Chlorphenamine, also known as Piriton, is classified as a first-generation antihistamine that functions by obstructing the H1 receptor. This sedative antihistamine is utilized to treat allergic conditions like hay fever. Additionally, it is present in certain cough medicines as it reduces the production of mucus.

MAOIs: A Guide to Mechanism of Action, Adverse Effects, and Dietary Restrictions

First introduced in the 1950s, MAOIs were the first antidepressants introduced. However, they are not the first choice in treating mental health disorders due to several dietary restrictions and safety concerns. They are only a treatment option when all other medications are unsuccessful. MAOIs may be particularly useful in atypical depression (over eating / over sleeping, mood reactivity).

MAOIs block the monoamine oxidase enzyme, which breaks down different types of neurotransmitters from the brain: norepinephrine, serotonin, dopamine, as well as tyramine. There are two types of monoamine oxidase, A and B. The MOA A are mostly distributed in the placenta, gut, and liver, but MOA B is present in the brain, liver, and platelets. Selegiline and rasagiline are irreversible and selective inhibitors of MAO type B, but safinamide is a reversible and selective MAO B inhibitor.

The most common adverse effects of MAOIs occurring early in treatment are orthostatic hypotension, daytime sleepiness, insomnia, and nausea; later common effects include weight gain, muscle pain, myoclonus, paraesthesia, and sexual dysfunction.

Pharmacodynamic interactions with MAOIs can cause two types of problem: serotonin syndrome (mainly due to SSRIs) and elevated blood pressure (caused by indirectly acting sympathomimetic amines releasers, like pseudoephedrine and phenylephrine). The combination of MAOIs and some TCAs appears safe. Only those TCAs with significant serotonin reuptake inhibition (clomipramine and imipramine) are likely to increase the risk of serotonin syndrome.

Tyramine is a monoamine found in various foods, and is an indirect sympathomimetic that can cause a hypertensive reaction in patients receiving MAOI therapy. For this reason, dietary restrictions are required for patients receiving MAOIs. These restrictions include avoiding matured/aged cheese, fermented sausage, improperly stored meat, fava of broad bean pods, and certain drinks such as on-tap beer. Allowed foods include fresh cottage cheese, processed cheese slices, fresh packaged of processed meat, and other alcohol (no more than two bottled or canned beers of two standard glasses of wine, per day).

Unfortunately, the college requires candidates to have some understanding of the German language. It is also important to be familiar with certain German terms such as Gedankenlautwerden (thought echo), Gegenhalten (a condition where a patient resists all passive movements with the same amount of force as applied by the examiner), Schnauzkrampf (a facial expression resembling pouting that is sometimes observed in catatonic patients), and Vorbeigehen/vorbeireden (a symptom seen in Ganser syndrome where patients give approximate answers to questions, such as responding with 14 when asked how many fingers a man has).

Borderline Learning Disability

Borderline learning disability is a term used to describe individuals with an IQ between 70-85. This category is not officially recognized as a diagnosis by the ICD-11. It is estimated that approximately 15% of the population falls within this range (Chaplin, 2005). Unlike mild learning disability, borderline learning disability is not typically associated with deficits in adaptive functioning, such as grooming, dressing, safety, of money management.

Sertraline and other selective serotonin reuptake inhibitors (SSRIs) are effective in treating paraphilias by reducing libido and delaying orgasm. While all serotonergic antidepressants have sexual effects, they are most common with SSRIs. Although these effects are typically considered side effects, they can be beneficial in treating paraphilias.

Sexual side effects are prevalent with many antidepressants, with SSRIs having the highest incidence at 60-70%. Venlafaxine has a 70% incidence, duloxetine has a 46% incidence, monoamine oxidase inhibitors (MAOIs) have a 40% incidence, tricyclic antidepressants (TCAs) have a 30% incidence (but are more common with clomipramine), mirtazapine has a 25% incidence, reboxetine has a 5-10% incidence, and the incidence with trazodone is unknown.

Cyproterone acetate (Androcur) is an effective treatment for hypersexuality as an anti-androgen that reduces testosterone to pre-pubescent levels. These findings are based on the Maudsley Guidelines, 11th edition, page 210.

