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33-PSYCHIATRY

delusion(thought content)-false, fixed belief idea-false, fluctuating belief extracampine hallucination-outside limit of sensory field thought-form(loosening of association), stream, content(delusion), possession(schizophrenia, OCD) delirium-a/c,altered sensorium, autonom dysfn, sleep reversal, sundowning, floccilation Alz ds-intracellular-neurofibrillar tangle, tau prot, Extracl-bEt amyloid plaque 1-40,1-41 involutional melanocholia-intense nihilism, somatization, agitation old age

proponent-therapy/school Aaron Beck-cognitive therapy, cognitive theory(–ve thought of future, self, environm) Benedict MOrel-demence precOce Burrhus F Skinner-operant conditioning Carl Gustav Jung-analytical thinking Costa&McCrae 5 factor model of personality(CANOE)-Conscientiousness, Agreeableness, Neuroticism, Openness, Extroversion Dendy Walter Cooper-psychotherapy Edward HEcker-HEbephrenia Emil Kraeplin-dementia precox Erikson-8 stage classific of human life Esquirol-hallucination is perception without stimulation Eugen Bleuler-schizophrenia, Autism, Ambivalene, Affect, Association disturbance(4A) Ivan Pavlov-classical conditioning James Braid-hypnosis Kubler Ross-5stage grief/death(DABDA) -Denial, Anger, Bargain, Depression, Acceptance

→ Prochaska&Diclemente stages of motivation cycle-precontemplation(denial) → → → →contemplation preparation(decision, planning) action maintenance

→relapse/recovery precontemplation Schneider-3 feature of healthy thinking-constancy, organisation, continuity Sigmund Freud(died in London)-psychoanalysis, psychotherapy, psychosexual developm, oedipus complex, free association, penis envy, repression, topographical theory(conscious, semiconscious, unconscious) William CUllEN-NEUrosis Timothy Crow-2type schizophrenia

General Adaptation Syndrome(GAS) path of ANS when we are aroused by stressful situation

obsession

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repetitive behaviour, ego dystonic, compulsion

panic attack a/c anxiety, feeling of impending doom, quick resolution sympt

phobia acro-high place agora-open place algo-pain api-bees claustro-close place cyno-dog eremo-being alone gamo-marriage gato-cat gyno-woman kakorrhaphio-failure ophidio-snake pnigero-smothering sito-eating techno-technology thanato-death xeno-stranger zoo-animal

level of intelligence-IQ range idiot=0-24 imbecile=25-49 moron=50-69 borderline=70-79 low normal=80-89 normal=90-109 superior=110-119 very superior=120-139 near genius≥140

mental status-IQ normal≥70 mild=50-69-educable moderate=35-49-trainable severe=20-34-dependent very severe<20-need life support

schizophrenia1st rank sympt 3auditory hallucination-1st person(thought echo), 2nd(commentary, commanding), 3rd(talking among themselves) 3made phenomenon-impulse(motor act), volition(planned behaviour), affect 3thought disord-insertion, broadcast, withdrawal somatic passivity

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delusional perceptiontype1-+ve sympt, good progn, compliant to med, respond to medic, CT/MRI norm, family support, a/c onset, late onset, f/h/o mood disord, stressful event, fem

neuroleptic malign synd→ → antipsychotic hypertherm, altered sensorium, leadpipe rigidity, autonomic dysfn

↑ ↑WBC, CPK, MburiaRx-(BADE)-Bromocriptine, Amantadine, Dantrolene, ECT

a/c stress disorder-durat<1mth PostTraum Stress Disord(PTSD)>1mth late PTSD-appear>6mth adjustment disord-resolve<6mth

Pervasive sadness-Persists throughout d terminal insomnia-early morning wakefulness depression(pseudodement)-sad mood>14d postpartum depression-within 4w PP recurr depress disord≥2episode depress dysthymia-sad mood>2y

