Important Psychiatry One-Liners for NEET PG/FMGE

CAPGRAS Syndrome 

The person believes that someone who is closely related to him has been replaced by an exact double.

Fragoli Syndrome 

The patient believes that a familiar person is posing as a stranger and can take multiple appearances. The physical appearance of the people changes, and there is acknowledgement of it.

Tests

Digit repetition/digit span test: A test to assess attention has two components:

• Digit forward test
• Digit backward test: The digit forward test is better out of checking attention.

Serial 7s subtraction test / (100-7) test: Test for checking concentration. Test judgment: A hypothetical situation is given to the patient, and then he is asked what he will do.

Test for Abstract Thinking

Ability to understand hidden meanings. The second test is similarity testing. Loss of abstract thinking is known as concrete thinking and may be seen in schizophrenia.

Grades of Insight

In neurosis insight is present; in psychosis insight is absent.

1. Grade 1: Complete denial of illness.
2. Grade 2: Slight awareness of being ill but denying it at the same time.
3. Grade 3: There is awareness of the illness, but the patient attributes it to external/physical/medical/unknown factors.
4. Grade 4: Intellectual insight.

Also read: Dissociative Disorders, Conversion Disorder and Somatic Symptoms

Lewy Body Disease (Dementia with lewy body)

Core features are:

• Fluctuating cognition.
• Visual hallucination.
• Motor features of parkinsonism.
• Dementia occurs with or before parkinsonism.

Alzheimer's disease

Neurotransmitters

Decrease of acetylcholine. Excessive stimulation by glutamate may damage neurons.

Microscopic findings

Amyloid plaque: It is called senile or neuritic plaques. Neurofibrillary tangles.

Pharmacotherapy

Cholinesterase inhibitors

It is the reversible inhibitor of the enzyme acetylcholinesterase.

Memantine

It is an NMDA antagonist.

Some of the new drugs are

Aducanumab: It is a human IgG1 monoclonal antibody. It is given as an IV infusion, which makes it a target-oriented drug. Lecanemab: Amyloid-directed antibody.

Also read: INI-CET High Yield Questions For Psychiatry

Delirium

It is the most common organic mental disorder.

Diagnosis of Delirium

Consciousness and attention: impairment of consciousness is depicted by clouding of consciousness, confused state, altered sensorium, and reduced orientation. Impairment of attention is depicted by reduced ability to focus, sustaining/shifting attention. Acute psychosis—no impairment of consciousness. Delirium: impairment of consciousness present.

Visual hallucination

The most common hallucinations in organic mental disorders are visual hallucinations.

Symptoms of Schizophrenia

Positive Symptoms (psychotic symptoms)

• Delusions: Most common is the delustion of persecution.
• Hallucinations: false perceptions without any real object.
• Most common: auditory hallucinations.
• Patients respond well to medications.

Negative Symptoms

• Anhedonia: loss of interest.
• Avolition: loss of will / drive (loss of motivation).
• Affective blunting: inability to express emotions.
• Asociality: decrease in drive to socialize.
• Alogia: decrease in verbal communication.
• Attention deficits: not able to pay any attention.
• Apathy: lack of concern.

Also read: Forensic Psychiatry : Mental Health Care Act

Prognostic factors of Schizophrenia

Treatment of Schizophrenia

Important Points About Chlorpromazine Drug

• Anticholinergic side effects.
• Corneal and lenticular deposits, photosensitivity.
• Cholestatic jaundice.
• Has maximum sedation.

Important Points about Thioridazine

• Retinal pigmentation (irreversible)
• ↑ OTc interval → cardiac arrhythmias
•  Least EPS.

Also read: Electroconvulsive Therapy (ECT)

Acute Dystonia Symptoms

• Eyes: Oculogyric crisis (rolling upwards)
• Neck: Torticollis (neck muscle will be twisted to one side).
• Jaw muscles: Trismus (contracted)
• Larynx: Laryngospasm
• Glossopharyngeal: Dysarthria, Dysphasia, Dystonia

Treatment

Parenteral (IV/IM) Anticholinergic: Benztropine, Diphenhydramine, Promethazine

Drug-induced Parkinsonism Pseudo Parkinsonism

Parkinson's symptoms: tremors, rigidity, Bradykinesia, rabbit syndrome (perioral tremors, usually at a later stage).

Treatment: anticholinergic drugs (benztropine, diphenhydramine, trihexyphenidyl).

Akathisia

The most common symptoms are subjective signs (patient may tell that he has restlessness), objective signs (others will notice), rocking motion, placing around, and rapid alteration of sitting and standing. Treatment: Beta blocker: Propranolol (DoC)

Tardive Dyskinesia

Cause: supersensitization of D2 receptors. Symptoms are involuntary moments, lip smacking/chewing, tongue protrusion (fly catching), choreiform hand movements (piano playing), and pelvic thrusting. 

