Depression: A Summary

Hey guys! Here’s a review of Major Depressive Disorder using a whiteboard as help.

Depression is a type of mood disorder with primary disturbance in internal emotional state causing subjective distress and socio-occupational dysfunction.

Learned helplessness is when the individual learns that he/she is helpless in situations where there is a presence of aversive stimuli, has accepted that there’s no control over it, and thus gives up trying.

CLINICAL FEATURES:

The classic mnemonic goes as-

• Depressed mood: Can show diurnal variation. Patient reported. Essential for diagnosis.
• Sleep disturbance: Patients have decreased slow wave sleep duration and R.E.M. latency while having increased total R.E.M. duration with early R.E.M. onset in sleep cycle.
• Interest loss or anhedonia: Inability to attain pleasure from almost any activity. Patient reported. Essential for diagnosis.
• Guilty: Patients have feelings of worthlessness or sin for events they have little or no role in/ control of.
• Energy loss or fatigue
• Concentration difficulties: Usually accompanied with indecisiveness.
• Appetite and weight changes: Can increases or decrease. Usually, there’s a loss of body weight by 5% or more, associated with GI complaints of constipation, dyspepsia etc.
• Psychomotor changes: Retardation or agitation.
• Suicidal ideations: Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide.

MANAGEMENT:

1st line-

Psychotherapy: Cognitive Behavioural Therapy, Problem Solving Therapy, Emotions Focused Therapy and Behavioural Activation etc.

Selective Serotonin Reuptake Inhibitors: Fluoxetine, Paroxetine, Fluvoxamine, Escitalopram and Sertraline.

2nd line-

Serotonin/ Norepinephrine Reuptake Inhibitors: Duloxetine, Venlafaxine, Desvenlafaxine.

Tricyclic Antidepressants: Amitriptyline, Nortriptyline, Clomipramine, Desipramine and Imipramine.

Monoamine Oxidase Inhibitors: Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline.

Atypical antidepressants: Bupropion, Trazodone, Mirtazapine.

Last line-

Electroconvulsive therapy is reserved for:

-Need for a rapid antidepressant reponse

-Failure of drug therapies

-History of good response to ECT

-High risk of suicide

-High risk of medical morbidity and mortality

Further reading:

Normal vs. abnormal grief reaction

Cyclothymia vs Dysthymia

Types of psychotherapy

Hope this helps. Happy studying!

--Ashish Singh

Schizophrenia First Rank Criteria : Mnemonic

Kurt Schneider laid down the First Rank Symptoms of Schizophrenia.
They're tedious to remember but we need to know them for MCQs and entrance tests!
So here goes :

Mnemonic :
ABDS VV (Very Vella)

A = Audible Thoughts (Echo de la Penses)
B = Broadcasting Thoughts + Insertion/Withdrawal of Thoughts
D = Delusional Perception
S = Somatic Passivity

V = Volition absent (Avolition)
V = Voices speaking / Arguing

That's all !

Few contributions to Schizophrenia :

The word was Coined by : Bleuler
Demence Praecoxe : Morel
Dementia Praecox : Kraeplin
1st rank symptoms : Schneider

Bleuler also gave the 4 A's of Schizophrenia !
They are Avolition, Autism , Ambivalence and flat affect.

Hope this was a good list for you !
Happy studying !
Stay awesome !

~ A.P. Burkholderia

The Oedipus Complex

The Oedipus Complex has been an ever popular Freudian concept.
Here's a summary of Psychosexual development as per Freud and the Oedipus Complex concept.
I insist you put up with this incestuous concept :p

So Freud was an extraordinary Psychoanalyst and gave the stages of 'Psycho Sexual Development'  in his book 'Interpretation of Dreams'.

There Are 4 stages of Psychosexual development in Freud's opinion that all of us pass through to reach the mature stage eventually.

The 4 stages are :

1. Oral
2. Anal
3. Phallic
Latent period
4. Genital

Remember -
Mnemonic : On A PG break.

If one fails to break through any of these stages , it is said he'd develop specific psychiatric illnesses.
It's important for a child to go through these stages without 'fixation' over any of those.

For example Oral stage fixation Makes you SAD
Schizophrenia
Anxiety
Dependent Personality disorder.

Anal Stage fixation makes you an 'Anal' person.
So you're likely to develop Obsessive Compulsive disorder or Obsessive Compulsive Personality (Ankanastic Personality)

Phallic Stage Fixation is "complex."
So in previous stages , it's been obvious what the object of gratification has been (Mouth and Anus respectively).
This one's slightly more "complex".

So as per Freudian theory , Boys would be sexually fixated on their Mothers, viewing their Fathers as a threat ;
This is called the 'Oedipus Complex'.
And also have Castration anxiety.

The theory says similarly Girls would be sexually fixated on their Fathers , viewing their mothers as a threat ;
This is called the 'Elektra Complex'.
And have Penis Envy.

The Oedipus Complex :
So this stems from the Greek story where Oedipus marries his own mother unkowningly , after he kills his father.

