PSYCHOTHERAPY PSYCHOTHERAPY Treatment of psychiatric disorders by using psychological methods. Most important method – Behavior therapy. Behavior therapy: Psychological treatment where patient’s maladaptive behaviors changed to improve quality of life. “Behavior therapy” is generic term – Used to describe a variety of specific techniques intended to remove maladaptive behaviors. Techniques of behavior therapy: Systematic desensitization. Therapeutic […]
DEATH & DYING DEATH & DYING Is a series of responses in an iindividual after informing about his impending death. 3 stages of death and dying were proposed by Elizabeth Kubler-Ross. Stage 1 – Denial and shock: Characterized by refusal to accept diagnosis & reaction of shock. Stage 2: Anger. Stage 3: Bargaining. Stage 4:
ADJUSTMENT DISORDER ADJUSTMENT DISORDER Disorders characterized by emotional responses to stressful events like financial problems, medical illness, relationship problems or death of a loved one. Symptoms: Symptom complex includes anxiety & depressive symptoms. Depressed mood Worry Feeling of inability to cope. Disturbance in individuals daily functioning. Differential diagnosis: Depression – Depression follows negative life event. Differentiated by
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BIPOLAR DISORDERS BIPOLAR DISORDERS Characterized by episodes of both mania & depression. Equally prevalent in men & women. Manic episodes – More common in men; depressive episodes – More common in women. More commonly seen in divorced and single persons. Onset age – 30 yrs (average). Causes: Neurotransmitters: Increased dopamine levels for manic episode. Genetic factors: Chromosomes
SUICIDE – PSYCHIATRIC INPUTS SUICIDE – PSYCHIATRIC INPUTS Cause: Low CSF levels of 5-hydroryindoleacetic acid (5 HIAA). 5-hydroryindoleacetic acid (5 HIAA)- Serotonin metabolite associated with higher suicide risk. Psychiatric illnesses & suicide risks: Depressive disorder Schizophrenia Alcohol dependence & other substance dependence. Personality disorders (especially borderline personality disorder & antisocial personality disorder). Suicidal risk factors: Male sex Age >
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LITHIUM – PSYCHIATRIC USAGE LITHIUM – PSYCHIATRIC USAGE Indications of lithium in psychiatric disorders: Used for treatment of acute episodes (both mania & depression). Effective treatment for acute mania – Effective serum concentration for acute mania treatment is 1.0-1.5 mEq/ dl. Antimanic efficacy of lithium is more than its antidepressive efficacy. Prophylaxis in bipolar disorder. Maintenance treatment
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EXTRAPYRAMIDAL SIDE EFFECTS EXTRAPYRAMIDAL SIDE EFFECTS Caused by antipsychotics. More common with high-potency typical antipsychotics (compared to atypical antipsychotics). Various movement disorders caused are collectively referred to as “extrapyramidal symptoms/extrapyramidal side effects”. Mechanism: Due to dopamine receptor blockade in nigrostriatal tract (neural pathway from substantia nigra to striatum). TYPES OF MOVEMENT DISORDERS: Acute dystonia. Acute akathisia Drug-induced
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DEPRESSION – INTRODUCTION & SYMPTOMS Q. 1 Risk factor for suicide in depression are all EXCEPT: A Female B Male > 45 C Child with conduct disorder D Family Q. 1 Risk factor for suicide in depression are all EXCEPT: A Female B Male > 45 C Child with conduct disorder D Family Ans. A
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DEPRESSION – INTRODUCTION & SYMPTOMS DEPRESSION – INTRODUCTION & SYMPTOMS INTRODUCTION: One of commonest psychiatric disorder. Responsible for maximum DALYs (disability-adjusted life years) amongst all psychiatric disorders. Most common cause of suicide. Characterized by major depressive episodes in absence of any manic, mixed or hypomanic episodes. EPIDEMIOLOGY: Lifetime prevalence = 17% More prevalent in women
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DEPRESSION – TREATMENT DEPRESSION – TREATMENT Treatment modalities: Pharmacotherapy. Psychotherapy. Other somatic treatments. 1. Pharmacotherapy: Considerations: All available antidepressants takes 3-4 weeks to exert significant therapeutic effect. Usage of specific pharmacotherapy doubles chances for recover within 1 month. All available antidepressants have similar profile except adverse effects. Choice of drug also depends on their adverse effects.
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