In humans, neurogenesis or new neurons are continually born during adulthood in two regions of the brain: The subgranular zone (SGZ), part of the dentate gyrus of the hippocampus and the striatum. In other species of mammals, adult-born neurons also appear in the olfactory bulb. In humans, however, few if any olfactory bulb neurons are generated after birth.

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.

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.

Simultagnosia is a condition where an individual is unable to focus on more than one aspect of a complex scene at a time. This condition, along with optic ataxia and oculomotor apraxia, is part of Balint’s syndrome.

Gerstmann syndrome is characterized by four symptoms: dysgraphia/agraphia, dyscalculia/acalculia, finger agnosia, and left-right disorientation. This syndrome is linked to a lesion in the dominant parietal lobe, specifically the left side of the angular and supramarginal gyri. It is rare for an individual to present with all four symptoms of the tetrad.

Genomic Imprinting and its Role in Psychiatric Disorders

Genomic imprinting is a phenomenon where a piece of DNA behaves differently depending on whether it is inherited from the mother of the father. This is because DNA sequences are marked of imprinted in the ovaries and testes, which affects their expression. In psychiatry, two classic examples of genomic imprinting disorders are Prader-Willi and Angelman syndrome.

Prader-Willi syndrome is caused by a deletion of chromosome 15q when inherited from the father. This disorder is characterized by hypotonia, short stature, polyphagia, obesity, small gonads, and mild mental retardation. On the other hand, Angelman syndrome, also known as Happy Puppet syndrome, is caused by a deletion of 15q when inherited from the mother. This disorder is characterized by an unusually happy demeanor, developmental delay, seizures, sleep disturbance, and jerky hand movements.

Overall, genomic imprinting plays a crucial role in the development of psychiatric disorders. Understanding the mechanisms behind genomic imprinting can help in the diagnosis and treatment of these disorders.

The reason behind absent-mindedness is typically due to insufficient activation of the left inferior prefrontal and parahippocampal regions during the initial encoding process, resulting in shallow processing.

Memory: Encoding, Storage, Retrieval, and Failure

Memory is a complex process that involves encoding, storage, and retrieval of information. Encoding refers to how information is placed into memory, and it can be improved by organizing data using techniques such as chunking and mnemonics. Storage refers to keeping information in memory, which can be short-term of long-term. Retrieval refers to getting information back from memory when needed, and it can be affected by primacy and recency effects.

However, memory is not infallible, and there are seven ways in which it tends to fail. Transience refers to the decreasing accessibility of memory over time, while absent-mindedness is characterized by lapses of attention and forgetting to do things. Blocking is the temporary inaccessibility of stored information, while suggestibility involves the incorporation of misinformation into memory due to leading questions of deception.

Bias refers to retrospective distortions produced by current knowledge and beliefs, while persistence involves unwanted recollections that people cannot forget, such as the intrusive memories of post-traumatic stress disorder. Finally, misattribution refers to the attribution of memories to incorrect sources of believing that one has seen of heard something that they have not, such as in the case of deja vu of cryptomnesia.

Overall, memory is a complex and active process that can be affected by various factors, leading to failures in encoding, storage, retrieval, and attribution.

Group C nerve fibers are unmyelinated and have a small diameter, which means they conduct impulses at a low velocity. They carry sensory information and nociception.

Frontal Lobe Tests

The frontal lobe is responsible for a variety of cognitive functions, including initiation, abstraction, problem-solving, decision-making, response inhibition, and set shifting. Different tests can be used to assess these functions.

Verbal and categorical fluency tests can be used to assess initiation. These tests require individuals to generate as many words of items as possible within a specific category of starting letter.

Proverbs, similarities, and cognitive estimates are examples of tests that can be used to assess abstraction. These tests require individuals to identify similarities between objects of concepts, make judgments based on incomplete information, of estimate quantities.

Tower of London, Cambridge stockings, and gambling tasks are examples of tests that can be used to assess problem-solving and decision-making. These tests require individuals to plan and execute a sequence of actions to achieve a goal of make decisions based on uncertain outcomes.

