Showing posts with label Psychiatry. Show all posts
Showing posts with label Psychiatry. Show all posts

Saturday, May 29, 2021

Psychogenic non epileptic seizure (PNES)

 PNES  characteristics : 

  • No loss of consciousness or postictal period

  • Psychiatric conditions (depression, anxiety)
  • Physical/sexual abuse
  • Epilepsy

Mnemonic = “WALT” - means Unsteady! 

Thank you! 🩺🫀

Wednesday, January 13, 2021

Medications that can cause depression

Did you know that the medications we prescribe can be associated with depression?

Beta-blockers and reserpine should also be considered as the cause of depression in those newly started on the medication.

Other such medications include:

Sunday, January 3, 2021

Mnemonic for LAB evaluations for SSRI overdose


Short mnemonic!

Isolated SSRI overdose = Asx / mild CNS Depression 

If symptomatic SSRI overdose with altered mental status & abnormal physical findings. 

Then Check for “ECG” 

Mnemonic = ECG! 

 = ECG ( As Citalopram & Escitalopram can cause QT prolongation ) 


C = Coingestants (Ethanol , Benzodiazepines, Acetaminophen )& biCarbonate Levels ( assess for Metabolic acidosis ) 

G = Glucose levels ( rule out hypoglycemia as a cause of altered mental status) 

Saturday, December 12, 2020

COVID-19 and the increased risk of Parkinson's disease


Currently posted in psychiatry, I was reading articles on Parkinson's disease and came through this important finding in context with the coronavirus disease.

Sunday, July 19, 2020

Facebook: Schizophrenia treatment

Q2) A schizophrenic patient was on chlorpromazine and olanzapine for the past 6 months, with each drug being prescribed for atleast 6 weeks. The patient is still symptomatic. What is next line of management?
A) Haloperidol depot
B) Aripiprazole
C) Risperidone depot
D) Clozapine


Answer to the above question is D) Clozapine.
Explanation: If two drugs are used for schizophrenia and yet no improvement is seen, then Clozapine is used. Clozapine is DOC for resistant schizophrenia.

Some key points of Clozapine:-
1) It is most effective Antipsychotic
2) Clozapine is most toxic Antipsychotic.
3) It causes following special side effects:-
    a) Agranulocytosis :
-Therapeutic Drug monitoring (TDM) cannot be done because plasma concentration is not proportional with agranulocytosis
- Hence it is C/I with Carbamazepine.
   b) De novo seizure.
   c) Myocarditis.
   d) Sedation - Most common side effect.
   e) Sialorrhea- Wet pillow syndrome.
4) It shows Antisuicidal effect.

That's all!

- Demotional bloke!

Friday, March 27, 2020

COVID-19: Coping with GRIEF in midst of coronavirus pandemic

The known death toll from the coronavirus has surpassed 25,000 globally. The pandemic has ended communal prayer and congregational funeral gatherings at many major churches, synagogues, mosques, and temples. With these restrictions and isolation measures, dying people can’t see their families at the endpoint of their life. The internet, however, offered some solace to others ( Facebook live streaming, Video calling, etc.) 

Tragic losses of life…Let’s understand grief in the midst of coronavirus.

Normal grief reaction :

Precipitated by the loss of a loved one (bereavement).

Sadness revolves around feelings of loss and typically occurs in "waves" intermixed with positive memories of the deceased.  
Simple hallucinations ( Visual / Auditory ) of the deceased one. 

Thoughts of dying involve wish to join the deceased but active suicidality uncommon 
For most, the natural mourning process lasts 6-12 months 

f/b the integration of grief, in which the individual continues to feel transient but less pronounced sadness, and life plans/routines have adapted to living without the deceased.

There are 5 stages of grief according to the Kübler-Ross model are denial, anger, bargaining, depression, and acceptance (may occur in any order).

