The women’s movements are being narrated in real-time by the voices, which is known as ‘running commentary’. It does not appear that the voices are affecting her thoughts in any way.

First Rank Symptoms: Their Significance in Identifying Schizophrenia

First rank symptoms were introduced by Kurt Schneider in 1938 as a practical tool for non-psychiatrists to identify schizophrenia. While they are highly suggestive of schizophrenia, they are not pathognomonic and can also be seen in affective and personality disorders. Additionally, there is no evidence to support their prognostic significance.

A systematic review in 2015 found that first rank symptoms differentiated schizophrenia from nonpsychotic mental health disorders with a sensitivity of 61.8% and a specificity of 94.1%. They also differentiated schizophrenia from other types of psychosis with a sensitivity of 58% and a specificity of 74.7%.

The first rank symptoms include running commentary, thought echo, voices heard arguing, thought insertion, thought withdrawal, thought broadcast, delusional perception, somatic passivity, made affect, and made volition. While they can be helpful in identifying schizophrenia, they should not be relied upon as the sole diagnostic criteria.

This scenario highlights the distinction between projection and projective identification. The woman is projecting her own sadness onto the cows, as she is unable to acknowledge of process her emotions. In projective identification, the recipient of the projection internalizes and identifies with the projected feelings. However, since it is impossible for the cows to experience human emotions, the correct term for this situation is projection.

Intermediate Mechanism: Rationalisation

Rationalisation is a defense mechanism commonly used by individuals to create false but credible justifications for their behavior of actions. It involves the use of logical reasoning to explain away of justify unacceptable behavior of feelings. The individual may not be aware that they are using this mechanism, and it can be difficult to identify in oneself.

Rationalisation is considered an intermediate mechanism, as it is common in healthy individuals from ages three to ninety, as well as in neurotic disorders and in mastering acute adult stress. It can be dramatically changed by conventional psychotherapeutic interpretation.

Examples of rationalisation include a student who fails an exam and blames the teacher for not teaching the material well enough, of a person who cheats on their partner and justifies it by saying their partner was neglectful of unaffectionate. It allows the individual to avoid taking responsibility for their actions and to maintain a positive self-image.

Overall, rationalisation can be a useful defense mechanism in certain situations, but it can also be harmful if it leads to a lack of accountability and an inability to learn from mistakes.

Melanie Klein, a prominent psychoanalyst, introduced two significant concepts in her work: the paranoid-schizoid position and the depressive position. The paranoid-schizoid position is a state of mind where the individual perceives the world as fragmented, dividing it into good and bad. This position is characterized by the defense mechanism of splitting, where the individual separates the good and bad aspects of themselves and others.

On the other hand, the depressive position follows the paranoid-schizoid position and is characterized by the ability to accept ambivalence, where something can be both good and bad. This position represents a more integrated state of mind, where the individual can hold conflicting emotions and thoughts simultaneously. These concepts have been influential in psychoanalytic theory and have contributed to our understanding of the human psyche.

The German psychiatrist August Cramer coined the term ‘gedankenlautwerden’ to describe the experience of hearing one’s thoughts spoken out loud just before of at the same time as they occur, which is a first rank symptom of schizophrenia. ‘Thought echo’ is another term used to describe the phenomenon of hearing one’s thoughts spoken after they have occurred. ‘Running commentaries’ and ‘thought withdrawal’ are also first rank symptoms of schizophrenia, with the former referring to auditory hallucinations commenting on the patient’s actions and the latter being a delusional belief that thoughts are being taken away from the patient’s mind.

Antipsychotic drugs are known to cause weight gain, but some more than others. The reason for this is not due to a direct metabolic effect, but rather an increase in appetite and a decrease in activity levels. The risk of weight gain appears to be linked to clinical response. There are several suggested mechanisms for this, including antagonism of certain receptors and hormones that stimulate appetite. The risk of weight gain varies among different antipsychotics, with clozapine and olanzapine having the highest risk. Management strategies for antipsychotic-induced weight gain include calorie restriction, low glycemic index diet, exercise, and switching to an alternative antipsychotic. Aripiprazole, ziprasidone, and lurasidone are recommended as alternative options. Other options include aripiprazole augmentation, metformin, orlistat, liraglutide, and topiramate.

Neurotrophins: Crucial for Neuronal Growth and Development

Neurotrophins are essential for the growth and development of neurons. However, disturbances in neurotrophic factors may contribute to some neurodevelopmental aspects of schizophrenia and major depression.

Studies have shown that patients with schizophrenia have increased concentrations of Brain-derived neurotrophic factor (BDNF) in cortical areas, but decreased levels in the hippocampus compared to controls. Additionally, patients with schizophrenia have lower concentrations of neurotrophin-3 in frontal and parietal areas than controls.

These findings suggest that neurotrophins play a critical role in the pathophysiology of schizophrenia and major depression. Further research is needed to fully understand the mechanisms underlying these disturbances in neurotrophic factors.

There is no correlation between multiple sclerosis and raised intraocular pressure, which is known as glaucoma when accompanied by visual field loss.

Multiple Sclerosis: An Overview

Multiple sclerosis is a neurological disorder that is classified into three categories: primary progressive, relapsing-remitting, and secondary progressive. Primary progressive multiple sclerosis affects 5-10% of patients and is characterized by a steady progression with no remissions. Relapsing-remitting multiple sclerosis affects 20-30% of patients and presents with a relapsing-remitting course but does not lead to serious disability. Secondary progressive multiple sclerosis affects 60% of patients and initially presents with a relapsing-remitting course but is then followed by a phase of progressive deterioration.

The disorder typically begins between the ages of 20 and 40 and is characterized by multiple demyelinating lesions that have a preference for the optic nerves, cerebellum, brainstem, and spinal cord. Patients with multiple sclerosis present with a variety of neurological signs that reflect the presence and distribution of plaques. Ocular features of multiple sclerosis include optic neuritis, internuclear ophthalmoplegia, and ocular motor cranial neuropathy.

Multiple sclerosis is more common in women than in men and is seen with increasing frequency as the distance from the equator increases. It is believed to be caused by a combination of genetic and environmental factors, with monozygotic concordance at 25%. Overall, multiple sclerosis is a predominantly white matter disease that can have a significant impact on a patient’s quality of life.

Melatonin: The Hormone of Darkness

Melatonin is a hormone that is produced in the pineal gland from serotonin. This hormone is known to be released in higher amounts during the night, especially in dark environments. Melatonin plays a crucial role in regulating the sleep-wake cycle and is often referred to as the hormone of darkness.

The production of melatonin is influenced by the amount of light that enters the eyes. When it is dark, the pineal gland releases more melatonin, which helps to promote sleep. On the other hand, when it is light, the production of melatonin is suppressed, which helps to keep us awake and alert.

Melatonin is also known to have antioxidant properties and may help to protect the body against oxidative stress. It has been suggested that melatonin may have a role in the prevention of certain diseases, such as cancer and neurodegenerative disorders.

Overall, melatonin is an important hormone that plays a crucial role in regulating our sleep-wake cycle and may have other health benefits as well.

Controversial studies in psychiatry have been a popular topic in exams. One such study was the Willowbrook School Study, where healthy children with learning difficulties were inoculated with hepatitis to assess the potential of gamma globulin to treat the disorder. Beecher’s study listed over 20 cases of mainstream research where subjects were experimented on without being fully informed of the risks. The Tuskegee syphilis experiment followed impoverished African-American sharecroppers with syphilis, and a significant proportion did not receive available treatment. Stanford’s prison experiment created a simulated prison environment where participants became their assigned roles, with guards becoming harsh and cruel to prisoners. The Tearooms Study involved Humphreys pretending to be a ‘watch queen’ to study men who have sex in public toilets, raising the issue of informed consent. Milgram’s Study investigated authority and obedience, where participants administered fake shocks to a confederate, with 30 participants continuing to administer shocks until 450 volts was reached. The Rosenhan experiment involved pseudopatients presenting themselves at institutions with the same symptoms and being admitted and diagnosed with serious mental disorders, leading to deinstitutionalisation.

The National Adult Reading Test as a Valid Measure of Premorbid Intelligence

The National Adult Reading Test (NART) is a reliable and valid assessment tool for measuring Premorbid intelligence. It comprises 50 words with irregular spellings, and the test-taker must correctly pronounce each word to receive a point. The NART is a useful tool for assessing cognitive function in individuals with neurological disorders of brain injuries, as it provides a baseline measure of their intellectual abilities before the onset of their condition. The NART is a widely used and respected measure of Premorbid intelligence, and its results can inform clinical decision-making and treatment planning.

Motor Neuron Lesions

Signs of an upper motor neuron lesion include weakness, increased reflexes, increased tone (spasticity), mild atrophy, an upgoing plantar response (Babinski reflex), and clonus. On the other hand, signs of a lower motor neuron lesion include atrophy, weakness, fasciculations, decreased reflexes, and decreased tone. It is important to differentiate between the two types of lesions as they have different underlying causes and require different treatment approaches. A thorough neurological examination can help identify the location and extent of the lesion, which can guide further diagnostic testing and management.

