
BASIC PSYCHIATRY REVISION NOTES BASED ON LECTURE NOTES AND HIGH YIELD FACTS
BASED ON PREVIOUS YEAR QUESTIONS
PSYCHIATRY
CATALEPSY
MINIMENTAL STATUS EXAMINATION
CORTICAL AND SUBCORTICAL DEMENTIA
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.
Depression: What Is It and What Are My Treatment Options? (Community Lecture)Summit Health
In this community lecture, Summit Medical Group practitioners share insights regarding the warning signs of depression and offer options for treatment, including therapy and medication.
anxiety disorder , a common mental health problemArchanaPokharel2
A prevalent mental health concern worldwide is anxiety disorder. These are the signs of anxiety disorder, along with a treatment strategy and helpful hints.
PSYCHIATRY REVISION NOTES REVISION NOTES BASED ON LECTURE NOTES WITH PREVIOUS YEAR QUESTIONS
WITH HIGH YIELD TOPICS
ALCOHOL
CAFFEINE
NICOTINE
COCAINE
SUBSTANCE ABUSE DISORDERS
NEET AIIMS PG PREPARATION
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
5. Panic disorder
• a/c intake of intense anxiety accompanied by felling of impending
doom
• Sudden onset of palipitation
• Choking
• Dizziness
• Feeling of realty
• Fear of dying /losing of control /going mad
TONY SCARIA 2010
KMC
6. CF panic disorder
• Discrete episodes of intense fear
• Abrupt onset
• Last for some minutes
• Symptoms like palpitation /sweating /shortness of breath /chest
constriction /impending doom
TONY SCARIA 2010
KMC
7. • Mean age is 25 yrs
• F>>M
• NT involved
• NE ,5HT & GABA ,cholecystokinin
• DD
• MI , angina , MVP, asthma,pulmonary embolism
• Pheochromocytoma /hyperthyroidism /carcinoid syndrome /hypoglycaemia
TONY SCARIA 2010
KMC
13. Types of phobia
Agoraphobia Social phobia Specific fobia
Commonest type of phobia Irrational fear of one or more social
or performance situations
• Public speech
• Public drinking /eating
Phobias limited to highly specific
situationsCharacterised by irrational fear of
being in places away from familiar
setting of home & patient believes
that he cannot escapr from this
places
• Crowd
• Travelling alone
TONY SCARIA 2010
KMC
14. Agoraphobia
• Commonest type of phobia
• Irrational fear of being in unfamiliar places (crowd /public /open
space) from where it is not easy to escape to a safe place
TONY SCARIA 2010
KMC
18. Animal type phobias
• Ailurophobias
• Fear of cats
• sitophobias
• Fear of dogs
• Zoophobia
• Fear of animals
TONY SCARIA 2010
KMC
19. Social phobia
• Social anxiety disorder
• Fear of social situations
• Including that involving contact with strangers
TONY SCARIA 2010
KMC
20. Rx of phobia
• PTx
• BZD + SSRI + b blockers
• Psychotherapy
• Behaviour therapy most effective Rx
• Systematic desensitisation
• Best evidence in Rx of phobias
• Exposed to least anxiety provoking stimulus fb muscle relaxation techniquemoves up
• Therpaeutic graded exposure or in vivo exposure
• No relaxation
• Same as above
• Flooding (implosion)
• Phobic stimulus in its severe form
• Modeling (participant modelling)
• Therapist himself exposes to phobic stimulus & demonstrates this to the patient
TONY SCARIA 2010
KMC
21. Desensitisation Flooding Exposure in
everyday practise
Aversion therapy Covert sensitisation
Exposure can be
gradual starting
with situations that
provoke little
anxiety &
progressing
gradually through
more difficult one
Exposure is
intensive from start
which provokes
maximum anxiety &
is allowed to remain
there until anxiety
has diminished
Intermediate in
speed & intensity in
desensitisation &
flooding
• Aversion therpay
• Used to Rx
conditions which
are pleasant but
undesirable
• Pleasant stimulus
is paired with
unpleasant
response
(electric shock)
Alcoholism
Transvestism
Homosexuality
Other sexual
deviation
• When
unpleasant
stimulus is
produced by
fantasy instead