King Laius was the king of Greek city Thebes. He and his wife Jocasta bore a child : Oedipus.
The problem is some Seer prophesized that this child would kill him. And so he sent away his child, who was found and raised in another city by another King. Years later he returned to Thebes and quarreled with an old man and ended up killing him.
After a while he was told that the King had been killed , and that he could take charge of the town if he defeats the Sphinx. He did so, and won the hand of the King's wife Jacosta as well.
Years later he found out the King was actually his Father , and his Wife was his mother.
Here's where the 'Oedipus Complex' gets its name from.

Electra Complex
Stems from another Greek story.
Electra was the daughter of Agamemnon, whose wife killed him.
Electra then avenged her father's death by killing her mother.
(Talk about Daddy's lil girl ;;) )

Another complex is 'Pharoah Complex' where siblings are fixated sexually on each other.

Fixation in Phallic phase leads to Paraphilias and Hysteria.

Hope this wasn't overly disturbing !
Happy studying !
Stay awesome.
~ A.P. Burkholderia

Varenicline mnemonic

Hello!

A short post on Varenicline :)

Mirtazapine mnemonic

Hello!

Here's a short post on the atypical antidepressant, Mirtazapine! It's an alpha 2 antagonist that increases release of NE (norepinephrine) and 5-HT (serotonin)

Mirtazapine causes sedation (desirable in depressed patients with insomnia)

Mnemonic: MirtaZZZZapine
Zzz for 😴 sleep

Mirtazapine increases appetite, causes weight gain (desirable in elderly or anorexic patients)

Mnemonic:
M - Mirtazapine makes you motu
(Motu in Hindi / Urdu is fat)

-IkaN

Poor prognostic factors for schizophrenia mnemonic

Hello!

This is a mnemonic for some (not all) prognostic factors for schizophrenia.

Brain to gut: Lets talk

Hey Awesomites

The brain and gut chat and share neurohumoral and immunologic messages with each other most of the times. That is why our emotions affect our stomach and intestines and vice versa. This healthy communication is disturbed when we are stressed out, anxious, or depressed.



Stress (more of psychological type) influences the type of bacteria inhabiting the gut, making a loss of our bowel flora diversification and increasing the concentration of harmful pathogens in the gut, thus leading to certain inflammatory and infectious processes.

Chronic flare - ups of inflammatory bowel disease result in deviation of the mood towards negative side by upto 60 percent by a process of rewiring the neuronal circuitary, called neuroplasticity. This inturn worsens the condition of gut on long-term basis.
Recent studies suggest that talk therapy - particularly cognitive behavioral therapy, and anti- depressants may be supportive in such cases to reduce the flaring up of inflammatory bowel syndrome.

In case of irritable bowel syndrome, that is a functional disorder ( without any actual organic cause ), the CBT and use of anti- depressants improve the symptoms in upto 60 percent patients. But which patients are likely to benefit still needs further research. Till then, we know that a referral for talk therapy in the patients of IBS is a must.


Thats all
- Jaskunwar Singh

REM, NREM and dream content recall mnemonic

My friend had difficulty remembering whether dreams can be recalled from REM sleep or NREM sleep.

I have a mnemonic!

REM REMembers nightmares.

Similarly, NREM does Not REMember night terrors.

That's all!
The North remembers.
-IkaN

mPFC activation in depression: The Associations

Hey Awesomites

I had talked about how people with neuroticism also have an advantage of being creative in a previous post.
Lets now know the basis of this in brief -

Baclofen for treatment of alcohol dependence

Hello!

Recent evidence suggest that the gamma-aminobutyric acid-B receptor agonist baclofen is a promising agent for the treatment of alcoholism.

Yep!

Baclofen produces an effortless decrease or suppression of alcohol craving. It decreases alcohol consumption including in those with poor motivation. The drug causes few side effects and does not add to the intoxication effect of alcohol.

It benefits patients with alcohol dependence (even those who are still in precontemplation stage of motivation!)

Research has shown that baclofen reduces withdrawal symptoms of alcohol and is safe in those with liver impairment.

Although further studies that compare long-term alcohol-related outcome of baclofen with established drugs such as naltrexone and disulfiram are needed.

Interesting, isn't it?

-IkaN

Step 2 CK: Psychiatry tip for possible depression questions

Hello! 

Whenever I come across a possible major depression question, I write SIGECAPS (full form at the end of the post) down and strike out the alphabets as and when I come across the symptoms.

For example, weight loss - strike out A for appetite change, fatigue because staying up at night - strike out S for sleep change, E for loss of energy.

Then re-read the stem and see for symptoms I missed out due to twisted wording (she stopped singing a month ago - strike out I for loss of interest)

It REALLY helps in figuring out 5/9 SIGECAPS for diagnosis of MDD because if you are not actively looking for the symptoms in the question stem, you'll miss them out. Also, if you are not counting, you might wrongly over diagnose MDD.

Writing it down also saves time because you don't have to keep re-reading the stem over and over.

It also helps getting the count right because if you have already striked out an alphabet, you can't strike it out again. So you won't get the count wrong for possible rephrasing of the same symptom in the question stem. (patient says she has lost appetite, there is weight loss - it is one alphabet in SIGECAPS, so you can't strike A out again - you will get the symptom count right!)