The patient’s long-term use of a first-generation depot antipsychotic and the involuntary symptoms presented suggest a diagnosis of tardive dyskinesia. Acute anxiety is unlikely as the patient has a long standing relationship with their psychiatrist and the symptom combination does not fit. Akathisia, characterized by restlessness and leg movement, is also an unlikely diagnosis. Neuroleptic malignant syndrome (NMS) can be ruled out as the patient has had symptoms for two years. The patient is compliant with medication, has no psychotic symptoms, and is well-functioning in their job and home life, making a relapse of schizophrenia an incorrect diagnosis.

According to the Maudsley Guidelines, it is recommended to administer a test dose for all first generation antipsychotics. Following the test dose, it is advised to wait 4-10 days before administering the next dose.

, coma, respiratory depression (rare)

Cotard’s syndrome is a disorder characterized by sudden onset of nihilistic delusions, including beliefs of poverty, negation, and meaninglessness. Hypochondriacal delusions and feelings of guilt may also be present. This condition is more prevalent in elderly individuals and females, and is often associated with depression and organic illnesses.

Classical Conditioning: A Learning Theory by Ivan Pavlov

Classical conditioning is a learning theory developed by Ivan Pavlov. It suggests that events that occur together are associated and acquire a similar meaning. Unlike operant conditioning, which focuses on responses to behavior, classical conditioning looks at responses to stimuli. In classical conditioning, animals behave as if they have learned to associate a stimulus with a significant event. Pavlov demonstrated that innate responses, such as a dog salivating when it sees food, can be associated with a neutral stimulus, such as ringing a bell, so that ringing the bell can cause salivation even in the absence of food.

Important terms used in classical conditioning include stimulus generalization and discrimination, higher order conditioning, spontaneous recovery, and aversive conditioning. Extinction is the laboratory analogue of exposure therapy for anxiety disorders, while Counterconditioning involves pairing a feared conditioned stimulus with a positive outcome. Incubation occurs in fear responses, and reciprocal inhibition is a technique that aims to replace an undesired response with a desired one by counterconditioning. Some stimuli are more prone to conditioning than others, which is referred to as stimulus/biological preparedness.

The symptoms experienced during discontinuation can be similar to those of anxiety and depression, leading to the possibility of misinterpreting them as a relapse.

Antidepressants can cause discontinuation symptoms when patients stop taking them, regardless of the type of antidepressant. These symptoms usually occur within 5 days of stopping the medication and can last up to 3 weeks. Symptoms include flu-like symptoms, dizziness, insomnia, vivid dreams, irritability, crying spells, and sensory symptoms. SSRIs and related drugs with short half-lives, such as paroxetine and venlafaxine, are particularly associated with discontinuation symptoms. Tapering antidepressants at the end of treatment is recommended to prevent these symptoms. TCAs and MAOIs are also associated with discontinuation symptoms, with amitriptyline and imipramine being the most common TCAs and all MAOIs being associated with prominent discontinuation symptoms. Patients at highest risk for discontinuation symptoms include those on antidepressants with shorter half-lives, those who have been taking antidepressants for 8 weeks of longer, those using higher doses, younger people, and those who have experienced discontinuation symptoms before. Agomelatine is not associated with any discontinuation syndrome. If a discontinuation reaction occurs, restarting the antidepressant of switching to an alternative with a longer half-life and tapering more slowly may be necessary. Explanation and reassurance are often sufficient for mild symptoms. These guidelines are based on the Maudsley Guidelines 14th Edition and a study by Tint (2008).

Hepatomegaly

Chronic alcohol abuse can lead to hepatomegaly, which is an enlargement of the liver. This can be detected on physical examination by palpating the liver below the right ribcage. Hepatomegaly can also be associated with other signs of liver disease, such as jaundice, spider naevi, and caput medusa. It is important for psychiatrists to be aware of these physical findings in patients with alcohol use disorder, as they may indicate the need for further medical evaluation and treatment.

Ethical theory and principles are important in medical ethics. There are three key ethical theories that have dominated medical ethics: utilitarianism, deontological, and virtue-based. Utilitarianism is based on the greatest good for the greatest number and is a consequentialist theory. Deontological ethics emphasize moral duties and rules, rather than consequences. Virtue ethics is based on the ethical characteristics of a person and is associated with the concept of a good, happy, flourishing life.

More recent frameworks have attempted to reconcile different theories and values. The ‘four principles’ of ‘principlism’ approach, developed in the United States, is based on four common, basic prima facie moral commitments: autonomy, beneficence, non-maleficence, and justice. Autonomy refers to a patient’s right to make their own decisions, beneficence refers to the expectation that a doctor will act in a way that will be helpful to the patient, non-maleficence refers to the fact that doctors should avoid harming their patients, and justice refers to the expectation that all people should be treated fairly and equally.

In psychology, the spacing effect suggests that humans are more likely to remember of learn items in a list when they are studied a few times over a long period of time (spaced presentation) rather than repeatedly in a short period of time, which is known as massed practice.

Classical Conditioning: A Learning Theory by Ivan Pavlov

Classical conditioning is a learning theory developed by Ivan Pavlov. It suggests that events that occur together are associated and acquire a similar meaning. Unlike operant conditioning, which focuses on responses to behavior, classical conditioning looks at responses to stimuli. In classical conditioning, animals behave as if they have learned to associate a stimulus with a significant event. Pavlov demonstrated that innate responses, such as a dog salivating when it sees food, can be associated with a neutral stimulus, such as ringing a bell, so that ringing the bell can cause salivation even in the absence of food.

Important terms used in classical conditioning include stimulus generalization and discrimination, higher order conditioning, spontaneous recovery, and aversive conditioning. Extinction is the laboratory analogue of exposure therapy for anxiety disorders, while Counterconditioning involves pairing a feared conditioned stimulus with a positive outcome. Incubation occurs in fear responses, and reciprocal inhibition is a technique that aims to replace an undesired response with a desired one by counterconditioning. Some stimuli are more prone to conditioning than others, which is referred to as stimulus/biological preparedness.

Boys typically begin puberty around the age of 12, while girls typically begin around the age of 11.

Puberty

Puberty is a natural process that occurs in both boys and girls. The age range for the onset of puberty is between 8-14 years for females and 9-14 years for males, with the mean age of onset being 11 years for girls and 12 years for boys. The duration of puberty is typically 3-4 years. The onset of puberty is marked by the appearance of secondary sex characteristics, such as breast development in females and testicular enlargement in males. These characteristics evolve over time and are rated into 5 stages according to Tanner’s criteria. The sequence of events differs between boys and girls, with the onset of breast development (thelarche) generally preceding the onset of the first period (menarche) by around 2 years in girls. The pubertal growth spurt occurs during stages 3 to 4 in most boys and during stages 2 and 3 in girls. Precocious puberty, which occurs earlier than usual, is more common in girls than in boys. The age of onset of puberty in girls has been decreasing over time, with environmental factors such as nutrition potentially playing a role in this trend.

EEG waveforms may be slightly disrupted by antipsychotic medication, while sporadic Creutzfeldt-Jakob disease (CJD) is linked to specific periodic sharp wave complexes (PSWC) during the middle and late stages of the illness. Generalized seizures would exhibit more pronounced irregularities, whereas temporal lobe epilepsy (TLE) would display anomalous activity originating from a single temporal lobe.

Understanding the Volume of Distribution in Pharmacology

The volume of distribution (Vd) is a crucial concept in pharmacology that helps determine how a drug distributes in the body. It is also known as the apparent volume of distribution, as it is an abstract volume. The Vd indicates whether a drug concentrates in the plasma of spreads out in the body. Drugs that are highly polar tend to stay in central compartments such as the plasma, resulting in a low Vd. Conversely, drugs that are more lipid-soluble are distributed widely, such as in fat, resulting in a high Vd.

The Vd is calculated by dividing the amount of drug in the body by the concentration in the plasma. Clinically, the Vd is used to determine the loading dose of a drug required for a desired blood concentration and to estimate blood concentration in the treatment of overdose. The units of Vd are in volume.

The apparent volume of distribution is dependent on the drug’s lipid of water solubility, plasma protein binding, and tissue binding. Plasma protein binding affects the Vd, as drugs that bind to plasma proteins like albumin have a smaller apparent volume of distribution. This is because they are extracted from plasma and included in drug concentration measurements, which can give a misleading impression of their volume of distribution. Understanding the Vd is essential in pharmacology to ensure the safe and effective use of drugs.

The half-life of a drug is the time taken for its concentration to fall to one half of its value. Drugs with long half-lives may require a loading dose to achieve therapeutic plasma concentrations rapidly. It takes about 4.5 half-lives to reach steady state plasma levels. Most drugs follow first order kinetics, where a constant fraction of the drug in the body is eliminated per unit time. However, some drugs may follow zero order kinetics, where the plasma concentration of the drug decreases at a constant rate, despite the concentration of the drug. For drugs with nonlinear kinetics of dose-dependent kinetics, the relationship between the AUC of CSS and dose is not linear, and the kinetic parameters may vary depending on the administered dose.

