1. The patient has a diagnosis of paranoid personality disorder that has been exacerbated by the onset of vascular dementia. He exhibits paranoid and aggressive behaviors, as well as neurological symptoms of dementia including tremors, shuffling gait, and impaired judgment.
2. The psychiatrist recommends increasing the patient's medication to better manage his behaviors. Non-pharmacological recommendations include engaging the patient in meaningful activities and bringing in familiar objects from home to create a more soothing environment.
3. Due to the severity of his dementia, the patient lacks capacity to make his own medical and living decisions. His health care agent and guardianship are therefore responsible for those decisions. Ongoing management will focus on behavioral techniques to diminish problem
• Attention Deficit Hyperactivity Disorder (ADHD)
• Paranoid Schizophrenia
After clicking a disorder, click the Diagnostic Overview tab in the left column. This will cover the major diagnostic features of the disorder. After that, click the DSM-5 Features tab. You can then go though the Case History, Interview, and Treatment sections on the website. Finally, in the Assessment section, you can complete an optional multiple-choice quiz. You have to write a case report for each case study.
The format for the sample report is as follows:
Your Name
Instructor's Name
Class/Section Number
Background
• Outline the major symptoms of this disorder.
• Briefly outline the client's background (age, race, occupations, etc.).
• Describe any factors in the client's background that might predispose him or her to this disorder.
Observations
• Describe any symptoms that you have observed that support the diagnosis. You can include direct quotes or behaviors that you may have observed.
• Describe any symptoms or behaviors that are inconsistent with the diagnosis.
• Provide any information that you have about the development of this disorder.
Diagnosis
• Did you observe any evidence of general medical conditions that might contribute to the development of this disorder?
• Did you observe any evidence of psychosocial and environmental problems that might contribute to this disorder?
• As per your observations, what is the client’s overall level of safety regarding potential harm to self or others (suicidality or homicidality)?
• What cross-cultural issues, if any, affect the differential diagnosis?
Therapeutic Intervention
• In your opinion, what are the appropriate short-term goals of this intervention?
• In your opinion, what are the appropriate long-term goals of this intervention?
• Which therapeutic strategy seems the most appropriate in this case? Why?
• Which therapeutic modality seems the most appropriate in this case? Why?
APA format
Diagnostic overview
Schizophrenia is the most debilitating form of mental illness . This disorder which can come on quite suddenly distorts a person thoughts , perceptions and mood, and leaves them unable to meet the ordinary demands of life .
There is no single test to determine who suffers from schizophrenia. Instead the diagnoses is made when a person expresses a collection set of symptoms. The symptoms can be divided into three categories. One positive symptoms two negative symptoms and three social dysfunction.
One positive sentence
Positive symptoms include overt behaviors that are unusual and that interferes with the persons ability to interact in a daily life. The Two most common types of positive symptoms include delusional and hallucinations. It is essential to understand the difference between these two.
A delusion is a firmly held beliefs that is not grounded in real life. There are many types of delusions for example when a person vastly overestimate his or her importance we would ...
• Attention Deficit Hyperactivity Disorder (ADHD)
• Paranoid Schizophrenia
After clicking a disorder, click the Diagnostic Overview tab in the left column. This will cover the major diagnostic features of the disorder. After that, click the DSM-5 Features tab. You can then go though the Case History, Interview, and Treatment sections on the website. Finally, in the Assessment section, you can complete an optional multiple-choice quiz. You have to write a case report for each case study.
The format for the sample report is as follows:
Your Name
Instructor's Name
Class/Section Number
Background
• Outline the major symptoms of this disorder.
• Briefly outline the client's background (age, race, occupations, etc.).
• Describe any factors in the client's background that might predispose him or her to this disorder.
Observations
• Describe any symptoms that you have observed that support the diagnosis. You can include direct quotes or behaviors that you may have observed.
• Describe any symptoms or behaviors that are inconsistent with the diagnosis.
• Provide any information that you have about the development of this disorder.
Diagnosis
• Did you observe any evidence of general medical conditions that might contribute to the development of this disorder?
• Did you observe any evidence of psychosocial and environmental problems that might contribute to this disorder?
• As per your observations, what is the client’s overall level of safety regarding potential harm to self or others (suicidality or homicidality)?
• What cross-cultural issues, if any, affect the differential diagnosis?
Therapeutic Intervention
• In your opinion, what are the appropriate short-term goals of this intervention?
• In your opinion, what are the appropriate long-term goals of this intervention?
• Which therapeutic strategy seems the most appropriate in this case? Why?
• Which therapeutic modality seems the most appropriate in this case? Why?
APA format
Diagnostic overview
Schizophrenia is the most debilitating form of mental illness . This disorder which can come on quite suddenly distorts a person thoughts , perceptions and mood, and leaves them unable to meet the ordinary demands of life .
There is no single test to determine who suffers from schizophrenia. Instead the diagnoses is made when a person expresses a collection set of symptoms. The symptoms can be divided into three categories. One positive symptoms two negative symptoms and three social dysfunction.
