The tools mentioned are used for screening and diagnosing personality disorders. The SAPAS is an interview method that focuses on 8 areas and takes 2 minutes to complete. The FFMRF is self-reported and consists of 30 items rated 1-5 for each item. The IPDE is a semistructured clinical interview compatible with the ICD and DSM and includes both a patient questionnaire and an interview. The PDQ-R is self-reported and consists of 100 true/false questions based on DSM-IV criteria. The IPDS is an interview method that consists of 11 criteria and takes less than 5 minutes. The IIP-PD is self-reported and contains 127 items rated 0-4.

In psychiatry, various questionnaires and interviews are used to assess different conditions and areas. It is important for candidates to know whether certain assessment tools are self-rated of require clinical assistance. The table provided by the college lists some of the commonly used assessment tools and indicates whether they are self-rated of clinician-rated. For example, the HAMD and MADRS are clinician-rated scales used to assess the severity of depression, while the GDS is a self-rated scale used to screen for depression in the elderly. The YMRS is a clinician-rated scale used to assess the severity of mania in patients with bipolar disorder, while the Y-BOCS is used to measure both the severity of OCD and the response to treatment. The GAF provides a single measure of global functioning, while the CGI requires the clinician to rate the severity of the patient’s illness at the time of assessment. The CAMDEX is a tool developed to assist in the early diagnosis and measurement of dementia in the elderly.

Brain Blood Supply and Consequences of Occlusion

The brain receives blood supply from the internal carotid and vertebral arteries, which form the circle of Willis. The circle of Willis acts as a shunt system in case of vessel damage. The three main vessels arising from the circle are the anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA). Occlusion of these vessels can result in various neurological deficits. ACA occlusion may cause hemiparesis of the contralateral foot and leg, sensory loss, and frontal signs. MCA occlusion is the most common and can lead to hemiparesis, dysphasia/aphasia, neglect, and visual field defects. PCA occlusion may cause alexia, loss of sensation, hemianopia, prosopagnosia, and cranial nerve defects. It is important to recognize these consequences to provide appropriate treatment.

While certain factors in his medical history, such as smoking, may heighten the likelihood of a cardiac event, it is solely his bradycardia that is associated with QTc prolongation.

Amantadine and QTc Prolongation

Amantadine is a medication used to treat Parkinson’s disease and influenza. It has been associated with QTc prolongation, which can increase the risk of Torsades de points. Therefore, caution should be exercised when prescribing amantadine to patients with risk factors for QT prolongation. If a patient is already taking amantadine and develops a prolonged QTc interval, the medication should be discontinued and an alternative treatment considered. It is important to monitor the QTc interval in patients taking amantadine, especially those with risk factors for QT prolongation.

Edinburgh Postnatal Depression Scale (EPDS)

The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item self-report questionnaire designed to screen for postnatal depression in primary care settings. It should only be used to assess a women’s mood over the past seven days and cannot be used to diagnose depression. The EPDS excludes some symptoms common in the perinatal period, such as tiredness and irritability, as they do not differentiate between depressed and non-depressed postnatal women. Women are asked to select one of four responses that most closely represents how they have felt over the past seven days. Scores for the 10 items are added together, with a score of 0-9 indicating a low likelihood of depression, 10-12 indicating a moderate likelihood, and 13 of more indicating a high likelihood. The statements include feelings of happiness, sadness, anxiety, and thoughts of self-harm.

It is not advisable to limit fluid intake in cases of lithium-induced DI as it can result in severe hypernatremia.

Lithium – Pharmacology

Pharmacokinetics:
Lithium salts are rapidly absorbed following oral administration and are almost exclusively excreted by the kidneys unchanged. Blood samples for lithium should be taken 12 hours post-dose.

Ebstein’s:
Ebstein’s anomaly is a congenital malformation consisting of a prolapse of the tricuspid valve into the right ventricle. It occurs in 1:20,000 of the general population. Initial data suggested it was more common in those using lithium but this had not held to be true.

Contraindications:
Addison’s disease, Brugada syndrome, cardiac disease associated with rhythm disorders, clinically significant renal impairment, untreated of untreatable hypothyroidism, low sodium levels.

