Defense mechanism-Basics → Defense mechanism prevents excessive unbearable anxiety due to unacceptable urges → These unacceptable urges reflect the conflict between the ID and superego → The defense mechanism is produced by Ego Narcissistic Defense Mechanisms Immature Defense Mechanisms Neurotic Defense Mechanisms Mature Defense Mechanism All Defense mechanisms are at unconscious level except Suppression […]
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Beta hydroxybutyrate & Ketone Body Test Important Image Based Question → Beta Hydroxy butyrate does not give Rothera’s / Gerhardt’s Test for Ketones because it does not give ketone group → High NADH/NAD Ratio in Starvation & DM cause conversion of Acetoacetate to β OH Butyrate
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Palmitic Acid-Energetics Step 1 – Activation of Palmitic Acid [Loss of 2 ATP] Step 2 – Break Down of Palmitic Acid into Acetyl CoA – Total 7 Cycles Each Cycle Produce 1 Mole of Each NADPH + FADH = 2.5 + 1.5 ATP = 4 ATP Total Energy Produced by this Step = 7 X
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Ketone Body-Energetics → Each Acetyl CoA Produces 10 ATP → Conversion of Acetoacetate to Acetoacetyl CoA leads to Loss of an ATP Production Step in TCA Cycle → Conversion of Beta Hydroxy Butyrate to Acetoacetate generate 1 Mol of NADPH+H Acetoacetate = (2 X 10)- 1 ATP = 19 ATP Beta OH Butyrate = (2
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Ketone body utilization Betahydroxybutrate is converted into 2 molecules of acetyl coA which is further utilized by the body. he conversion into Acetyl coA consists of following steps: Betahydroxybutrate is first converted into Acetoacetate Acetoacetate is converted to Acetoacetyl coA in the presence of thiophorase. Liver does not have thiophorase, hence liver & RBC
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Ketone body synthesis Ketogenesis: → Ketone Bodies are water soluble carrier form of Acetyl CoA → Occurs inside mitochondrial of liver cells → LIVER and RBCs cannot utilize Ketone Bodies → Fatty Acid – Albumin cannot cross blood brain barrier Steps of Ketogenesis: Fatty Acid Oxidation Converts to Acetyl CoA X 2 In the
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Generalized anxiety disorder Excessive and persistent Anxiety and not restricted to any particular symptom Also called free floating anxiety or excessive worries Management: BDZ and SSRIs Psychotherapy Cognitive Behavioral therapy Insight oriented Psychotherapy Supportive Psychotherapy
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Other mood disorders Mood disorders apart from depression & bipolar disorder are: Recurrent Depressive Ds- More than one depressive episodes Dysthymia – Presence of mild depressive symptoms for a period of more than 2 years Chronic Depression- Depression > More than 2 Years Cyclothymia- Milder form of bipolar disorder but never severe enough for mania/hypomania
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Lithium Monovalent cation and get rapidly and completely absorbed after oral administration t1/2 – 1.3 days but increased to 2.4 days after continued TT for more than 1 year Not metabolized in body and excreted unchanged in kidney Indications: Acute Manic Episode Schizoaffective Ds Bipolar Depression OCD Gout Epilepsy Maintenance Therapy Cluster migraine Ulcerative Colitis
Bipolar Disorder-Treatment Pharmacological treatment of bipolar disorder: 1. Mood Stabilizers Lithium, Valproate, Carbamazepine, Oxacarbamazepine and Lamotrigine Lithium – Prototypical mood stabilizer. Takes 1-2 weeks to start acting Valproate – Preferred Drug for acute mania Lamotrigine – Used in Acute depressive episode of bipolar disease [Bipolar Depression] 2. Antipsychotics 3. Benzodiazepines High potency BDZ used for
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