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***PARANOID SCHIZO:
Kurt Schneider Schzi First grade crtieria:
At least 5 of these allow you to expect schizophrenia:
● Sounding thoughts
● Opposing or discussing voices
● Commenting voices
● Impact delusions
● Thought reading phenomenon
● The phenomenon of openness of mind
● Clinical perception disorders
● Sounding thoughts
● Opposing or discussing voices
● Commenting voices
● Impact delusions
● Thought reading phenomenon
● The phenomenon of openness of mind
● Clinical perception disorders
^^Diff Dx:
| Deficiency | Parkinson | Delirium | X(amphetamine) |
-B12 -Folate | -Basal Ganglia problem | -fluctuates level of concioussness -Altered sleep Wake Cycle -(-) cognition | -No True Delusion -Some Audtory hallucination |
| Schizoid Personality | Catatonic Schizo | |
-Auditory hallucination -Personality Deterioration | -prominent Psychomotor -Catatonic Stupor -Catatonic Excitment | -Dx in adolescents/ young adults -Affective charge Promenent -unpredictable & Inappropriate Behavior! |
-Paranoid :preocc with 1+2 delusion or Frequency Audtiory Hllucination
-Disoraganized : Disorganized speech & behavior .Flatt inaapropriate !
-Catatonic: 2 motoric (-) ,mutusm, excessive activity
^^Research plan:(TO MAIN)
-Blood test-Anemia excludion
-brain CT
-Thyroid Test(T3,T4,TSH)
-Pscyhological Diagnosis
-Urine examination
^^Tx:(TO MAIN)
I-Acute phase :
1-halepreridol 5mg , Antipyschotic
2-Diazepam: start 5-10 mg /4 hours -->Anxeity
until Acute Sx go ↓
II-LAter phasE:
atypical neruoleptic
Risperidone(2-6 mg /day)
***DEPRESSION WITHOUT PSYCHOSIS!
I-at least 5 sx for 2 weeks!
-Depreseed mood
-loss of interest or pelasure, ahtadonia
-Apetite disturbance( up or down)
-Hypersomnia or Insomnia
-Psychomotor aggitation or retardataion( anzious or sluggish)
-Fatigue loss of energy everyday
-Feelign of worthlesness or inappropriate guilt!
-Decreased ability to concentrate!
-Reccurent thought of death
-Clinical significant distress , Not explained though substance use
-NO schizo effect disroder
-never been a manic episode
^^Diff Dx:
● Anemia
● history of mania and episodes - Bipolar disorder
● X-induced disorders
● Some medicines may cause depression
● history of mania and episodes - Bipolar disorder
● X-induced disorders
● Some medicines may cause depression
(beta-blockers, antihypertensive, H2 blockers, oral contraceptives, corticosteroids)
● Hypothyroidism
● Hypothyroidism
^^Research:(Add to Main)
CBC-->An
Urine
-Thyroid Hormone
-Psychologist: emotion& personality
^^Tx:(add to Main)
I-Antidepressant
-Amitratyline75-300mg/day
-SSRI m,seraline 50-200 mg
-Mitrazapine ,15-45mg
II-psychotherpay
(in hospital)
III-psychological rehab
***Depression: syndrome:
11. Depressive syndrome
Major Depressive Symptoms: | Somatic Depression Symptoms: |
-Modified mood (sadness, depression, ) ● ↓ interest and satisfaction ( ● ↓energy and activity and increased fatigue. Other Depressive Symptoms: • ↓concentration and retention • ↓self-esteem and self-confidence • Guilty and inferiority ideas • Delicate and pessimistic vision of the future • Humorous or suicidal ideation or actions | • ↓interest and satisfaction with activities that are enjoying a normal mood • Weaker emotional response • Depression is more severe in the morning • Significant • Weight loss; • Lipid weakness; • Psychomotor(-) |
^^Dx:
at least 5 of these Sx for 2 W or More''
-Sleep changes
-Lost of interest, Aidonia
-Feeling of guilt worthlessness
-Lack of energy
-Distractability loss of Focus
-Change in apetite( More or LesS)
-Psychomotor agitation
-Suicidal ideas
^^Rule out;
-Hypothyrodism-X used
^^Tx
● Acute intoxication
● Acute psychosis is not caused by PAM (simple psychosis)
● CNS trauma and other CNS pathologies
● Hallucinosis. There is no permanent state of hallucination, but only acute psychosis
● Alcoholic Korsakov illness - typical dyed or paralyzed, but not here
● Sysophrenia + alcohol
Clinic: two types
1. 65 years(-)
- SSRI
(setraline, citalopram. Paroxetine, esentalpram , )
-individual psychotherapy
-electroconvulsive therapy is rarely used as last resort!