Alternating sequences, go-no-go test, Luria motor test, trail making test, Wisconsin card sorting test, and Stroop test are examples of tests that can be used to assess response inhibition and set shifting. These tests require individuals to inhibit prepotent responses, switch between tasks of mental sets, of ignore irrelevant information.

Overall, these tests can provide valuable information about an individual’s frontal lobe functioning and can be used to diagnose and treat various neurological and psychiatric conditions.

Cytokinesis: The Final Stage of Cell Division

Cytokinesis is the final stage of cell division, where the cell splits into two daughter cells, each with a nucleus. This process is essential for the growth and repair of tissues in multicellular organisms. In mitosis, cytokinesis occurs after telophase, while in meiosis, it occurs after telophase I and telophase II.

During cytokinesis, a contractile ring made of actin and myosin filaments forms around the cell’s equator, constricting it like a belt. This ring gradually tightens, pulling the cell membrane inward and creating a furrow that deepens until it reaches the center of the cell. Eventually, the furrow meets in the middle, dividing the cell into two daughter cells.

In animal cells, cytokinesis is achieved by the formation of a cleavage furrow, while in plant cells, a cell plate forms between the two daughter nuclei, which eventually develops into a new cell wall. The timing and mechanism of cytokinesis are tightly regulated by a complex network of proteins and signaling pathways, ensuring that each daughter cell receives the correct amount of cytoplasm and organelles.

Overall, cytokinesis is a crucial step in the cell cycle, ensuring that genetic material is equally distributed between daughter cells and allowing for the growth and development of multicellular organisms.

The spinothalamic tract is an ascending or a sensory tract, responsible for transmission of pain and temperature. The neospinothalamic tract is responsible for fast pain or discriminative pain whereas the palaeospinothalamic tract is responsible for transmission of slow pain.

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.

Epilepsy: An Overview

Epilepsy is a condition that is diagnosed when a person experiences at least two unprovoked seizures that occur more than 24 hours apart. In the UK, the prevalence of epilepsy is 5-10 cases per 1000. Seizure types are categorized as focal onset of generalized onset. Focal seizures only involve a localized part of the brain, while generalized seizures involve the whole of both hemispheres. Temporal lobe epilepsy is the most common type of focal epilepsy, accounting for 60-70% of cases.

In 60% of people with epilepsy, there is no identifiable cause. Approximately 70% of people with epilepsy achieve remission, meaning they have no seizures for 5 years on of off treatment. of those with convulsive seizures, 2/3 have focal epilepsies and secondary generalized seizures, while the other 1/3 have generalized tonic-clonic seizures.

The National Institute for Health and Care Excellence (NICE) recommends treatment with antiepileptic drugs (AEDs) after a second epileptic seizure. For newly diagnosed focal seizures, carbamazepine of lamotrigine are recommended as first-line treatment. Levetiracetam, oxcarbazepine, of sodium valproate may be offered if carbamazepine and lamotrigine are unsuitable of not tolerated. For newly diagnosed generalized tonic-clonic seizures, sodium valproate is recommended as first-line treatment, with lamotrigine as an alternative if sodium valproate is unsuitable. For absence seizures, ethosuximide of sodium valproate are recommended as first-line treatment. For myoclonic seizures, sodium valproate is recommended as first-line treatment, and for tonic of atonic seizures, sodium valproate is also recommended as first-line treatment.

The examiner’s use of minimal force to move the patient’s arm is an instance of automatic obedience, but it can be categorized more precisely as mitgehen, which represents a heightened form of automatic obedience.

– Catatonia is a psychiatric syndrome characterized by disturbed motor functions, mood, and thought.
– Key behaviors associated with catatonia include stupor, posturing, waxy flexibility, negativism, automatic obedience, mitmachen, mitgehen, ambitendency, psychological pillow, forced grasping, obstruction, echopraxia, aversion, mannerisms, stereotypies, motor perseveration, echolalia, and logorrhoea.
– These behaviors are often tested in exam questions.
– Karl Ludwig Kahlbaum is credited with the original clinical description of catatonia.

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.