Side-effects:
Common side effects include nausea, tremor, polyuria/polydipsia, rash/dermatitis, blurred vision, dizziness, decreased appetite, drowsiness, metallic taste, and diarrhea. Side-effects are often dose-related.

Long-term use is associated with hypothyroidism, hyperthyroidism, hypercalcemia/hyperparathyroidism, irreversible nephrogenic diabetes insipidus, and reduced GFR.

Lithium-induced diabetes insipidus:
Treatment options include stopping lithium (if feasible), keeping levels within 0.4-0.8 mmol/L, once-daily dose of the drug taken at bedtime, amiloride, thiazide diuretics, indomethacin, and desmopressin.

Toxicity:
Lithium salts have a narrow therapeutic/toxic ratio. Risk factors for lithium toxicity include drugs altering renal function, decreased circulating volume, infections, fever, decreased oral intake of water, renal insufficiency, and nephrogenic diabetes insipidus. Features of lithium toxicity include GI symptoms and neuro symptoms.

Pre-prescribing:
Before prescribing lithium, renal function, cardiac function, thyroid function, FBC, and BMI should be checked. Women of childbearing age should be advised regarding contraception, and information about toxicity should be provided.

Monitoring:
Lithium blood levels should be checked weekly until stable, and then every 3-6 months once stable. Thyroid and renal function should be checked every 6 months. Patients should be issued with an information booklet, alert card, and record book.

Sick Euthyroid Syndrome: Abnormal Thyroid Function in Non-Thyroidal Illness

Sick euthyroid syndrome, also known as low T3 syndrome, is a condition where thyroid function tests show abnormal results, typically low T3 levels, while T4 and TSH levels remain normal. This condition is commonly observed in patients with non-thyroidal illness. For instance, individuals with anorexia who have undergone prolonged starvation may develop this syndrome.

Hyperthyroidism is typically associated with brisk reflexes, while hypothyroidism is associated with reduced reflexes. However, the other symptoms and signs can be present in both hyperthyroidism and hypothyroidism.

Thyroid Examination Findings

Hypothyroidism:

– Weight gain (with decreased appetite)
– Intolerance to cold
– Lethargy
– Constipation
– Menstrual disturbances
– Decreased perspiration

Exam findings:

– Hair loss
– Bradycardia
– Periorbital puffiness and dry skin
– Coarse, brittle, straw-like hair
– Myxoedema
– Hyporeflexia

Hyperthyroidism:

– Weight loss (with increased appetite)
– Intolerance to heat
– Palpitations
– Menstrual disturbances

Exam findings:

– Hair loss
– Tachycardia
– Warm, moist, and smooth skin
– Tremor
– Brisk reflexes

During the formal operational stage, individuals possess the capacity to conceive of intangible concepts that are not perceptible through the senses. This includes the ability to formulate hypotheses and process abstract ideas.

Piaget’s Stages of Development and Key Concepts

Piaget developed four stages of development that describe how children think and acquire knowledge. The first stage is the Sensorimotor stage, which occurs from birth to 18-24 months. In this stage, infants learn through sensory observation and gain control of their motor functions through activity, exploration, and manipulation of the environment.

The second stage is the Preoperational stage, which occurs from 2 to 7 years. During this stage, children use symbols and language more extensively, but they are unable to think logically of deductively. They also use a type of magical thinking and animistic thinking.

The third stage is the Concrete Operational stage, which occurs from 7 to 11 years. In this stage, egocentric thought is replaced by operational thought, which involves dealing with a wide array of information outside the child. Children in this stage begin to use limited logical thought and can serialise, order, and group things into classes on the basis of common characteristics.

The fourth and final stage is the Formal Operations stage, which occurs from 11 through the end of adolescence. This stage is characterized by the ability to think abstractly, to reason deductively, to define concepts, and also by the emergence of skills for dealing with permutations and combinations.

Piaget also developed key concepts, including schema, assimilation, and accommodation. A schema is a category of knowledge and the process of obtaining that knowledge. Assimilation is the process of taking new information into an existing schema, while accommodation involves altering a schema in view of additional information.