One positive sentence
Positive symptoms include overt behaviors that are unusual and that interferes with the persons ability to interact in a daily life. The Two most common types of positive symptoms include delusional and hallucinations. It is essential to understand the difference between these two.
A delusion is a firmly held beliefs that is not grounded in real life. There are many types of delusions for example when a person vastly overestimate his or her importance we would ...
It explains about what is personality, give a brief introduction about personality disorder, describes three clusters of personality disorder with detailed explanations about the 10 personality disorder starting from cluster A disorder paranoid personality disorder to anti social personality disorder from cluster B to Obsessive compulsive personality disorder
Psychiatry– it deals with study, diagnosis, treatment and prevention of mental illness.
Forensic psychiatry- application of knowledge of psychiatry
These are the person who are unable to cope with the ordinary social circumstance
This is a project for a high school AP Psychology course. This is a fictionalized account of having a psychological ailment. For questions about this blog project or its content please email the teacher Chris Jocham: jocham@fultonschools.org
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
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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!
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
Paranoid Personality Disorder
1. 1
Mental Health Consultation
Patient Name: paranoid personality disorder/VaD Facility: XXXX
Date: 7-16 -13 Room: 000
Reasonfor Referral: XX-year-old, white, xxxxx, male… I was asked to see him to clarify his
diagnoses, as well as, offer assistance with his many behavior problems. Reportedly, he often “refuses
care… yells… swears… strikes out and generally frightens staff and other residents” He has eloped
from the facility. He is preoccupied with the notion of being discharged from XXXX and moving to
Arizona where he plans to find an apartment. At times, he “apologizes for his behavior” and he has also
been seen “crying”.
Background Information: There is very little useful history available. Highlights of what there is
follows:
He was admitted to the XXXX on 4-18-13 where he was treated for a bowel obstruction. While
at the XXXX he was described as “confused, disoriented and belligerent” He referred to himself
as the “Mayor of Buffalo” and was kept in restraints for most of his stay. He reportedly, had a
grand mal seizure just prior to admission. He was transferred to XXXX on 5-2-13.
According to family he was in decline for many months prior to admission to the XXXX: he
purchased a car and totaled it… wasn’t paying his bills… failed to pay his rent and was evicted
from his apartment. He had a drinking problem most of his adult life, hanging out in bars but has
not been a drinker for 20 years. He was always an angry person who used extremely bad
language which offended people but he loved his family and his ex-wife’s dog. Because of his
abusive behavior he “burned all of his bridges with the family”
There is no neuroimaging available. Recent labs are unremarkable. He has a Health Care Proxy.
His daughter-in-law is designated the Health Care Agent. She also has POA.
Current Medications: Coreg, Aricept, Zoloft 50mg qd, Seroquel 50mg qhs and 25mg bid prn, Haldol
0.5mg q8hr prn, Ativan 0.5mg tid prn, Compazine prn
Medical History: Hyperlipidemia, Hypertension, Peripheral Vascular Disease, dementia.
Mental Status Exam: He was a fit looking elderly gentleman with a full head of silver hair who was
readily engageable. He was restless moving about as he spoke. He exhibited bilateral hand tremors, and
when I asked him to walk, a stooped posture and a shuffling gait with short steps. His speech was
spontaneous but laden with word finding pauses and semantic paraphasic errors. His affect was mostly
flat but could be labile alternating between laughing and joking and flashes anger. He ruminated on his
desire to leave the nursing home and set up shop Arizona. He was preoccupied with the many injustices
which were perpetrated on him. When I asked about depression, he said “I know my son and the others
don’t want me but I understand” He carefully avoided answering my questions about orientation. He
became animated when I asked about his experiences during the Korean War. He was quite paranoid but
not hallucinated or delirious.
2. 2
Findings and Recommendations:
There are several interacting and compounding issues here:
Based on his history and his clinical presentation what we appear to have here is a man with a premorbid
paranoid personality disorder. According to his family, he has a lifelong history of abusive behavior
“angry…yelling…swearing”. He has “burned all of his bridges” with them because of this behavior.
Individuals with a Paranoid Personality Disorder are mistrustful of others and suspicious of the motives
and intentions of those around them. They tend to be loners with few close, personal relationships. They
can be impressive even charming, but are always looking for hidden meanings in the speech and
behavior of the people they encounter. They can be argumentative and quarrelsome and their impatience
is often expressed in angry, emotional outbursts. They sometimes convey an attitude of superiority,
arrogance and grandiosity which antagonizes other people. They can unconsciously create the following
self-defeating vicious cycle: They expect to be rejected; as a result, they are hostile to others and reject
before they are rejected; because of their defensiveness and hostility, others reject them; this confirms
their original belief that most people are hostile to them and the cycle is repeated over and over again
with each new interpersonal contact.
The above has been compounded and complicated by the onset of a vascular dementia (VaD). Despite
the lack of neuroimaging this appears to be VaD because of the risk factors and his clinical presentation.
I am ruling out alcohol dementia because his family said he stopped drinking 20 years ago and Lewy
body because of the absence of hallucinations and wide swings in consciousness. Patients with VaD are
especially vulnerable to delirium. Irritability and mild paranoia are often seen in these patients.
