The document provides guidance on presenting long psychiatric cases. It discusses common and less common psychiatric conditions seen in inpatients and outpatients. It offers tips on documenting the diagnosis, management, history of present illness, past psychiatric history, mental status examination, and reasoning the diagnosis. Key areas to focus on include symptoms, syndromes, disorders, illness effects on patient and family, precipitating and perpetuating factors, and chief complaint. The disturbance getting worse at night refers to the circadian rhythm phenomenon. Measures like lowering noise and lights can help reduce symptoms. An antipsychotic may be suitable given the acute onset of psychosis and disorientation.
This is a presentation done on 4/6/11 for the Grand Rounds at Wayne State university by Pallav Pareek M.D.
This presentation talks about the concept of prdrome as it is(if?) applicable to schizophrenia, and if schizophrenia is becoming more of a preventable illness as science progresses. If so what are the various ways and means in which we can accomplish this prevention.
Amidst so much controversy on the issue , whether there is a prodrome for this illness or not, here I have tried to present the recent advances in this field and the recent scientific literature in this regard.
This is a presentation done on 4/6/11 for the Grand Rounds at Wayne State university by Pallav Pareek M.D.
This presentation talks about the concept of prdrome as it is(if?) applicable to schizophrenia, and if schizophrenia is becoming more of a preventable illness as science progresses. If so what are the various ways and means in which we can accomplish this prevention.
Amidst so much controversy on the issue , whether there is a prodrome for this illness or not, here I have tried to present the recent advances in this field and the recent scientific literature in this regard.
Somatoform disorder include different entities. One of complex and difficult to treat ailment among the somatoform disorder is illness anxiety disorder, formerly known as hypochondriasis. My power point presentation is an attempt to simplify the mystery of this common psychiatric diagnosis. (Dr Satyajeet Singh, MD, Neuropsychiatrist, Aiims Patna)
Non schizophrenic Psychosis
Brief Psychotic Disorder
Schizophreniform Disorder
Substance-Induced Psychotic Disorder
Psychotic Disorder Due to a General Medical Condition
Schizoaffective Disorder
Shared Psychotic Disorder
Delusional Disorder
Dr. Mohammad Hussein
الذهان الغير فصامي
د.محمد حسين
استشاري الطب النفسي
Alzheimers Diseaseo Prepare· Review the interactive me.docxjack60216
Alzheimer's Disease"
o Prepare
· Review the interactive media piece assigned by your Instructor.
· Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
· Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
· You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.
Write a 1- to 2-page summary paper that addresses the following:
· Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
· Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
· What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
· Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.
Interactive media piece case study below:
BACKGROUND
Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal.
According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.”
Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficult “finding the right words” in a conversation and then will shift to an entirely different line of conversation.
SUBJECTIVE
During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so you perform a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.
MENTAL STATUS EXAM
Mr. Akkad is 76 year old Iranian male.
Somatoform disorder include different entities. One of complex and difficult to treat ailment among the somatoform disorder is illness anxiety disorder, formerly known as hypochondriasis. My power point presentation is an attempt to simplify the mystery of this common psychiatric diagnosis. (Dr Satyajeet Singh, MD, Neuropsychiatrist, Aiims Patna)
Non schizophrenic Psychosis
Brief Psychotic Disorder
Schizophreniform Disorder
Substance-Induced Psychotic Disorder
Psychotic Disorder Due to a General Medical Condition
Schizoaffective Disorder
Shared Psychotic Disorder
Delusional Disorder
Dr. Mohammad Hussein
الذهان الغير فصامي
د.محمد حسين
استشاري الطب النفسي
Alzheimers Diseaseo Prepare· Review the interactive me.docxjack60216
Alzheimer's Disease"
o Prepare
· Review the interactive media piece assigned by your Instructor.
· Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
· Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
· You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.
Write a 1- to 2-page summary paper that addresses the following:
· Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
· Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
· What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
· Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.
Interactive media piece case study below:
BACKGROUND
Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal.
According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.”
Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficult “finding the right words” in a conversation and then will shift to an entirely different line of conversation.
SUBJECTIVE
During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so you perform a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.
MENTAL STATUS EXAM
Mr. Akkad is 76 year old Iranian male.