Overall, Piaget’s stages of development and key concepts provide a framework for understanding how children learn and acquire knowledge.

Logistic regression is employed when dealing with dichotomous variables, which are variables that have only two possible values, such as live/dead of head/tail.

Stats: Correlation and Regression

Correlation and regression are related but not interchangeable terms. Correlation is used to test for association between variables, while regression is used to predict values of dependent variables from independent variables. Correlation can be linear, non-linear, of non-existent, and can be strong, moderate, of weak. The strength of a linear relationship is measured by the correlation coefficient, which can be positive of negative and ranges from very weak to very strong. However, the interpretation of a correlation coefficient depends on the context and purposes. Correlation can suggest association but cannot prove of disprove causation. Linear regression, on the other hand, can be used to predict how much one variable changes when a second variable is changed. Scatter graphs are used in correlation and regression analyses to visually determine if variables are associated and to detect outliers. When constructing a scatter graph, the dependent variable is typically placed on the vertical axis and the independent variable on the horizontal axis.

Heritability: Understanding the Concept

Heritability is a concept that is often misunderstood. It is not a measure of the extent to which genes cause a condition in an individual. Rather, it is the proportion of phenotypic variance attributable to genetic variance. In other words, it tells us how much of the variation in a condition seen in a population is due to genetic factors. Heritability is calculated using statistical techniques and can range from 0.0 to 1.0. For human behavior, most estimates of heritability fall in the moderate range of .30 to .60.

The quantity (1.0 – heritability) gives the environment ability of the trait. This is the proportion of phenotypic variance attributable to environmental variance. The following table provides estimates of heritability for major conditions:

Condition Heritability estimate (approx)
ADHD 85%
Autism 70%
Schizophrenia 55%
Bipolar 55%
Anorexia 35%
Alcohol dependence 35%
Major depression 30%
OCD 25%

It is important to note that heritability tells us nothing about individuals. It is a population-level measure that helps us understand the relative contributions of genetic and environmental factors to a particular condition.

According to Erlanger- Grasser classification preganglionic fibers are B fibers whereas post ganglionic fibers are C fibers.

Aneuploidy: Abnormal Chromosome Numbers

Aneuploidy refers to the presence of an abnormal number of chromosomes, which can result from errors during meiosis. Typically, human cells have 23 pairs of chromosomes, but aneuploidy can lead to extra of missing chromosomes. Trisomies, which involve the presence of an additional chromosome, are the most common aneuploidies in humans. However, most trisomies are not compatible with life, and only trisomy 21 (Down’s syndrome), trisomy 18 (Edwards syndrome), and trisomy 13 (Patau syndrome) survive to birth. Aneuploidy can result in imbalances in gene expression, which can lead to a range of symptoms and developmental issues.

Compared to autosomal trisomies, humans are more able to tolerate extra sex chromosomes. Klinefelter’s syndrome, which involves the presence of an extra X chromosome, is the most common sex chromosome aneuploidy. Individuals with Klinefelter’s and XYY often remain undiagnosed, but they may experience reduced sexual development and fertility. Monosomies, which involve the loss of a chromosome, are rare in humans. The only viable human monosomy involves the X chromosome and results in Turner’s syndrome. Turner’s females display a wide range of symptoms, including infertility and impaired sexual development.

The frequency and severity of aneuploidies vary widely. Down’s syndrome is the most common viable autosomal trisomy, affecting 1 in 800 births. Klinefelter’s syndrome affects 1-2 in 1000 male births, while XYY syndrome affects 1 in 1000 male births and Triple X syndrome affects 1 in 1000 births. Turner syndrome is less common, affecting 1 in 5000 female births. Edwards syndrome and Patau syndrome are rare, affecting 1 in 6000 and 1 in 10,000 births, respectively. Understanding the genetic basis and consequences of aneuploidy is important for diagnosis, treatment, and genetic counseling.

Neurotrophins: Crucial for Neuronal Growth and Development

Neurotrophins are essential for the growth and development of neurons. However, disturbances in neurotrophic factors may contribute to some neurodevelopmental aspects of schizophrenia and major depression.