***OH withdrawl:
^^Sx:
-Aniety
-Depression:
iirtatbility
-fatugie tremor
-Palpitation
-swearing
-heacahce
-vommiting
-seizures
^^Diff Dx
● Acute intoxication
● Acute psychosis is not caused by PAM (simple psychosis)
● CNS trauma and other CNS pathologies
● Hallucinosis. There is no permanent state of hallucination, but only acute psychosis
● Alcoholic Korsakov illness - typical dyed or paralyzed, but not here
● Sysophrenia + alcohol
^^Research plan:( TO MAIN)
● Rapid Urine Toxicology - Rejected Acute Toxication
● Liver enzymes in the blood to confirm long-term use and termination
● Head CT CNS - injuries rejected
● Psychologist's research: thinking, emotions, personality
● Rapid Urine Toxicology - Rejected Acute Toxication
● Liver enzymes in the blood to confirm long-term use and termination
● Head CT CNS - injuries rejected
● Psychologist's research: thinking, emotions, personality
^^Tx:
(ADD X NAMES)
Psychopharmacotherapy / Pharmacology:
● Haloperidol (neuroleptic) - 5 mg
Psychopharmacotherapy / Pharmacology:
● Haloperidol (neuroleptic) - 5 mg
( ↓psychomotor agitation, hallucinations &delusions.
● Diazepam (tranquillizer) - 5-10 mg every 4 hours.Alleviate anxiety,
● Adjust the somatic state of the electrolytes,
● Diazepam (tranquillizer) - 5-10 mg every 4 hours.Alleviate anxiety,
● Adjust the somatic state of the electrolytes,
| Stage I (6-36 hours): | Stage II (12-48 hours): | Stqge III (6-48 hous): | Stage IV (48-96 hours) |
HBP HR ↑ low grade fever diaphoresis | -visual auditory tactile hallucination -HR ↑ -Pallor -Seizures -OH withdrawl deliruim | Grand mal Seirzures!! | Most severe -Deliruim tremens -paranoid delusion -severe ANS Hyperactivit -tachycardia -HBP -Fever |
***Alz:
Clinic: two types
1. 65 years(-)
-rapid development
-the functions of the higher brain cortex
(speaking, writing, practical skills)
2. Late after 65 years:
-First, memory gets worse.
The main symptom is memory impairment (progressive amnesia)
Stages:(PROJECT)
The main symptom is memory impairment (progressive amnesia)
Stages:(PROJECT)
STAGES:
-Stages Can Extend to up to 20 years, And Stages CAN overlap
STAGES | DURATION | Characteristics: |
Stage 1 (Reisberg Scale) | 2-7 years | -No Impairment -Normal cognition |
Stage 2 (Reisberg Scale) | 2-7 | -mild cognition problem, Recognizing recent event -forgetting words -misplacing things |
stage 3 (Reisberg Scale) | 7 years | Mild Impairment -Affect Daily life -problem with planning & organization -Affect Home & Work |
^^DX:
I-clinical
| MEMORY | -Recent memory affected,longterm memory spared -Problem planning 0or solving problem |
| Hallucination & Delusion : | -Confusion in time or place -trouble understanding visual images & spatial relationships misplacing thing s and losign the ability to retrace them -Decrease Poor Judgment -Change in mood and personality |
| Psychiatric Phenomena With Disease Progression | personality change, agitation ,paranoid delusion) |
II- It is also possible to perform a clock drawing test,
III-Other:
○ Electroencephalography - Polymorphic, slow, low voltage activity.
○ Computerized CT scan - enlarged subarachnoid spacings, lateral ventricles, especially the posterior horn.
○ Nuclear magnetic resonance - atrophy in the hippocampus, almond body and in the limbic system.
○ Electroencephalography - Polymorphic, slow, low voltage activity.
○ Computerized CT scan - enlarged subarachnoid spacings, lateral ventricles, especially the posterior horn.
○ Nuclear magnetic resonance - atrophy in the hippocampus, almond body and in the limbic system.
