Psychiatry Notes by DV 1

PSYCHIATRY NOTES 1
1. Circumstantiality: communication of unnecessary details before finally arriving at the central idea.
2. Delusion of reference refers to events, objects, or persons in one’s environment that are believed to have particular personal significance.
3. Retts Disorder (a Pervasive developmental Disorder): seen only in females, very rare, normal prenatal and post natal development with subsequent regression of milestones and severe to profound mental retardation, severe language defects with stereotyped hand movements(hand wringing or hand washing) decelerated head growth during 5 to 30 months. HC is normal at birth.
4. Functional imaging in depression showed abnormal excessive activity of Brodman area no: 25, subgenual prefrontal cortex. Patients with obsessive-compulsive disorder tend to show hyperactivity in the head of the caudate.
5. All antipsychotic drugs in current use block or diminish the action of dopamine at its D2 receptors. Drugs useful in depression act by increasing synaptic levels of serotonin, norepinephrine, or less commonly dopamine.
6. Cognitive-behavioral psychotherapy: mild to moderately severe depression, fear-based anxiety disorders, and obsessive-compulsive disorder.
7. DSM IV 5 Axes I- Major mental disorder, II- Underlying personality disorder, III- general medical condition, IV- psychosocial and environmental problems that preceded mental disorder or symptoms and axis V- overall rating of general psychosocial functioning based on therapist’s view.
8. Acute panic attacks appear to be associated with increased noradrenergic discharges in the locus coeruleus. I.V. Sodium Lactate, Yohimbine (an alpha 2 blocker), CO2 inhalation and cholecystokinin- 4 evokes panic attack. R­­­­X is with SSRIs, Fluoxetine, Paroxetine and Sertraline.
9. Narcissistic personality disorder is preoccupied with perfection, but usually they are convinced of having already reached it. Individuals with obsessive-compulsive personality disorder, instead, are rarely satisfied with themselves.
10. R­­­­X for GAD Generalized Anxiety Disorder: BZD not more than 6 weeks, Buspirone 5-HT1A partial agonist (especially in patients with head injury or dementia), Escitalopram, Paroxetine and Venlafaxine.
11. Phobic Disorders RX for performance anxiety- Propranolol 20-40mg, 2hrs prior to event. For Social anxiety- MAOIs, others Venlafaxine, Sertraline and Paroxetine.
12. ‘Flashback episodes’ are seen in PTSD. There is excessive release of norepinephrine from the locus coeruleus in response to stress and increased noradrenergic activity at projection sites in the hippocampus and amygdala. Treatment of PTSD- Amitryptiline, Imipramine, Phenelzine (MAOI), Prazosin, Trazadone and SSRI. 30% recover completely.
13. Major depression is defined as depressed mood on a daily basis for a minimum duration of 2 weeks. 6–8% of all outpatients in primary care settings satisfy diagnostic criteria for the disorder. Approximately 4–5% of all depressed patients will commit suicide. 2:1 for female: male.
14. TCA with maximum toxicity is Desipramine.
15. Inner sense of restlessness and anxiety in addition to increased motor activity is called as AKATHISIA.
16. Hyper stimulation of brainstem 5HT1A receptors and characterized by myoclonus, agitation, abdominal cramping, hyperpyrexia, hypertension, and potentially death is called as ‘SEROTONIN SYNDROME’.
17. SSRIs can produce angina due to vasospasm and prolongation of PT.
18. The most specific SSRI currently available is Escitalopram.
19. Mainstay of treatment of Bipolar disorder is Lithium Carbonate. Excreted 95% through kidneys within 24hrs, therapeutic blood level is 0.8- 1.2mEq/L. Side effects: GI discomfort, diarrhea, wt gain, polyuria, edema, alopecia and acne.