Studies have shown that patients with schizophrenia have increased concentrations of Brain-derived neurotrophic factor (BDNF) in cortical areas, but decreased levels in the hippocampus compared to controls. Additionally, patients with schizophrenia have lower concentrations of neurotrophin-3 in frontal and parietal areas than controls.

These findings suggest that neurotrophins play a critical role in the pathophysiology of schizophrenia and major depression. Further research is needed to fully understand the mechanisms underlying these disturbances in neurotrophic factors.

The question implies that obsessions are characterized by urges, images, of thoughts, while compulsions involve acts, either motor of mental. However, it is important to note that in order to be classified as an obsession of compulsion according to DSM-5 and ICD-11 criteria, the behavior must be time-consuming (taking more than 1 hour per day) of cause significant distress of impairment in important areas of functioning.

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by the presence of either obsessions or compulsions, and often both. Obsessions are repetitive and persistent thoughts, images, of impulses that are intrusive and unwanted, while compulsions are repetitive behaviors of rituals that an individual feels driven to perform in response to an obsession of according to rigid rules. The symptoms can cause significant functional impairment and/of distress. To diagnose OCD, the essential features include the presence of persistent obsessions and/of compulsions that are time-consuming of result in significant distress of impairment in important areas of functioning. The symptoms cannot be attributed to another medical condition of the effects of a substance of medication on the central nervous system.

Pharmacokinetics is the study of how drugs are affected by the body. This includes how drugs are absorbed into the bloodstream, distributed throughout the body, metabolized into different forms, and eliminated from the body. The acronym ADME is often used to remember these processes. Absorption refers to the transportation of the drug from the site of administration to the bloodstream. Hydrophobic drugs are absorbed better than hydrophilic ones. Distribution refers to the movement of the drug from the bloodstream to other areas of the body. Metabolism involves the conversion of the drug into different forms, often to make it more easily excreted by the kidneys. This process occurs in two phases, involving reduction of hydrolysis in phase 1 and conjugation in phase 2. Excretion refers to the elimination of the drug from the body, which mainly occurs through the kidneys and biliary system.

Linguistic Development and Risk Factors for Delayed Speech and Language

The development of language skills is an important aspect of a child’s growth. The prelinguistic period, from birth to 12 months, is marked by crying, babbling, and echolalia. From 6 to 12 months, a child responds to their name and can differentiate between angry and friendly tones. By 18 to 24 months, a child can use up to 40-50 words, mainly nouns, and starts to combine words in short phrases. By 36 to 48 months, a child has a vocabulary of 900-1000 words, can use plurals and past tense, and can handle three-word sentences easily.

However, there are risk factors associated with delayed speech and language development. These include a positive family history, male gender, twins, lower maternal education, childhood illness, being born late in the family order, young mother at birth, and low socioeconomic status. of these, a positive family history is considered the most reliable risk factor. It is important to monitor a child’s language development and seek professional help if there are concerns about delayed speech and language.

The main purpose of the ‘serial sevens’ is to evaluate an individual’s ability to focus and maintain attention. It also has a secondary function of assessing memory to some degree.

Mini Mental State Exam (MMSE)

The Mini Mental State Exam (MMSE) was developed in 1975 by Folstein et al. Its original purpose was to differentiate between organic and functional disorders, but it is now mainly used to detect and track the progression of cognitive impairment. The exam is scored out of 30 and is divided into seven categories: orientation to place and time, registration, attention and concentration, recall, language, visual construction, and attention to written command. Each category has a possible score, and the total score can indicate the severity of cognitive impairment. A score equal to or greater than 27 indicates normal cognition, while scores below this can indicate severe, moderate, of mild cognitive impairment. The MMSE is a useful tool for detecting and tracking cognitive impairment.

The central sulcus divides the frontal lobe from the parietal lobe. It contains the motor cells for the movement function of the body.

Varenicline is a medication that helps people quit smoking by partially activating specific nicotine receptors in the body.

