Fact of the day: Psychiatric effects of steroids

Did you know corticosteroid therapy can cause depression, mania, psychosis, and delirium?

Why?

The mechanism by which the corticosteroid induces symptoms such as mania, depression, and psychosis is not clear.

The administration of prednisone is associated with decreased levels of corticotrophin, norepinephrine, and beta-endorphin in the cerebrospinal fluid. Furthermore, corticosteroids induce an increased release of glutamate that induces neuronal toxicity due to accumulation effect.

-IkaN

Fact of the day: Paradoxical agitation with benzodiazepines

Benzodiazepines frequently are administered to patients to induce sedation.

Paradoxical reactions to benzodiazepines, characterized by increased talkativeness, emotional release, excitement, and excessive movement, are relatively uncommon and occur in less than 1% of patients.

The exact mechanism of paradoxical reactions remains unclear. 

It is important to be aware of this side effect because increasing the dose of benzodiazepine would worsen the condition.

Risperidone mechanism of action mnemonic

Hello! This post is about the atypical antipsychotic - Risperidone!

Risperidone is a second-generation antipsychotic that has affinity for D2, 5-HT2A, alpha 1, alpha 2 and H1 receptors.

The mechanism of action of risperidone is not fully understood, current theories focus mainly on its ability to block D2 and 5-HT2A receptors.

Hard time remembering this? I've got a solution!

Adult ADHD : A Clinical Overview

Hey Awesomites

Attention - Deficit Hyperactivity Disorder ( ADHD ) is a mental health disorder that usually occurs in childhood and continues into adulthood. The symptoms in adults may not be as clear as in children. In India, there are more than 10 million cases of adult ADHD per year.

In adults, the symptoms of hyperactivity may decrease, but the characteristic features of decreased attention span, mood swings, impulsive behavior, difficulty in communication and language skills, restlessness may still continue to appear.

Now lets talk about the signs. The WHO has lately released a set of six questions to test the adults for signs of ADHD - Adult Self - Report Scale Screener (ASRS) is a self - screening questionnaire that you can use to determine if you might have ADHD. The answers to these questions predict the people suffering from this disorder and is a simple way of screening :

1. How often do you have difficulty in concentrating on what the other person is saying to you, directly as well as indirectly ?

2. How often do you leave your seat when you are in a group or meetings in which you are expected to remain seated?

3. How often do you have difficulty in unwinding and relaxing when you have time to yourself ?

4. When you are in a conversation, how often do you find yourself finishing sentences of the people you are talking to before they can finish them themselves?

5. How often do you put things off until the last minute?

6. How often do you depend on others to keep your life in order and attend to details?

- The answers to these set of questions can be 'never', 'rarely', 'sometimes', 'often', or 'very often'.
- If the answer to four of the six questions is 'sometimes', 'often' or 'very often' , the person may be considered to have ADHD!

Note that this is a simple way of screening the people for signs of ADHD, and not the diagnostic criteria.


Thats all
- Jaskunwar Singh

Neuroleptic Malignant Syndrome : A Crisp Overview

Hi everyone ! So I recently saw a patient who possibly had Neuroleptic malignant syndrome. So I though I would do a post on it !

1. The Syndrome -

NMS is an idiosyncratic reaction to Anti psychotic drugs. It causes a host of symptoms like Rigidity , Hyperpyrexia and altered consciousness.

2. The Etiology -

- All Antipsychotic drugs can cause NMS. But most commonly implicated are Haloperidol, Fluphenazine and Chlorpromazine.
- Especially at risk are those taking Depot preparations.
- Even lithium in high doses can precipitate this.
- Atypical Antipsychotic drugs have a lower propensity to cause this.

3. The Pathophysiology -
- Although largely speculative , the cause is said to be the dopaminergic blockade by the anti psychotic drugs.
- Blockade of D2 in Hypothalamus is responsible for the Behavioral and Temperature changes.
- Blockade of D2 in the basal ganglia ( nigro striatal pathway) causes the Rigidity.
- increased muscular activity can cause muscle break down.

4. The Clinical Features - 

- generally within 4-10 days after starting the Antipsychotic drug. But can even occur years later.
- Hyperthermia ( Hypothalamus is conked off )
- Lead pipe Rigidity ( Basal ganglia are screwed)
- Altered mental state - delirious.
- Sweating/ Diaphoresis  ( compensation for high temp)
- Tachycardia
- Dyspnea
- Urinary incontinence
- Dysphagia
- Pallor.

Symptoms develop over a period of 24-72 hours.

5. Tests -
- Creatine Phosphokinase (CPK MM) is raised
- Leukocytosis
- Low Iron
- Deranged LFT and LDH

( Can be used to differentiate from serotonin syndrome)

- Diagnosis requires Hyperthermia + Rigidity +   2  other features ( including riased leukocytes and CK MM)

6. Management -
- ABCD
- Ventilatory support if needed
- stop Antipsychotic drugs.
- Anti pyrectics . Ice packs. Cooling blankets.
- BDZ
- Specific -->
Dantrolene - Muscle relaxant and Hyperthermia management. 400 mg/D.

