This document discusses schizophrenia and provides a case study example. It begins with definitions of psychosis and lists different types of psychotic disorders. It then presents a case history of a 35-year-old woman who began experiencing paranoid delusions about her neighbor conspiring against her and hearing threatening voices. Her symptoms worsened until she attempted suicide. The document analyzes her clinical presentation and diagnosis of paranoid schizophrenia. It discusses differential diagnosis, investigations, treatment including pharmacotherapy and ECT, management of side effects, and her response to risperidone treatment.
The patient is a 45-year-old married female who has been experiencing psychiatric symptoms for 12 years. She initially presented with fear, talking to herself, and suspicious behavior. Medications provided minimal relief and her condition has worsened over time. She now experiences auditory hallucinations, delusions that she is being harassed, and shows unpredictable and aggressive behavior. A mental status examination revealed impaired thought processes and insight.
1. Said Mohammad, an 18-year-old male from Peshawar, presented with suspiciousness, aggression, insomnia, lack of appetite, and social withdrawal over the past month.
2. His symptoms began one month ago when he started socially withdrawing and expressing beliefs that his family was plotting to kill him. Over the past three days, he became aggressive, refused to eat or sleep, and believed his family would poison him.
3. He was brought to the hospital by his family after attempts to treat him with spiritual healers were unsuccessful. His symptoms appeared to develop after recently relocating with his family due to security concerns.
Sarah, a 34-year-old teacher, has experienced chronic, remitting episodes of depression for 10 years. Her current episode involves low self-esteem, sleep problems, lack of enjoyment, suicidal thoughts, weight gain, despair, isolation, worthlessness and concentration difficulties. Previous treatments with SSRIs provided initial relief but symptoms returned. Amitriptyline was prescribed but exacerbated manic symptoms, leading to a diagnosis of bipolar disorder. Hospitalization and lithium stabilized her condition. The case highlights how bipolar disorder can initially present as depression and the importance of a thorough psychiatric history for correct diagnosis.
The patient is a 65-year-old retired male teacher presenting with a 4-year history of progressive cognitive and behavioral decline. He has been diagnosed with bipolar affective disorder for over 35 years. Over the last 4 years, his family has reported increasing forgetfulness, irritability, suspiciousness, sleep disturbances, and difficulties with activities of daily living. His cognitive evaluation shows impairments in attention, memory, visuospatial abilities, and executive function. Brain imaging reveals diffuse cerebral atrophy. Based on the clinical presentation and investigations, the provisional diagnosis is late-onset Alzheimer's disease with behavioral and psychological symptoms of dementia. Other considerations include mixed Alzheimer's and vascular dementia or vascular dementia. The patient is being treated with
This document discusses Bipolar Disorders I and II as defined by the DSM-5. Bipolar I Disorder requires at least one manic episode, along with potential hypomanic or depressive episodes. Diagnostic criteria for manic, hypomanic, and depressive episodes are provided. Bipolar II Disorder involves at least one hypomanic and one depressive episode, without mania. It further defines hypomanic and depressive episode criteria and discusses the development, course, and age of onset for both disorders.
This document summarizes the case history of a 50-year-old married woman with a 10-year history of schizophrenia. She exhibits symptoms like depression, irritability, suspiciousness, insomnia, hallucinations, and social withdrawal. A mental status examination found coherent thought with visual hallucinations and phobias. She has good memory and intelligence but poor judgment. The patient displays signs of delusions of persecution, jealousy, and grandiosity as well as hallucinatory voices.
This document provides an overview of the management of alcohol dependence. It discusses the assessment, diagnosis and treatment of alcohol intoxication, withdrawal, and complications. It covers pharmacological management using benzodiazepines and other medications. It also discusses relapse prevention strategies like pharmacological deterrents/anticraving agents and psychotherapies including cognitive behavioral therapy, motivational interviewing, and group therapy. The goal is to safely detoxify patients, treat complications, prevent relapse, and support long term abstinence through an integrated treatment approach.
This document discusses alcohol use disorder and provides information on its historical aspects, epidemiology, types of alcoholic beverages, effects on the body, etiology, and diagnostic criteria. Some key points:
- Alcohol has been used by humans for intoxication purposes throughout history, with the earliest evidence of intentionally fermented beverages dating back over 10,000 years.
- Worldwide, alcohol causes over 1.8 million deaths per year through conditions like cancer, liver disease, accidents, and violence.
- Types of alcoholic beverages include spirits like whiskey and rum, wines, beers, and liqueurs. The alcohol content varies significantly between different types.
- Alcohol affects the brain through its interactions with neurotransmit
The patient is a 45-year-old married female who has been experiencing psychiatric symptoms for 12 years. She initially presented with fear, talking to herself, and suspicious behavior. Medications provided minimal relief and her condition has worsened over time. She now experiences auditory hallucinations, delusions that she is being harassed, and shows unpredictable and aggressive behavior. A mental status examination revealed impaired thought processes and insight.
1. Said Mohammad, an 18-year-old male from Peshawar, presented with suspiciousness, aggression, insomnia, lack of appetite, and social withdrawal over the past month.
2. His symptoms began one month ago when he started socially withdrawing and expressing beliefs that his family was plotting to kill him. Over the past three days, he became aggressive, refused to eat or sleep, and believed his family would poison him.
3. He was brought to the hospital by his family after attempts to treat him with spiritual healers were unsuccessful. His symptoms appeared to develop after recently relocating with his family due to security concerns.
Sarah, a 34-year-old teacher, has experienced chronic, remitting episodes of depression for 10 years. Her current episode involves low self-esteem, sleep problems, lack of enjoyment, suicidal thoughts, weight gain, despair, isolation, worthlessness and concentration difficulties. Previous treatments with SSRIs provided initial relief but symptoms returned. Amitriptyline was prescribed but exacerbated manic symptoms, leading to a diagnosis of bipolar disorder. Hospitalization and lithium stabilized her condition. The case highlights how bipolar disorder can initially present as depression and the importance of a thorough psychiatric history for correct diagnosis.
The patient is a 65-year-old retired male teacher presenting with a 4-year history of progressive cognitive and behavioral decline. He has been diagnosed with bipolar affective disorder for over 35 years. Over the last 4 years, his family has reported increasing forgetfulness, irritability, suspiciousness, sleep disturbances, and difficulties with activities of daily living. His cognitive evaluation shows impairments in attention, memory, visuospatial abilities, and executive function. Brain imaging reveals diffuse cerebral atrophy. Based on the clinical presentation and investigations, the provisional diagnosis is late-onset Alzheimer's disease with behavioral and psychological symptoms of dementia. Other considerations include mixed Alzheimer's and vascular dementia or vascular dementia. The patient is being treated with
This document discusses Bipolar Disorders I and II as defined by the DSM-5. Bipolar I Disorder requires at least one manic episode, along with potential hypomanic or depressive episodes. Diagnostic criteria for manic, hypomanic, and depressive episodes are provided. Bipolar II Disorder involves at least one hypomanic and one depressive episode, without mania. It further defines hypomanic and depressive episode criteria and discusses the development, course, and age of onset for both disorders.