Aphasia is a language impairment that affects the production of comprehension of speech, as well as the ability to read of write. The areas involved in language are situated around the Sylvian fissure, referred to as the ‘perisylvian language area’. For repetition, the primary auditory cortex, Wernicke, Broca via the Arcuate fasciculus (AF), Broca recodes into articulatory plan, primary motor cortex, and pyramidal system to cranial nerves are involved. For oral reading, the visual cortex to Wernicke and the same processes as for repetition follows. For writing, Wernicke via AF to premotor cortex for arm and hand, movement planned, sent to motor cortex. The classification of aphasia is complex and imprecise, with the Boston Group classification and Luria’s aphasia interpretation being the most influential. The important subtypes of aphasia include global aphasia, Broca’s aphasia, Wernicke’s aphasia, conduction aphasia, anomic aphasia, transcortical motor aphasia, and transcortical sensory aphasia. Additional syndromes include alexia without agraphia, alexia with agraphia, and pure word deafness.

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.

Rett syndrome should be suspected in a young girl who exhibits autistic features and hand wringing movements. Despite having a normal number of chromosomes, a mutation in the MECP2 gene on the X chromosome is believed to be the cause. For more information, please refer to the Rett Syndrome Fact Sheet provided by the National Institute of Neurological Disorders and Stroke.

The initial SSRI to be developed was fluoxetine.

A Historical Note on the Development of Zimelidine, the First Selective Serotonin Reuptake Inhibitor

In 1960s, evidence began to emerge suggesting a significant role of serotonin in depression. This led to the development of zimelidine, the first selective serotonin reuptake inhibitor (SSRI). Zimelidine was derived from pheniramine and was marketed in Europe in 1982. However, it was removed from the market in 1983 due to severe side effects such as hypersensitivity reactions and Guillain-Barre syndrome.

Despite its short-lived availability, zimelidine paved the way for the development of other SSRIs such as fluoxetine, which was approved by the FDA in 1987 and launched in the US market in 1988 under the trade name Prozac. The development of SSRIs revolutionized the treatment of depression and other mood disorders, providing a safer and more effective alternative to earlier antidepressants such as the tricyclics and MAO inhibitors.

The Relative Risk Reduction (RRR) is calculated by subtracting the experimental event rate (EER) from the control event rate (CER), dividing the result by the CER, and then multiplying by 100 to get a percentage. In this case, the RRR is (35-20)÷35 = 0.4285 of 42.85%.

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).

Understanding Action Potentials in Neurons and Muscle Cells

The membrane potential is a crucial aspect of cell physiology, and it exists across the plasma membrane of most cells. However, in neurons and muscle cells, this membrane potential can change over time. When a cell is not stimulated, it is in a resting state, and the inside of the cell is negatively charged compared to the outside. This resting membrane potential is typically around -70mV, and it is maintained by the Na/K pump, which maintains a high concentration of Na outside and K inside the cell.

To trigger an action potential, the membrane potential must be raised to around -55mV. This can occur when a neurotransmitter binds to the postsynaptic neuron and opens some ion channels. Once the membrane potential reaches -55mV, a cascade of events is initiated, leading to the opening of a large number of Na channels and causing the cell to depolarize. As the membrane potential reaches around +40 mV, the Na channels close, and the K gates open, allowing K to flood out of the cell and causing the membrane potential to fall back down. This process is irreversible and is critical for the transmission of signals in neurons and the contraction of muscle cells.

There is limited evidence of effectiveness for fluoxetine, making it the only viable option. It is worth noting that the contents of ketamine injections have been used sublingually and have shown apparent efficacy.

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.

Monoamine oxidase inhibitors (MAOIs) increase levels of noradrenaline, serotonin, and dopamine by inhibiting one of both of the monoamine oxidase enzymes, MAO-A and MAO-B. This is different from selective serotonin reuptake inhibitors (SSRIs) and tricyclics, which primarily affect serotonin levels. Tricyclics have anticholinergic and noradrenergic side effects, while SSRIs cause fewer anticholinergic effects but may lead to gastrointestinal problems, agitation, insomnia, and headaches. MAOIs have their own set of potential side effects, including interactions with certain foods and medications, as well as possible hypertensive crises.