- Bromocriptine - D2 agonist.

- ECT may be needed.

Hope this was helpful ! Happy studying and Stay awesome.

~ A.P.Burkholderia

Reversible Causes of Dementia : Mnemonic

Hi everyone ! This is a short post on causes of dementia that can be corrected. This is very important as most causes other than these have no available treatment ! (One Reversible cause of dementia is the Demeantor's kiss ;;) Treat using  Expectro Patronum)

So the medically treatable causes include the following.

Remember : ABCD2E

- Alcoholism
- Vitamin B deficiency - Thiamine / Niacin /B12
- CNS infections - HIV , Chronic Meningoencephalitis , Whipple Disease, Neurosyphilis.
- Depression
- Drug induced
- Endocrine - Thyroid disturbances

Let's look at how these can be corrected medically.
- A = Alcohol abuse. May be a result of Alcoholic delirium/ Wernicke-Korsakoff syndrome. So the management would include giving Thiamine to the patient , and alcohol withdrawal using Disulfiram ans other anti craving drugs like Ondansetron, Acamprosate, Topiramate and Naltrexone.

- Vitamin B Deficiency = Thiamine deficiency we've seen above.
Niacin Deficiency causes 3 D's - Diarrhea , Dermatitis and Dementia. So treat that using Niacin.
B12 Deficiency and possibly folic acid can also cause Dementia.

- CNS Infections = They cause transient cognitive changes that are reversible on treating the disease.

- Depression = may cause depressive pseudodementia or even true dementia. (pseudo dementia = no confabulation or impaired recent memory)

- Drug induced = Chronic use of drugs like BDZ , Opiates and TCA's.