This document summarizes the case history of a 50-year-old married woman with a 10-year history of schizophrenia. She exhibits symptoms like depression, irritability, suspiciousness, insomnia, hallucinations, and social withdrawal. A mental status examination found coherent thought with visual hallucinations and phobias. She has good memory and intelligence but poor judgment. The patient displays signs of delusions of persecution, jealousy, and grandiosity as well as hallucinatory voices.
This document provides an overview of the management of alcohol dependence. It discusses the assessment, diagnosis and treatment of alcohol intoxication, withdrawal, and complications. It covers pharmacological management using benzodiazepines and other medications. It also discusses relapse prevention strategies like pharmacological deterrents/anticraving agents and psychotherapies including cognitive behavioral therapy, motivational interviewing, and group therapy. The goal is to safely detoxify patients, treat complications, prevent relapse, and support long term abstinence through an integrated treatment approach.
This document discusses alcohol use disorder and provides information on its historical aspects, epidemiology, types of alcoholic beverages, effects on the body, etiology, and diagnostic criteria. Some key points:
- Alcohol has been used by humans for intoxication purposes throughout history, with the earliest evidence of intentionally fermented beverages dating back over 10,000 years.
- Worldwide, alcohol causes over 1.8 million deaths per year through conditions like cancer, liver disease, accidents, and violence.
- Types of alcoholic beverages include spirits like whiskey and rum, wines, beers, and liqueurs. The alcohol content varies significantly between different types.
- Alcohol affects the brain through its interactions with neurotransmit
DISORDER CONTENTOF THOUGHT -DELUSION
BY DR.WASIM
UNDER GUIDANCE OF
DR.SANJAY.JAIN
Definition of delusion:
Delusions are categorized into four different groups
THERE ARE 2 TYPES OF DISORDERS OF THOUGHT CONTENT
1.DELUSION
2.OVERVALUED IDEAS
DISTINGUISED
DELUSION
OTHER MEMBERS OF THE CULTURE DONOT SHARE THE BELIEF.
NEED NOT BE ASSOCIATED WITH AFFECT.
FIRMLY SUSTAINED BELIEF.
CONVINCED THAT DELUSION IS REAL.
RECOGNIZED AS ABSURED.
CANNOT BE ACCEPTED.
OCCUR IN MENTALLY ILL PATIENTS.
OVERVALUED IDEAS
OTHER MEMBERS OF THE CULTURE SHARE THE BELIEF.
ASSOCIATED WITH VERY STRONG AFFECT.
NOT HELD FIRMLY.
ATLEAST SOME LEVEL OF DOUBT AS TO ITS TRUTHFULNESS.
NOT RECOGNIZED AS ABSURED.
ACCEPTABLE.
CAN OCCUR IN BOTH HEALTHY AND MENTALLY ILL PATIENTS.
KENDLER’S VECTORS FOR DELUSION:
five stages in the development of delusion(FISH & CONRAD)
FACTORS CONCERNED WITH GENERATION OF DELUSIONS
PATHPOPHYSIOLOGY OF DELUSIONS
PRIMARY DELUSIONS
SECONDARY DELUSIONS
SYSTEMATIZATION
DELUSIONS ON THE BASIS OF CONTENT OF DELUSIONS
THANK YOU
This case presentation describes a 57-year-old man with a 2-3 year history of symptoms of sadness, disturbed sleep, irritability, and muttering to himself. His symptoms started gradually without a clear stressor. After a thorough examination, he was diagnosed with agitated depression. He was treated on an outpatient basis with escitalopram and lorazepam, along with family psychoeducation and relaxation techniques. Within 6 weeks of treatment, he showed over 80% improvement in his symptoms.
Personality disorders are common, chronic conditions that affect 10-20% of the general population. They have genetic and biological factors like low serotonin levels and childhood experiences like trauma that contribute to their development. The epidemiology of specific personality disorders is discussed, such as borderline personality disorder affecting 1-2% of the population, twice as common in women. Personality disorders are also more prevalent among prison populations and relatives of those with conditions like schizophrenia.
A 33-year-old male presented with symptoms of loss of interest, lethargy, and reduced mental and physical well-being for the past 6-7 years. He has a family history of possible psychiatric illness in his grandfather. On examination, he displayed anxious and inappropriate behavior, impaired comprehension, rapid speech, an anxious mood, paranoid delusions, and impaired judgment and insight. He was diagnosed with paranoid schizophrenia based on his symptoms. Schizophrenia is a chronic mental disorder caused by genetic and environmental factors. It involves positive symptoms like hallucinations and delusions as well as negative symptoms and is typically treated with antipsychotic medication.
Mrs. R is a 34-year-old married Malay woman diagnosed with schizopheniform disorder who was admitted to the psychiatric ward on December 8, 2014. She has a family history of mental illness and experiences auditory hallucinations telling her to harm her son. On assessment, she shows signs of disorganized speech and thought, mood disorder, and psychotic symptoms including auditory hallucinations and paranoid delusions. Objective assessments find mild to moderate cognitive impairment and difficulties with social interaction and managing stress. She is prescribed olanzapine and clozapine and is responsive to treatment.
This document provides an overview of psychiatry case taking and examination, including history taking and mental status examination (MSE). It discusses the purpose and general principles of history taking, as well as how to structure the interview room and questions. It then describes how to obtain information on a patient's identifying data, chief complaints, history of present illness, past history, family history, personal history, and pre-morbid personality. Finally, it outlines the components of the MSE including general appearance, psychomotor activity, speech, mood, thought, perception, and cognitive functions.
Alcohol related disorders- by Swapnil AgrawalSwapnil Agrawal
The document discusses the history and effects of alcohol use. It notes that alcohol has existed for over 10,000 years and was one of the earliest intentionally fermented substances consumed by humans. It then summarizes some of the key health effects of alcohol, including its impacts on the brain, body, and potential for dependence. Overall, the document provides a broad overview of the long history of alcohol consumption and some of the social and medical issues related to its use.
case presentation on mania presented by ajay morajaymor33
This document presents the case of a 23-year-old male patient presenting with symptoms of mania including irritability, wandering behavior, muttering to self, suspiciousness, loud speech, auditory hallucinations, and grandiosity. The patient has a 4-year history of untreated psychiatric illness with similar symptoms in the past requiring hospitalization. A family history of psychiatric illness is denied. The document defines mania and provides classification, etiology, clinical features, and objective/subjective symptoms of mania based on this patient's presentation and ICD-10 criteria.
Normal thinking involves goal-directed progression of ideas and associations leading to rational conclusions. Thought disorders involve errors in this process and can be categorized as disorders of form, progression, content, or possession. Delusions are a type of thought content disorder characterized by false beliefs that are firmly held despite evidence. Conrad proposed a 5-stage model of delusion development including mood changes, search for meaning, heightening of psychosis, formation of a new worldview, and eventual isolation. Delusions are classified based on origin, theme, mood congruence, reality value, and complexity. Common delusional themes include persecution, guilt, infidelity, grandeur, poverty, and somatic or religious beliefs. Case studies demonstrate delusional
This document defines and classifies hallucinations, which are false sensory perceptions that occur without external stimuli. Hallucinations are categorized by sensory modality (auditory, visual, etc.), complexity, organization, and reality value. Neuroimaging research has found that auditory hallucinations are associated with reduced grey matter in language processing areas of the brain and altered connectivity between these areas and regions involved in control. Current models propose that hallucinations result from overactivity in sensory processing regions combined with weakened top-down control.