^^Differential diagnostics:
1. Brain tumors
2. Vascular diseases
3. Other dementias
4. Neuroinfections
Treatment: complex
1. Brain tumors
2. Vascular diseases
3. Other dementias
4. Neuroinfections
Treatment: complex
^^TREATMENT:
-No Cure, the Drugs avialbe Slow progression but do not Stop
2 Class of Drug:
1-Cholineterase Inhibitors to help communication!
-prevent Breakdown of Acetylcholine NT connection
-Drugs include: Deonpezil/ Rivastigmine/Galatamine!
2-Memantine to control amount of glutamate
***Schizoaffective Disorder:
^^Sx:
-Sx of schizo & mood disorder(depression are present at same time)
I-Schizophrenia:
- agitation or restlessness, absurd behavior
- agitation or restlessness, absurd behavior
-hallucinations, delusions.
II-Depression:
-Major Depressive Symptoms:
- Modified mood (sadness, depression, upset, dysphoria, etc.)
- ↓of interest/ satisfaction
- ↓ energy
Other Depressive Symptoms:
- Lack of concentration and retention
- Decreased self-esteem and self-confidence
- Guilty and inferiority ideas
- pessimistic vision of the future
- Humorous or suicidal ideation or actions
• in relevant weight changes)
- Modified mood (sadness, depression, upset, dysphoria, etc.)
- ↓of interest/ satisfaction
- ↓ energy
Other Depressive Symptoms:
- Lack of concentration and retention
- Decreased self-esteem and self-confidence
- Guilty and inferiority ideas
- pessimistic vision of the future
- Humorous or suicidal ideation or actions
• in relevant weight changes)
^^TxCOMPLEX
-Focus on Tc Affectice Sx
-Lith therpay + neuropleptic in Acute phase( psychosis)
I-Lithuim
0.9-1.2 mmol / l - acute mania treatment,
0.6 to 0.8 mmol / l for long-term relapse prophylaxis
0.6 to 0.8 mmol / l for long-term relapse prophylaxis
II-Carbamazepine (16-42 μmol / l)
is a therapeutic concentration in the blood
(400 - 1200 mg / day)
(400 - 1200 mg / day)
III-Electro pulsed therapy is also
IV-Psychotherapy
V-Psychosocial rehabilitation
***General anziety disorder
^^Sx:
-Mentaion tension
(concenr ,tension and nervousness)
-Somatic Tension
(stomach headache tremor)
-Vegetative agitation
(dizziness swearing)
-Sx for month and repeat
^^Diff Dx:
1. Depression
(Mourning or depressed mood prevails)
2. Panic disorder -
2. Panic disorder -
(Emergency anxiety attacks occur)
3. Phobic disorder -
3. Phobic disorder -
(the patient is afraid of something or avoids coexistence situations)
4. Tyrotoxicosis -
4. Tyrotoxicosis -
(Symptoms of anxiety can be caused)
5. Medications (methyl csstatins, beta agonists) - can cause symptoms of anxiety
5. Medications (methyl csstatins, beta agonists) - can cause symptoms of anxiety
^^Tx:
-supporative interpersonal therpay
-supporative interpersonal therpay
Medication ( Secondary.)
● Anxiety medicines. Diazepam 5-10mg for the night.
● Anxiety medicines. Diazepam 5-10mg for the night.
(not more then 2 W additvie)
● Beta-blockers Helps control somatic symptoms.
● G.B. And antidepressants
● Beta-blockers Helps control somatic symptoms.