of electric
stimulus or drugs
If relaxation
technique is carried
out with this
systemic
desensitisation
TONY SCARIA 2010
KMC
22. Impulse
• Sudden irrestible force compelling a person to the conscious
performance of some action with out notice or forethought
• Pyromania
• Recurrent & purposeful setting of fire
• Kleptomania
• Recurrent stealing of objects
• Suicidal / homicidal impulses
• Trichitillomania
• Pathological gambling
• Excessive gambling economic troublesTONY SCARIA 2010
KMC
23. Obsessive compulsive disorder
Obsessions
• Recurrent & intrusive thoughts
images or impulses which can
cause marked anxiety or distress
• Insight +
• Product of their own mind
• Irrational & senseless
• Ego dystonic (unwanted &
unacceptable)
Compulsions
• Repetitive behaviours (hand
washing or checking)
• Done to reduce the distress &
anxiety
TONY SCARIA 2010
KMC
24. OCD may be accompanied with depression
TONY SCARIA 2010
KMC
27. Contamination Pathological doubts Intrusive thoughts (pure
onsessions)
Symmetry
Most common pattern of
obsession followed by
washing
Compulive checking Intrusive obsessional
thoughts with out a
compulsion (repitious
thoughts of a sexual or
agrreive act)
Obsession of symmetry
followed by compulsion
of slowness
TONY SCARIA 2010
KMC
31. Symmetry
• Need for symmetry or precision
• Compulsion of sloweness
TONY SCARIA 2010
KMC
32. Neuroanatomy in OCD
• Orbitofrontal cortex cingulate gyrus
basal ganglia (caudate nucleus)thaamus
Serotonergic system is involved in
pathogenesis
TONY SCARIA 2010
KMC
33. Rx of OCD
Pharmacotherapy Behaviour therapy Psychotherapy Psychosurgery
SSRI Fluoxetine • Exposure & response
prevention most
commonly used
• Systemic desensitisation
• Flooding
• Psychoanalytic
psychotherapy
• Suppotive psychotherapy
must include attention to
family members
• Cingulotomy
• CapsulotomyTCA Clomiprmaine
Others • Li
• Venlafaxine
• Pindolol
• MAOI
• Carbamazepin
e
• Valproate
TONY SCARIA 2010
KMC
34. Rx of OCD
• PTx
• SSRI clomipramine
• Augment with haloperidol
• Li/venlafaxine /carbamazepine/valproate
• Psychotherapy
• Exposure and response prevention
• Exposure to stimulus which causes obsession and prevent response
• Other Rx
• Psychosurgery
• Cingulotomy & capsuotomy (subcaudate tractotomy )TONY SCARIA 2010
KMC
36. Hans selye stress adaptation
Alarm phase resistance phase exhaustion phase
TONY SCARIA 2010
KMC
37. Stress disorder
Acute stress disorder Post traumatic stress disorder
Symptoms last <1 month Symptoms last > 1 month
TONY SCARIA 2010
KMC
38. Post traumatic stress disorder & a/c stress
disorder
• Following a stress (war earth quake floods rape serious accidents )
life threatening event
• Intrusion symptoms
• Cb flashbacks (as if trauma is reoccurring)
• Night mares (dreams about the trauma)
• Avoidance
• Avoid all those stimuli which can remind of trauma
• Hyper Arousal symptoms
• Hypervigilance / exaggerated startle response/insomnia / poor concentration
TONY SCARIA 2010
KMC
40. Stressors for PTSD
• Extreme traumatic events involving threat of personal death or injury
• Symptoms of PTSD with in 6 months of stressor
TONY SCARIA 2010
KMC
41. Risk factor & protective factor for PTSD
Risk factors Protective factors
• Low education • High IQ
• Female • Male
• Lower social class • Higher social class
• Previous h/o psychiatric problems(mood /anxiety
disorders)
• External locus of control • internal locus of control
TONY SCARIA 2010
KMC
42. PTSD
• Increased NE inAmygdala & hippocampus are involved
• Noradrenenrgic system
• Opiod system
• hypothalamic pituitary axis
TONY SCARIA 2010
KMC
43. Rx of PTSD
• SSRI
• Cognitive behaviour therapy
• Rx of choice
• Psychodynamic psychotherapy
• Eye movement desensitisation & reprocessing (EMDR)
TONY SCARIA 2010
KMC
44. Adjustment disorder
• Stressor
• Financial issue