The document discusses disorders of stream of thought, including disorders of tempo such as flight of ideas, retardation of thinking, and circumstantiality, as well as disorders of continuity such as perseveration and thought blocking. It provides definitions and examples of each disorder. Assessment methods are also summarized, including observation, clinical interviews, mental status examinations, scales like PANSS and BPRS, and other tools like the Rorschach ink blot test and Thought and Language Index.
Alcohol dependence is a spectrum of alcohol use that ranges from abstinence to severe dependence. It involves a loss of control over drinking, compulsivity, and continuation despite consequences. Diagnosis involves structured clinical interviews and looking for signs of tolerance, withdrawal, increased use over time, and continued use despite problems. Treatment typically involves a combination of inpatient/outpatient therapy, 12-step programs like AA, and medications like naltrexone or acamprosate. The outcome depends on factors like severity, psychiatric issues, social support, and length of treatment.
In Psychiatry and Psychology, Insight means the recognition of one’s own condition. (mental illness)
It refers to:-
the conscious awareness and understanding of one’s own psychodynamics and symptoms of maladaptive behavior; highly important in effecting changes in the personality and behavior of a person.
insight,
true insight,
impaired insight,
judgement,
mental status examination,
Multi-dimensional model of Insight,
Grades of Insight, intellectual insight
assesment
Treatment resistant schizophrenia & Treatment resistant depressionEnoch R G
This document discusses treatment resistant schizophrenia and provides guidelines for its management. It defines treatment resistance and outlines criteria from Kane and others. Factors associated with poor outcomes are biological, symptomatic, environmental, illness-related and pharmacological. The neurobiology of treatment resistant schizophrenia involves dopamine, glutamate, genetics and neuroanatomy. Management guidelines are provided from NICE and involve trials of clozapine as the gold standard treatment. Clozapine details include pharmacology, dosage, side effects, monitoring and predictors of response. Studies demonstrate clozapine's superior efficacy over other antipsychotics for treatment resistant schizophrenia.
A 22-year-old female medical student presented with a two month history of deteriorating concentration, poor memory, and failing tests. Her mother reported disturbed behavior for a year. On examination, she displayed restless and confused behavior with an organized delusional system involving reference, persecution, and sexual delusions. A provisional diagnosis of acute psychotic episode was made, with differential diagnoses of affective disorder or schizophrenia. She was started on antipsychotics, antidepressants, iron supplements, and engaged in supportive therapy, daily activity planning, and family therapy to address biological, psychological, and social aspects of her condition.
This document provides an overview of schizophrenia, including:
- Eugen Bleuler first renamed dementia as schizophrenia in 1911 and recognized it as a group of disorders, describing the four primary symptoms.
- Schizophrenia is a major mental illness that affects the entire mind and personality. Patients may have a disconnection between their thoughts and feelings.
- Around 1% of the world population is affected. Onset is usually later for females than males. Genetic factors contribute to risk.
- Diagnosis involves tools like the Brief Psychiatric Rating Scale and tests of cognitive function. Imaging scans can also provide information.
- Causes may include genetic, biochemical, psychological, and social factors. Path
Schizophrenia is a severe brain disorder that causes alterations in thinking, emotions and behavior. Symptoms include hallucinations, delusions, disorganized speech and behavior. Possible causes include genetic factors and environmental influences like prenatal infections or malnutrition. While there is no known single cause, treatments include antipsychotic medications and psychosocial therapies to help manage symptoms. Living with schizophrenia can be challenging as sufferers experience depression, confusion, fear and a loss of control over their thoughts and actions due to auditory and visual hallucinations.
DISORDER CONTENTOF THOUGHT -DELUSION
BY DR.WASIM
UNDER GUIDANCE OF
DR.SANJAY.JAIN
Definition of delusion:
Delusions are categorized into four different groups
THERE ARE 2 TYPES OF DISORDERS OF THOUGHT CONTENT
1.DELUSION
2.OVERVALUED IDEAS
DISTINGUISED
DELUSION
OTHER MEMBERS OF THE CULTURE DONOT SHARE THE BELIEF.
NEED NOT BE ASSOCIATED WITH AFFECT.
FIRMLY SUSTAINED BELIEF.
CONVINCED THAT DELUSION IS REAL.
RECOGNIZED AS ABSURED.
CANNOT BE ACCEPTED.
OCCUR IN MENTALLY ILL PATIENTS.
OVERVALUED IDEAS
OTHER MEMBERS OF THE CULTURE SHARE THE BELIEF.
ASSOCIATED WITH VERY STRONG AFFECT.
NOT HELD FIRMLY.
ATLEAST SOME LEVEL OF DOUBT AS TO ITS TRUTHFULNESS.
NOT RECOGNIZED AS ABSURED.
ACCEPTABLE.
CAN OCCUR IN BOTH HEALTHY AND MENTALLY ILL PATIENTS.
KENDLER’S VECTORS FOR DELUSION:
five stages in the development of delusion(FISH & CONRAD)
FACTORS CONCERNED WITH GENERATION OF DELUSIONS
PATHPOPHYSIOLOGY OF DELUSIONS
PRIMARY DELUSIONS
SECONDARY DELUSIONS
SYSTEMATIZATION
DELUSIONS ON THE BASIS OF CONTENT OF DELUSIONS
THANK YOU
This case presentation describes a 57-year-old man with a 2-3 year history of symptoms of sadness, disturbed sleep, irritability, and muttering to himself. His symptoms started gradually without a clear stressor. After a thorough examination, he was diagnosed with agitated depression. He was treated on an outpatient basis with escitalopram and lorazepam, along with family psychoeducation and relaxation techniques. Within 6 weeks of treatment, he showed over 80% improvement in his symptoms.
Personality disorders are common, chronic conditions that affect 10-20% of the general population. They have genetic and biological factors like low serotonin levels and childhood experiences like trauma that contribute to their development. The epidemiology of specific personality disorders is discussed, such as borderline personality disorder affecting 1-2% of the population, twice as common in women. Personality disorders are also more prevalent among prison populations and relatives of those with conditions like schizophrenia.
A 33-year-old male presented with symptoms of loss of interest, lethargy, and reduced mental and physical well-being for the past 6-7 years. He has a family history of possible psychiatric illness in his grandfather. On examination, he displayed anxious and inappropriate behavior, impaired comprehension, rapid speech, an anxious mood, paranoid delusions, and impaired judgment and insight. He was diagnosed with paranoid schizophrenia based on his symptoms. Schizophrenia is a chronic mental disorder caused by genetic and environmental factors. It involves positive symptoms like hallucinations and delusions as well as negative symptoms and is typically treated with antipsychotic medication.
Mrs. R is a 34-year-old married Malay woman diagnosed with schizopheniform disorder who was admitted to the psychiatric ward on December 8, 2014. She has a family history of mental illness and experiences auditory hallucinations telling her to harm her son. On assessment, she shows signs of disorganized speech and thought, mood disorder, and psychotic symptoms including auditory hallucinations and paranoid delusions. Objective assessments find mild to moderate cognitive impairment and difficulties with social interaction and managing stress. She is prescribed olanzapine and clozapine and is responsive to treatment.