Maslow’s Hierarchy of Needs is a theory of motivation introduced by Abraham Maslow. The hierarchy consists of five levels, with the most basic needs at the bottom and the most advanced needs at the top. Maslow proposed that a person would only become concerned with the needs of a particular level when all the needs of the lower levels had been satisfied. The levels include physiological needs, safety needs, social needs, esteem needs, and self-actualization needs. Maslow also made a distinction between D-needs (deficiency needs) and B-needs (being needs), with B-needs allowing us to reach our full potential but only after D-needs have been satisfied. Later in life, Maslow expanded upon the model and included cognitive, aesthetic, and transcendence needs, resulting in an eight-staged model. The cognitive needs include knowledge and understanding, while aesthetic needs involve appreciation and search for beauty. Transcendence needs are motivated by values that transcend beyond the personal self.

Drug Interactions: Understanding the Different Types

Drug interactions can occur in different ways, and it is important to understand the different types to avoid potential harm. Pharmacokinetic drug interactions happen when one drug affects the metabolism, absorption, of excretion of another drug. This can be due to enzyme induction of inhibition, changes in gastrointestinal tract motility and pH, chelation, competition for renal tubular transport, of changes in protein binding. On the other hand, pharmacodynamic drug interactions occur when one drug directly alters the effect of another drug. This can happen through synergism, antagonism, of interaction at receptors, such as allosteric modulation. It is important to note that pharmacodynamic drug interactions do not involve any absorption, distribution, metabolism, of excretion processes directly. By understanding the different types of drug interactions, healthcare professionals can better manage patients’ medications and prevent potential adverse effects.

Imipramine antidepressant effects were discovered by Kuhn. Kane introduced clozapine into clinical practice after conducting a successful double-blind multicenter trial comparing it with chlorpromazine in treatment-resistant schizophrenia. Charpentier synthesized chlorpromazine, while Klein discovered the use of iproniazid. Cade discovered the beneficial effect of lithium in treating mania.

Out of the given options, the Raven’s progressive matrices test is the sole test that does not involve verbal elements.

Intelligence Test: Raven’s Progressive Matrices

The Raven’s Progressive Matrices (RPM) test is designed to measure general intelligence without the use of verbal language. The test consists of a series of items where the participant is required to identify the missing pattern in a sequence. The difficulty level of the items increases progressively, which demands greater cognitive capacity to encode and analyze the patterns.

There are three versions of the RPM test, each designed for different age groups and abilities. The Coloured Progressive Matrices is intended for younger children and special groups, while the Stanford Progressive Matrices is suitable for individuals aged 6 to 80 years old with average intelligence. The Advanced Progressive Matrices is designed for above-average adolescents and adults.

Mahler’s Separation-Individuation theory of child development proposes that personality development occurs in distinct stages. The first stage, the Autistic phase, occurs during the first few weeks of life, where the child is mostly sleeping and cut off from the world. The second stage, the Symbiotic phase, lasts until around six months of age, where the child sees themselves and their mother as a single unit. The third stage, Separation-Individuation, has four subphases. The first subphase, Differentiation, occurs between six to ten months, where the child begins to see themselves as an individual and experiences separation anxiety. The second subphase, Practicing, occurs between ten to sixteen months, where the child explores connections with the external world and people other than the mother. The third subphase, Rapprochement, occurs between sixteen to twenty-four months, where the child struggles to balance their desire for independence and proximity to the mother, often resulting in tantrums and the use of transitional objects. The fourth subphase, Object constancy, occurs between twenty-four to thirty-six months, where the child accepts the idea of object constancy and is more comfortable with the mother being separate for periods of time.

Lewy body dementia is a neurodegenerative disorder that is characterized by both macroscopic and microscopic changes in the brain. Macroscopically, there is cerebral atrophy, but it is less marked than in Alzheimer’s disease, and the brain weight is usually in the normal range. There is also pallor of the substantia nigra and the locus coeruleus, which are regions of the brain that produce dopamine and norepinephrine, respectively.

Microscopically, Lewy body dementia is characterized by the presence of intracellular protein accumulations called Lewy bodies. The major component of a Lewy body is alpha synuclein, and as they grow, they start to draw in other proteins such as ubiquitin. Lewy bodies are also found in Alzheimer’s disease, but they tend to be in the amygdala. They can also be found in healthy individuals, although it has been suggested that these may be pre-clinical cases of dementia with Lewy bodies. Lewy bodies are also found in other neurodegenerative disorders such as progressive supranuclear palsy, corticobasal degeneration, and multiple system atrophy.

In Lewy body dementia, Lewy bodies are mainly found within the brainstem, but they are also found in non-brainstem regions such as the amygdaloid nucleus, parahippocampal gyrus, cingulate cortex, and cerebral neocortex. Classic brainstem Lewy bodies are spherical intraneuronal cytoplasmic inclusions, characterized by hyaline eosinophilic cores, concentric lamellar bands, narrow pale halos, and immunoreactivity for alpha synuclein and ubiquitin. In contrast, cortical Lewy bodies typically lack a halo.

Most brains with Lewy body dementia also show some plaques and tangles, although in most instances, the lesions are not nearly as severe as in Alzheimer’s disease. Neuronal loss and gliosis are usually restricted to brainstem regions, particularly the substantia nigra and locus ceruleus.

Neurotransmitters are substances used by neurons to communicate with each other and with target tissues. They are synthesized and released from nerve endings into the synaptic cleft, where they bind to receptor proteins in the cellular membrane of the target tissue. Neurotransmitters can be classified into different types, including small molecules (such as acetylcholine, dopamine, norepinephrine, serotonin, and GABA) and large molecules (such as neuropeptides). They can also be classified as excitatory or inhibitory. Receptors can be ionotropic or metabotropic, and the effects of neurotransmitters can be fast of slow. Some important neurotransmitters include acetylcholine, dopamine, GABA, norepinephrine, and serotonin. Each neurotransmitter has a specific synthesis, breakdown, and receptor type. Understanding neurotransmitters is important for understanding the function of the nervous system and for developing treatments for neurological and psychiatric disorders.

Antipsychotics are commonly used to treat various mental health conditions. Most atypical antipsychotics require twice daily administration due to their short half-lives, except for olanzapine, aripiprazole, and risperidone. These medications have longer half-lives and can be administered once daily. A recent randomized controlled trial compared once versus twice daily dosing of risperidone and olanzapine and found no significant difference in effectiveness and efficacy outcomes. However, the study suggests that once-daily dosing may be preferable due to lower mean dose and better side effect profile, especially for olanzapine.

Flooding as a Treatment for Phobias

Flooding is a treatment method for phobias that involves directly confronting the fear and remaining in the situation until the anxiety subsides. This process is called habituation and is different from systematic desensitization. However, flooding can be challenging for patients as it produces high levels of anxiety, which can cause them to leave the situation before the fear response is extinguished. As a result, desensitization is generally preferred over flooding as a treatment method for phobias.

Sertraline is the preferred medication for treating post-MI depression as it has minimal impact on heart rate, blood pressure, and the QTc interval. Tricyclics are not recommended due to their potential to cause postural hypotension, increased heart rate, and QTc interval prolongation. Fluoxetine may be used with caution as it has a slight effect on heart rate but does not significantly affect blood pressure of the QTc interval. Trazodone should be used with care as it can cause significant postural hypotension and QTc interval prolongation in post-MI patients. Venlafaxine should be avoided in these patients as it can increase blood pressure, particularly at higher doses.

Attachment (Ainsworth)

Psychologist Mary Ainsworth developed the ‘Strange Situation procedure’ to study and categorize attachment in children aged 12 to 18 months. The procedure involves seven steps, including two separations and two reunions, and takes place in one room. The child’s attachment is classified into one of three styles: secure, anxious-resistant, and anxious-avoidant. A fourth category, disorganized, is sometimes observed. Ainsworth suggested that the child’s attachment style is determined by the primary caregiver’s behavior.

Mary Main later developed the Adult Attachment Interview and identified four categories of attachment in adults that correspond to those observed in the strange situation. The distribution of adult attachment styles correlates with those of the strange situation, with 70% of children and adults having secure attachment. Attachment styles also seem to be passed on to subsequent generations.

ADHD medications can be classified into stimulant and non-stimulant drugs. The therapeutic effects of these drugs are believed to be mediated through the action of noradrenaline in the prefrontal cortex. Common side effects of these drugs include decreased appetite, insomnia, nervousness, headache, and nausea. Stimulant drugs like dexamphetamine, methylphenidate, and lisdexamfetamine inhibit the reuptake of dopamine and noradrenaline. Non-stimulant drugs like atomoxetine, guanfacine, and clonidine work by increasing noradrenaline levels in the synaptic cleft through different mechanisms. The most common side effects of these drugs are decreased appetite, somnolence, headache, and abdominal pain.