Mechanisms of Action of Different Drugs

Understanding the mechanisms of action of different drugs is crucial for medical professionals. It is a common topic in exams and can earn easy marks if studied well. This article provides a list of drugs and their mechanisms of action in different categories such as antidepressants, anti dementia drugs, mood stabilizers, anxiolytic/hypnotic drugs, antipsychotics, drugs of abuse, and other drugs. For example, mirtazapine is a noradrenaline and serotonin specific antidepressant that works as a 5HT2 antagonist, 5HT3 antagonist, H1 antagonist, alpha 1 and alpha 2 antagonist, and moderate muscarinic antagonist. Similarly, donepezil is a reversible acetylcholinesterase inhibitor used as an anti dementia drug, while valproate is a GABA agonist and NMDA antagonist used as a mood stabilizer. The article also explains the mechanisms of action of drugs such as ketamine, phencyclidine, buprenorphine, naloxone, atomoxetine, varenicline, disulfiram, acamprosate, and sildenafil.

The inability to accurately replicate intersecting pentagons may indicate a constructional apraxia, which is a symptom of non-dominant parietal lobe dysfunction.

Parietal Lobe Dysfunction: Types and Symptoms

The parietal lobe is a part of the brain that plays a crucial role in processing sensory information and integrating it with other cognitive functions. Dysfunction in this area can lead to various symptoms, depending on the location and extent of the damage.

Dominant parietal lobe dysfunction, often caused by a stroke, can result in Gerstmann’s syndrome, which includes finger agnosia, dyscalculia, dysgraphia, and right-left disorientation. Non-dominant parietal lobe dysfunction, on the other hand, can cause anosognosia, dressing apraxia, spatial neglect, and constructional apraxia.

Bilateral damage to the parieto-occipital lobes, a rare condition, can lead to Balint’s syndrome, which is characterized by oculomotor apraxia, optic ataxia, and simultanagnosia. These symptoms can affect a person’s ability to shift gaze, interact with objects, and perceive multiple objects at once.

In summary, parietal lobe dysfunction can manifest in various ways, and understanding the specific symptoms can help diagnose and treat the underlying condition.

When treating catatonia, the preferred initial treatment is benzodiazepines such as lorazepam. If this approach is unsuccessful, electroconvulsive therapy (ECT) should be considered.

Catatonia Treatment

Catatonia can lead to complications such as dehydration, deep vein thrombosis, pulmonary embolism, and pneumonia. Therefore, prompt treatment is essential. The first-line treatment is benzodiazepines, particularly lorazepam. If this is ineffective, electroconvulsive therapy (ECT) may be considered. The use of antipsychotics is controversial and should be avoided during the acute phase of catatonia.

Clock Drawing Test: A Screening Tool for Cognitive Dysfunction

The clock drawing test is a widely used screening tool for cognitive dysfunction. It involves asking the patient to draw a clock on a piece of paper, placing the numbers on the clock face and drawing the hands to indicate 10 minutes past 11. This simple task assesses a range of cognitive functions, including visuospatial ability, motor function, attention, and comprehension.

The test is quick and easy to administer, making it a useful tool for healthcare professionals to identify potential cognitive impairment in patients. The clock drawing test has been shown to be effective in detecting cognitive dysfunction in a variety of conditions, including Alzheimer’s and Parkinson’s disease.

The image below illustrates examples of clocks drawn correctly by healthy controls and those drawn by patients with Alzheimer’s and Parkinson’s disease. By comparing the drawings, healthcare professionals can quickly identify potential cognitive dysfunction and take appropriate action.

The muscle spindle is supplied by both sensory and motor nerves. Sensory supply is Type Ia fibers whereas motor supply is via gamma motor neurons. These neurons also play a role in adjusting the sensitivity of muscle spindles. Increased neuron activity increases the muscle spindle sensitivity.

First Rank Symptoms: Their Significance in Identifying Schizophrenia

First rank symptoms were introduced by Kurt Schneider in 1938 as a practical tool for non-psychiatrists to identify schizophrenia. While they are highly suggestive of schizophrenia, they are not pathognomonic and can also be seen in affective and personality disorders. Additionally, there is no evidence to support their prognostic significance.