This document provides an overview of psychiatry case taking and examination, including history taking and mental status examination (MSE). It discusses the purpose and general principles of history taking, as well as how to structure the interview room and questions. It then describes how to obtain information on a patient's identifying data, chief complaints, history of present illness, past history, family history, personal history, and pre-morbid personality. Finally, it outlines the components of the MSE including general appearance, psychomotor activity, speech, mood, thought, perception, and cognitive functions.
Alcohol related disorders- by Swapnil AgrawalSwapnil Agrawal
The document discusses the history and effects of alcohol use. It notes that alcohol has existed for over 10,000 years and was one of the earliest intentionally fermented substances consumed by humans. It then summarizes some of the key health effects of alcohol, including its impacts on the brain, body, and potential for dependence. Overall, the document provides a broad overview of the long history of alcohol consumption and some of the social and medical issues related to its use.
case presentation on mania presented by ajay morajaymor33
This document presents the case of a 23-year-old male patient presenting with symptoms of mania including irritability, wandering behavior, muttering to self, suspiciousness, loud speech, auditory hallucinations, and grandiosity. The patient has a 4-year history of untreated psychiatric illness with similar symptoms in the past requiring hospitalization. A family history of psychiatric illness is denied. The document defines mania and provides classification, etiology, clinical features, and objective/subjective symptoms of mania based on this patient's presentation and ICD-10 criteria.
Normal thinking involves goal-directed progression of ideas and associations leading to rational conclusions. Thought disorders involve errors in this process and can be categorized as disorders of form, progression, content, or possession. Delusions are a type of thought content disorder characterized by false beliefs that are firmly held despite evidence. Conrad proposed a 5-stage model of delusion development including mood changes, search for meaning, heightening of psychosis, formation of a new worldview, and eventual isolation. Delusions are classified based on origin, theme, mood congruence, reality value, and complexity. Common delusional themes include persecution, guilt, infidelity, grandeur, poverty, and somatic or religious beliefs. Case studies demonstrate delusional
This document defines and classifies hallucinations, which are false sensory perceptions that occur without external stimuli. Hallucinations are categorized by sensory modality (auditory, visual, etc.), complexity, organization, and reality value. Neuroimaging research has found that auditory hallucinations are associated with reduced grey matter in language processing areas of the brain and altered connectivity between these areas and regions involved in control. Current models propose that hallucinations result from overactivity in sensory processing regions combined with weakened top-down control.
The document discusses disorders of stream of thought, including disorders of tempo such as flight of ideas, retardation of thinking, and circumstantiality, as well as disorders of continuity such as perseveration and thought blocking. It provides definitions and examples of each disorder. Assessment methods are also summarized, including observation, clinical interviews, mental status examinations, scales like PANSS and BPRS, and other tools like the Rorschach ink blot test and Thought and Language Index.
Alcohol dependence is a spectrum of alcohol use that ranges from abstinence to severe dependence. It involves a loss of control over drinking, compulsivity, and continuation despite consequences. Diagnosis involves structured clinical interviews and looking for signs of tolerance, withdrawal, increased use over time, and continued use despite problems. Treatment typically involves a combination of inpatient/outpatient therapy, 12-step programs like AA, and medications like naltrexone or acamprosate. The outcome depends on factors like severity, psychiatric issues, social support, and length of treatment.
In Psychiatry and Psychology, Insight means the recognition of one’s own condition. (mental illness)
It refers to:-
the conscious awareness and understanding of one’s own psychodynamics and symptoms of maladaptive behavior; highly important in effecting changes in the personality and behavior of a person.
insight,
true insight,
impaired insight,
judgement,
mental status examination,
Multi-dimensional model of Insight,
Grades of Insight, intellectual insight
assesment
Treatment resistant schizophrenia & Treatment resistant depressionEnoch R G
This document discusses treatment resistant schizophrenia and provides guidelines for its management. It defines treatment resistance and outlines criteria from Kane and others. Factors associated with poor outcomes are biological, symptomatic, environmental, illness-related and pharmacological. The neurobiology of treatment resistant schizophrenia involves dopamine, glutamate, genetics and neuroanatomy. Management guidelines are provided from NICE and involve trials of clozapine as the gold standard treatment. Clozapine details include pharmacology, dosage, side effects, monitoring and predictors of response. Studies demonstrate clozapine's superior efficacy over other antipsychotics for treatment resistant schizophrenia.
A 22-year-old female medical student presented with a two month history of deteriorating concentration, poor memory, and failing tests. Her mother reported disturbed behavior for a year. On examination, she displayed restless and confused behavior with an organized delusional system involving reference, persecution, and sexual delusions. A provisional diagnosis of acute psychotic episode was made, with differential diagnoses of affective disorder or schizophrenia. She was started on antipsychotics, antidepressants, iron supplements, and engaged in supportive therapy, daily activity planning, and family therapy to address biological, psychological, and social aspects of her condition.
This document provides an overview of schizophrenia, including:
- Eugen Bleuler first renamed dementia as schizophrenia in 1911 and recognized it as a group of disorders, describing the four primary symptoms.
- Schizophrenia is a major mental illness that affects the entire mind and personality. Patients may have a disconnection between their thoughts and feelings.
- Around 1% of the world population is affected. Onset is usually later for females than males. Genetic factors contribute to risk.
- Diagnosis involves tools like the Brief Psychiatric Rating Scale and tests of cognitive function. Imaging scans can also provide information.
- Causes may include genetic, biochemical, psychological, and social factors. Path
Schizophrenia is a severe brain disorder that causes alterations in thinking, emotions and behavior. Symptoms include hallucinations, delusions, disorganized speech and behavior. Possible causes include genetic factors and environmental influences like prenatal infections or malnutrition. While there is no known single cause, treatments include antipsychotic medications and psychosocial therapies to help manage symptoms. Living with schizophrenia can be challenging as sufferers experience depression, confusion, fear and a loss of control over their thoughts and actions due to auditory and visual hallucinations.
1) The document discusses psychiatric disorders like neurosis, adjustment disorders, anxiety, minor depression, and psychosis including schizophrenia and other types of psychosis.
2) It describes the characteristics of psychosis including delusions, hallucinations, and impaired reality testing. It notes that schizophrenia is a special type of psychosis with features like auditory hallucinations, feelings of being controlled, inserted/withdrawn thoughts, and disorganized behavior.
3) The management of schizophrenia involves long-term antipsychotic treatment to control symptoms, managing side effects to improve compliance, teaching relapse prevention, and helping patients improve coping strategies.
Schizophrenia is a severe mental disorder characterized by disordered thoughts, abnormal behaviors, and difficulties perceiving reality. It is prevalent worldwide and genetic and environmental factors likely contribute to its development. Symptoms include hallucinations, delusions, disorganized speech and behavior, negative symptoms like apathy, and impaired social and occupational functioning. Treatment involves antipsychotic medications and psychotherapy. Nurses monitor symptoms, assess functioning, and aim to promote health, self-care, and appropriate thought processes through therapeutic interventions.
