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Explanation:

• Delirium: It is an acute organic mental disorder characterized by impairment of consciousness (hallmark sign), disorientation, and disturbances in perception and restlessness.
• Dementia can be differentiated from delirium by acute onset and lack of orientation.
• Signs & Symptoms:
• Impairment of consciousness.
• Impairment of attention
• Perceptual disturbance ( hallucination, illusion)
• Disturbance of cognition
• Psychomotor disturbance ( Tremor, Unsteady gait)
• Disturbance of sleep-wake cycle
• Treatment:
• Identification of cause and its immediate correction.
• Symptomatic measures: benzodiazepines or antipsychotics may be given.

Additional Information

• Amnesia: Severe memory loss.
• Retrograde amnesia: Cannot recall events that occurred prior to the brain trauma.
• Anterograde amnesia: Cannot recall events that occur after the brain trauma.
• Occurs due to failure to make permanent traces.
• Dementia: It is an acquired global impairment of intellect, memory, and personality without impairment at the consciousness level.
• Sundown phenomena are also common in dementia.
• Sundown phenomena are characterized by drowsiness, confusion, and ataxia.
• Accidental falls may also occur at night when external stimuli such as light and interpersonal orienting cues are diminished.
• Pick's disease; Is a type of frontotemporal dementia, a neurodegenerative disease.
• In this affected neurons ( brain or nerve cells) gradually stop working.
• Caused by abnormal amounts or types of nerve cell proteins called Tau.
• These proteins are found in all of nerve cells, they often accumulate into spherical clumps, known as Pics bodies or Pick cells.

Explanation:

• Glove Anesthesia:
• A mental disorder involving loss of sensitivity in the hand & wrist.
• It is a type of Conversion disorder, conversion hysteria, or conversion reaction.
• Conversion disorder:  A loss or change in body function resulting from a psychological conflict.
• The physical symptoms cannot be explained by any known medical disorder or pathophysiological mechanism.

Additional Information

• La-belle indifference :
• It is present in the case of conversion disorder.
• Refers to symptoms that appear suddenly and often the person expresses a relative lack of concern that is out of keeping with the severity of the impairment.
• It gives clue to the physician that the problem may be psychological rather than physical.
• Munchausen syndrome by proxy:
• It is also known as Factitious disorder imposed on another (FDIA) is a mental illness in which a person acts as if he is caring for a person have a physical or mental illness when the person is not really sick.

Concept:

• Personality disorder:
• It results when personality traits become abnormal that become inflexible and maladaptive and cause significant social or occupational impairment or significant subjective distress.

Explanation:

• Personality disorder is divided into Cluster A, Cluster B & Cluster C.
• Cluster C Personality disorder is divided into:
• Avoidant personality disorder: Overly serious, fears criticism, withdrawn, sensitive to rejection, inflexibility.
• Dependent personality disorder:
• This disorder is characterized by an extreme need to be taken care of, which leads to submissive and fear of separation or rejection.
• People with this disorder, let others make important discussions  & decisions for them and have a  strong need for constant reassurance and support.
• Sign & Symptoms:
• Feeling uncomfortable and helpless.
• Inability to make decisions.
• Low self-esteem and lack of self-confidence.
• Hypersensitivity.
• Obsessive-compulsive personality disorder: Perfectionist, rigid & passive aggressive.

Additional Information

• Cluster A Personality disorder:
• Paranoid Personality: Long-standing suspicious, hypersensitive, secretive, hostile & irritable.
• Schizoid personality: Passive, seclusive, indifferent, cold & aloof.
• Schizotypal personality: Odd thinking, peculiar language, bizarre thinking, the idea of reference.
• Cluster B Personality disorder:
• Histrionic personality: Attention seeking, provocative ( intended to make somebody angry) & dramatic.
• Narcissistic personality: Excessive self-admiration, self-importance, sense of grandiose, egocentric.
• Borderline personality: Impulsive, manipulative, self-mutilative.
• Treatment of Personality disorder:
• Group therapy, occupational therapy.
• Recreation therapy.
• Interaction & guidance by the therapist.

Concept:

• Obsessive Compulsive disorder (OCD):
• OCD is repetitive, irresistible with unwanted thoughts & ritualistic action.
• It is characterized by intrusive thoughts that produce uneasiness, apprehension, fear of worry ( obsession), repetitive behavior aimed at reducing the associated anxiety ( compulsion), or a combination of such obsessions & compulsion.
• Neurotransmitter serotonin plays a role in the psychopathology of OCD.

