Tag: NEET PG

OCD-Management & prognosis


OCD-Management & prognosis


Management:

Pharmacotherapy:

  • First Line – SSRIs and Clomipramine [adverse side effect profile]
  • If first line fails then antipsychotics [Haloperidol, quetiapine, risperidone, olanzapine]
  • Other Drugs [Venlafaxine, Lithium, valproate and carbamazepine]

Psychotherapy:

  • Cognitive Behavior therapy [Exposure & Response prevention]
  • Desensitization, thought stopping, flooding and aversive conditioning

Other T/T modalities – ECT, Psychosurgery [Cingulotomy, capsulotomy – Caudate tractotomy]

Prognosis:

Acute Onset – 50%. 20-30% Significant improvement, 40-50% moderate, rest may so deterioration

Panic Disorder-Management


Panic Disorder-Management


Establishing a Differential Diagnosis:

  • MI / Angina / Other Cardiac Conditions
  • Asthma / Other Pulmonary conditions
  • Hypothyroidism, Hypoglycemia, Carcinoid Syndrome, Pheochromocytoma.

After ruling out all the above-mentioned conditions, the management of panic disorder involves:

  • BDZ and SSRIs
  • Psychotherapy – Cognitive Behavioral therapy
  • Relaxation techniques

Schizophrenia-Epidemiology


Schizophrenia-Epidemiology


Prevalence of schizophrenia Incidence Rate 0.15-0.25 Per 1000
General population 1%
Non twin sibling of schizophrenic patient 8%
Dizygotic twin of schizophrenic patient 12%
Monozygotic twin of schizophrenic patient 47%
Child with 1 schizophrenic parent 12%
Child with both parents’ schizophrenic 40%
  • Usual Age of onset in Adolescence & Young Adulthood [If age > 45 then Late Onset]
  • Male= Female, However the onset is earlier in males
  • Prevalence more in LOWER SOCIO-ECONOMIC status
  • Body Type – Asthenic [Thin & Weak] > Athletic [Muscular] > Pyknic [Short – Fat]
  • Pyknic predisposed to manic depressive illness [Bipolar Ds]

Etiopathogenesis of schizophrenia-Genetic factors


Etiopathogenesis of schizophrenia-Genetic factors


The etiopathogenesis of schizophrenia consists of following factors:

  • Genetic
  • Biochemical
  • Neuropathological

Genetic Factors:

  • Nine Linkage sites identified – 1q, 5q, 6p, 8p, 10p, 13q, 15q, 22q
  1. α- 7 nicotinic receptor
  2. DISC 1 [Disrupted in Schizophrenia]
  3. COMT [Catechol-o-methyl transferase]
  4. NRG 1 [Neuregulin 1]
  5. GRM 3 [Glutamate receptor metabotropic]
  6. RGS 4 [Regulator of G Signaling]
  7. DAOA [ D Amino Acid Oxidase Activator]

Etiopathogenesis of schizophrenia-Biochemical factors


Etiopathogenesis of schizophrenia-Biochemical factors


The etiopathogenesis of schizophrenia consists of following factors:

  • Genetic
  • Biochemical
  • Neuropathological

Biochemical factors:

Dopamine Hypothesis – Excess of dopaminergic activity

Serotonin – Currently along with dopamine excess of serotonin is also considered

Other Neurotransmitter – GABA, NE, Ach, Nicotine, Glutamate

Schizophrenia-Disorganization symptoms


Schizophrenia-Disorganization symptoms


The symptoms of schizophrenia are divided into:

  • Positive
  • Negative
  • Disorganization
  • Motor

Disorganization symptoms:

  • Formal Thought disorder – Loss of organization of thought
  • Disorganized behavior – inappropriate behavior which breaks social norms
  • Inappropriate affect – Affect which is not in sync with the social situation

Schizophrenia-Diagnosis


Schizophrenia-Diagnosis


Diagnosis of Schizophrenia:

  1. Delusions

  2. Hallucinations

  3. Disorganized Speech [ Formal thought disorder]

  4. Disorganized or Catatonic behavior

  5. Negative Symptoms

DSM 5

2 or More of above for > 1months [with one from [1], [2] or [3]

Duration of Illness > 6 Months

ICD-10

2 or More of above for > 1months [with one from [1], [2] or [3]

Duration of Illness > 1 Months

Schizoaffective disorder


Schizoaffective disorder


Has both features of Schizophrenic and mood disorders

Schizoaffective disorder [Bipolar or manic type]

Schizoaffective disorder [Depressive type]

Management

Mood Stabilizers, Antipsychotics and Antidepressants

Other antipsychotics


Other antipsychotics


  • Long Acting Injectable [Depot] Antipsychotics used in patients with poor compliance
  • Available for
  1. Fluphenthixol
  2. Fluphenazine
  3. Haloperidol
  4. Pipotiazine
  5. Risperidone
  6. Zuclopenthixol
  7. Olanzapine
  8. Paliperidone
  9. Aripiprazole
  • Thioridazine can cause irreversible retinal pigmentation, QT Prolongation but Less EPM side effect
  • Chlorpromazine with corneal and lenticular deposits
  • Penfluridol is the longest acting antipsychotic
  • Ziprasidone can cause QT Prolongation [Cardiac arrythmias]
  • Aripiprazole is a partial agonist at D2 Receptors [All other antipsychotic are D2 Antagonists]

Delusional disorder


Delusional disorder


Delusional disorder:

  • Development of a single or a set of related delusion which are persistent
  • Hallucination, disorganization and negative symptoms are absent
  • Persecutory Type, Jealous Type, Erotomania Type, Grandiose Type
  • Somatic Type – Delusional parasitosis, Delusional dysmorphophobia, Delusion of Halitosis
  • Capgras Syndrome – Familiar person has been replaced by an imposter
  • Fregoli Syndrome – Familiar person are taking the guise of strangers
  • Syndrome of intermetamorphosis – People can change into other person
  • Syndrome of subjective doubles – Patient has many doubles who are living life of their own

Induced delusional disorder:

  • Characterized by spread of delusion from one person to another
  • Folie-e-deux – When two people are involved [Folie e trois, Folie e quatre]
  • The patient functions normally in domains which are unaffected by the delusion
  • Management – Antipsychotic Drugs
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