Nyeli Brooks experienced the onset of schizophrenia at age 19. She had her first hallucination of her mother harming her cat. Her psychiatrist diagnosed her with schizophrenia based on this hallucination and her worsening symptoms, which included disorganized thoughts, lack of sleep due to visual distortions, commanding voices, paranoia, and jumping at noises. After months of therapy, medication, and continued worsening of symptoms, her condition started improving after 6 months. Within a year, she had a full recovery, though still experienced some writing difficulties.
The document provides information about various mental disorders categorized into anxiety disorders, affective disorders, psychotic disorders, impulse disorders, somatoform disorders, and personality disorders. It defines key terms like anxiety, depression, apathy, and stigma. It describes the symptoms and examples of different disorders like panic disorder, phobias, obsessive compulsive disorder, post traumatic stress disorder, depression, schizophrenia, and more. It also discusses available treatment options and resources for mental health disorders.
Here are some important areas that should be assessed when working with Sam:
- Assess the severity and frequency of positive symptoms like auditory hallucinations, delusional thoughts, and paranoia to determine the level of psychosis.
- Evaluate how much the symptoms are interfering with his daily functioning like self-care, work, and relationships. His psychosis seems to be impacting his job performance.
- Assess for any history of substance use, medical conditions, or medications that could be exacerbating or causing the psychotic symptoms.
- Evaluate suicidal and homicidal ideation since the voices sometimes make him angry and his stress level is high. Ensure he has no plan or intent currently.
Schizophrenia is a chronic and severe brain disorder that affects about 1% of Americans. It is characterized by positive symptoms like hallucinations and delusions, negative symptoms such as lack of pleasure and emotional expression, and cognitive symptoms involving problems with attention, working memory, and executive function. While genes play a role, environment factors are also involved in causing schizophrenia. Treatment involves antipsychotic medications to reduce symptoms as well as psychosocial therapies. Researchers are working to better understand the causes and find more effective treatments, but schizophrenia typically involves lifelong management of symptoms.
This document provides background information on a 41-year-old male patient who has been detained under the Mental Health Act since 2010. It details his family, social, criminal, substance use, and psychiatric histories. Regarding his psychiatric history, he has a history of psychosis dating back to 1993 while imprisoned, with episodes of relapse presenting with hallucinations and delusions. He has a diagnosis of schizophrenia. The document also discusses his risk factors such as personality traits like callousness and impulsivity, as well as ongoing risk management.
Dr. Hamed Borham and Dr. Nashwa Osman presented the case of Said Fathy Mohammed AbdelAal, a 32-year-old married male admitted involuntarily to the hospital. Said has a 3-year history of paranoid delusions about his wife and auditory hallucinations. His condition worsened over the past month as he became socially isolated and convinced his wife and friends had betrayed him. His history notes periods of improvement on medication but non-compliance led to relapses. A mental status exam found dysphoric mood, delusional thoughts, and auditory hallucinations. The diagnosis was determined to be paranoid schizophrenia, continuous type with a non-functioning level.
Schizophrenia is a long-term mental disorder involving a breakdown in thought, emotion and behavior. It causes symptoms like hallucinations, delusions, and disorganized thinking. It is treated with antipsychotic medications which help control symptoms, though they come with side effects. Living with schizophrenia is challenging due to the distressing voices and paranoid thoughts, but treatment and social support can help improve quality of life.
Schizophrenia (A Psychological perspective)Mèhshara Khan
This document provides an overview of schizophrenia, including its history, definitions, classifications, epidemiology, etiology, psychopathology, clinical features, types, diagnostic evaluation, and treatment options. Some key points:
- Schizophrenia is a chronic psychotic disorder characterized by distortions in thinking, perception, emotions, and behavior. It affects approximately 1% of the population and has genetic and environmental risk factors.
- It is classified in the DSM-V and ICD-10 and involves positive symptoms like delusions and hallucinations as well as negative symptoms such as blunted affect.
- The disorder involves dysfunctions in thoughts/speech, perception, affect, and motor behavior. It has
“Bipolar Disorder in Youth: Does it Exist?” Halifax, Nova Scotia, Canada; March 22, 2006, Community presentation at IWK Health Centre
*Learn clinical presentation of pediatric bipolar disorder
*Differentiate pediatric bipolar disorder from other psychiatric disorders
*Learn genetics of bipolar disorder
*Learn treatment of pediatric bipolar disorder
Schizophrenia is a chronic mental disorder characterized by distortions in thinking, perception, emotions, language, sense of self and behavior. It is defined by symptoms such as delusions, hallucinations, disorganized speech and behavior, and negative symptoms. The disorder has been recognized since the late 19th century and was termed "dementia praecox" and later "schizophrenia". It affects about 1% of the population and has varying levels of severity and outcomes depending on factors like symptom type, treatment adherence and social support. Treatment involves antipsychotic medications and psychosocial therapies.
1) The document describes the experience of a man named Jack Keaton who was diagnosed with paranoid schizophrenia at age 22.
2) It details his experience with symptoms like delusions, hallucinations, and paranoia prior to and after his diagnosis, as well as his struggles with medication side effects over many years.
3) Now age 45, Jack continues to struggle with the challenges of living with schizophrenia and the lasting impacts it has had on his life and ability to function normally.
This document provides information on schizophrenia, including its definition, prevalence, causes, symptoms, types, and treatment. Some key points:
- Schizophrenia is a severe psychotic disorder marked by distortions in thinking, perception, emotions, language, sense of self and behavior.
- About 1% of people will develop schizophrenia, most often appearing between ages 15-30. Genetic factors are strongly implicated in its causes.
- Symptoms include delusions, hallucinations, disorganized speech and behavior, negative symptoms like reduced emotional expression.
- Treatment involves antipsychotic medications to manage acute symptoms and prevent relapse, as well as psychosocial therapies to address functional impairments. Prognosis
Emily Boyles is a senior in high school taking psychology courses who is interested in a career in criminal psychology. She chose to research mental illness for a school project. Her plan is to define mental illness, explore criminal psychology as a career path including the education and job outlook, and examine the daily life, treatment, myths, and life expectancy of those with mental illness. She interviewed a licensed mental health counselor to learn more about their career path and experiences treating mental illness.
Schizophrenia is a chronic and severe brain disorder that affects about 1% of Americans. It is characterized by positive symptoms like hallucinations and delusions, negative symptoms such as lack of pleasure and emotional expression, and cognitive symptoms involving problems with attention, working memory, and decision-making. While genes play a role, environment factors during development may also contribute to the disorder. Treatment involves antipsychotic medications to reduce symptoms as well as psychosocial therapies, though symptoms often persist lifelong. More research is still needed to better understand and prevent schizophrenia.
This document summarizes a mental health consultation for a 78-year-old female patient who is experiencing auditory hallucinations of voices making critical comments about her. The consultation examines whether the hallucinations could be due to schizophrenia, a mood disorder, an organic brain condition, or substance withdrawal. While some factors point to schizophrenia, the late onset of symptoms makes the diagnosis difficult. The consultation recommends increasing the patient's medication and engaging her in distracting activities to help diminish the hallucinations.