The medial temporal lobe, comprising the hippocampus and parahippocampal gyrus, exhibits the earliest neuropathological alterations.

Alzheimer’s disease is characterized by both macroscopic and microscopic changes in the brain. Macroscopic changes include cortical atrophy, ventricular dilation, and depigmentation of the locus coeruleus. Microscopic changes include the presence of senile plaques, neurofibrillary tangles, gliosis, degeneration of the nucleus of Meynert, and Hirano bodies. Senile plaques are extracellular deposits of beta amyloid in the gray matter of the brain, while neurofibrillary tangles are intracellular inclusion bodies that consist primarily of hyperphosphorylated tau. Gliosis is marked by increases in activated microglia and reactive astrocytes near the sites of amyloid plaques. The nucleus of Meynert degenerates in Alzheimer’s, resulting in a decrease in acetylcholine in the brain. Hirano bodies are actin-rich, eosinophilic intracytoplasmic inclusions which have a highly characteristic crystalloid fine structure and are regarded as a nonspecific manifestation of neuronal degeneration. These changes in the brain contribute to the cognitive decline and memory loss seen in Alzheimer’s disease.

Although CAGE is commonly used for screening, it should not be used as a diagnostic tool. Additionally, it is not recommended to use CAGE as an outcome measure. AUDIT has been found to be more effective than CAGE and is the preferred screening tool according to the NICE Guidelines (CG115).

Alcohol screening tools are available to assist in the diagnosis of alcohol problems. One such tool is the AUDIT (Alcohol Use Disorders Identification Test), which consists of 10 questions and covers harmful use, hazardous use, and dependence. Another tool is the FAST (Fast Alcohol Screening Test), which has just 4 questions and was developed for use in a busy medical setting. The CAGE is a well-known 4 question screening tool, but recent research has questioned its value. Other tools include SASQ (Single alcohol screening questionnaire), PAT (Paddington Alcohol Test), MAST (Michigan Alcoholism Screening Test), and RAPS4 (Rapid Alcohol Problem Screen 4). These tools can help identify hazardous of harmful alcohol consumption and alcohol dependence.

The SASQ is a screening questionnaire that consists of a single question asking about the last time an individual had more than a certain number of alcoholic drinks in one day (8 for men and 6 for women). If the response indicates that this occurred within the past 3 months, it suggests that the individual may be engaging in harmful of hazardous drinking.

Alcohol screening tools are available to assist in the diagnosis of alcohol problems. One such tool is the AUDIT (Alcohol Use Disorders Identification Test), which consists of 10 questions and covers harmful use, hazardous use, and dependence. Another tool is the FAST (Fast Alcohol Screening Test), which has just 4 questions and was developed for use in a busy medical setting. The CAGE is a well-known 4 question screening tool, but recent research has questioned its value. Other tools include SASQ (Single alcohol screening questionnaire), PAT (Paddington Alcohol Test), MAST (Michigan Alcoholism Screening Test), and RAPS4 (Rapid Alcohol Problem Screen 4). These tools can help identify hazardous of harmful alcohol consumption and alcohol dependence.

Cranial Nerve Reflexes

When it comes to questions on cranial nerve reflexes, it is important to match the reflex to the nerves involved. Here are some examples:

– Pupillary light reflex: involves the optic nerve (sensory) and oculomotor nerve (motor).
– Accommodation reflex: involves the optic nerve (sensory) and oculomotor nerve (motor).
– Jaw jerk: involves the trigeminal nerve (sensory and motor).
– Corneal reflex: involves the trigeminal nerve (sensory) and facial nerve (motor).
– Vestibulo-ocular reflex: involves the vestibulocochlear nerve (sensory) and oculomotor, trochlear, and abducent nerves (motor).

Another example of a cranial nerve reflex is the gag reflex, which involves the glossopharyngeal nerve (sensory) and the vagus nerve (motor). This reflex is important for protecting the airway from foreign objects of substances that may trigger a gag reflex. It is also used as a diagnostic tool to assess the function of these nerves.

Memory Forms

Memory is the ability to store, retain, and retrieve information. There are different forms of memory, including sensory memory, short-term/working memory, and long-term memory.

Sensory memory is the capacity for briefly retaining the large amounts of information that people encounter daily. It includes echoic memory (gathered through auditory stimuli), iconic memory (gathered through sight), and haptic memory (acquired through touch).

Short-term memory is the ability to keep a small amount of information available for a short period of time. Atkinson and Shiffrin’s multistore model (1968) suggests the existence of a short-term storehouse with limited capacity. Baddeley and Hitch (1974) further developed the concept of short-term memory, which eventually became known as Baddeley’s multi-storehouse model (2000). This model includes the central executive, visuospatial sketchpad, phonological buffer/loop, and episodic buffer.

Long-term memory includes declarative (of explicit) memories, which can be consciously retrieved, and nondeclarative (of implicit) memories, which cannot. Declarative memory includes episodic memory (stores personal experiences) and semantic memory (stores information about facts and concepts). Non-declarative memory includes procedural memory (recalls motor and executive skills), associative memory (storage and retrieval of information through association with other information), and non-associative memory (refers to newly learned behavior through repeated exposure to an isolated stimulus).

Overall, memory is a complex and essential cognitive function that plays a crucial role in learning, reasoning, and understanding.

As the concentration decreases, the half-life of a zero order reaction becomes shorter. This is because zero order kinetics involve constant elimination, meaning that the rate of elimination does not change with increasing concentration. Therefore, as the concentration decreases, there is less drug available to be eliminated at a constant rate, resulting in a shorter half-life.

The half-life of a drug is the time taken for its concentration to fall to one half of its value. Drugs with long half-lives may require a loading dose to achieve therapeutic plasma concentrations rapidly. It takes about 4.5 half-lives to reach steady state plasma levels. Most drugs follow first order kinetics, where a constant fraction of the drug in the body is eliminated per unit time. However, some drugs may follow zero order kinetics, where the plasma concentration of the drug decreases at a constant rate, despite the concentration of the drug. For drugs with nonlinear kinetics of dose-dependent kinetics, the relationship between the AUC of CSS and dose is not linear, and the kinetic parameters may vary depending on the administered dose.

Across all medical specialties, it is typical for patients to take less than half of their prescribed doses of self-administered medications, indicating low adherence rates that have been shown to be around 50%.

FGM is against the law in the UK, and arranging for a child to undergo the procedure abroad is also illegal. Those who are caught can face a prison sentence of up to 14 years and a hefty fine. Shockingly, it is estimated that 66,000 women in the UK have already undergone FGM, and over 20,000 girls under the age of 15 are at risk. Often, children are taken to have the procedure during the summer holidays so that they have time to heal before returning to school. There are four main types of FGM, including clitoridectomy, excision, infibulation, and other harmful procedures such as pricking, piercing, cutting, scraping, and burning the genital area. FGM is carried out for cultural, religious, and social reasons and is most prevalent in Africa, although it also occurs in Asia and the Middle East. The experience can be extremely traumatic, and those who have undergone FGM may require counseling in the future. Recently, medical professionals have faced criminal prosecution for allegedly performing the procedure, which is illegal in the UK.

Extrapyramidal side-effects (EPSE’s) are a group of side effects that affect voluntary motor control, commonly seen in patients taking antipsychotic drugs. EPSE’s include dystonias, parkinsonism, akathisia, and tardive dyskinesia. They can be frightening and uncomfortable, leading to problems with non-compliance and can even be life-threatening in the case of laryngeal dystonia. EPSE’s are thought to be due to antagonism of dopaminergic D2 receptors in the basal ganglia. Symptoms generally occur within the first few days of treatment, with dystonias appearing quickly, within a few hours of administration of the first dose. Newer antipsychotics tend to produce less EPSE’s, with clozapine carrying the lowest risk and haloperidol carrying the highest risk. Akathisia is the most resistant EPSE to treat. EPSE’s can also occur when antipsychotics are discontinued (withdrawal dystonia).

Neurodevelopment: Understanding Brain Development

The development of the central nervous system begins with the neuroectoderm, a specialized region of ectoderm. The embryonic brain is divided into three areas: the forebrain (prosencephalon), midbrain (mesencephalon), and hindbrain (rhombencephalon). The prosencephalon further divides into the telencephalon and diencephalon, while the hindbrain subdivides into the metencephalon and myelencephalon.

The telencephalon, of cerebrum, consists of the cerebral cortex, underlying white matter, and the basal ganglia. The diencephalon includes the prethalamus, thalamus, hypothalamus, subthalamus, epithalamus, and pretectum. The mesencephalon comprises the tectum, tegmentum, ventricular mesocoelia, cerebral peduncles, and several nuclei and fasciculi.