● G.B. And antidepressants
( in case Dep Sx)
***Bipolar disorder:
^^CF:
Manic episodes
Manic episodes | Depression |
| - ↑ energy and activity - ↑ mood or irritability -Fast speech ● ↓sleep ● Increased self-esteem The patient is easily agitated and relaxed | mood or sadness ● ↓ of interest or pleasure The most common symptoms are: ● Sleepiness ● guilty or bad self-esteem ● Fatigue ● ↓ concentrate ● Affected appetite ● Thoughts about suicide |
^^Differential Dx:
● Manic episode
● Depression episode
● Alcohol or drug-induced disorders
● Manic episode
● Depression episode
● Alcohol or drug-induced disorders
^^Research plan
● Urine Toxicological Study
● Clinic
● Psychologist. Emotions, personality
^^Treatment
1-Starting lithium therapy,
0.9-1.2 mmol / l - acute mania treatment,
0.6 to 0.8 mmol / l for long-term relapse prophylaxis
● Urine Toxicological Study
● Clinic
● Psychologist. Emotions, personality
^^Treatment
1-Starting lithium therapy,
0.9-1.2 mmol / l - acute mania treatment,
0.6 to 0.8 mmol / l for long-term relapse prophylaxis
-------------------------------
**&Acquired Dementia:
-It is Chronic & Progrssive Deterioration of cognitive Function & CNS
-Symptom not Disease,
-An Umbrella Term! Under which Things like :Alzheimers ,Parkinson , Multiple Sclerosis , Vascular Dementia are Found!, With Alzeheirmers Accounting for Roughly 60% of the Cause
-Contrary to Some Believe it Is NOT Normal Aging Rather brain damage
-Dementia is Not 1 specific disease its a Combination Symptomns
^^DIAGNOSIS :
Is Made o Clinical Bases But Some Test Such as :CBC /glucose /TSH level/Sensory Deficit (proprioception / Biration/ Deep tendon Reflex /Pathological Reflex All Are made to exclude other possiblities
^^Differential Diagnosis:
-Other Then Alzheirmer There are Other Causes For Dementia including : Vascular Changes in Brain/Parkinson/Thyroid problem/ Lewy body disease/Chronic brain infection
| Alzhemeir | Vascular dementia | Lewy Bodies | mild congitive Impairment |
-insideous onset,Gradual onset -progressive decline | -Sudden Onset -History of Recent Stroke -Dementia due to infarction to brain -High Blood Pressure | -Lewy bodies in Cerebral Cortex /Midbrain / Brainstem | -Memory loss but not functional decline |
| Depression | Fronto temporal | ||
-Less then 3 Month -Mood: Depressed anzious -Cognition: unimpaired -Somatic symptomn:Fatigue/lethary | -personality changes -lack of social awarness -change in Food preferance -Overeating -difficulty making plans |
^^TREATMENT:
-There is No Cure Teatment Focuses of Prevention & Delaying the progression of the Disease
Dugs to help with Symptomns Include:
1-Cholineterase Inhibitors to help communication!
2-Memantine to control amount of glutamate which can be toxic in high amounts
***ADAPTATION DISORDER:
Definition
Adjustment disorder is an abnormal and excessive reaction to an identifiable life stressor. The reaction is more severe than would normally be expected and can result in significant impairment in social, occupational, or academic functioning. Symptoms must arise within three months of the onset of the stressor and last no longer than six months after the stressor has ended
^^Sx:
-Depressed Mood
-Anxeity
-Inaiblity to cope
-no plan for future
-Agrresive antisocial
-Chjild adaption ( Regressive behavior)
(wetting in bed ,finger sucking)
^^Dx:
-Sx assesment
-Personality & hisotry
-Recent Life Crises
-Short term depreesive rxn 1 Month
-Emotional disturbance+anx/dep/tension/anger
● AJD with prevailing emotional disturbances
(Along with anxiety, depression, tension anger)
● AJDt prevailing behavioral disorders.
● AJDt prevailing behavioral disorders.
(, adolescents' failure to respond can be aggressive or antisocial.)
● Adjustment disorder mixed emotional and behavioral disorders.
● Adjustment disorder mixed emotional and behavioral disorders.
(The emotional and behavioral disorders are also intense.)
^^Diff Dx:
-Great Depression episode
-Personality disorder
-PTSD
^^Tx:
-Psychoherpay/ pharmatherpy:
-Short term : Tranquilizer
-need less AntiDep
-Pscyhotherpay!!
****Vascular dementia:
--->Caused by Vascular event( Stroke)
^^Stages:
1- Neurasthenia
-rapdi tired
-decrease work capaicity
-memory deteioration(-)
-malaise
-bad mood
2-Clincially:
-insomnia
-headache
-ea sound
-aplu;plia
-slow thinking
-Disoreintation
^^Diff Dx:
-Depression
-Other Demenia
-Anemia
-Mild Congntive impairment
^^Dx:
-CBC: anemia
-General assesment* eye movment CVS status)
-MRI in brain to disprove Alz
-Doplet +MRI to see BFin brain
-Infeciton(Syphilis, AIDS)
-Thyroid test
-psychological test
^^Tx:
-nitroglycerin 15-30 mg
(vasodialaotry improves cirulation)
-Mirtazapine , low doses for Depresion