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5. CASE HISTORY
A 35 year old married woman, teacher by profession , used to stay with her
husband and 10 year old child in a small town….. Around 6-7months back she
had a quarrel with her neighbor who complained that her son had broken her
window glass while playing cricket… She got the glass replaced at her own
expense and also reprimanded her son, asked him to be careful next
time………
But since that incident she remained worried that the neighbour would harass
her……and take revenge for the incident….. Once when someone called her
and the phone got cut…..she felt….. The missed call was a warning from the
neighbour…….When the milkman or the maid reached late, she felt that the
neighbour was asking them also to harass her…. Whenever she saw her
neighbour talking to someone she believed she was talking about her…..Her
neighbour once sent her some sweets on a festival.. She was sure that it had
poison in it…and threw it in the dustbin……
She started remaining alone ….lost in thoughts about how the neighbor would
possibly harm her and how she could save herself……..
6. CASE HISTORY
Gradually she started hearing voices when alone ……clear female voices
threatening to kill her…abusing her …and commanding her to behave in a
certain manner and laughing at her……..
Now she was convinced that the neighbor had conspired against her and that
she was definitely going to kill her……or her son…or she would do some black
magic on her husband….
She became fearful and started praying to God all the time begging him to
save her and her family… She could not concentrate on her job……Increasingly
she remained absent and finally she stopped going to work……She also did not
allow her son to go to school or go out to play and she also asked her husband
to stay at home for their safety…
Gradually her self care deteriorated ….her grooming and hygiene was
poor…she could not eat….she lost weight…….and would remain sleepless at
night ….She continued to hear the voices which she believed to be real
7. CASE HISTORY
Confused and worried about her extremely odd behavior, her husband tried to
explain the reality to her…..told her there were no voices and reassured her that
he would go and talk to the neighbor to apologize and sort out issues if any….
Few days later when she saw her husband talking to her neighbor she became
suspicious that her husband was involved with her in the plan to kill her …..when
her husband came home….. She fought with him telling him that he was cheating
on her…even he wanted to kill her and marry the neighbour…..Even on repeated
reassurance by him, she continued to believe he was unfaithful and that he was
now not interested in her because she did not earn anymore and could not do
even household work properly.
Few days later when her husband was cooking food for the family, and he took
the knife in his hand to cut vegetables, she felt he was going to kill her with the
knife!!!! She grabbed the knife, yelled at him – “I will kill myself before you can
kill me” and slashed her wrist…….. She was immediately brought to the
emergency department of the hospital…
9. CLINICAL FEATURES
In the present case-
Persecution
•DELUSIONS Reference
Infidelity
Other issues-
•Social, occupational Impairment
•Impairment in family functioning
•Poor self care,Sleep Appetite Problems
•Impulsive Suicidal behaviour
•HALLUCINATIONS- Auditory
10. DIAGNOSTIC CRITERIA
Any 2 out of 5 as per DSM IV TR
•Delusions
•Hallucinations
•Disorganized speech ( frequent derailment /incoherence)
•Grossly disorganized or catatonic behavior
•Negative symptoms – Alogia
Avolition
Anhedonia
Affect flattening
Attention deficits
11. DISORGANISED SPEECH
Question- what was the reason of quarrel between you and your
brother???
Answer- “It started with a two by two feet iron piece
without any conclusion or enquiring they have been
contacting the inspector of police without any authority
before they could give a boxful of medicines and the
flasks for use till noon”
12. DISORGANISED SPEECH
“Mental health is the blessed trinity, and as man cannot
be without god, it is futile to deny his son. For the
creation understand germ-any in voice new order, not lie
of chained reaction, spawning mark in temple Cain with
Babel’s grave’n image to wanton V day Israel”
13. DIAGNOSTIC CRITERIA
Any 2 out of 5 as per DSM IV TR
•Delusions
•Hallucinations
•Disorganized speech ( frequent derailment /incoherence)
•Grossly disorganized or catatonic behavior
•Negative symptoms – Alogia
Avolition
Anhedonia
Affect flattening
Attention deficits
14. CATATONIC BEHAVIOUR
Group of catatonic patients
This photograph appeared in the fifth edition of Emil Kraepelin's
Psychiatrie (Leipzig Johann Ambrosius Barth, 1896).
21. CASE HISTORY
In the emergency department, a medicolegal case was done, the patient
received primary management for her wrist wound and was subsequently
referred to the psychiatrist for self-injurious behavior with possible suicidal
intent….
The psychiatrist, after taking the history from her husband, interviewed her
and did a detailed mental status examination….. The patient was fearful and
reported that she was badly trapped, people were trying to kill her, and that
she continuously heard voices abusing her…..
Her husband was equally confused as to what had happened to his wife….The
doctor told him that this was a kind of mental illness for which she needed
treatment and advised admission because there was a threat of further self-
harm or violence………
The patient did not think she had any illness, but she was coaxed to get
admitted, saying that it would help in calming down her anxious thoughts, and
her wound could also be examined on a daily basis…..
Reluctantly…they agreed…
22. CASE HISTORY
An extensive history was subsequently taken including her birth history,
developmental history , education history, past medical and psychiatric history,
family history, personal history including menstrual history, obstetric history and
history of her married life and interpersonal relations with husband…history of
any substance use and premorbid personality traits ….
It was inquired whether she had any history of fever, convulsions or head injury
before the onset of symptoms….
Routine investigations were sent including…. Complete blood count, electrolytes,
liver function tests, renal function tests, fasting and postprandial blood sugar,
serum lipid profile ,X ray and ECG……..which were all normal..
Tab Risperidone 2 mg and tab diazepam 5 mg at bedtime were started for her ….
Risperidone was increased by 2 mg every 2 days… (upto 8 mg ) and an additional
haloperidol and phenargan injection was given to her when she became agitated,
and an additional lorazepam injection was given to her at night if her sleep was
disturbed……
24. DIFFERENTIAL DIAGNOSIS
1) Other Psychiatric conditions
2) Medical conditions with schizophrenia -like symptoms
• Temporal lobe epilepsy
• Neoplasm, cerebrovascular disease or trauma
•( especially frontal or limbic)
29. INVESTIGATIONS
•Routine Investigations in all cases- differential diagnosis
baseline
•Neuroimaging in selected cases
•Psychometric tests-
Thematic apperception test
Rorschach
Special batteries for neuropsychological assessment
Minnesota multiphasic personality inventory
30. ACUTE PHASE TREATMENT
•Decision of Indoor v/s Outdoor treatment
•Decision of treatment per se-
Three modalities of treatment available-
•Pharmacotherapy
•Electroconvulsive therapy
•Psychotherapy
37. CASE HISTORY
Initially she refused to take medicines….especially when her husband would give
it to her…….got angry on him….and threw the medicines on his face ..shouting….
I know you want to kill me !!!! And then would start crying…….
But she took it when the on-duty doctor gently but firmly gave it to her, after
sending her husband away for a while.