Explanation:

• Types of Obsession:
• Obsessional doubts: Actions not completed adequately. e.g.: forgetting to turn off the stove, doubting whether the door has been locked or not, doubting the existence of God. This form of obsession is common.
• Obsessional thoughts: They are usually unpleasant and repetitively intrude ( interfere) into consciousness (words, phrases, and rhymes), interfering with a normal train of thoughts and causing distress to the person. Often these thoughts are nonsensical or obscene.
• Obsessional rumination: There are endless internal debates about everyday activities.  For eg: who created me? What is the purpose of my life?
• Obsessional impulses: These are urges to perform acts usually of a violent or embarrassing kind, such as injuring a child, or shouting obscenities in church or temples.
• Obsessional images: vividly imagined scenes, often of a violent or disgusting kind of abnormal sexual practices (images of child being killed, parents having sexual intercourse repeatedly come to mind)
• Obsessional Slowness: in performing daily activities.
• Obsessional rituals: These may include both mental activities such as counting repeatedly in a special way or repeating certain forms of words, and repeated but senseless behavior such as washing hands 20 times a day.
• Sometimes such compulsive acts may be preceded by obsessional thoughts, e.g. repeated hand washing, and may be preceded by thoughts of contamination.
• This patient believes that the contamination is spread from object to object or person to person even by slight contact and may literally rub the skin off their hands by excessive hand washing.

Additional Information

• Treatment of Personality disorder:
• Antidepressant ( SSRI)'s: Clomipramine, Fluvoxamine, Fluoxetine, Sertraline)
• Exposure & Response Prevention (ERP) and thought stopping the most effective treatment.
• Thought Stoppage: it is a technique to help an individual to learn to stop thinking unwanted thoughts. Steps as follows:
• Sit on a comfortable chair, and bring the mind the unwanted thoughts concentrating on only one thought per procedure.
• As soon as the thoughts forms, give the command "STOP"!
• Follow this with calm and deliberate relaxation of muscles and diversion of thought to something present.
• Repeat the procedure to bring unwanted thoughts under control.

Concept:

• Amnesia: Severe memory loss.
• Retrograde amnesia: Cannot recall events that occurred prior to the brain trauma.
• Anterograde amnesia: Cannot recall events that occur after the brain trauma.
• Occurs due to failure to make permanent traces.

Explanation:

• Most common cause of amnestic syndrome is the Deficiency of Vitamin B1 ( Thiamine) which mostly occurs due to chronic alcohol abuse & dietary deficiency.
• Amnestic disorder due to general medical condition:
• Head Trauma, Hypoxia, Herpes simplex encephalitis, Transient global amnesia & Seizures.
• Substance-induced persisting amnestic disorder:
• Alcohol, Sedatives, Hypnotics, Anxiolytics, Wernicke- Korsakoff syndrome.

Additional Information

Forms of Amnesia:

• Transient global amnesia:  It is characterized by a patient's inability to learn new material.
• Perception & personal identity are normal.
• Hypomnesia: Abnormally poor memory of the past.
• Hypermnesia: Unusual power or enhancement of memory, typically under abnormal conditions such as trauma, hypnosis, or narcosis.
• Amnesic disorientation: Characterized by disorientation particularly in time, impairment of immediate recall.
• loss of recent memory, retroactive loss of remote memory of varying extent, and a tendency to confabulation.

Note: Confabulation means gaps in memory are unconsciously filled with fabricated, misinterpreted, or distorted information.

• Alzheimer's disease:
• It is the most common cause of dementia, a group of disorder that impairs mental functioning.
• More commonly seen in women than in men.
• Alzheimer's is a progressive & irreversible disease.
• Memory loss is one of the earliest symptoms, along with a gradual decline of other intellectual & thinking abilities.

Concept:

• Mental retardation refers to significantly sub-average general intellectual functioning.
• Resulting in or associated with concurrent impairments in adaptive behavior ( communication, self-help skills,) and manifested during the developmental period before the age of 18 years.
• Causes:
• Genetic factor: Down's syndrome ( caused due to trisomy 21).
• Advance age of mother > 35 years
• Metabolic disorder.
• Environmental factor
• Socio cultural factor.

Explanation: 

• The primary caregiver has a realistic expectation of the child's behavior.
• Oriented with reality help into sets the goals of care.
• Provide training on self-care & life skills.
• Train & motivate for vocational activities.
• Provide family support & parental teaching.
• Prevention Strategies of MR:
• Primary prevention:
• Preconception:  Genetic counseling, Immunization of mother
• Routine investigation, Balanced diet for mothers
• Family planning
• During gestation: Proper prenatal care, Fetal monitoring
• At delivery: Delivery is conducted by an expert, Apgar scoring is done at 1 & 5 minutes after the birth of a child.
• Monitoring of mother and child
• Childhood: Proper Nutrition throughout the developmental period especially the first 6 months after birth.
• Providing a safe environment to children.
• Secondary Prevention: Early detection and treatment of preventable disorders., Early diagnosis for MR
• Psychiatric treatment for emotional and behavioral difficulties.
• Tertiary prevention: This includes rehabilitation in vocational, physical and, social areas, Institutionalization
• Health education regarding the mentally retarded.