“Mnemonic” = ABCD 

Saturday, February 1, 2020

Correct order of Stage of Death

Proposed by Kubler Ross 

" Mnemonic = DA BudDhA "

D Denial = Refuse to believe Dx 
A Anger = Frustrated , Ask "Why Me ? "

B Bargaining = in return for a cure , they promise to fulfill one or many pledges ( Charity ) 

D Depression 
A Acceptance = Realize that death is inevitable

Thank you 
By Drashtant 

Saturday, January 11, 2020

Psychiatry MCQ-1

So here are two multiple choice questions, whose answer changes with options

Q1)Most common psychiatric disorder is :-
A) Anxiety
B) Depression
C) Phobia
D) Schizophrenia

Here answer is A) Anxiety

Most common psychiatric disorder is 
A) General Anxiety disorder
B) Panic anxiety disorder 
C) Phobia anxiety disorder 
D) Depression

Here answer is D) Depression

Reason for such variation is that Anxiety is not just a single disease like depression.
Infact it is group of disorders. 

So Depression is the single most common psychiatric disease whereas Anxiety is the most common psychiatric disease. 

Tuesday, December 24, 2019

Treatment resistant depression notes

Hi! Quick notes for a friend :)

Treatment resistant depression: Major depressive episodes that do not respond satisfactorily to at least two trials of antidepressant monotherapy.

Things to consider:
Assess adherence
Identify comorbidities
Reassess diagnosis

Treatment strategies:
Augmentation (adding a treatment)
Switching treatment

Friday, August 16, 2019

Lamotrigine: A depression mood stabilizer

Lamotrigine is used primarily as an anticonvulsant for the treatment of generalized and partial seizures and is effective for treating focal epilepsies in the presence or absence of secondary generalization.

Wednesday, July 3, 2019

Fregoli and Capgras.

So this post is regarding Delusional misidentifiaction syndromes.
There are two of them i. e. Capgras and Fregoli syndrome.

Now both of them are super confusing and are often asked in entrances. I made a mnemonic to remember them. If you can remember any one of them, you can figure out other.

So I hope all of you are aware of GOT-Game of thrones! Remember Arya stark had face swaping ability? She killed entire Frey family by it. So did how she kill them? She disguised herself as head of the family - Walder Frey and killed them.

So take A from Capgras. Here A stands for Arya stark. Arya killed family of Frey by disguising as Walder Frey (Family member). So in Capgras, patient thinks that murderer is going to disguise as a  family member and kill him. Eg Nurse disguised as a wife to kill him.
Capgras is also know as The Delusion of doubles! 

OR (To non GOT fans)

F= Family
G=Gun (In hindi you can simply remember Goli)
"Family members trying to kill patient with Gun but disguised as someone else"
Eg: Wife disguised as Nurse to kill patient (Husband)

"Valar Morghulis"

That's it

-Demotional bloke.

Tuesday, April 23, 2019

Treating Alcohol withdrawal - scheduled vs PRN benzodiazepines


Sometimes it's frustrating to see different physicians use different approaches to management of the same condition or disease. How do you practice in that case?

You look at the evidence, the guidelines and make your own decision based on it.

Then even though if your attending practices something opposite of what the guidelines say, you know what is right and what you will practice in the future :)

Anyway, now that I am done venting - what do guidelines say about scheduled vs as needed benzodiazepines for alcohol withdrawal?

Monday, February 18, 2019


The arthritis in SLE may look very similar to RA.

The main difference is that it is non erosive, unlike RA.

Pearls of wisdom :

When treating chronic conditions like Rheumatoid Arthritis, Osteoarthritis, SLE, Fibromyalgia, Psoriasis, and Psoriatic Arthritis, you've got to involve the patient in the care. You've got to explain to them that these are  chronic conditions with no cure. Goals should be damage control and remission.

A good strong patient doctor relationship when dealing with these conditions, works better than any pill on planet Earth.