Maintenance Electroconvulsive Therapy Augmentation on Clozapine-Resistant Psy...Zahiruddin Othman
Case Report: Maintenance electroconvulsive therapy augmentation on clozapine-resistant psychosis with neurosyphilis is effective and safe but has never been reported in the literature to the authors' knowledge. It is hoped that this case report would contribute to the scarce literature on this augmentation strategy
Case Report: Schizophrenia patient with prodromal OCS is probably at increased risk of developing TTM while on atypical
antipsychotics treatment. Atypical antipsychotics and SSRI combination therapy is a useful strategy in such patient
Isolated Cerebellar Stroke Masquerades as DepressionZahiruddin Othman
There are numerous reports on neurological conditions masquerading as psychiatric disorders. However, cerebellar
stroke is not established as one of it. The 2 case reports will highlight that this masquerade is possible and the physician's
high index of suspicion is the key to accurate diagnosis.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. Common Long CasesCommon Long Cases
In-patient = psychoticIn-patient = psychotic
SchizophreniaSchizophrenia
Major depression w psychotic featMajor depression w psychotic feat
Mania w psychotic featuresMania w psychotic features
Out-patient = neuroticOut-patient = neurotic
DepressionDepression
Anxiety disordersAnxiety disorders
Panic with agoraphobiaPanic with agoraphobia
Social phobiaSocial phobia
3. Less Common CasesLess Common Cases
In-patientIn-patient
Organic disorderOrganic disorder
Mental disorder DTGMCMental disorder DTGMC
Psychotic disorder due to epilepsyPsychotic disorder due to epilepsy
Substance-related disorderSubstance-related disorder
Addiction or dependenceAddiction or dependence
Substance-induced psychosisSubstance-induced psychosis
Out-patientOut-patient
GADGAD
OCDOCD
4. Presenting Long Case - 1Presenting Long Case - 1
Diagnosis & managementDiagnosis & management
SymptomsSymptoms
Objective = observableObjective = observable
Subjective = phenomenologySubjective = phenomenology
SyndromesSyndromes
Number, duration, severityNumber, duration, severity
May be > 1May be > 1
Cross sectional and longitudinalCross sectional and longitudinal
6. Presenting Long Case - 3Presenting Long Case - 3
Chief complaintChief complaint
Be as accurate possibleBe as accurate possible
Punched father vs. aggressivePunched father vs. aggressive
Avoid technical termAvoid technical term
Heard voices vs. audit. hallucinationsHeard voices vs. audit. hallucinations
Consider patient poor insightConsider patient poor insight
Choose easy to elaborateChoose easy to elaborate
Typical of the illnessTypical of the illness
Example palpitations for panicExample palpitations for panic
7. Presenting Long Case - 4Presenting Long Case - 4
HOPIHOPI
Most crucialMost crucial
SymptomsSymptoms illnessillness
Inclusion = relevant +veInclusion = relevant +ve
Adequate to convinced examinerAdequate to convinced examiner
e.g. provide examples of pt behaviore.g. provide examples of pt behavior
Exclusion = relevant -veExclusion = relevant -ve
Need not be detail … to save timeNeed not be detail … to save time
e.g. no history to suggest organicity suche.g. no history to suggest organicity such
as recent head trauma etcas recent head trauma etc
8. Presenting Long Case - 5Presenting Long Case - 5
Past Psych.Past Psych.
Number of admissionNumber of admission
e.g. pt was 7 times between 95 to 99e.g. pt was 7 times between 95 to 99
In between functional levelIn between functional level
Personal & FamilyPersonal & Family
Predisposing vs. assetsPredisposing vs. assets
Disorder & prognosisDisorder & prognosis
9. Presenting Long Case - 6Presenting Long Case - 6
MSEMSE
Brief and accurateBrief and accurate
Use specific termUse specific term
Provide example when necessaryProvide example when necessary
Thorough and focusedThorough and focused
Don’t forget cognitive testDon’t forget cognitive test
e.g. attention / concentratione.g. attention / concentration
+ve findings merit > detail+ve findings merit > detail
assessmentassessment
e.g. in MR, > arithmetic, knowledgee.g. in MR, > arithmetic, knowledge
10. Presenting Long Case - 7Presenting Long Case - 7
Physical ExaminationPhysical Examination
Vital signsVital signs
Relevant systemRelevant system
History of alcoholismHistory of alcoholism
Liver, neurologicalLiver, neurological
Chief complaint palpitationsChief complaint palpitations
CVS, thyroidCVS, thyroid
Older patientOlder patient
Higher possibility of organicHigher possibility of organic
11. Characteristic Vs. TypicalCharacteristic Vs. Typical
CharacteristicsCharacteristics
Operational definitionOperational definition necessary ornecessary or
minimum requiredminimum required
Sensitivity > specificitySensitivity > specificity
Need TRO other disordersNeed TRO other disorders
TypicalTypical
How much the case resembles theHow much the case resembles the
textbook casetextbook case
Useful in doubtful casesUseful in doubtful cases
e.g. Schneider FRSe.g. Schneider FRS
12. Atypical FeaturesAtypical Features
Make your diagnosis lessMake your diagnosis less
certaincertain differential dx.differential dx.