That's all!

I've read so many comments by students in forums where people get MDD wrong just because they didn't see the obvious 5/9 SIGECAPS. Don't miss it out guys, it's very easy to diagnose with this trick! :)
Hope that helps!

-IkaN

For those who don't know what SIGECAPS stands for :

S: Sleep changes: Increase during day or decreased sleep at night

I: Interest (loss): of interest in activities that used to interest them

G: Guilt (worthless): Devalue themselves, feel guilty

E: Energy (lack): common presenting symptom (fatigue) 

C: Cognition / Concentration: Reduced cognition &/or difficulty concentrating

A: Appetite (weight loss): Usually declined, occasionally increased

P: Psychomotor: Agitation (anxiety) or retardations (lethargic)

S: Suicide / preoccupation with death

Originally when a physician would write a prescription, the abbreviation “SIG” would be written which was to mean directions. The "E" CAPS was to remind the prescriber to write “Energy” capsules for depression (antidepressants).

Hence:  SIG:  E. CAPS

Therapist near me, BetterHelp

Pharmacotherapy for PTSD in pregnancy mnemonic

The two FDA approved drugs for PTSD are: Paroxetine and Sertaline.

Fact of the day: Valbenazine for treatment of tardive dyskinesia

Here's a cool fact: Valbenazine is a highly selective vesicular monoamine transporter 2 (VMAT2) inhibitor. It modulates dopamine release during nerve communication.

CMS psychiatry form 4 question on tardive dyskinesia

Disclaimer: This is an CMS neurology form 2 question for step 2 CK. If you are planning to take USMLE step 2 CK in the future, I would recommend that you DO NOT read this post because it will bias your assessments.

Wifi-allergy !

Now,being teenager we all know how much we are addicted to word "Wi-fi" or let's say  "Free Wi-fi".But today I came to know about a weird disorder "Wifi-allergy" .

Electromagnetic hypersensitivity is popularly known as "Wifi-allergy".
Adverse reaction to electromagnetic field is seen even if a victim is exposed to EM field below threshold level .
There are no scientific basis for Wi-fi allergy .

No scientific signs and symptoms are specified,but non-specific symptoms such as headache,fatigue,stress,sleep distractions,skin prickling,burning sensation,rashes pain,and acne in muscles,ringing in the ear,tinnitus,unexpected earache,memory loss,inability to concentrate,nausea,insomnia,fluctuation in heart rate,deteriorating vision,weakness and spasm of muscles,
bladder problems can develop.

Many of these symptoms overlaps with other syndromes such as Idiopathic Environmental Intolerance(IEI)

Cause:

No relation is found between exposure of electromagnetic field and symptoms.Studies shows it is a psychological disorder rather than a physiological .Many scientists claims that it is actually a nacebo effect.

Diagnosis:

Electromagnetic hypersensitivity is not an accepted diagnosis.No case definition /clinical practice guidelines are performed.No specific tests are performed.A French scientist Dr Belpomme has developed a technique using a computer and a Pulsed Eco-doppler which envelops diagnosis of electrical sensitivity.

Treatment:

There are no specific protocols for treatment of this psychological disorder.The basic treatment involes less use of devices which emits electromagnetic fields.

Stay awesome and cool:)
 
~Ojas

Methamphetamine intoxication mnemonic

Hello!

This post is about crystal meth.

Research update : Genetic locus of Anorexia nervosa revealed

Hey Awesomites

A Research landmark study led by UN school of medicine has found the first genetic locus for the perplexing illness, anorexia nervosa. Previously it was known that this eating disorder runs in families with genetic and environmental factors both playing their role and there is ten - fold risk in first -degree relatives, but no particular association with a genetic locus was provided.

Thought to be associated with psychiatric disorders like neuroticism and schizophrenia, it has also been positively correlated with underlying metabolic abnormalities including body - mass index (BMI) and insulin - glucose metabolism. Genome - wide association studies ( GWAS ) have revealed a significant locus for anorexia nervosa on chromosome 12, in a region previously shown to be associated with type -1 diabetes mellitus and autoimmune disorders. This means that this eating disorder shares common roots with metabolic and psychiatric traits !!

These results may help in reconceptualizing the underlying aetiology and pathogenesis of such a lethal disorder and also coming up with new treatment interventions to cure the disease.


Thats all
- Jaskunwar Singh

Treatment of restless leg syndrome mnemonic + notes

Hello!

This is a loooooong post on the treatment of restless leg syndrome. (Bear with me!)

Those who are just here for the mnemonic 

Mechanism of action of gabapentin and pregabalin

Gabapentin binds to which of the following receptors?
1. GABAA receptors
2. GABAB receptors
3. alpa2delta subunit of voltage-sensitive Ca2+ channels
4. NMDA receptors

Fact of the day : Testosterone administration impairs 'cognitive reflection' in men

Hey Awesomites

You must have tried solving brain teasers at some point of time.. right? Ok so how many of you tried to solve it right at that instant ( sensing your gut reaction ), but guessed it wrong? If so, you might be having loads of testosterone in your veins!