The rhombencephalon includes the medulla, pons, and cerebellum, which can be subdivided into a variable number of transversal swellings called rhombomeres. In humans, eight rhombomeres can be distinguished, from caudal to rostral: Rh7-Rh1 and the isthmus. Rhombomeres Rh7-Rh4 form the myelencephalon, while Rh3-Rh1 form the metencephalon.

Understanding neurodevelopment is crucial in comprehending brain development and its complexities. By studying the different areas of the embryonic brain, we can gain insight into the formation of the central nervous system and its functions.

If there are no T wave abnormalities on the ECG, the Maudsley guidelines deem a QTc of 460 ms acceptable for women.

Amantadine and QTc Prolongation

Amantadine is a medication used to treat Parkinson’s disease and influenza. It has been associated with QTc prolongation, which can increase the risk of Torsades de points. Therefore, caution should be exercised when prescribing amantadine to patients with risk factors for QT prolongation. If a patient is already taking amantadine and develops a prolonged QTc interval, the medication should be discontinued and an alternative treatment considered. It is important to monitor the QTc interval in patients taking amantadine, especially those with risk factors for QT prolongation.

Frégoli syndrome is a type of delusional misidentification syndrome where a person believes that a familiar person is taking on the appearance of other people. It is named after Leopold Frégoli, a famous impersonator known for his quick changes. In contrast, Capgras syndrome involves the belief that a familiar person has been replaced by an imposter, while Cotard’s syndrome is characterized by nihilistic delusions such as the belief that one is dead. Intermetamorphosis is another delusional misidentification syndrome where a person thinks they can see others physically and physiologically transform into someone else. Finally, the syndrome of subjective doubles involves the belief that another person has become a copy of oneself.

Kurt Schneider identified a set of symptoms that are highly indicative of schizophrenia, but not diagnostic. These are known as first-rank symptoms and include thought echo, third person auditory hallucinations, running commentary, made affect, made volition, made impulse, thought withdrawal, thought insertion, thought broadcast, delusional perception, and somatic passivity. Additionally, Schneider identified second-rank symptoms, which are common in schizophrenia but also occur in other mental illnesses. These include mood changes, emotional blunting, perplexity, and sudden delusional ideas.

D.W. Winnicott – Good enough mother, transitional object: Winnicott believed that a good enough mother is one who provides a secure and nurturing environment for her child, allowing them to develop a sense of self and independence. He also introduced the concept of the transitional object, such as a teddy bear of blanket, which helps a child transition from the mother’s care to the outside world.

Carl Jung – Collective unconscious, archetype, anima, animus: Jung believed in the existence of a collective unconscious, a shared pool of knowledge and experience that all humans possess. He also introduced the concept of archetypes, universal symbols and patterns that are present in the collective unconscious. The anima and animus are archetypes representing the feminine and masculine aspects of the psyche.

Melanie Klein – Paranoid-schizoid position, depressive position, splitting: Klein introduced the concept of the paranoid-schizoid position, a stage of development in which a child experiences intense anxiety and fear of persecution. She also introduced the depressive position, a stage in which the child learns to integrate positive and negative feelings towards others. Splitting is the defense mechanism in which a person sees things as either all good of all bad.

Sigmund Freud – Free association, transference, ego, super-ego, id, eros, thanatos, defense mechanisms, oedipus Complex, the unconscious: Freud is known for his theories on the unconscious mind, including the id, ego, and super-ego. He also introduced the concepts of eros (the life instinct) and thanatos (the death instinct), as well as defense mechanisms such as repression and denial. The Oedipus complex is a theory about a child’s sexual desire for their opposite-sex parent.

Wilfred Bion – Basic assumption group: Bion introduced the concept of the basic assumption group, a group that forms around a shared fantasy of assumption. He believed that these groups can be helpful of harmful, depending on the assumptions they are based on.

Karen Horney – Womb envy: Horney believed that men experience womb envy, a feeling of inferiority and jealousy towards women due to their inability to bear children. She also introduced the concept of neurotic needs, such as the need for affection and the need for power.

Erving Goffman – Total institution: Goffman introduced the concept of the total institution, a place where people are completely cut off from the outside world and subjected to strict rules and regulations. Examples include prisons and mental hospitals.

Siegfried Foulkes – Foundation matrix: Foulkes introduced the concept of the foundation matrix, a group’s shared history and experiences that shape their current dynamics and interactions.

The inability to carry out complex instructions is referred to as Ideational Apraxia, while the inability to perform previously learned actions with the appropriate tools is known as Ideomotor Apraxia.

Apraxia: Understanding the Inability to Carry Out Learned Voluntary Movements

Apraxia is a neurological condition that affects a person’s ability to carry out learned voluntary movements. It is important to note that this condition assumes that everything works and the person is not paralyzed. There are different types of apraxia, each with its own set of symptoms and characteristics.

Limb kinetic apraxia is a type of apraxia that affects a person’s ability to make fine of delicate movements. This can include tasks such as buttoning a shirt of tying shoelaces.

Ideomotor apraxia, on the other hand, is an inability to carry out learned tasks when given the necessary objects. For example, a person with ideomotor apraxia may try to write with a hairbrush instead of using it to brush their hair.

Constructional apraxia affects a person’s ability to copy a picture of combine parts of something to form a whole. This can include tasks such as building a puzzle of drawing a picture.

Ideational apraxia is an inability to follow a sequence of actions in the correct order. For example, a person with ideational apraxia may struggle to take a match out of a box and strike it with their left hand.

Finally, oculomotor apraxia affects a person’s ability to control eye movements. This can make it difficult for them to track moving objects of read smoothly.

Overall, apraxia can have a significant impact on a person’s ability to carry out everyday tasks. However, with the right support and treatment, many people with apraxia are able to improve their abilities and maintain their independence.

Both hyperthyroidism and hypothyroidism can lead to the development of pretibial myxoedema, while hyporeflexia is typically only observed in cases of hypothyroidism.

Thyroid Examination Findings

Hypothyroidism:

– Weight gain (with decreased appetite)
– Intolerance to cold
– Lethargy
– Constipation
– Menstrual disturbances
– Decreased perspiration

Exam findings:

– Hair loss
– Bradycardia
– Periorbital puffiness and dry skin
– Coarse, brittle, straw-like hair
– Myxoedema
– Hyporeflexia

Hyperthyroidism:

– Weight loss (with increased appetite)
– Intolerance to heat
– Palpitations
– Menstrual disturbances

Exam findings:

– Hair loss
– Tachycardia
– Warm, moist, and smooth skin
– Tremor
– Brisk reflexes

The Yerkes-Dodson curve suggests that performance is optimal at moderate levels of arousal, forming an inverted U-shaped relationship.
Cox developed a stimulus model theory inspired by engineering principles, including Hooke’s Law of Elasticity.
Lazarus and Folkman investigated how the perception and interpretation of stressors affect emotional responses.
Seyle is known for his work on response models and the general adaptation syndrome (GAS).
Plutchik identified eight fundamental emotions.

Enzymes known as RNA polymerases are responsible for transcribing RNA from DNA. The role of RNA is crucial in the process of protein synthesis. Messenger RNA, a specific type of RNA, carries genetic information from DNA to ribosomes. Ribosomes are composed of ribosomal RNAs and proteins, and they function as a molecular apparatus that can interpret messenger RNAs and convert the information they contain into proteins.

Genomics: Understanding DNA, RNA, Transcription, and Translation

Deoxyribonucleic acid (DNA) is a molecule composed of two chains that coil around each other to form a double helix. DNA is organised into chromosomes, and each chromosome is made up of DNA coiled around proteins called histones. RNA, on the other hand, is made from a long chain of nucleotide units and is usually single-stranded. RNA is transcribed from DNA by enzymes called RNA polymerases and is central to protein synthesis.

Transcription is the synthesis of RNA from a DNA template, and it consists of three main steps: initiation, elongation, and termination. RNA polymerase binds at a sequence of DNA called the promoter, and the transcriptome is the collection of RNA molecules that results from transcription. Translation, on the other hand, refers to the synthesis of polypeptides (proteins) from mRNA. Translation takes place on ribosomes in the cell cytoplasm, where mRNA is read and translated into the string of amino acid chains that make up the synthesized protein.

The process of translation involves messenger RNA (mRNA), transfer RNA (tRNA), and ribosomal RNA (rRNA). Transfer RNAs, of tRNAs, connect mRNA codons to the amino acids they encode, while ribosomes are the structures where polypeptides (proteins) are built. Like transcription, translation also consists of three stages: initiation, elongation, and termination. In initiation, the ribosome assembles around the mRNA to be read and the first tRNA carrying the amino acid methionine. In elongation, the amino acid chain gets longer, and in termination, the finished polypeptide chain is released.

