Psychiatry Course Review

1. Psychiatry Course Review Dr Mohamed Al Nafaiei Senior Psychiarist

2. Psychotic Disorder Schizophrenia: A chronic severe brain disorder; often they hear voices, believe media are broadcasting their thoughts to the world or may believe someone is trying to harm them. In men it usually develops in teen years and early 20s; in women it usually develops in 20s and 30s.

3. Symptoms of Schizophrenia Profound disruption in cognition and emotion, affecting the most fundamental human attributes: Language Thought Perception Affect Sense of self

4. Positive Symptoms Those that appear to reflect an excess or distortion of normal functions. Delusions. Those where the patient thinks he is being followed or watched are common; also the belief that people on TV, radio are directing special messages to him/her. Hallucinations. Distortions or exaggerations of perception in any of the senses.

5. Disorganized thinking/speech. loose associations; speech is tangential, loosely associated or incoherent enough to impair communication. Grossly disorganized behavior. Difficulty in goal directed behavior, unpredictable agitation or silliness, social disinhibition, or bizarre behavior. There is a purposelessness to behavior.

6. Catatonic behavior Marked decrease in reaction to immediate environment, sometimes just unaware of surroundings, rigid or bizarre postures, aimless motor activity.

7. Summary of Positive Symptoms Delusions Hallucinations Disorganized thinking Disorganized behavior Catatonic behavior Inappropriate responses

8. Negative Symptoms Those that appear to reflect a diminution or loss of normal functions. May be difficult to evaluate because they are not as grossly abnormal as positive symptoms. Affective flattening Reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact and body language.

9. Negative Symptom Alogia (poverty of speech) Lessening of speech fluency and productivity, thought to reflect slowing or blocked thoughts; often manifested as short, empty replies to questions.

10. Negative Symptom Avolition The reduction, difficulty or inability to initiate and persist in goal-directed behavior. Often mistaken for apparent disinterest.

11. Examples of Avolition No longer interested in going out with friends No longer interested in activities that the person used to show enthusiasm No longer interested in anything Sitting in the house for hours or days doing nothing

12. Disorganized Symptoms This one is somewhat new and may not be considered valid. It is thought disorder, confusion, disorientation and memory problems.

13. Summary of Negative Symptoms Lack of emotion Low energy Lack of interest in life Affective flattening Alogia Inappropriate social skills Inability to make friends Social isolation

14. Cognitive Symptoms Difficulties in concentration and memory: Disorganized thinking Slow thinking Difficulty understanding Poor concentration Poor memory Difficulty expressing thoughts Difficulty integrating thoughts, feelings, behaviors

15. Treatment Antipsychotic Medication Psychosocial Approaches Family Therapy (focus on expressed emotion) Individual Psychotherapy (coping skills and personal management) Social-Skills Training Outcome studies demonstrate around 40% social recoveries with medication use in conjunction with other treatment

16. Delusional Disorder Individual feels singled out and taken advantage of, mistreated, plotted against, stolen from, spied on, ignored or otherwise mistreated Hold a delusional system usually centered on one theme Aside from delusional system such individuals may appear perfectly normal in conversation, emotionality, and conduct

17. A. Nonbizarre delusions (i.e., involving situations that occur in real life, such as being followed, poisoned, loved at a distance, or deceived by spouse or lover, or having a disease) of at least 1 month's duration. B. Criterion A for Schizophrenia has never been met. Note: Tactile and olfactory hallucinations may be present if they are related to the delusional theme. C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired and behavior is not obviously odd or bizarre. D. If mood episodes have occurred concurrently with delusions, their total duration has been brief relative to the duration of the delusional periods. E. The disturbance is not due to the direct physiological effects of a substance (drug abuse, medication or a medical condition)

18. Mood Disorders Episodes and Patterns Major depressive episode Manic episode Mixed episode Hypomanic episode Cycling patterns

19. Major depressive episode Five or more of the following, most of the day and/or nearly every day for at least 2 weeks, including at least symptom 1 or 2: 1. Depressed mood Sad, empty, weepy; irritable, angry 2. Loss of interest or pleasure in previously enjoyable activities 3. Change in weight or appetite 4. Sleep changes

20. More depressive symptoms 5. Noticeable change in movement 6. Fatigue 7. Feelings of worthlessness or guilt 8. Impaired cognition or volition 9. Repeated thoughts of death or suicide, or planned or attempted suicide The five symptoms must occur in the same two weeks

21. Manic episode One week of persistently high, expansive, or irritable mood, and 3 of: Grandiose self-esteem Lower sleep need Overly talkative Racing thoughts Easily distracted Increased activity or agitation High risk activities

22. Mixed episode One week of both manic and major depressive symptoms with rapidly alternating moods Common symptoms: Agitation Insomnia Irregular appetite (binge-fast) Delusions Thoughts of suicide

23. Hypomanic episode Four days of manic episode symptoms Mood disturbance does not critically impair ability to work or maintain social responsibilities Response pattern is uncharacteristic Not euthymia

24. Bipolar disorders Bipolar I Disorder One or more manic or mixed episodes Usually one or more major depressive episodes Subcategorized based on the character of the most recent episode Most recent episode depressed Most recent episode manic Most recent episode mixed

25. Bipolar disorders Bipolar II Disorder One or more major depressive episodes One or more hypomanic episodes NO manic or mixed episode Cyclothymic Disorder Two years of alternating hypomanic and depressive symptoms No remission of more than two months NO major depressive, manic, or mixed episodes

26. Depressive disorders No history of manic, hypomanic, or mixed episodes Major Depressive Disorder Current major depressive episode Dysthymic Disorder Two years of chronically depressed mood Two additional depression symptoms (appetite, sleep, energy, concentration, low self-esteem, hopeless feelings)

27. Patterns of mood disorders

28. More patterns

29. Treatement Depresive episode: Anti depressents :Manic episode Antipsychotics or/and mood stabilizers