→ → cyclothymia-sad happy sad>2y double depression=dysthymia+depression mania-elated mood≥7d hypomania-elated mood≥4d bipolar1=mania+depression bipolar2=hypomania+depression rapid cycling disord≥4episode/y antidepressant effect≥3w depression age-middle age fem Oto Veraguth fold-triangle fold in nasal corner of upper eyelid-depression

↑ atypical depression-wt gain, appetite, hypersomnia, heavy sensation in limb, interpersonal rejection sensitivity

NT—schizophrenia—depression↓ ↓ NE- -

↑ ↓ D- -↑ ↓ 5HT- -↓ ↑ ACh- -

↓ ↑ glutamate- -

suicide→ → → suicide threaten suicide gesture parasuicide(deliberate self harm) suicide

attempt↓ biological marker-CSF 5HIAA

antisuicidal-Li, clozapine suicide incidence India=36/lacds-suicide risk factor depression=15% schizophrenia=10-12%

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substance dependence=10% borderline personality=10%

classif bipolar disord Young&Kleman Akiskal

astasia abasia-bizarre unexplainable gait in conversion disord conversion disord-express stress as bizarre involunt motor/sens complaint dis-associate-circumscribed memory loss dissociative fugue-forget prim identity, purposeful wandering FActitious disord-deliberat FAke sympt hypochondriasis-body dysmorphic disord labelle indifference-conversion disorder malinger-fake sympt somatoform disord-psychological stress expressed in physical form

Id-birth, pleasure, immed Ego-5-6mth, reality, def mech Superego-4-5y, ideal

def mech mature-humor, anticipation(doing), altruism(charity), sublimation(most mature, express as society accepts), suppression(forgive+forget) less adaptive-disPlacement(Phobia), intellectualization, isolation, rationalization(illogical explanation), rxn formation(OCD), undoing(OCD) immature-Denial(Drug addict), splitting(borderline personality), acting out, Projection(Paranoid Personality), repressive(forgive, not forget, ability to filter unpleasant memory)

Anorexia nervosa-Amenorrhoea, fear of wt gain, restrict diet, exercise, purge, somatization disord Bulimia nervosa-Binge eating, fear of Body image, purge, Mallory Weiss synd

Sleep(BATSDrinkBld) Bet-awake, eye open-parietofrontal->14Hz-low amplitude Alp-awake, eye closed-parietooccipital-(8-13 Hz)-high amplitude Thet-NREM(orthodox, slow wave sleep) I-parietoTemporal, hippocampus(4-7Hz)-high amplitude-microsleep(hypnoeic jerk), emotion state, dissapointment, frustration, crying(child) Spindle&K compleX-NREM II-large amplitude-bruXism, frontal lobe sz Delt-NREM III,IV(3-5Hz)-sleepwalking(somnabulism), sleeptalking(somniloquy), bed wetting, night terror(pavor nocturnus-autonom arousal) Bet-REM(paradox sleep)-nightmare(dream), narcolepsy, memory consolidation,

↑penile tumescence, activity in pons,amygdala,hippocampus,ant cingulate gyrus

personality disord cluster A-odd,eccentric paranoid-suspicious schizoid-emotionless

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↑ schizotypal- chance of schizophrenia cluster B-Borderline personality disord, ASPD(antisocial personality disord), emotional, erratic(self harm), dramatic Borderline histrionic narcissitic

cluster C-anxious, fearful OCPD(anakaspic person disord) dependent AAPD(anxious avoidant person disord)

typeD-CAD

addiction craving control lost tolerance withdrawal salience(waiting) knowledge of harmful use for ≥3mth

locus ceruleus-NE substantia nigra-D raphe nucleus-5HT nucleus of Meynert-ACh

general anxiety disord-free floating anxiety≥3mth

↓ narcolepsy-hynoGOgic(GOing to sleep), hypnopompic hallucination, REM latency

↑ catatonia-physical sign- m tone at rest(catalepsy), posturing, waxy flexibility, forced grasping, negativism, rigidity, Gagenhalten, automatic obedience, echolalia, echopraxia, ambivalence↓ D