A systematic review in 2015 found that first rank symptoms differentiated schizophrenia from nonpsychotic mental health disorders with a sensitivity of 61.8% and a specificity of 94.1%. They also differentiated schizophrenia from other types of psychosis with a sensitivity of 58% and a specificity of 74.7%.

The first rank symptoms include running commentary, thought echo, voices heard arguing, thought insertion, thought withdrawal, thought broadcast, delusional perception, somatic passivity, made affect, and made volition. While they can be helpful in identifying schizophrenia, they should not be relied upon as the sole diagnostic criteria.

Delusions are false beliefs that are fixed and can be categorized as primary of secondary. Primary delusions include delusional intuition, delusional perception, delusional atmosphere, and delusional memory. Delusional atmosphere refers to a feeling that something is not right in the world around the patient, without any change in perception. Delusional intuition arises suddenly and occurs in a single stage, while delusional perception is a two-stage phenomenon where the patient misinterprets a normal perception with a delusional meaning. Delusional memory involves remembering past events with a delusional meaning. An example of delusional perception is when a patient misinterprets the marks of freckles and believes that water is being taken out of their body.

A diagnosis of reactive attachment disorder cannot be made until the child reaches at least one year of age.

Disorders resulting from inadequate caregiving during childhood are recognised by both the DSM-5 and the ICD-11, with two distinct forms of disorder identified: Reactive attachment disorder and Disinhibited social engagement disorder. Reactive attachment disorder is characterised by social withdrawal and aberrant attachment behaviour, while Disinhibited social engagement disorder is characterised by socially disinhibited behaviour. Diagnosis of these disorders involves a history of grossly insufficient care, and symptoms must be evident before the age of 5. Treatment options include video feedback programs for preschool aged children and parental training with group play sessions for primary school aged children. Pharmacological interventions are not recommended in the absence of coexisting mental health problems.

Fragile X Syndrome: A Genetic Disorder Causing Learning Disability and Psychiatric Symptoms

Fragile X Syndrome is a genetic disorder that causes mental retardation, an elongated face, large protruding ears, and large testicles in men. Individuals with this syndrome tend to be shy, avoid eye contact, and have difficulties reading facial expressions. They also display stereotypic movements such as hand flapping. Fragile X Syndrome is the most common inherited cause of learning disability.

The speech of affected individuals is often abnormal, with abnormalities of fluency. This disorder is caused by the amplification of a CGG repeat in the 5 untranslated region of the fragile X mental retardation 1 gene (FMR1). These CGG repeats disrupt synthesis of the fragile X protein (FMRP), which is essential for brain function and growth. The gene is located at Xq27. The greater number of repeats, the more severe the condition, as with other trinucleotide repeat disorders.

The fragile X phenotype typically involves a variety of psychiatric symptoms, including features of autism, attention deficit/hyperactivity disorder, anxiety, and aggression. Both males and females can be affected, but males are more severely affected because they have only one X chromosome. The prevalence estimate of Fragile X Syndrome is 1/3600-4000.

The steady state for this scenario is 337.5 hours, which is equivalent to 14 days. This calculation was obtained by multiplying the half-life of 75 hours by a factor of 4.5, as per the given formula.

The half-life of a drug is the time taken for its concentration to fall to one half of its value. Drugs with long half-lives may require a loading dose to achieve therapeutic plasma concentrations rapidly. It takes about 4.5 half-lives to reach steady state plasma levels. Most drugs follow first order kinetics, where a constant fraction of the drug in the body is eliminated per unit time. However, some drugs may follow zero order kinetics, where the plasma concentration of the drug decreases at a constant rate, despite the concentration of the drug. For drugs with nonlinear kinetics of dose-dependent kinetics, the relationship between the AUC of CSS and dose is not linear, and the kinetic parameters may vary depending on the administered dose.

Depression rates are elevated among those who are unemployed of divorced. Additionally, the prevalence of major depression is twice as high in women compared to men, although the reasons for this disparity are not fully understood. The mean age of onset for major depression is 27 years, and lifetime rates are estimated to be between 10% and 20%.