Additional Information

• Classification of Mental Retardation:
• Mild retardation: IQ 50/55 to 70
• (85%) population suffering from mild MR.
• Self-care
• Education- (up to 6^th-grade)
• Social skills- The child can learn and use skills in structured settings.
• Psychomotor skills- develop average to good skills but experience minor coordination problems.
• May acquire vocational skills and be self–supportive
• Moderate retardation: IQ 35/40 to 50/55
• (10%) population suffering from moderate MR
• Social and Communication skills develop but impaired, Early detection ( i.e. before entering school)
• The child requires close supervision when performing certain independent activities.
• Achieve skills up to the second level
• Child may have difficulty with gross motor skills and may have limited vocational opportunities
• Severe mental retardation IQ 20/25 to 35/40
• (3%) population suffering from severe MR.
• Child requires complete supervision but may be able to
• perform simple hygiene skills.
• May learn a few simple skills
• Child has limited verbal skills.
• Poor psychomotor skills.
• Unable to benefit from vocational training.
• Profound retardation: IQ below 20/25
• (1-2%)  population suffering from profound MR.
• Social and Communication skills rarely have
• The child requires constant assistance and supervision.
• Cannot benefit from academic training.
• Lack of both fine and gross motor skills.
• Child has little speech development. lack of social skills.
• Minimal sensory-motor abilities.

Concept-

• Genetic linkage analysis is a powerful tool for tracing the chromosomal location of disease genes.
• It is based on the observation that genes that are physically close on a chromosome remain linked during meiosis.

Genetic Linkage Analyses:

• Analyses concerning comparisons of the inheritance of characteristics for which gene location is well known (e.g. eye color) with the inheritance of symptoms of psychopathology.
• Deletion or duplication of genetic material in any of several chromosomes, which can affect multiple genes, is also thought to increase the risk of schizophrenia.

Important Points

• The inheritance pattern for schizophrenia is generally unidentified. The risk of developing schizophrenia is slightly higher for family members of affected individuals than for the general public; Yet, most people with close relatives who have schizophrenia will not develop the disorder themselves.

Additional Information

• Psychobiology describes the relationship between psychological and behavioral processes and the underlying physiological mechanisms.

Concept:

• Personality disorder:
• It results when personality traits become abnormal that become inflexible and maladaptive and cause significant social or occupational impairment or significant subjective distress.

Explanation:

• Personality disorder is divided into Cluster A, Cluster B & Cluster C.
• Cluster C Personality disorder is divided into:
• Avoidant personality disorder: Overly serious, fears criticism, withdrawn, sensitive to rejection, inflexibility.
• Dependent personality disorder:
• This disorder is characterized by an extreme need to be taken care of, which leads to submissive and fear of separation or rejection.
• People with this disorder, let others make important discussions  & decisions for them and have a  strong need for constant reassurance and support.
• Sign & Symptoms:
• Feeling uncomfortable and helpless.
• Inability to make decisions.
• Low self-esteem and lack of self-confidence.
• Hypersensitivity.
• Obsessive-compulsive personality disorder: Perfectionist, rigid & passive aggressive.

Additional Information

• Psychological Test for Assessment of Personality:
• Objective Personality tests:
• To determine the personality traits of a person.
• Minnesota Multiphasic personality inventory ( MMPI)
• 16 Personality factors.
• Million clinical multiaxial inventory ( MCMI)
• Eysenck personality questionnaire.
• Projective personality tests:
• Test reveals hidden emotions and internal conflicts projected by the person into the test.
• Draw a person test (DAPT)
• Thematic apperception test (TAT)
• Rorschach inkblot test
• Sentence completion test ( SCT)

Concept-

• A therapeutic diet is an eating plan that controls the intake of certain foods or nutrients.
• It is part of the treatment of a medical condition and is usually prescribed by a doctor and employed by a dietitian.
• A therapeutic diet is usually a modification of a regular diet.
• Diarrhoea is loose, watery stool. If diarrhoea occurs three or more times a day, it is diarrhoea. Acute diarrhoea is diarrhoea that lasts for a short time. This is a common problem. It usually lasts for about a day or two, but it can last longer.

Important Points

• A clear liquid diet is often used before tests, procedures, or surgeries that do not require food to enter your stomach or intestines, such as before a colonoscopy. It may also be recommended as a short-term diet if you have certain digestive problems, such as nausea, vomiting, or diarrhoea, or after certain types of surgery.

The most common causes of diarrhoea include:

• Bacteria from contaminated food or water
• Medicines such as antibiotics, cancer drugs, and antacids containing magnesium
• Food intolerance and sensitivities are problems digesting certain ingredients or foods. An example is lactose intolerance.
• Diseases affecting the stomach, small intestine, or colon, such as Crohn's disease
• problems with how the colon works, such as irritable bowel syndrome

Additional Information

• A Soft diet also called a bland diet, is made up of foods that are easy to digest. They are generally soft in texture and low in fibre.

Concept-

• Nutrients are substances or compounds that are present in food and are essential for the normal functioning of the body. By digesting these nutrients, the body obtains the energy needed for various cellular activities.
• The six main nutrients provided by food to the body are carbohydrates, vitamins, proteins, fats, minerals, and water. These nutrients have a certain value that the body requires. When these nutrients are present in the body in less or more quantity than the prescribed value, it can lead to various nutritional disorders.

Important Points

• Nutrition screening is a process used to quickly identify people who may be at risk of malnutrition so that a complete nutritional assessment and appropriate nutritional intervention can be provided.
• Nutritional screening is the first step toward identifying patients who are at risk of nutritional problems or who have not been diagnosed with malnutrition. This allows for the prevention of nutritional problems when risks are identified and early intervention when problems are confirmed.