Personality Disorder Classification

A personality disorder is a persistent pattern of behavior and inner experience that deviates significantly from cultural expectations, is inflexible and pervasive, and causes distress of impairment. The DSM-5 and ICD-11 have different approaches to classifying personality disorders. DSM-5 divides them into 10 categories, grouped into clusters A, B, and C, while ICD-11 has a general category with six trait domains that can be added. To diagnose a personality disorder, the general diagnostic threshold must be met before determining the subtype(s) present. The criteria for diagnosis include inflexibility and pervasiveness of the pattern, onset in adolescence of early adulthood, stability over time, and significant distress of impairment. The disturbance must not be better explained by another mental disorder, substance misuse, of medical condition.

Course

Borderline and antisocial personality disorders tend to become less evident of remit with age, while others, particularly obsessive-compulsive and schizotypal, may persist.

Classification

The DSM-5 divides personality disorders into separate clusters A, B, and C, with additional groups for medical conditions and unspecified disorders. The ICD-11 dropped the separate categories and instead lists six trait domains that can be added to the general diagnosis.

SNRIs are a type of antidepressant medication that work by blocking the reuptake of both serotonin and norepinephrine, providing two mechanisms to help with the antidepressant effect. They are particularly effective at inhibiting the norepinephrine transporter compared to the serotonin transporter. Examples of SNRIs include Venlafaxine, Desvenlafaxine, Duloxetine, and Milnacipran. Bupropion is a different type of antidepressant that works by inhibiting the reuptake of norepinephrine and dopamine (NDRI). Escitalopram is a selective serotonin reuptake inhibitor (SSRI), while Mirtazapine is a noradrenergic and specific serotonin antidepressant (NaSSA). Nefazodone is a serotonin antagonist/reuptake inhibitor (SARI).

Mental Age and IQ

The concept of mental age (MA) was introduced by Alfred Binet in 1905. It involves administering a series of tests to a person of child, which are then ranked according to the age at which people are expected to complete them. The mental age can be used to calculate the intelligence quotient (IQ) using the formula: IQ = MA/CA x 100, where CA is the chronological age. An IQ of 100 indicates that the mental and chronological ages are equal. IQ tends to remain stable throughout life. The Stanford-Binet test was the first IQ test, while the WAIS-IV (Wechsler Adult Intelligence Scale) is the most commonly used IQ test today.

Culture bound illnesses are psychiatric conditions that are specific to one particular culture. There are many different types of culture bound illnesses, including Amok, Shenjing shuairuo, Ataque de nervios, Bilis, colera, Bouffee delirante, Brain fag, Dhat, Falling-out, blacking out, Ghost sickness, Hwa-byung, wool-hwa-byung, Koro, Latah, Locura, Mal de ojo, Nervios, Rootwork, Pibloktoq, Qi-gong psychotic reaction, Sangue dormido, Shen-k’uei, shenkui, Shin-byung, Taijin kyofusho, Spell, Susto, Zar, and Wendigo.

Some of the most commonly discussed culture bound illnesses include Amok, which is confined to males in the Philippines and Malaysia who experience blind, murderous violence after a real of imagined insult. Ataque de nervios is a condition that occurs in those of Latino descent and is characterized by intense emotional upset, shouting uncontrollably, aggression, dissociation, seizure-like episodes, and suicidal gestures. Brain fag is a form of psychological distress first identified in Nigerian students in the 1960s but reported more generally in the African diaspora. It consists of a variety of cognitive and sensory disturbances that occur during periods of intense intellectual activity. Koro is a condition that affects Chinese patients who believe that their penis is withdrawing inside their abdomen, resulting in panic and the belief that they will die. Taijin kyofusho is a Japanese culture bound illness characterized by anxiety about and avoidance of interpersonal situations due to the thought, feeling, of conviction that one’s appearance and actions in social interactions are inadequate of offensive to others. Finally, Wendigo is a culture bound illness that occurs in Native American tribes during severe winters and scarcity of food, characterized by a distaste for food that leads to anxiety and the belief that one is turning into a cannibalistic ice spirit.