- Endocrine = Hypothyroidism is notorious to cause Dementia.

~~~~~~~~~~~~~~~~~~~~~~~

The surgically correctable causes are below.
Remember = T2 H2

- Tumors  (esp frontal lobe tumors )
- Trauma (Subdural Hematoma)
- Normal Pressure Hydrocephalus (NPH)
- Hydrocephalus

- Tumors are resected surgically.
-  For the hydrocephalus group , ventriculo peritoneal shunting is performed.
- NPH = Triad of symptoms showing Gait disturbances , Urinary incontinence and Dementia. (GUD)

Hope this post helped you and didn't leave you too demented. !  If it did, have some chocolate like Lupin would offer ;;)
Happy studying.
Stay awesome.

~ A.P.Burkholderia

Fact of the day: Nightmares are a warning for serious mental problems

Hello

Not one or two, but frequent nightmares are major caveats for underlying serious mental problems. Rapid Eye Movement sleep disorder is a rare disorder that causes the person to act violently during dreamy state. This may be a warning sign for major neurologic disorders like Parkinson's and neurodegenerative diseases like Alzheimer's !!

Night owls are more likely to have frequent sleep and mood disturbances than the early sleepers. Evidences suggest people suffering from nightmares and related sleep disorders are more likely to have suicidal tendencies than those not, in addition to other contributing factors.


- Jaskunwar Singh

Medicowesome secret project: Cyclothymia

What is the secret project? How can I participate?

Fact of the day : Neuroticism and creative thinking

Hey Awesomites

While the medial prefrontal cortex is a part of the brain that shows high levels of activity in the neurotics, innovation of new ideas is also something the frontal areas of our ( mainly right ) brain function for.

There is often a preponderance to generation of self - generated thoughts and a perception of threat appraisal when there is no such actual external stimulus. The neurotics tend to 'create' situations of threat in their mind and respond accordingly, but they also come up with creative ideas to find solutions to such 'internal' problems by overthinking and overactivating their thought - provoking areas of brain. They also have oversensitive amygdalae, that is concerned with panic attacks, excess fear and anxiety.


Thats all
- Jaskunwar Singh

Did you know? Sir Isaac Newton suffered from bouts of depression and once had a mental breakdown. Inspite of that he made use of his creative mind and formulated laws of gravity, and fathomed several mathematical theories.

How I remember the duration of symptoms for Generalized anxiety disorder (GAD) required for diagnosis

The symptoms of generalized anxiety disorder should be present for at least 6 months. For me, it's hard to remember the duration of the symptoms in psychiatry. So I mnemonic-ify them :D

I remember G6PD, and say G6AD instead!

For those who don't know what GAD is here is the DSM V criteria for diagnosis of Generalized Anxiety Disorder...

Fact of the day: Regulate brain activity with your type of music

Hey Awesomites

Which genre or type of music do you like the most? Well, it surely has to do a lot with the functioning of our brain. Some of you may like slow music while others like to rock n roll on the floor while listening to their favourite beats. I am more of the latter type too, depending on the mood. ;p

Tricyclic antidepressants (TCAs) - MOA and side effects

Hello!
This is a fun and concise post on the pharmacology of TCAs. Excited? :D

Fact of the day: Psychosomatic symptoms love to travel

Hey Awesomites

Yes, you read it right. The symptoms of psychosomatic disorders flit from one body part to another, and just too easily and quickly ( they love to travel a lot ;p ) . Just as one symptom is discovered, it disappears and another one emerges in some other part of the body.

The psychosomatic symptoms have been linked to a chameleon. Every time a medicine tries to pin them down,  they become something different.

That's all
- Jaskunwar Singh

The colours of a chameleon are not more numerous and inconstant than the varieties of the hypochondriac and hysteric disease.
 - Robert Whytt

Munchausen's syndrome

Hello

"Psychosomatic disorders are conditions in which a person suffers from significant physical symptoms (causing real distress and disability), that is out of proportion to that which can be explained by medical tests and physical examinations."

Karl Friedrich Von Munchausen, the "Baron of Lies" gave his name to the syndrome. Munchausen's syndrome (now more correctly called factitious disorder in DSM- 5 classification of somatic symptom and related disorders ) refers to patients who imitate illness (may be in an exaggerated form ) for medical attention and care and may even expose themselves to life- threatening operations, amputations, unnecessary medications and toxic treatments.

Lets take an example: A woman presents to hospital with a headache and a dilated pupil. On investigations, scans were normal and no other systemic abnormality seen. Then, a nurse walks into her room and finds the patient self- administering dilating eye drops into the affected eye.

The person has an awareness of the lies they are telling but they surely do it to seek medical care and attention, being unaware of their own motivation and uncontrolled behavior.

Upto one- third of patients in neurology ward suffer from psychosomatic illness and most often, an emotional cause is suspected.


Thats all
- Jaskunwar Singh

Fact of the day: Multi- vitamin supplements beneficial for schizophrenics

Hello

Recent studies suggest that high- doses of vitamin B help in reducing the symptoms of schizophrenic patients and those with other neuropsychological disorders, when added to the normal treatment in early stages. (Source)


- Jaskunwar Singh

Delirium and Dementia mnemonics

Hello

Delirium- "It is a transient, usually reversible cause of mental dysfunction that results in a wide range of neuropsychiatric abnormalities, mostly presented by elderly as
- waxing and waning type of acute- confusional state
- fall in attention- span
- decreased awareness of surroundings
- low cognition levels."

Causes of Delirium- (mnemonic: DELIRIUM)
D- Drugs (anti- cholinergics, antipsychotics etc)
E- Encephalopathy (Wernicke's)
L-  LSD intoxication
I- Infections
R- Respiratory failure
I- Insomnia
U- (v) visual sphere hallucinations
M- Metabolic disorders


Dementia- "A group of neuropsychiatric disorders characterised by chronic and gradual decrease in the ability of person to think, create memories, express emotions and other mental symptoms that affect the general well being."

Causes of Dementia (mnemonic: DEMENTIA)-
D- Degeneration (Primary cerebral)
E- Endocrinal dysfunction
M- Multiple sclerosis
E- Embolisation (vascular pathology)
N- Normal tension hydrocephalus
T- Tumors
I- Infections
A- Alcohol intoxication


That's all
- Jaskunwar Singh

Fact of the day: Talking to yourself is a sign of smartness

"Look at that guy, roaming around here and there in the marketplace, muttering words and talking to himself. He seems totally insane. Doesn't he?"

Fact of the day: 'Experience- taking' from books

Today's fact is relatable for all medicos and books lovers <3

Yes, you can subconsciously take on the attributes of your favourite fictional characters when reading a story- not just the thoughts and beliefs of the character, but the whole state of being itself.

Well, it is more often seen in those who are depressed or who don't have much life experiences of their own.

Also, if the reader is able to relate experiences in the life of character of the story, he might take it to his own life and adopt the mindset and perspective of the character. This may lead to temporary or permanent changes in his real life.

Excessive openness to experiences may lead to schizotypal, narcissistic or paranoid personality disorders among others.


Happy reading :D

- Jaskunwar Singh

Fact of the day: Handedness arises from genes in the spinal cord

Handedness is an asymmetry arising due to left-right differences in the development of nervous system. Evidences suggest that a human embryo of eight weeks is able to move its right arm more than the left arm.

Well, if you know something about neurologic development in-utero, you must know that at eight weeks signals are not transmitted from the brain yet. Instead the signals travel from the spinal cord.

The left side of the cord matures faster than the right cord. This means the genes that control growth and development are activated faster on the left cord than the right one. In the hindbrain, it is the other way around.


That's all
- Jaskunwar Singh

GABA A and GABA B receptor agonist antagonist mnemonic

Here's a super short post.

Flumazenil acts on the GABA-A receptor and baclofen acts on the GABA-B receptor.

How do you remember this?