Clinical Psychiatry: Diagnosis and Treatment Protocols

Paranoid Schizophrenia

Kurt Schneider First Rank Criteria

At least five of these criteria allow for a diagnosis of schizophrenia:

• Audible thoughts (thought echoing)
• Voices arguing or discussing
• Voices commenting on the patient's actions
• Delusions of control (impact delusions)
• Thought withdrawal, insertion, or broadcasting
• Phenomenon of openness of mind
• Clinical perception disorders

Differential Diagnosis

Clinical Subtypes

• Paranoid: Preoccupation with delusions or frequent auditory hallucinations.
• Disorganized: Disorganized speech and behavior; flat or inappropriate affect.
• Catatonic: Motoric immobility, mutism, or excessive activity.

Research and Treatment Plan

Diagnostic Tests

• Blood test (to exclude anemia)
• Brain CT scan
• Thyroid function tests (T3, T4, TSH)
• Psychological diagnosis
• Urine examination

Treatment Protocols

I. Acute Phase:

1. Haloperidol: 5 mg (Antipsychotic)
2. Diazepam: 5-10 mg every 4 hours for anxiety until acute symptoms subside.

II. Later Phase:

• Atypical neuroleptics such as Risperidone (2-6 mg/day).

Depression Without Psychosis

Diagnostic Criteria

At least five symptoms present for at least two weeks:

• Depressed mood
• Loss of interest or pleasure (anhedonia)
• Appetite disturbance (weight gain or loss)
• Hypersomnia or insomnia
• Psychomotor agitation or retardation
• Fatigue or loss of energy daily
• Feelings of worthlessness or inappropriate guilt
• Decreased ability to concentrate
• Recurrent thoughts of death

Differential Diagnosis

• Anemia
• Bipolar Disorder (history of mania)
• Substance-induced disorders
• Medication side effects (beta-blockers, corticosteroids, oral contraceptives)
• Hypothyroidism

Treatment Plan

• Antidepressants: Amitriptyline (75-300 mg/day), SSRIs (Sertraline 50-200 mg), or Mirtazapine (15-45 mg).
• Psychotherapy: Individual therapy and psychological rehabilitation.

Alcohol Withdrawal Syndrome

Clinical Stages

Treatment

• Haloperidol: 5 mg to reduce agitation and hallucinations.
• Diazepam: 5-10 mg every 4 hours to alleviate anxiety.
• Somatic Support: Electrolyte adjustment and hydration.

Alzheimer's Disease and Dementia

Clinical Classification

1. Early Onset (Under 65): Rapid development affecting higher cortical functions (speech, writing).
2. Late Onset (Over 65): Progressive memory impairment (amnesia).

Reisberg Scale Stages

• Stage 1: No impairment; normal cognition.
• Stage 2: Mild cognitive decline; forgetting words or misplacing objects.
• Stage 3: Mild impairment affecting daily life, planning, and organization.

Treatment

While there is no cure, medications can slow progression:

• Cholinesterase Inhibitors: Donepezil, Rivastigmine, or Galantamine.
• NMDA Receptor Antagonists: Memantine (to control glutamate levels).

Bipolar Disorder

Clinical Features

• Manic Episodes: Increased energy, irritability, fast speech, decreased need for sleep, and inflated self-esteem.
• Depressive Episodes: Sadness, fatigue, guilt, and suicidal ideation.

Treatment

• Lithium Therapy: 0.9-1.2 mmol/l for acute mania; 0.6-0.8 mmol/l for long-term prophylaxis.

Adjustment Disorder

Definition

An abnormal and excessive reaction to an identifiable life stressor. Symptoms must arise within three months of the stressor and last no longer than six months after the stressor has ended.

Symptoms and Treatment

• Symptoms: Anxiety, inability to cope, and regressive behavior in children.
• Treatment: Psychotherapy is the primary intervention; short-term tranquilizers may be used.

Vascular Dementia

Etiology and Stages

Caused by vascular events such as a stroke. Stages include Neurasthenia (rapid fatigue, memory deterioration) followed by clinical disorientation and slow thinking.

Diagnosis and Treatment

• Diagnosis: MRI to exclude Alzheimer's, Doppler ultrasound to check blood flow, and CBC.
• Treatment: Vasodilators (e.g., Nitroglycerin) to improve circulation and low-dose antidepressants for mood symptoms.