She tolerated risperidone well…..in the first 2 days her sleep & appetite
improved… by the fifth day she felt like taking a good bath, dressed well and
even went out for a walk around the ward…
By the end of around 10 days, her aggressive outbursts almost stopped , the
voices she heard were also less frequent ….. She also told the doctor she felt
much better and that maybe her husband was not as bad as she thought…after
all he was taking good care of her since a week….. She also started talking to him
& taking medicines from him……
38. CASE HISTORY
However she still stongly believed that her neighbour was actively conspiring
against her and that she was safe only because she was in the hospital…she was
afraid of going home……
the doctor spoke to her husband, told him that she was responding well to
medicines and that he would have to wait a little more for her to be even
better……
But 2 days later… her husband noticed that her body was very stiff….. Her speech
became slurred ….saliva dribbled from her mouth and her hands were
tremulous………
The doctor examined her, there were signs of parkinsonism! the patient had
developed extrapyramidal side effects of antipsychotic medications………
The doctor gave her one injection phenargan and started trihexiphenidyl 2 mg
orally once daily……within 2 days the side effect resolved…………
40. SIDE EFFECTS OF ANTIPSYCHOTIC DRUGS
Extrapyramidal side effects –
More with typical, but also seen with atypicals rarely
•Acute muscular dystonia-
oculogyric crisis, opisthotonus,
Torticollis, limb and trunk dystonia
•Parkinsonian side effects- tremors, rigidity, salivation,
bradykinesia
•Akathisia
•Tardive dyskinesia
•Neuroleptic malignant syndrome
43. SIDE EFFECTS OF ANTIPSYCHOTIC DRUGS
Other side effects –
•Cardiac- QT interval prolongation- ventricular arrhythmia
•Postural hypotension
•Sexual dysfunction
•Anticholinergic side effects- dry mouth, constipation,
urinary retention
•Elevated prolactin levels
•Lowering of seizure threshold
•Transient abnormalities in the liver function tests
•Skin and eye reactions
44. SIDE EFFECTS OF ANTIPSYCHOTIC DRUGS
Atypical antipsychotics
•Hyperlipidemia & Weight gain
•Increased risk of type 2 Diabetes Mellitus
•Hyperprolactinemia- galactorrhoea, amenorrhoea,
infertility
•QT interval prolongation
•Obsessive compulsive symptoms- risperidone, olanzapine,
clozapine
45. SIDE EFFECTS OF ANTIPSYCHOTIC DRUGS
Side effects of clozapine
•Agranulocytosis
•Seizures
•Acute myocarditis
•Constipation
•sialorrhea
•Sedation
•Weight gain (average 4.45 kg in 10 weeks)
•Increased risk of type 2 Diabetes Mellitus
47. CASE HISTORY
After around 3 weeks… the patient was almost completely alright…..did not hear
any voices, did not suspect her husband… also reconsidering her doubts on her
neighbor…….
She was now also worried about her son who was staying with her parents in law
…and about her job in which she had remained absent for so long………..She was
asking for discharge……
When the doctor asked her what was wrong with her for so many days…….she
replied…. “I don’t know anything…..may be I was a little upset and stressed out
with too much work…but I am completely ok now !!” the doctor explained to her
that she has had a mental illness, and she was better now because of
medicines…and that she must take her medicines regularly … she nodded.
The husband also told the doctor that his boss had been calling him and now he
could no longer get leaves. The doctor decided to discharge the patient after a
detailed conversation with her husband…..
48. CASE HISTORY
Husband: Doctor, thank you very much, we never knew that this was mental
illness and that it could be treated….. My wife is much better now…..but doctor I
am wondering…why this happened to my wife???? She is so kind hearted and well
educated… so perfect in her work and family life as well……
Doctor- I understand this is a very upsetting illness, but just like any other illness it
could happen to anyone…..
Husband: yes but what are the reasons??? Just like if some insect bites there is
malaria….or smoking can cause lung cancer…what causes this kind of illness???
Doctor: there are various biological, psychological and social reasons…..heredity
also plays a role….you told me her grandmother had some psychological
problems.. Also there are some chemicals in the brain that go topsy turvy to
cause such odd symptoms, which can be corrected by administering medicines
49. CASE HISTORY
Husband: But doctor …it all started after that small quarrel with the
neighbour……Does it mean that now onwards we should take extra care not to
give her any stress……
Doctor: well, it is true that stress can activate the biological vulnerability to cause
symptoms…. But life and stress go hand in hand…..do you think it is possible to
avoid any kind of stress…???? It would be better if we support her at the times of
stress to help her cope very well…..
Husband: you mentioned it is hereditary…. Does it mean my son will also have
this illness when he grows up???
Doctor: It is a matter of probability…. He has more chance of developing this
illness than the general population….. But he is not sure to have it. He may
develop, he may not develop…… god forbid if he does, early treatment can make
him alright soon…..
50. CASE HISTORY
Husband: Ok doctor .. How long should my wife take these medicines….???
Doctor: For a long time….3 years, may be even more…..but we will see to it that
she is well on the least possible dose of the least number of medicines…..one of
the medicines (diazepam) we will stop in a few days……the other ones will be
continued …
Husband: In between my wife had become rigid like a robot and her speech was
slurring and hands were trembling…. You said it was some side effect and it
improved after the other medicine….. But does it mean she can develop paralysis
anytime if on these medicines??????
Doctor: No, that was not paralysis, and these medicines will not cause paralysis.
However there is a risk of some side effects, both short term and long term..a list
of which will be given to you with your discharge card. But overall the medicine is
safe and effective, and many patients tolerate it very well without any side
effects…. And clearly, at present the benefit is more than the risk….. We will keep
monitoring her and take prompt action in case anything goes wrong..
51. CASE HISTORY
Husband: What should I do if she becomes violent or suicidal again???
Doctor: If she keeps taking her medicines well… it is least likely to happen….
However, if you feel that something is going wrong in her mind, you bring her to
us right away….
Husband: After we complete the full course, will she be cured completely???
Doctor: This is a very tricky illness … the chances of relapse are drastically reduced
by taking medicines for a long time, but it can still occur, if it does, she may have
to start medicines again…….dont worry, we will be following her up regularly and
together we will do what is best for her as and when required…..
Husband: Ok doctor…. One more thing….Can she join her job or she needs to
rest???
Doctor: oh..She is already worried about her job….. Further absenteeism may
make matters worse…. I think she should join in a day or two after settling down
at home…
52. CASE HISTORY
Husband: We have conveyed at the workplace she was not coming as she was not
well….. The principal of the school is as such very supportive…doctor if needed will
you give a certificate that she was unwell??
Doctor: yes sure, you can put an application with the case papers and discharge
card, and if they ask for, we will also give an official certificate.
Husband: Ok doctor , thanks for your support…when should we come next???
Doctor: Next Monday , 4 pm……………….
56. CASE HISTORY
Monday 4 pm….
Patient was doing well, had restarted her job…..
Her husband also had joined his job…
son was also happy as his mother now allowed her to go out and play…
Patient’s mother in law had come to stay with them for a few months to help her
in household work and to take care of her…….
Diazepam was omitted and rest of the medicines were continued…..