Schizophrenic who plan to getSchizophrenic who plan to get
married, talked in malay + englishmarried, talked in malay + english
Mania? e.g. schizoaffectiveMania? e.g. schizoaffective
First onset of mood symptoms atFirst onset of mood symptoms at
60 years of age60 years of age
Organic? e.g. dementiaOrganic? e.g. dementia
13. SchizophreniaSchizophrenia
ComplianceCompliance
Reasons for poor complianceReasons for poor compliance
Atypical vs. typical antipsychoticsAtypical vs. typical antipsychotics
Oral vs. depotOral vs. depot
PsychoeducationPsychoeducation
BehaviourBehaviour
Leading to admissionLeading to admission
Burden to familyBurden to family
Aggressive, apathy, asocial etcAggressive, apathy, asocial etc
14. ManiaMania
ComplianceCompliance
Need for maintenance?Need for maintenance?
Irritability, aggressiveIrritability, aggressive
Pleasurable activity wPleasurable activity withith badbad
consequenceconsequence
Spending spreeSpending spree
PromiscuityPromiscuity
15. Major DepressionMajor Depression
Major or not?Major or not?
Severity, psychotic, durationSeverity, psychotic, duration
Biological, suicidalBiological, suicidal
Risk of suicideRisk of suicide
Suicidal intent?Suicidal intent?
Psychosocial problemsPsychosocial problems
Interpersonal conflictsInterpersonal conflicts
16. Panic With AgoraphobiaPanic With Agoraphobia
RUPARUPA
RecurrentRecurrent UUnexpected PAnexpected PA
For stable out-patientFor stable out-patient
Agoraphobia > panicAgoraphobia > panic
ImpairmentsImpairments
May confuse with social phobiaMay confuse with social phobia
Behavior therapy > anxiolyticsBehavior therapy > anxiolytics
17. Reasoning A Diagnosis – 1Reasoning A Diagnosis – 1
Provisional diagnosis of pt is …Provisional diagnosis of pt is …
because he has characteristicbecause he has characteristic
features such as …(symptoms)features such as …(symptoms)
…(duration) … (severity)…(duration) … (severity)
There is no prominent …There is no prominent …
(organic, substance, other axis(organic, substance, other axis
I) to suggest otherwiseI) to suggest otherwise
18. Reasoning A Diagnosis – 2Reasoning A Diagnosis – 2
DDx is … because bothDDx is … because both
conditions have … (shareconditions have … (share
similar features, thus can besimilar features, thus can be
confused)confused)
However, … is unlikely becauseHowever, … is unlikely because
… (what make provisional >… (what make provisional >
characteristics or typical)characteristics or typical)
19. ManagementManagement
Bio and psychosocial approachBio and psychosocial approach
In two stagesIn two stages
AcuteAcute = in-patient= in-patient
Fastest symptoms reductionFastest symptoms reduction
Primary medication + othersPrimary medication + others
MaintenanceMaintenance = out-patient= out-patient
Prevent future recurrence or relapsePrevent future recurrence or relapse
Primary medication +/- othersPrimary medication +/- others
Adjunct, augmentationAdjunct, augmentation
20. MEQ - 1MEQ - 1
A man developed abnormalA man developed abnormal
behavior on the 4th day ofbehavior on the 4th day of
admission to a medical ward.admission to a medical ward.
He was restless, shouting away,He was restless, shouting away,
and hallucinating. Theand hallucinating. The
disturbance was worse at night.disturbance was worse at night.
He was disorientated when youHe was disorientated when you
saw him.saw him.
21. List two (2) differential diagnosesList two (2) differential diagnoses
State the phenomenon referred to asState the phenomenon referred to as
“the disturbance was worse at night”“the disturbance was worse at night”
List two (2) measures with regard toList two (2) measures with regard to
patient’s environment in order topatient’s environment in order to
reduce the severity of phenomenonreduce the severity of phenomenon
mentionedmentioned aboveabove
Name a suitable antipsychotic forName a suitable antipsychotic for
this patient and give two (2) reasonsthis patient and give two (2) reasons
for your selectionfor your selection
22. MEQ - 2MEQ - 2
A 25-year-old male schizophrenicA 25-year-old male schizophrenic
was admitted to medical ward duewas admitted to medical ward due
to an overdose of medication. Theto an overdose of medication. The
patient did not recognize you as apatient did not recognize you as a
doctor and was unaware he was indoctor and was unaware he was in
the hospital. According to his fatherthe hospital. According to his father
he was depressed after recoveringhe was depressed after recovering
from the last relapse of his illness.from the last relapse of his illness.
He took a handful of medicationHe took a handful of medication
that was prescribed to him before.that was prescribed to him before.
23. StateState the most likely conditionthe most likely condition
patient is havingpatient is having
Describe the mechanism involvedDescribe the mechanism involved
If the patient fulfilled the diagnosis ofIf the patient fulfilled the diagnosis of
major depression, state yourmajor depression, state your
provisional diagnosis at this stageprovisional diagnosis at this stage
List 4 other points in history toList 4 other points in history to
suggest a high suicidal intentsuggest a high suicidal intent