Treatment: Valbenazine (DOC)—VMAT vesicular monoamine transporter type 2 receptor inhibitor.

Also read: Attention Deficit Hyperactivity Disorder (ADHD)

Postpartum Mental Health

Postpartum blues

Symptoms: Tanzania has depressive symptoms like sadness, mood instability, tearfulness, irritability, and sleep disturbances.

Postpartum Depression

Symptoms include depressed mood, tearfulness, insomnia, and weight changes. Anhedonia guilt is most often. Suicidal thoughts and thoughts of harming the baby occur sometimes.

Postpartum Psychosis

Initial symptoms include insomnia, tearfulness, mood lability, and fatigue. Psychiatric emergency treatment includes antipsychotics + lithium in a combination of anti-depression.

SSRI and Pregnancy

Paroxetine should be avoided in pregnancy as it can result in cardiovascular defects. SSRIs and SNRIs are given especially late in the pregnancy and are known to cause persistent pulmonary hypertension in the newborn. Neurodevelopmental/motor disorders, ADHD, Autism SD, low APGAR score, ↓ Gestational Age/↓ Birth weight, GDM, pre-eclampsia.

Also read: Alcohol Induced Disorders : Clinical Features

Mood Stabilizers in Pregnancy

Carbamazepine

Neural tube defect (risk lower than valproate) (folate). Cleft palate, fingernail hypoplasia

Lamotrigine

Safer than valproate, CBZ

Obsessive-Compulsive Disorder (OCD)

R: recurrent and intrusive thoughts/images/impulses.

O: Patient acknowledges that thoughts are his, not imposed by others.

S: Patient also acknowledges them to be senseless

I: He wants to get rid of these thoughts, but these are irresistible.

Compulsions

Repetitive behaviors (e.g., washing, checking) or mental acts (e.g., counting).

Treatment of OCD

First-line treatment: SSRIs (preferred) and Clomipramine (the most common serotonin-selective tricyclic antidepressant). Augmenting agents such as Antipsychotics: Risperidone, Aripiprazole, Haloperidol, and Olanzapine

Also read: Mood Disorder: Types, Symptoms and Treatment

Opioid Intoxication

Treatment Drug of Choice

IV Naloxone: It is an opioid antagonist, which is short-acting. It is given at a slow rate of 0.8 mg / 70 kg of body weight.

Signs of improvement: increased respiratory rate, Pupillary Dilation

Opioid Withdrawal 

Withdrawal symptoms are flu-like symptoms:

• Patients may complain of diarrhea, lacrimation, rhinnorrhea, or sweating.
• Patients may complain of Piloerection or Gooseflesh
• The eyes of the patient would show Pupillary Dilation (mydriasis)
• Patient may also show insomnia, hypertension, or tachycardia.
• Temperature Dysregulation (Hypothermia, Hyperthermia)
• Nausea, Vomiting, Restlessness

Cannabis

There is an excessive feeling of euphoria. There may also be a sense of time distortion (slowing down of time) · impaired motor coordination. Sometimes the patients experience some unpleasant symptoms of: Bad Trip: Sometime after cannabis use, patients experience restlessness, fear, panic symptoms, or a feeling of going crazy.

Withdrawal Symptoms of Cannabis

• Irritability, Anxiety
• Sleep difficulty (Insomnia, disturbing dreams)
• Decreased Appetite
• Depressed Mood
• Physical Symptoms: Tremors, sweating, fever, abdominal pain, chills.

Also read: Bipolar Disorder: Types, Symptoms and Causes

Epidemiology (Male and female)

• In schizophrenia, prevalence is nearly the same in both males and females.
• Depression is more common in females as compared to males; the ratio is 2:1.
• Bipolar Disorder 1 prevalence is the same in males and females.
• Bipolar Disorder 2 is more common in females as compared to males.
• Depersonalization-derealization disorder—male is equal to females.
• Dissociative Identity Disorder: Females are more than males.
• Social anxiety disorders: males are more than females.

Percentage Age & Common Comorbidities

• The prevalence of personality disorder in the general population is 10-20%.
• Borderline personality disorder is more common in females.
• The age of patients with schizophrenia who commit suicide is 5 to 6%.
• The age of patients with depression who commit suicide is 10 to 15%.
• The most common cause of premature death among people with schizophrenia is suicide.
• The age of reversible causes of dementia is 10 to 15%.
• The mean age of onset of depression is around 40 years.
• The mean age of onset of bipolar 1 disorder is 30 years.
• The lifetime prevalence of OCD in the general population is 2–3%.
• The mean age of onset of OCD is 19 years ( early onset will be more in males); prevalence in females is higher than in males.
• The most common comorbidity with agoraphobia is panic disorder.
• The most common comorbidity with OCD is depression.
• The most common comorbidity with anorexia nervosa is depression.

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