• Medical illness of self or beloved ones
• Relationship problems (divorce/ break up)
• Development of emotional or behavioural problems with in 3 months
of onset of stressor
• Shouldnot persist > 6 months if stressor is terminated
TONY SCARIA 2010
KMC
45. Symptoms of adjustment disorder
Disturbance in emotions Disturbance in conduct
Depressive Anxious Conduct
• Low mood
• Lack of interest
• Hopelessnes s
• Lethargy
• Suicidal attempt
• Anxiety
• Irritability
• Palpitation
• Tremor
• Aggressive or dramatic behaviour
TONY SCARIA 2010
KMC
46. Adjustment disorder
• In adolescent females
• Maladaptive response to stressful stimuli
• Depression , anxiety worry & feeling of inability to cope
• Symptoms should start with in 3 months & should not last more than
6 months
• Rx
• Psychotherapy
TONY SCARIA 2010
KMC
47. Bereavement & grief
Death of beloved one Bereavement
Symptoms d/t bereavement Grief
Normal grief resolve with in
6-12 months
TONY SCARIA 2010
KMC
48. CF of pathological grief
• Intrusive thoughts of deceased person which produces anxiousness &
depressive symptoms
• Preoccupation with thought of deceased
• Patient may see or hear voice of deceased
TONY SCARIA 2010
KMC
53. Dissociative disorders /hysteria
• Symptoms are produced unconsciously and help the patient to get
attention
• c/b disturbance in one or mental function (memory
/identity/perception/consciousness)
TONY SCARIA 2010
KMC
54. • Primary gain
• refers to internal psychological motivation
• As he is nt able to work Feels guiltdevelops paralysis (now patients
patients guilt decreases as it is understood that paralyzed patient can’t work)
• Secondary gain
• Refers to external psychological motivation
• Paralyzed patient need not work and he is relieved of his duties
• Tertiary gain
• Gain that a third person derives bcz of patients symptoms
• As he is paralysed his family receives lots of money from relatieves
TONY SCARIA 2010
KMC
56. • Dissociative amnesia
• Loss of memory
• Amnesia of traumatic events of
personal significance
• Eg : rape survivor not able to recall any
thing about rape
TONY SCARIA 2010
KMC
57. • Dissociative fugue
• sudden unexpected travel away form home or work place with inability to
recall some or all of one’s past
• Basic self care is maintained
• Even assume a new identity
TONY SCARIA 2010
KMC
58. • Dissociative identity disorder
• Multiple personality disorder
• 2 or more distinct personalities exist
• Personalities are unware of each others
existences
TONY SCARIA 2010
KMC
59. • Dissociation of trance & possession
• Loss of sense of identity and full
awareness of the surroundings
• Middle aged women claimed that she has
been possessed by a goddess and
demanded that everybody should pray in
front of her
TONY SCARIA 2010
KMC
60. • Dissociative stupor
• Patient is in stupor
• Caused by psychological factors
TONY SCARIA 2010
KMC
61. • Depersonlisation or
derealisation disorder
• Feeling of unrealty of self
• He feels external world is
unreal
• He feels as if he has changed
• he feels as if he has detached
from his body and are watching
themselves like in movie
TONY SCARIA 2010
KMC
62. Gansers syndrome
• Approximate answers are given
• Indicating that qstn was understood
• Frequently seen in prisoners
• But not confined to them
TONY SCARIA 2010
KMC
63. • Dissociative disorders of movement & sensation
• Presents with symptoms that suggest deficit in motor or sensory functions
• No evidence of physical disorder
• Dissociative motor
• Ataxia paralysis
• Dissociative sensory
• Sensory loss
• Dissociative seizures
TONY SCARIA 2010
KMC
65. Conversion disorder
• Presence of symptoms or deficits affecting motor or sensory function suggesting a
medical or neurological disorder. autonomic nervous system is not typically involved
• Sudden onset.
