Psychiatry Notes by DV 2

1.

Consensus Guidelines for Drug Treatment of Acute Mania and Bipolar Depression
Condition Preferred Agents
Euphoric mania Lithium
Mixed/dysphoric mania Valproic acid
Mania with psychosis---- Valproic acid with olanzapine, conventional antipsychotic, or risperidone
Hypomania --- Lithium, lamotrigine, or Valproic acid alone
Severe depression with psychosis---Venlafaxine, bupropion, or paroxetine plus lithium plus olanzapine, or risperidone; consider ECT
Severe depression without psychosis----Bupropion, paroxetine, sertraline, venlafaxine, or citalopram plus lithium
Mild to moderate depression---Lithium or lamotrigine alone; add bupropion if needed

2. 4-2-1-1 rule for diagnosis is used for Somatoform disorder. 4 pain, 2 GI, 1 sexual and 1 pseudoneurological symptom.
3. Dramatic, chronic, or severe factitious illness is termed as Munchausen’s Syndrome.
4. Minnesota Multiphasic Personality Inventory (MMPI) consists of 566 T/F questions
5. Konrad Lorenz- Described attachment behavior of geese after hatching, Ethology, ‘early experience helps to shape social behavior in adulthood.’
6. William Cullen- Neurosis.
7. Binet- IQ test.
8. Cade - Lithium.
9. Delay and Deniker- Chlorpromazine.
10. Manfred Sakel: Insulin Coma Therapy.
11. Cerletti and Bini: Electro Convulsive Therapy.
12. Wilhelm Wundt- Structuralism.
13. William James- Functionalism in psychology.
14. John Bowlby- Infant Attachment.
15. Erickson’s eight psychosocial developmental stages.
16. Margaret Mahler: ‘Ego Psychology’, Theory of Infant Development, known for’ Theory of Separation Individualization’.
17. Piaget: Theory of Cognitive Development.
18. Kohut- Importance of early interpersonal experiences in the development of a cohesive and stable sense of self.
19. D.W.Winnicott- Concept of Transitional Object .e.g. - Blanket or toy which can substitute mother for some time.
20. Karl Kahlbaum: ‘Catatonia’.
21. Unipolar depressive disorder is the psychiatric disorder with maximum YLD years of life lived with disability.
22. “Performance improves as a function of anxiety up to a threshold beyond which there is a fall off in performance”, this law is known as Yerkes-Dodson law.
23. Alzheimer’s disease: Involves cholinergic system arising in basal forebrain, nucleus basalis of Meynert. Chromosome 21, chr.14 with severe form.

SCHIZOPHRENIA
24. The rate of schizophrenia in the general population is ~1%. When one member of a monozygotic twin pair is diagnosed with schizophrenia, the other twin, who is genetically identical, has nearly a 50% chance of also manifesting the disease, for dizygotic twin risk is 17%. A first-degree relative of an affected has a 9% risk of schizophrenia. One parent 17%, two parents 46%.
Genes associated with Schizophrenia: disrupted in schizophrenia (DISC1), distrobrevin-binding protein 1 (DTNBP1); and neuroregulin 1 (NRG1).
Potential risk factors: maternal malnutrition, IU infection, advanced paternal age, migration and urban birth. Serial structural MRI in Schizophrenia shows accelerated loss of gray matter. Echo de la pensee or gendankenlautwerden- ‘Thought echo’. Classification of Schizophrenia by CROW types 1(+) and 2(-). Emil Kraepplin (Father of Modern Psychiatry) – ‘Dementia Praecox’, Eugen Bleuler- Coined the term, Kurt Schneider- First Rank Symptoms of Schizophrenia. About FRS- 58% of patients show atleast 1 FRS, 20% of patients do not show FRS and 10% of normal persons can show FRS.

25. Bleuler’s 4As: 1. Ambivalence 2. Affect flattening 3. Association loosening 4. Autism.
26. Male=Female ratio is 1. Excess dopaminergic activity in mesolimbic and cortical pathways
27. In Catatonia patient resists attempts to change position, in waxy flexibility patient maintains the body position into which they are placed.