Toxicity in Overdose: Comparing MAOIs, SSRIs, Tricyclics, and Mirtazapine

When it comes to the risk of overdose, not all antidepressants are created equal. MAOIs (except for moclobemide) have a high toxicity level, with as little as 400 mg of phenelzine being potentially fatal. On the other hand, SSRIs are considered relatively safe in overdose. Tricyclics, except for lofepramine, have a higher risk of toxicity in overdose. However, lofepramine is relatively safe in overdose. Mirtazapine, while sedative, has a low risk of toxicity even in large doses, and may not produce any symptoms. It’s important to note that regardless of the perceived safety of a medication, any overdose should be taken seriously and medical attention should be sought immediately.

To obtain an accurate measurement of the QT interval, it is recommended to measure it in lead II of leads V5-6. The Bazett formula may not provide accurate corrections for heart rates above 100 bpm of below 60 bpm, but it can be used to estimate the QT interval at a standard heart rate of 60 bpm through the corrected QT interval (QTc).

QTc Prolongation: Risks and Identification

The QT interval is a measure of the time it takes for the ventricles to repolarize and is calculated from the beginning of the QRS complex to the end of the T wave. However, the QT interval varies with the heart rate, making it difficult to use a single number as a cut-off for a prolonged QT. Instead, a corrected QT interval (QTc) is calculated for each heart rate using various formulas. A QTc over the 99th percentile is considered abnormally prolonged, with approximate values of 470 ms for males and 480 ms for females.

Prolonged QT intervals can lead to torsade de pointes (TdP), a polymorphic ventricular tachycardia that can be fatal if it degenerates into ventricular fibrillation. TdP is characterized by a twisting of the QRS complexes around an isoelectric line and is often asymptomatic but can also be associated with syncope and death. An accurate diagnosis requires an ECG to be recorded during the event. It is important to note that an increase in the QT interval due to a new conduction block should not be considered indicative of acquired LQTS and risk for TdP.

Personality assessment can be approached in two ways: objective and projective. Objective assessment involves structured, standardized measurement tools that typically require self-reporting. This approach uses direct questions to gather information about a person’s opinion of themselves. In contrast, projective assessment involves unstructured and often ambiguous stimuli to elicit responses that reveal information about a person’s personality. The Holtzman inkblot technique (HIT) is an example of a projective measure, while the Eysenck personality questionnaire (EPQ), Personality Assessment Inventory (PAI), and Millon Clinical Multiaxial Inventory (MCMI) are all examples of objective measures. The EPQ, PAI, and MCMI all use a true of false self-reporting format to gather information about a person’s personality.

Cranial Nerve Reflexes

When it comes to questions on cranial nerve reflexes, it is important to match the reflex to the nerves involved. Here are some examples:

– Pupillary light reflex: involves the optic nerve (sensory) and oculomotor nerve (motor).
– Accommodation reflex: involves the optic nerve (sensory) and oculomotor nerve (motor).
– Jaw jerk: involves the trigeminal nerve (sensory and motor).
– Corneal reflex: involves the trigeminal nerve (sensory) and facial nerve (motor).
– Vestibulo-ocular reflex: involves the vestibulocochlear nerve (sensory) and oculomotor, trochlear, and abducent nerves (motor).

Another example of a cranial nerve reflex is the gag reflex, which involves the glossopharyngeal nerve (sensory) and the vagus nerve (motor). This reflex is important for protecting the airway from foreign objects of substances that may trigger a gag reflex. It is also used as a diagnostic tool to assess the function of these nerves.

The classification of body integrity dysphoria falls under the group of conditions known as ‘disorders of bodily distress of bodily experience’, which was previously referred to as somatoform disorder.

Somatoform and dissociative disorders are two groups of psychiatric disorders that are characterised by physical symptoms and disruptions in the normal integration of identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, of behaviour. Somatoform disorders are characterised by physical symptoms that are presumed to have a psychiatric origin, while dissociative disorders are characterised by the loss of integration between memories, identity, immediate sensations, and control of bodily movements. The ICD-11 lists two main types of somatoform disorders: bodily distress disorder and body integrity dysphoria. The former involves bodily symptoms that the individual finds distressing and to which excessive attention is directed, while the latter involves a disturbance in the person’s experience of the body manifested by the persistent desire to have a specific physical disability accompanied by persistent discomfort of intense feelings of inappropriateness concerning current non-disabled body configuration. Dissociative disorders, on the other hand, are characterised by involuntary disruption of discontinuity in the normal integration of identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, of behaviour. The ICD-11 dissociative disorders include dissociative neurological symptom disorder, dissociative amnesia, trance disorder, possession trance disorder, dissociative identity disorder, partial dissociative identity disorder, depersonalization-derealization disorder, and other specified dissociative disorders. Each disorder has its own set of essential features and diagnostic criteria.

The pupils are innervated by both sides of the midbrain and respond to ambient light levels. If there is an optic nerve lesion, the non-damaged nerve becomes dominant and both pupils respond to ambient light from that nerve. A helpful mnemonic for remembering the cranial nerves and their functions is OOOTTAFVGVAH for the nerves and SSMMBMBSBBMM for their functions. To recall the innervation of the extraocular muscles, one can use SO4 LR6. The optic nerve is II, oculomotor is III and supplies all extraocular muscles except for the superior oblique and lateral rectus, trochlear is IV and innervates the superior oblique muscle for depression and intorsion, trigeminal is V and supplies sensory information and muscles of mastication, and abducens is VI and controls the lateral rectus muscle of the eye.

– Catatonia is a psychiatric syndrome characterized by disturbed motor functions, mood, and thought.
– Key behaviors associated with catatonia include stupor, posturing, waxy flexibility, negativism, automatic obedience, mitmachen, mitgehen, ambitendency, psychological pillow, forced grasping, obstruction, echopraxia, aversion, mannerisms, stereotypies, motor perseveration, echolalia, and logorrhoea.
– These behaviors are often tested in exam questions.
– Karl Ludwig Kahlbaum is credited with the original clinical description of catatonia.

Types of Gender and Sexual Identity

Dual-role transvestism refers to the act of wearing clothing typically associated with the opposite sex without experiencing discomfort with one’s biological gender of a desire to permanently live as the opposite sex. This behavior is not accompanied by sexual arousal, which distinguishes it from fetishistic transvestism. Fetishistic transvestism, on the other hand, involves wearing clothing of the opposite sex for the purpose of sexual arousal. Transsexualism is a desire to live as a member of the opposite sex, often accompanied by discomfort with one’s biological gender and a desire for gender reassignment. Sexual dysfunction encompasses a range of difficulties with sexual desire and performance.

The Sick Role and Illness Behavior

Mechanic and Volkart (1961) introduced the term illness behavior to describe how individuals perceive, evaluate, and respond to symptoms of physical dysfunction. Meanwhile, Talcott Parsons (1951) introduced the concept of the sick role as a temporary form of deviant behavior that is medically sanctioned.

According to Parsons, a sick person experiences conflicting desires to recover from the illness and to enjoy the secondary gains of attention and exemption from normal duties. The sick role is characterized by several rules, including the exemption of the sick person from their normal social roles, which is legitimized by society through the physician. The severity of the illness determines the strength of the exemption.

Additionally, sick persons are not held responsible for their illnesses, as they are beyond personal control. However, they have a duty to try to get well, as sickness is considered undesirable by society. Seeking competent technical help and cooperating with caregivers are also expected of sick persons.

In summary, the sick role and illness behavior are important concepts in understanding how individuals respond to physical dysfunction and how society legitimizes and responds to illness.

Mental Health Issues Common Among UK MPs

A 2008 survey has revealed that mental health problems are prevalent among UK Members of Parliament (MPs). The survey found that one in five MPs had personally experienced mental health issues. This is not a new phenomenon, as even Winston Churchill, a prominent political figure, suffered from depression throughout his career. Churchill described his depression as being followed around by a black dog. The survey highlights the need for greater awareness and support for mental health issues among politicians and the wider population.

A delusional perception is when a normal percept is interpreted in a delusional way, rather than simply fitting into an existing delusional belief system. This is different from disorders of form of thought, such as circumstantiality (slow thinking with inclusion of trivial details), thought block (sudden interruption of thought), derailment (breakdown of association between thoughts), and flight of ideas (increase in flow of thinking with frequent changes in goal and tangents).

The primary purpose of intersecting pentagons is to evaluate constructional apraxia, with attention being a secondary factor.

Apraxia: Understanding the Inability to Carry Out Learned Voluntary Movements

Apraxia is a neurological condition that affects a person’s ability to carry out learned voluntary movements. It is important to note that this condition assumes that everything works and the person is not paralyzed. There are different types of apraxia, each with its own set of symptoms and characteristics.

Limb kinetic apraxia is a type of apraxia that affects a person’s ability to make fine of delicate movements. This can include tasks such as buttoning a shirt of tying shoelaces.

Ideomotor apraxia, on the other hand, is an inability to carry out learned tasks when given the necessary objects. For example, a person with ideomotor apraxia may try to write with a hairbrush instead of using it to brush their hair.

Constructional apraxia affects a person’s ability to copy a picture of combine parts of something to form a whole. This can include tasks such as building a puzzle of drawing a picture.

