PNES characteristics :
- No loss of consciousness or postictal period
Comorbidities
- Psychiatric conditions (depression, anxiety)
- Physical/sexual abuse
- Epilepsy
PNES characteristics :
Hii!
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!
E = ECG ( As Citalopram & Escitalopram can cause QT prolongation )
MOST IMPORTANT
C = Coingestants (Ethanol , Benzodiazepines, Acetaminophen )& biCarbonate Levels ( assess for Metabolic acidosis )
G = Glucose levels ( rule out hypoglycemia as a cause of altered mental status)
Hi!
Currently posted in psychiatry, I was reading articles on Parkinson's disease and came through this important finding in context with the coronavirus disease.
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
#Medicowesome
#Psychiatry
#Pharmacology
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!
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)
FreGoli:
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.
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
1. Nightmare is a REM sleep behavior disorder. T or F
2. Night Terror is a REM sleep behavior disorder. T or F
ANSWERS
1. True
Things you should REMember for Nightmare disorder are :
REM
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.
1. Narcolepsy exhibits a reduced REM latency. T or F
ANSWER
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
Tetrad:
-Sleep attacks
-Cataplexy
-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!!
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