It is not typical for 16 month old children to have already mastered the skill of combining words with meaning.

Linguistic Development and Risk Factors for Delayed Speech and Language

The development of language skills is an important aspect of a child’s growth. The prelinguistic period, from birth to 12 months, is marked by crying, babbling, and echolalia. From 6 to 12 months, a child responds to their name and can differentiate between angry and friendly tones. By 18 to 24 months, a child can use up to 40-50 words, mainly nouns, and starts to combine words in short phrases. By 36 to 48 months, a child has a vocabulary of 900-1000 words, can use plurals and past tense, and can handle three-word sentences easily.

However, there are risk factors associated with delayed speech and language development. These include a positive family history, male gender, twins, lower maternal education, childhood illness, being born late in the family order, young mother at birth, and low socioeconomic status. of these, a positive family history is considered the most reliable risk factor. It is important to monitor a child’s language development and seek professional help if there are concerns about delayed speech and language.

When a stroke affects the thalamus, it can cause loss of sensation on the opposite side of the body and intense burning pain that can be treated with tricyclics. This type of sensory loss is commonly seen in conditions that affect the brain stem, thalamus, of cortex. In addition, a stroke in the thalamogeniculate artery can result in temporary paralysis on the opposite side of the body, followed by ataxia, and involuntary movements. Facial expression may also be affected. Treatment for these patients is similar to that for other stroke patients.

Extrapyramidal side-effects (EPSE’s) are a group of side effects that affect voluntary motor control, commonly seen in patients taking antipsychotic drugs. EPSE’s include dystonias, parkinsonism, akathisia, and tardive dyskinesia. They can be frightening and uncomfortable, leading to problems with non-compliance and can even be life-threatening in the case of laryngeal dystonia. EPSE’s are thought to be due to antagonism of dopaminergic D2 receptors in the basal ganglia. Symptoms generally occur within the first few days of treatment, with dystonias appearing quickly, within a few hours of administration of the first dose. Newer antipsychotics tend to produce less EPSE’s, with clozapine carrying the lowest risk and haloperidol carrying the highest risk. Akathisia is the most resistant EPSE to treat. EPSE’s can also occur when antipsychotics are discontinued (withdrawal dystonia).

Folie a deux is a type of shared psychosis where a mentally healthy person adopts the delusional beliefs of a mentally ill person with whom they have a close relationship. The mentally ill person is the primary individual with the delusion, while the mentally healthy person is the secondary individual who acquires the delusion. There are four different types of relationships between the primary and secondary individuals: folie imposée, folie communiqué, folie induite, and folie simultanée. In folie imposée, the delusions of the mentally ill person are imposed on the mentally healthy person, who may have some social of psychological disadvantage. In folie communiqué, the mentally healthy person initially resists the delusion but eventually adopts it and maintains it even after separation from the mentally ill person. In folie induite, a person who is already psychotic incorporates the delusions of a closely associated primary individual into their own delusional system. In folie simultanée, two of more people become psychotic and share the same delusional system at the same time.

Frontal lobe pathology can result in the elicitation of frontal release signs, such as palmomental reflexes. Ataxia may be present in conditions like normal pressure hydrocephalus, while cogwheel rigidity is commonly found in extrapyramidal syndromes. Contralateral hemisphere dysfunction can lead to postural arm drift. These signs occur when the frontal lobe’s normal inhibition of these responses is released. For more information, see Kipps and Hodges’ article Cognitive assessment for clinicians.

The onset of antipsychotic effect is noticeable within the first week of treatment, as reported by a large meta-analysis of almost 7,500 patients. This study found that there was a significant improvement of nearly 22% in the first two weeks of treatment, which contradicts the previous belief that it may take two to four weeks for antipsychotic action to take effect. The reduction in BPRS scores was as follows: 13.8% within the first week, 8.1% in the second week, 4.2% in the third week, and 4.7% in the fourth week.