Ideational apraxia is an inability to follow a sequence of actions in the correct order. For example, a person with ideational apraxia may struggle to take a match out of a box and strike it with their left hand.

Finally, oculomotor apraxia affects a person’s ability to control eye movements. This can make it difficult for them to track moving objects of read smoothly.

Overall, apraxia can have a significant impact on a person’s ability to carry out everyday tasks. However, with the right support and treatment, many people with apraxia are able to improve their abilities and maintain their independence.

Stigma Models

Stigma refers to any attribute, trait, of disorder that marks an individual as being unacceptably different from the normal people with whom they routinely interact, and that elicits some form of community sanction. The most popular model of stigma comes from the work of Link and Phelan, which has four aspects to it.

The first aspect is labelling, which refers to personal characteristics that mark individuals as different. These characteristics can be physical, mental, of social in nature and can include things like race, gender, sexual orientation, of mental illness.

The second aspect is stereotyping, which involves linking labelled characteristics to undesirable characteristics. For example, people with mental illness may be stereotyped as violent of unpredictable, even though the vast majority of them are not.

The third aspect is separating, which involves separating the labelled group and normal people by viewing them as very different. This can lead to social isolation and exclusion, which can further exacerbate the negative effects of stigma.

The fourth and final aspect is status loss and discrimination, which refers to the devaluing, rejecting, and excluding of the labelled group. This can take many forms, including employment discrimination, housing discrimination, and social exclusion.

Overall, the model of stigma developed by Link and Phelan provides a useful framework for understanding the complex and multifaceted nature of stigma and its effects on individuals and society as a whole.

The question pertains to the authority that comes with holding a higher position in a hierarchy. In the medical field, consultants have legitimate power over core trainees. However, a trainee may have more referent power due to their popularity, which can shift the balance of power in their favor. It is commonly assumed that consultants hold expert power over trainees, but this is not always the case. As one progresses to become a senior trainee, they may develop a condition known as consultantitis, which can challenge the notion of expert power.

Power Theory

French and Raven (1959) developed the 5 base theory of power, which identifies five types of power. These include legitimate power, which is held by an individual in an organization, referent power, which is held by a person with charisma who people gravitate towards, expert power, which is held by a person with specialist skills of knowledge, reward power, which is held by a person in a position to provide rewards, and coercive power, which is held by a person who has the ability to apply negative influences such as demotion. Other terms to be aware of include outcome power, which is the power of a person to bring about outcomes, social power, which is the power of a person to influence others so that they will bring about outcomes, and counterpower, which is the power of the oppressed to counterbalance the elite.

While there are situations where covert administration of medication may be necessary, it is important to approach this practice with caution due to its controversial nature. In cases where covert medication is deemed necessary to improve a patient’s mental health, it is recommended to convene a ‘best interests meeting’ involving the multidisciplinary team and family. The patient’s capacity should be taken into account, regardless of whether they are detained of not. While the views of the patient’s next of kin should be considered, they should not be the sole determining factor.

Theories of aggression can be categorized into three main perspectives: psychodynamic, sociological/drive, and cognitive and learning. Psychodynamic theory, proposed by Freud, suggests that aggression arises from a primary instinct called thanatos, which aims for destruction and death. Sociobiological/drive theory, proposed by Lorenz, suggests that aggression is instinctual and necessary for survival, and that stronger genes are selected through aggression. Cognitive and learning theory, proposed by Berkowitz, Rotter, Bandura, and Anderson, suggests that aggression can be learned through observational learning and is influenced by environmental factors. Bandura’s work introduced the concept of reciprocal determinism, which suggests that behavior is influenced by both the environment and the individual’s behavior. Rotter’s social learning theory emphasizes the interaction between the individual and their environment, while Anderson and Bushman’s general aggression model considers the role of social, cognitive, developmental, and biological factors on aggression.

This question is presented in two variations on the exam, with one implying that auras are primarily linked to temporal lobe epilepsy and the other to complex partial seizures. In reality, partial seizures are most commonly associated with auras compared to other types of seizures. While partial seizures can originate in any lobe of the brain, those that arise in the temporal lobe are most likely to produce an aura. Therefore, both versions of the question are accurate.

Epilepsy and Aura

An aura is a subjective sensation that is a type of simple partial seizure. It typically lasts only a few seconds and can help identify the site of cortical onset. There are eight recognized types of auras, including somatosensory, visual, auditory, gustatory, olfactory, autonomic, abdominal, and psychic.

In about 80% of cases, auras precede temporal lobe seizures. The most common auras in these seizures are abdominal and psychic, which can cause a rising epigastric sensation of feelings of fear, déjà vu, of jamais vu. Parietal lobe seizures may begin with a contralateral sensation, usually of the positive type, such as an electrical sensation of tingling. Occipital lobe seizures may begin with contralateral visual changes, such as colored lines, spots, of shapes, of even a loss of vision. Temporal-parietal-occipital seizures may produce more formed auras.

Complex partial seizures are defined by impairment of consciousness, which means decreased responsiveness and awareness of oneself and surroundings. During a complex partial seizure, a patient is unresponsive and does not remember events that occurred.

Understanding the Placebo Effect

In general, a placebo is an inert substance that has no pharmacological activity but looks, smells, and tastes like the active drug it is compared to. The placebo effect is the observable improvement seen when a patient takes a placebo, which results from patient-related factors such as expectations rather than the placebo itself. Negative effects due to patient-related factors are termed the nocebo effect.

Active placebos are treatments with chemical activity that mimic the side effects of the drug being tested in a clinical trial. They are used to prevent unblinding of the drug versus the placebo control group. Placebos need not always be pharmacological and can be procedural, such as sham electroconvulsive therapy.

The placebo effect is influenced by factors such as the perceived strength of the treatment, the status of the treating professional, and the branding of the compound. The placebo response is greater in mild illness, and the response rate is increasing over time. Placebo response is usually short-lived, and repeated use can lead to a diminished effect, known as placebo sag.

It is difficult to separate placebo effects from spontaneous remission, and patients who enter clinical trials generally do so when acutely unwell, making it challenging to show treatment effects. Breaking the blind may influence the outcome, and the expectancy effect may explain why active placebos are more effective than inert placebos. Overall, understanding the placebo effect is crucial in clinical trials and personalized medicine.

Anton’s syndrome, also known as Anton-Babinski syndrome, is a condition that results from damage to the occipital lobe. People with this syndrome are cortically blind, but they are not aware of it and deny having any problem, a condition known as anosognosia. They may start falling over furniture as they cannot see, but they believe they can still see and describe their surroundings in detail, even though their descriptions are incorrect (confabulation). This syndrome is characterized by a lack of awareness of visual impairment, which can lead to significant difficulties in daily life.

There is conflicting information regarding whether people should avoid only the pods of broad beans of both the beans and their pods.

MAOIs: A Guide to Mechanism of Action, Adverse Effects, and Dietary Restrictions

First introduced in the 1950s, MAOIs were the first antidepressants introduced. However, they are not the first choice in treating mental health disorders due to several dietary restrictions and safety concerns. They are only a treatment option when all other medications are unsuccessful. MAOIs may be particularly useful in atypical depression (over eating / over sleeping, mood reactivity).

MAOIs block the monoamine oxidase enzyme, which breaks down different types of neurotransmitters from the brain: norepinephrine, serotonin, dopamine, as well as tyramine. There are two types of monoamine oxidase, A and B. The MOA A are mostly distributed in the placenta, gut, and liver, but MOA B is present in the brain, liver, and platelets. Selegiline and rasagiline are irreversible and selective inhibitors of MAO type B, but safinamide is a reversible and selective MAO B inhibitor.

The most common adverse effects of MAOIs occurring early in treatment are orthostatic hypotension, daytime sleepiness, insomnia, and nausea; later common effects include weight gain, muscle pain, myoclonus, paraesthesia, and sexual dysfunction.

Pharmacodynamic interactions with MAOIs can cause two types of problem: serotonin syndrome (mainly due to SSRIs) and elevated blood pressure (caused by indirectly acting sympathomimetic amines releasers, like pseudoephedrine and phenylephrine). The combination of MAOIs and some TCAs appears safe. Only those TCAs with significant serotonin reuptake inhibition (clomipramine and imipramine) are likely to increase the risk of serotonin syndrome.

Tyramine is a monoamine found in various foods, and is an indirect sympathomimetic that can cause a hypertensive reaction in patients receiving MAOI therapy. For this reason, dietary restrictions are required for patients receiving MAOIs. These restrictions include avoiding matured/aged cheese, fermented sausage, improperly stored meat, fava of broad bean pods, and certain drinks such as on-tap beer. Allowed foods include fresh cottage cheese, processed cheese slices, fresh packaged of processed meat, and other alcohol (no more than two bottled or canned beers of two standard glasses of wine, per day).

Intelligence Test: Raven’s Progressive Matrices

The Raven’s Progressive Matrices (RPM) test is designed to measure general intelligence without the use of verbal language. The test consists of a series of items where the participant is required to identify the missing pattern in a sequence. The difficulty level of the items increases progressively, which demands greater cognitive capacity to encode and analyze the patterns.