Neurological signs of this disease include: gait problems and falls, weakness, ataxia, rigidity, dysarthria,
parkinsonism and urinary incontinence. Neuropsychiatric findings include: memory impairment, poor
judgment, lack of spontaneity, perseveration, psychomotor slowing, loss of vigor, general dilapidation in
cognitive functioning and apathy. Nocturnal confusion, fluctuating mental status and delirium like
episodes are also often seen. The vascular dementia as led to some degree of disinhibition which has
intensified the yelling and swearing. Disinhibition is also responsible for the reported “crying”. We
could be seeing some atypical depression not uncommon in VaD. He was not grossly psychotic or
delirious but he was paranoid. Sounds like he was delirious at the XXXX.
He exhibited pronounced Parkinson’s signs including bilateral hand tremors, a stooped posture and a
shuffling gait with short steps. This is probably a reflection of his VaD. It seems unlikely that it could be
EPS secondary to the Haldol given the fact that he rarely takes the Haldol. Idiopathic Parkinson’s
Disease cannot be completely ruled out.
Because of the severity of his dementia he lacks the capacity to make choices concerning living
arrangements. In order to provide informed consent for living arrangements, the patient must be able to
satisfy the following criteria:
1) Can the person make and communicate, by spoken words or otherwise, choices concerning his or
her own life?
2) Can the person offer any reasons for the choices made?
3) Are the reasons underlying the choice “rational”? That is, does the patient start with a plausible
premise about the facts surrounding a specific situation and reason logically from that premise to
a conclusion?
4) Is the person able to understand the likely risks and benefits of the choices?
5) Does the person understand the implications of those choices?
3. 3
Therefore, he cannot choose to leave the nursing home; that decision is in the hands of his Health Care
Agent. A Guardianship would be preferable.
His aggressive behavior is part of a lifelong ingrained personality style worsened now by compromised
brain functioning. We will be able to manage the problem behaviors and diminish them somewhat with
medications and, more importantly, consistent behavioral approaches but we will not be able to stop
them.
1. The Seroquel was a good choice because of its low antidopaminergic properties considering
XXXX pronounced Parkinson’s signs however the dose is much too low to have any effect.
Therefore, I would increase the Seroquel to 50mg TID. We can titrate up from there if we need
to. Continue the Ativan prn; by all accounts this has worked for him. Would DC the prn Seroquel
and start Risperdal 0.5mg bid prn PO. This is highly antidopaminergic which is not good in this
situation but onset of action is 30 min. vs. the 2 hrs. for the Seroquel. Staff can chose between
the two prns.
2. To treat any possible atypical depression (i.e. anxiety, agitation, irritability, emotional
incontinence) symptoms, as well as, disinhibition would discontinue the Zoloft and start him on
Lexapro 10mg qd times two weeks then increase to 20mg qd. The Lexapro and Seroquel will
interact synergistically.
3. His room is devoid of personal objects. Ask his son to bring in family photographs including
photos of XXXX ship and his dog and bring in objects which are of sentimental significance to
him and place them about his room. Try to create a soothing and familiar environment in his
room. Ask the son to bring in some examples of XXXX leather tooling to pump up his self-
esteem.
4. Would refer him to the Neurology Clinic at the XXXX to address the issue of “grand mal
seizure PTA” and to rule in or rule out Idiopathic Parkinson’s Disease. It looks like the surgeon
at the XXXX also wanted this to happen. It would be helpful if they did neuroimaging, as well.
5. His hobby was leather tooling. Perhaps the activities folks could find something similar for him
to do such as wallet making. The better he feels about himself the less he will act out.
6. He is very attached to his ex-wife’s dog. Ask her to bring the dog in on occasion.
7. Staff should avoid appearing directive with him. He would see this as a threat to his self-esteem
and become oppositional as a means of asserting his autonomy.
8. Model self-regulation by speaking and moving, calmly and slowly when dealing with him. He
seems to have a bit of a sense of humor. When it seems appropriate, try to diffuse a tense
situation with humor.
9. Do not allow him to make you feel responsible for immediately solving his problems. Do not
allow him to lure you into agreeing with his criticisms. Do not be intimidated by him. Do not try
to win his approval.
4. 4
10. Always allow him a face saving way out of a conflict or situation. When he talks about leaving
the nursing home never say he has to stay, change the subject to one you know he is interested in
such as: his dog, the Navy or his family.
11. When he does become abusive guide him back to his room. Say nothing other than walk with
me. Do not engage him in a back and forth. If necessary use a few silent people to help guide
him. Offer him a prn. Say you will talk to him when he gets better control of himself. Tell him
you know being out of control is as frightening to him as it is to other people. Do not indirectly
reward his aggressive behavior.
12. Stability and predictability will limit frustration and emotional outbursts. Establish a predictable
and consistent daily routine for him. Keep him busy with simple tasks but not excessively
stimulated.
13. Try not to ask questions which draw attention to his memory loss and general cognitive
impairment.
14. Please try to obtain additional history on this gentleman specifically any neurology and/or
psychiatry records which might be available. Start with the XXXX.
___________________________
Drew Chenelly, Psy.D
Clinical Neuropsychologist