Mx-1st-IV lorazepam, best-ECT

purpose of Classific in psychiatry Communication Comprehension Control

neurasthenia(cardiac neurosis, c/c asthenia, da costa synd, effort synd, fnal CVS ds, soldier heart, suba/c asthenia) general lassitude irritability lack of concentration worry hypochondria

neuropsycologic test(cognitive fn brain)

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attention, concentration memory language arithmetic, calculation visuospatial stability

attention, calculation-frontal lobe, ARAS serial (100–7) subtraction test digit span test d of w backward test

memory immed-s recent-min-24h 3object recall test

remote-d-w shortterm(working)-dorsolat prefrontal cortex longterm(remote)-neocortex explicit-declaration, fact, figure episodic-learn by time semantic-learn by meaning

implicit-procedural-amygdala, striatum, reflex pathw, cerebellum(most resistant to amnesia/dementia)

→ short longterm-hippocampus stage of memory registration-immed memory encoding(simplifying)-recent memory storage retreival-recall

visuospatial ability-rt parietal lobe(ACh) clock drawing test block design test Bender Gestalt test(MC screen test organic dysfn)

intelligence MC child(6-16y)-Weschler Intelligence test for child MC adult(>16y)-Weschler Adult Intelligence Test Bhatia battery test Alexander pass a long test Koh block design test

personality objective personality test MMPI(Minnesota Multiphase Personality Inventory) 16PF(Personality Factor) test

projective personality test Roschach inkblot test-10card, ambiguos stimul, personality struct assessm,underlying thought abnorm, 8,9,10-colour card Henry Murray&Christiana Morgan thematic apperception test-20card,

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semiambiguous stimuli, personality dynamic assessm, interpersonal conflict draw a person test sentence completion

somatic Rx modality ECT-u/l, b/l rTMS(repetitive Transcranial Magnetic Stimulation)=1.5-3tesla depression, OCD, refractory hallucination, schizophrenia, PTSD, migrainous headache, bradykinesia VNS(Vagus Nerve Stimulation)-lt CNX deep brain stimulation-Parkinson ds, depression(trimonoamine booster)

cognitive intervention cognitive behaviour therapy cognitive remediation/rehabilitation improvem memory

ICD-10 chapter=21, mental illness-5(f), axis=3(research), volume=3 DSMIV-axis=5DSMV-axis=0

Abbreviations a-artery, AA-amino acid, abtc-antibiotic, AI-autoimmune bef-before, bel-below, b/l-bilateral, bld-blood, b/n-between, bn-benign, br-branch, Bx-biopsy ca-carcinoma, carb-carbohydrate, c/i-contraindication, c/l-contralateral, conc-concentration, cong-congenital, Cx-cervix d-day, def-deficient, ds-disease, d/t-due to, Dx-diagnosis E-estrogen fem-female, fr-from gld-gland, glu-glucose h-hormone idiop-idiopathic, i/l-ipsilateral, inf-infection, inj-injury lig-ligament, LL-lower limb, l/t-leading to m-muscle, maj-major, mal-male, MC-most common, met-metastasis, min-minor, mtx-methotrexate, Mx-management n-nerve, norm-normal P-progesterone, pl-plasma, prot-protein, pt-patient Rx-treatment SCC-squamous cell carcinoma, sr-serum, Sx-surgery, sz-seizure tm-tumour, ts-tissue UL-upper limb, u/l-unilateral vag-vagina, VC-vocal cord, vel-velocity, vert-vertebra, vit-vitamin, vol-volume w-week, wt-weight Xr-X ray y-year #-fracture °-degree

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THESE NOTES ARE ONLY FOR THE PURPOSE OF GUIDANCE AND HELP TO PG ASPIRANTS, NOT FOR COMMERCIAL OR OTHER PURPOSE. REFERENCE HAS BEEN TAKEN FROM VARIOUS STANDARD TEXTBOOKS.

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