In psychiatry, various questionnaires and interviews are used to assess different conditions and areas. It is important for candidates to know whether certain assessment tools are self-rated of require clinical assistance. The table provided by the college lists some of the commonly used assessment tools and indicates whether they are self-rated of clinician-rated. For example, the HAMD and MADRS are clinician-rated scales used to assess the severity of depression, while the GDS is a self-rated scale used to screen for depression in the elderly. The YMRS is a clinician-rated scale used to assess the severity of mania in patients with bipolar disorder, while the Y-BOCS is used to measure both the severity of OCD and the response to treatment. The GAF provides a single measure of global functioning, while the CGI requires the clinician to rate the severity of the patient’s illness at the time of assessment. The CAMDEX is a tool developed to assist in the early diagnosis and measurement of dementia in the elderly.

Alternative Routes of Administration for Antidepressants

While most antidepressants are taken orally, there are a few alternative routes of administration available. However, it is important to note that these non-oral preparations should only be used when absolutely necessary, as they may not have a UK licence.

One effective alternative route is sublingual administration of fluoxetine liquid. Buccal administration of selegiline is also available. Crushed amitriptyline has been shown to be effective when administered via this route.

Intravenous administration is another option, with several antidepressants available in IV preparations, including citalopram, escitalopram, mirtazapine, amitriptyline, clomipramine, and allopregnanolone (which is licensed in the US for postpartum depression). Ketamine has also been shown to be effective when administered intravenously.

Intramuscular administration of flupentixol has been shown to have a mood elevating effect, but amitriptyline was discontinued as an IM preparation due to the high volumes required.

Transdermal administration of selegiline is available, and suppositories containing amitriptyline, clomipramine, imipramine, and trazodone have been manufactured by pharmacies, although there is no clear data on their effectiveness. Sertraline tablets and doxepin capsules have also been given rectally.

Attitude scales are used to measure a person’s feelings and thoughts towards something. There are several types of attitude scales, including the Thurstone scale, Likert scale, semantic differential scale, and Gutman scale. The Thurstone scale involves creating a list of statements and having judges score them based on their negativity of positivity towards an issue. Respondents then indicate whether they agree of disagree with each statement. The Likert scale asks respondents to indicate their degree of agreement of disagreement with a series of statements using a five-point scale. The semantic differential scale presents pairs of opposite adjectives and asks respondents to rate their position on a five- of seven-point scale. The Gutman scale involves a list of statements that can be ordered hierarchically, with each statement having a corresponding weight. Respondents’ scores on the scale indicate the number of statements they agree with.

While ventricular enlargement is often observed in individuals with schizophrenia, it is not a definitive indicator of the condition as it can also be present in other disorders.

Schizophrenia is a pathology that is characterized by a number of structural and functional brain alterations. Structural alterations include enlargement of the ventricles, reductions in total brain and gray matter volume, and regional reductions in the amygdala, parahippocampal gyrus, and temporal lobes. Antipsychotic treatment may be associated with gray matter loss over time, and even drug-naïve patients show volume reductions. Cerebral asymmetry is also reduced in affected individuals and healthy relatives. Functional alterations include diminished activation of frontal regions during cognitive tasks and increased activation of temporal regions during hallucinations. These findings suggest that schizophrenia is associated with both macroscopic and functional changes in the brain.

Serotonin Syndrome and Neuroleptic Malignant Syndrome are two conditions that can be difficult to differentiate. Serotonin Syndrome is caused by excess serotonergic activity in the CNS and is characterized by neuromuscular abnormalities, altered mental state, and autonomic dysfunction. On the other hand, Neuroleptic Malignant Syndrome is a rare acute disorder of thermoregulation and neuromotor control that is almost exclusively caused by antipsychotics. The symptoms of both syndromes can overlap, but there are some distinguishing clinical features. Hyper-reflexia, ocular clonus, and tremors are more prominent in Serotonin Syndrome, while Neuroleptic Malignant Syndrome is characterized by uniform ‘lead-pipe’ rigidity and hyporeflexia. Symptoms of Serotonin Syndrome usually resolve within a few days of stopping the medication, while Neuroleptic Malignant Syndrome can take up to 14 days to remit with appropriate treatment. The following table provides a useful guide to the main differentials of Serotonin Syndrome and Neuroleptic Malignant Syndrome.