Subsequent follow ups were uneventful…the patient continued to do well…did
not develop any side effects…. All her symptoms were under control , she could
resume her responsibility both at home and workplace……
58. COURSE AND PROGNOSIS
•20 to 30 % - able to live normal lives
•20 to 30 % - continue to experience moderate symptoms
•40 to 60 % - significantly impaired for their entire lives
•Classic course is of exacerbations and remissions
•Pattern of illness during the first five years is indicative
•20 to 25% may develop post psychotic depressive
symptoms
•Upto10 % may commit suicide
59. COURSE AND PROGNOSIS
Good prognosis Poor prognosis
Late onset Young onset
Precipitating factor No precipitating factor
Acute onset Insidious onset
Good premorbid functioning Poor premorbid functioning
Mood disorder symptoms Withdrawn autistic behaviour
Family history of mood disorder Family history of schizophrenia
Married Single, divorced, widowed
Good support systems Poor support system
Positive symptoms Negative symptoms
Neurological signs and symptoms
History of perinatal trauma
History of assaultiveness
Many relapses
No remission in 3 years
60. Resistant cases-
•Change antipsychotic
•Another antipsychotic
•Clozapine
•Ect
•psychotherapies
•Psychiatric rehabilitation
•Institutionalization- social skills and vocational training
•De institutionalization- community integration
COURSE AND PROGNOSIS
62. CASE HISTORY
7 months later…….
She was once again brought to the emergency psychiatry department by her
husband…this time in a worse condition…. She was shabbilly dressed, having
unkempt appearance, uncombed hair and was laughing and crying inappropriately
and talking to herself…
She was self absorbed and not interested in talking to the doctor even……
Her husband explained the situation to the doctor…..actually 2 months back there
was a vacation in the school and as she was feeling alright, she went to her village
with her son to stay with her parents…… She forgot to take her medicines with
her…......Neither a psychiatrist nor the medicines were available in the village…..
She was feeling alright and she was tempted to decide to do without her
medicines only………..
63. CASE HISTORY
After around one month … she started having symptoms of suspiciousness and
hearing of female voices abusing her, same as before…
Her mother got worried and started taking extra care of her…. She would
continuously instruct her “get up, take bath, go for a walk, take rest, eat, watch tv,
sleep etc….”
If she would be a little upset, she would go and probe her asking what happened
and give her advice that she should keep smiling, behave normally, and not think
too much……
She further worsened … started laughing and crying without reason and shouting
and using abusive language…..answering back to the voices she heard…….
Her parents felt that she had started behaving like her grandmother who also had
history of such abnormal behaviour…… or may be it was the evil eye…they took
her to the nearby temple to do some ritual…..and various faithhealers…..
She did not improve………
64. CASE HISTORY
Her parents were ashamed of telling her husband that her condition had
worsened while she was at their place…… hence they were trying their own ways
to make her alright……
Ultimately one day during a telephonic conversation……….her son told him- Papa,
mummy has fallen ill again, she is not alright….
And immediately she was brought back …..and the doctor was consulted….
Another hospitalization…… vehemently refused medicines, hence injectables were
to be given forcefully for 4-5 days ,2 ECTs were to be given, following which she
was put on oral medicines again.. And she again improved, but this time taking a
little longer………….
Again at the time of discharge, she and her husband were explained, in greater
detail, the importance of continued medicines……………
66. DIFFICULT ISSUES
In this case
•Compliance
•Faithhealers & cultural beliefs
•Expressed emotion- criticism, hostility, Overinvolvement
•Stigma
•Caregiver’s burden
67. DIFFICULT ISSUES
Other tricky issues- ( due to lack of insight into illness )
•Patient just not ready to come for consultation
•Patient just not taking medicines/ taking on sos basis (Role
of depot preparations or covert administration)
•Patient selectively taking only some drug …
eg only BZD or AP drug without trihexiphenidyl or vice versa
•Suddenly stopping all drugs
68. Other tricky issues (due to symptoms of illness per se)
•Patient suspicious on all family members and staying alone
•Patient getting lost
•Patient wandering on streets
•Concurrent substance use
•Suicide or self injurious behaviour
•Legal issues- crime- homicide
•Patient on antipsychotic becoming pregnant
•concurrent medical illness remaining undiagnosed
DIFFICULT ISSUES
69. •Other tricky issues (family / society related)
•Patient neglected and disowned, thought to be malingering
•Family sharing some of the psychotic beliefs of the patient
•Unattended patient, no-one to give history and care for
•Little children or old parents caring for youthful patients
•Inconsistent history given by parents and in laws…
•Illness becoming ground for divorce
DIFFICULT ISSUES
70. TO CONCLUDE….
Very intriguing, very challenging…..each patient
unfolding a different story………for us to do the
best for them !!!!!!!!!!
71. “They say when you talk to God
it's prayer, but when God talks to
you, it's schizophrenia!!!!!!!!
THANKYOU !!!!!!!!
Editor's Notes
So this becomes the point of first contact of the patient with a medical person…let us discuss what are the clinical features that come across in this case….
Dysdiadochokinesia, astereognosis, diminished dexterity, primitive reflexes
Inability to perceive prosody of speech and to inflect their own voices- nondominant parietal lobe
Based on the different symptoms, there are types of schizophrenia….our patient fits into the description of paranoid schizophrenia…now let us see what happens next………..
So that was the initial treatment plan for her…let us see how this was decided…..
First of all differential diagnosis…..she did fit into the symptomatology of paranoid schizophrenia..but we need to rule out other possibilities…..apart from other psychiatric conditions there could be medical conditions mimicking psychosis like………………
These are the various drugs that are available…. All are effective but differ in terms of potency and side effect profile…these days atypical antipsychotic drugs are preferred because of better side effect profile and better effect on negative symptoms.
Ect could have been a choice in our patient as well…if she would have refused medicines or if she would have had persistent self injurious or violent behaviors….but since, inspite of her suspicion she has agreed to take medicines…. Ect was not planned… so now let us see what happened to her….. With the treatment regimen she was prescribed….
As we all know all drugs have side effects and we have to go by the risk benefit ratio all the time….but it is always prudent to keep in mind the side effects and also inform the patients and caregivers about the possible side effects….and if they occur identify and manage them promptly…
As we all know all drugs have side effects and we have to go by the risk benefit ratio all the time….but it is always prudent to keep in mind the side effects and also inform the patients and caregivers about the possible side effects….and if they occur identify and manage them promptly…
As we all know all drugs have side effects and we have to go by the risk benefit ratio all the time….but it is always prudent to keep in mind the side effects and also inform the patients and caregivers about the possible side effects….and if they occur identify and manage them promptly…
As we all know all drugs have side effects and we have to go by the risk benefit ratio all the time….but it is always prudent to keep in mind the side effects and also inform the patients and caregivers about the possible side effects….and if they occur identify and manage them promptly…
As we all know all drugs have side effects and we have to go by the risk benefit ratio all the time….but it is always prudent to keep in mind the side effects and also inform the patients and caregivers about the possible side effects….and if they occur identify and manage them promptly…
As we all know all drugs have side effects and we have to go by the risk benefit ratio all the time….but it is always prudent to keep in mind the side effects and also inform the patients and caregivers about the possible side effects….and if they occur identify and manage them promptly…
In pyschotic disorders, pharmacotherapy is the mainstay of treatment…. However psychotherapy holds an imp place in the overall management of any mental illness.. In the acute phase…………….
Overall studies have shown that a combination is superior to either alone……
Not everyone with schizophrenia has such a favourable outcome… the course and prognosis are different in each case………………..