• Development of symptoms usually in the presence of a significant psychosocial stressor
temporal relationship between stressor & development or exacerbation of symptoms.
• Detailed physical examination do not reveal any abnormality that can explain the
symptoms adequately.
• Patient does not intentionally produce symptoms
• Astasia – abasia (Blocq’s disease) Inability to walk or stand in a normal manner. The
Gait is bizarre and is not suggestive of any organic lesion.
• Primary & secondary gain +
• “Labella” indifference: no regard for symptoms though look severe i.e. emotions are not
matching with loss. Labella - is a french word meaning emotion. i.e emotions are not
matching with the loss.
TONY SCARIA 2010
KMC
66. Symptoms of conversion disorder
Sensory symptoms Motor symptoms Seizure symptom
patient presents with sensory loss
which is not substantiated on
physical examination.
• Anaesthesia & paraesthesia
MC
• Not consistent with
dermatomes
loss of ability to move limb / in
coordination etc
• Atasia abasia
• Gait disturbances
• Usually in presence of family
members / friends,
• no injuries/frothing
incontinence, last more than 1
min, not stereotyped, never in
sleep
TONY SCARIA 2010
KMC
67. Astasia abasia / blocqs disease in conversion
disorder
Inability to walk or stand
in a normal manner. The Gait is
bizarre and is not suggestive of
any organic lesion.
TONY SCARIA 2010
KMC
68. La belle indifference is also seen in
• Multiple sclerosis
• Parietal lobe lesion
• Dissociative disorder
• Physical illness
TONY SCARIA 2010
KMC
69. Primary gain secondary gain in conversion
disorder
• Primary Gain - Relief from Unconscious signal Anxiety.
• Subconscious
• Defense mechanism
• Secondary Gain - Observable Gain or some benefit is called a secondary
Gain.
• Gains attention & care
• Relief from responsibilities
• Tertiary gain to others TONY SCARIA 2010
KMC
70. • Functional neurological symptom disorder / conversion disorder
• La belle indifference ‘
• Feeling of indifference which patients with conversion disorder have towards their
symptoms
• Patient will not be concerned about it
TONY SCARIA 2010
KMC
71. Rx
• Emphasise patient is normal
• Avoid secondary & tertiary gains
• Pychotherapy
• Behavioural therapy
• Abreaction
• Attempt is made to bring unconscious memories & emotions to conscious
awareness using hypnosis medications & other techniques
TONY SCARIA 2010
KMC
73. Somatoform disorders
• Typically present with physical symptoms which cant be explained by
any medical condition
• Types
• Somatization
• Undifferentiated
• Hypochondriasis
• Body dysmorphic disorder
• Somatoform autonomic dysfnction
• Persistent somatoform pain disorder
• Pseudocyesis
TONY SCARIA 2010
KMC
75. Somatization
disorder
Aka somatic symptom disorder
Multiple physical symptoms for which no medical cause
Patient refuses to accept the advice or reassurance of the
doctors
Symptoms appear in close relationship to upleasant life
events
• 4 pain symptom
• Pain at 4 different sites
• 2 gastrointestinal symptoms
• Nausea vomiting belching
• One sexual symptom
• Erectile dysfunction
• One pseudoneurological symptom
• Weakness visual disturbances
TONY SCARIA 2010
KMC
76. Somatisation
• Defence mechanism used in somatoform disorder is somatisation
• If stress+ present with multiple systemic somatic symptoms
TONY SCARIA 2010
KMC
79. Hypochondriasis
• Aka Illness anxiety disorder
• Aka medical student disorder
• 6 months of symptoms
• Preoccupation with the fear of having one
or more serious physical illness
• In hypochondriasis preoccupied with disease
• Somatization disorder is preoccupied with symptoms
• Despite normal investigations move from
doctor to doctor
• Unlike in delusion
• Here the belief is not fixed