Credits : Dr.G

Bhopalwala. H

Monday, November 12, 2018

True or False #7

1.Depression increases the risk of morbidity and mortality in Cardiovascular disease. T or F

2. Patients with Cardiovascular disease are more likely to develop Depression. T or F

True or False #6

1. Nightmare is a REM sleep behavior disorder. T or F

2. Night Terror is a REM sleep behavior disorder. T or F


1. True

Things you should REMember for Nightmare disorder are :


Second half of the night

Responsive to comfort

REMembers the dream

2. False

Night terrors:  Abrupt arousals from sleep (panicked scream, terror, autonomic arousal, unresponsive to comfort)

- Little or no dream recall

- Amnesia for episodes

Sleep is a gift, always be grateful for it.

True or False #5

1. Narcolepsy exhibits a reduced REM latency. T or F


1. True

Narcolepsy: depletion of hypocretin secreting neurons in lateral hypothalamus that are involved in maintaining wakefulness

Diagnostic: recurrent lapses into sleep or napping several times in the same day, >3 times a week for >3mo. and at least 1 of the following
-Cataplexy: Conscious of bilateral loss of muscle tone precipitated by emotions or abnormal facial movement (without emotional triggers)

-Hypocretin - 1 (orexin A) deficiency in CSF

- REM sleep latency <15 minutes

-Sleep attacks


-Hypnagogic or hypnopompic hallucinations

-Sleep paralysis

Dx: Shortened REM sleep latency on polysomnografy
Low levels of hypocretin 1 in CSF

You may feel weak, you may fall down, say no to Cataplexy, say yes to CATA GETUP!!

True or False #1

1. Vareniciline increases the risk of suicide and depression. T or F
2. Vareniciline increases the risk of CVS events. T or F

Friday, April 13, 2018

Schizophrenia: Types and Prognosis mnemonic

Schizophrenia: Types and Prognosis mnemonic.

So to begin with, Schizophrenia is a psychiatric disorder classified under psychosis.
Psychosis is a mental state involving loss of contact with reality, causing deterioration of normal social functioning. 

Features of psychosis are:
Loss of insight.
Marked disturbance in personality and behaviour.
Loss of contact with reality.
Impairment in judgement.
Presence of delusions and hallucinations.

A quick recap : Psychosis is classified as   -

• Organic e.g. Substance related psychosis, head trauma
• Major e.g. Schizophrenia, mood disorders
• Third psychosis e.g. delusional disorder, acute and transient psychotic disorders.

There are 7 types of schizophrenia and the mnemonic goes like
PHC (primary health centre) U R SO far

1. Paranoid: The commonest type and good prognosis. The onset is later in life 3-4th decade. Major symptoms are delusion of persecution and grandeur.

2. Hebephrenic: 2nd most common and the worst prognosis. Disorganisation of thought, speech, affect and personality is more prominent than other types. Also there is marked emotional impairment.

3. Catatonic: The best prognosis (especially reactive catatonia). Characterised by marked disturbance in motor activity. Further divided into 3 forms i.e. Excited, Stuporous, and one alternating between the two.

4. Undifferentiated: Where symptoms do not fit in any subtypes.

5. Residual: Chronic type where the positive symptoms vanish and patient is left with 'residual' negative symptoms

6. Simple: only negative symptoms from onset (no positive symptoms at all)

7. Others (f): 
Schizophrenia + mental retardation = Pfropf syndrome
Schizophrenia + self-mutilation = Van-Gogh syndrome

Now let us see what exactly we mean by positive and negative symptoms.
Positive symptoms are those psychotic symptoms not seen in normal individuals (of course, haa!) but are “actively expressed” in the patients (something is added extra and so called positive).

Negative symptoms are normally expected behaviours like emotions like feelings thoughts and drives that a normal person experiences are absent in the patient (Normal things are being taken away and so called negative).

That’s all for now,
Stay awesome!
Keep calm and keep studying!
-Ashish G. Gokhale