• Its fixed & unshakable in delusion
TONY SCARIA 2010
KMC
80. Body dysmorphic disorder
• Dysmorphobia
• Preoccupation with an imagined defect in
body appearance
• Or exaggeration of slight physical anomaly
• Usually in hair nose and skin
• Hampers routine functionality
TONY SCARIA 2010
KMC
81. Somatoform autonomic dysfunction
• Specific & unexplained autonomic symptoms such as palpitation
tremors sweating belching
TONY SCARIA 2010
KMC
83. Pseudocyesis
• Patient has a false belief that she is
pregnant
• Associated objective signs
• Distended abdomen (umbilicus does not
become inverted)
• Amenorrhea
• Subjective fetal movements
• Breast engorgement
• Labour pains
TONY SCARIA 2010
KMC
84. Factitious disorder
• Munchausen syndrome
• Hospital addiction / hospital
hoboes or professional patient
• Deliberately create symptoms
• For seeking medical attention
• Travels form doctor to doctor
hospital to hospital
• Patient has eagerness to
undergo various test
investigations & procedures
grid abdomen
• Distort clinical histories
,laboratory test reports TONY SCARIA 2010
KMC
85. Grid iron abdomen with multiple scars in a pt
with munchaussens syndrome
TONY SCARIA 2010
KMC
86. Munchausen syndrome by proxy
• In which a parent usually mother or care taker repeatedly fabricates
or actually inflicts injury to child
TONY SCARIA 2010
KMC
87. Malingering
• Deliberately fake symptoms for a conscious apparent reason
• Recognizable external motive
• Intentional production of false or exaggerated symptoms
TONY SCARIA 2010
KMC
90. Neurasthenia
• c/o of increased mental & physical fatigue
after mild efforts
• Patient is often concerned about lowered
physical & mental efficiency
• Muscular aches / pain/sleep
disturbances/irritability/dyspepsia/headache
/inability to relax
TONY SCARIA 2010
KMC
91. c/c fatigue syndrome
• Myalgic encephalomyelitis
• In western countries
• Severe debilitating fatigue
• Malaise
• Head ache pharyngitis
• Tender LN
• GI symptoms
• Low grade fever
TONY SCARIA 2010
KMC
92. Culture bound syndromes
• Limited to some cultures
• Dhat syndrome
• In indian subcontinent
• Feeling of Passing semen in urine physical & mental
weakness
• Koro
• In south east asia
• Fear that his penis retracts into abdomen death
• Latah
• In Malaysia
• Automatic obedience
• Echolalia/echopraxia
• Amok
• In philipiness
• Brooding followed by homicide
Koro
Dhat syndrome
TONY SCARIA 2010
KMC
93. Factitious disorder
• Munchausens syndrome
• Hospital addiction
• Professional patients
• Often from medical & related fields
• Produce fake symptoms for attaining medical attention
• In malingering
• Distort the history & make stories (pseudologia fantasica)
TONY SCARIA 2010
KMC
97. Alarm reaction
• Characterised by flight or fight response
Stage of reistance
• Stage of adaptation
• Body adapts to stress
Stage of exhaustion
• Resistance of body gradually decreases
TONY SCARIA 2010
KMC
98. Psychosomatic manifestation
• Gastrointestinal system
• Peptic ulcer / crohns d/s /ulcerative colitis
• Irritable bowel syndrome
• Abdominal pain cramps
• Alteration of bowel habits
• Respiratory system
• Asthma COPD
• hyperventilation syndrome
• Rapid & deep breathing for several minutes
• Accompniying symptoms of suffocation / giddiness /paraesthesia/ syncope (due to falling
pCO2)
TONY SCARIA 2010
KMC
100. Musculoskeletal system
• RA
• SLE
• Fibromyalgia
• Pain & stiffness of muscle ligaments
• Anxiety fatigue inability to sleep
• Local areas of tenderness TRIGGER
POINTS
TONY SCARIA 2010
KMC
102. • Bereavement
• State of being deprived of some one
d/t death
• Grief
• Psychological feeling precipitated by
death of a loved one
• Mourning
• External exression of grief through
funeral rituals
TONY SCARIA 2010
KMC