There are three versions of the RPM test, each designed for different age groups and abilities. The Coloured Progressive Matrices is intended for younger children and special groups, while the Stanford Progressive Matrices is suitable for individuals aged 6 to 80 years old with average intelligence. The Advanced Progressive Matrices is designed for above-average adolescents and adults.

DBS is primarily used to treat Parkinson’s disease by targeting the Globus pallidus interna and subthalamic nucleus. However, for treatment-resistant depression (TRD), the subcallosal cingulate was the first area investigated for DBS, while vagal nerve stimulation has also been used. Psychosurgical treatment for refractory OCD and TRD involves targeting the anterior limb of the internal capsule. Although the caudate nucleus is part of the basal ganglia and associated with Parkinson’s disease, it is not a primary target for DBS.

Munchausen syndrome, also known as factitious disorder, is a condition where individuals intentionally fabricate of induce illness to assume the patient role. It was named by London physician Richard Asher in 1951, who observed patients reporting false symptoms such as abdominal pain, bleeding, and headaches. Conversion disorder, also known as dissociative disorder, is another term used to describe this condition. Ganser’s syndrome, which is not specifically mentioned in the ICD-11, was previously listed as a dissociative disorder and is often seen in forensic psychiatry. It is characterized by symptoms such as approximate answers, hallucinations, clouded consciousness, and insensitivity to pain, and is usually acute and self-limiting. Patients may not remember experiencing the syndrome.

Somatoform and dissociative disorders are two groups of psychiatric disorders that are characterised by physical symptoms and disruptions in the normal integration of identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, of behaviour. Somatoform disorders are characterised by physical symptoms that are presumed to have a psychiatric origin, while dissociative disorders are characterised by the loss of integration between memories, identity, immediate sensations, and control of bodily movements. The ICD-11 lists two main types of somatoform disorders: bodily distress disorder and body integrity dysphoria. The former involves bodily symptoms that the individual finds distressing and to which excessive attention is directed, while the latter involves a disturbance in the person’s experience of the body manifested by the persistent desire to have a specific physical disability accompanied by persistent discomfort of intense feelings of inappropriateness concerning current non-disabled body configuration. Dissociative disorders, on the other hand, are characterised by involuntary disruption of discontinuity in the normal integration of identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, of behaviour. The ICD-11 dissociative disorders include dissociative neurological symptom disorder, dissociative amnesia, trance disorder, possession trance disorder, dissociative identity disorder, partial dissociative identity disorder, depersonalization-derealization disorder, and other specified dissociative disorders. Each disorder has its own set of essential features and diagnostic criteria.

Agnosia is a condition where a person loses the ability to recognize objects, persons, sounds, shapes, of smells, despite having no significant memory loss of defective senses. There are different types of agnosia, such as prosopagnosia (inability to recognize familiar faces), anosognosia (inability to recognize one’s own condition/illness), autotopagnosia (inability to orient parts of the body), phonagnosia (inability to recognize familiar voices), simultanagnosia (inability to appreciate two objects in the visual field at the same time), and astereoagnosia (inability to recognize objects by touch).

The Basal Ganglia: Functions and Disorders

The basal ganglia are a group of subcortical structures that play a crucial role in controlling movement and some cognitive processes. The components of the basal ganglia include the striatum (caudate, putamen, nucleus accumbens), subthalamic nucleus, globus pallidus, and substantia nigra (divided into pars compacta and pars reticulata). The putamen and globus pallidus are collectively referred to as the lenticular nucleus.

The basal ganglia are connected in a complex loop, with the cortex projecting to the striatum, the striatum to the internal segment of the globus pallidus, the internal segment of the globus pallidus to the thalamus, and the thalamus back to the cortex. This loop is responsible for regulating movement and cognitive processes.

However, problems with the basal ganglia can lead to several conditions. Huntington’s chorea is caused by degeneration of the caudate nucleus, while Wilson’s disease is characterized by copper deposition in the basal ganglia. Parkinson’s disease is associated with degeneration of the substantia nigra, and hemiballism results from damage to the subthalamic nucleus.

In summary, the basal ganglia are a crucial part of the brain that regulate movement and some cognitive processes. Disorders of the basal ganglia can lead to significant neurological conditions that affect movement and other functions.

Neuroleptic malignant syndrome (NMS) is a serious and potentially fatal complication of neuroleptic treatment that is characterized by hyperthermia, rigidity, confusion, diaphoresis, autonomic instability, elevated creatinine phosphokinase, and leukocytosis. It can occur at any time during antipsychotic treatment and is often misdiagnosed as an exacerbation of psychosis. Therefore, it is crucial to accurately diagnose NMS.

Dystonias are abnormal movements of postures caused by brief of prolonged muscle contractions, including oculogyric crisis, tongue protrusion, trismus, torticollis, laryngeal pharyngeal dystonias, and dystonic postures of limbs and trunk.

Symptoms of parkinsonism include muscle stiffness (lead pipe rigidity), cogwheel rigidity, shuffling gait, stooped posture, and drooling. The pill rolling tremor of idiopathic parkinsonism is rare, but a regular coarse tremor similar to essential tremor may be present.

Tardive dyskinesia is a delayed effect of antipsychotics that rarely occurs until after six months of treatment. Tardive dystonia is a form of drug-induced secondary dystonia.

Hypomania is a milder form of mania (F30.1) that lacks hallucinations of delusions but still presents persistent and noticeable changes in mood and behavior that exceed those seen in cyclothymia (F34.0). To diagnose hypomania, these features must be present for several consecutive days and cause significant interference with work of social activity. However, if the disruption is severe of complete, mania (F30.1 of F30.2) should be considered instead.

Projective identification is a multifaceted mechanism that involves elements of transference, countertransference, and projection. It occurs when a patient’s mistaken belief leads them to behave in a manner that causes the other person in the interaction to adopt the attitudes that the patient wrongly attributed to them.

For instance, a person at an airport who is overly anxious about being perceived as a terrorist may draw the attention of security guards. In a similar vein, a patient’s assumption that a doctor holds them in contempt may prompt them to act in a manner that elicits disrespectful feelings from the doctor.

The trigeminal nerve, which is the largest cranial nerve, serves both sensory and motor functions. It is composed of three primary branches, namely the ophthalmic, maxillary, and mandibular branches. This nerve is responsible for providing sensory information to the face and head, while also controlling the muscles involved in chewing. On the other hand, the facial nerve is responsible for controlling the muscles that enable facial expressions and transmitting information from the front two-thirds of the tongue.

Overview of Cranial Nerves and Their Functions

The cranial nerves are a complex system of nerves that originate from the brain and control various functions of the head and neck. There are twelve cranial nerves, each with a specific function and origin. The following table provides a simplified overview of the cranial nerves, including their origin, skull exit, modality, and functions.

The first cranial nerve, the olfactory nerve, originates from the telencephalon and exits through the cribriform plate. It is a sensory nerve that controls the sense of smell. The second cranial nerve, the optic nerve, originates from the diencephalon and exits through the optic foramen. It is a sensory nerve that controls vision.

The third cranial nerve, the oculomotor nerve, originates from the midbrain and exits through the superior orbital fissure. It is a motor nerve that controls eye movement, pupillary constriction, and lens accommodation. The fourth cranial nerve, the trochlear nerve, also originates from the midbrain and exits through the superior orbital fissure. It is a motor nerve that controls eye movement.

The fifth cranial nerve, the trigeminal nerve, originates from the pons and exits through different foramina depending on the division. It is a mixed nerve that controls chewing and sensation of the anterior 2/3 of the scalp. It also tenses the tympanic membrane to dampen loud noises.

The sixth cranial nerve, the abducens nerve, originates from the pons and exits through the superior orbital fissure. It is a motor nerve that controls eye movement. The seventh cranial nerve, the facial nerve, also originates from the pons and exits through the internal auditory canal. It is a mixed nerve that controls facial expression, taste of the anterior 2/3 of the tongue, and tension on the stapes to dampen loud noises.

The eighth cranial nerve, the vestibulocochlear nerve, originates from the pons and exits through the internal auditory canal. It is a sensory nerve that controls hearing. The ninth cranial nerve, the glossopharyngeal nerve, originates from the medulla and exits through the jugular foramen. It is a mixed nerve that controls taste of the posterior 1/3 of the tongue, elevation of the larynx and pharynx, and swallowing.

The tenth cranial nerve, the vagus nerve, also originates from the medulla and exits through the jugular foramen. It is a mixed nerve that controls swallowing, voice production, and parasympathetic supply to nearly all thoracic and abdominal viscera. The eleventh cranial nerve, the accessory nerve, originates from the medulla and exits through the jugular foramen. It is a motor nerve that controls shoulder shrugging and head turning.

The twelfth cranial nerve, the hypoglossal nerve, originates from the medulla and exits through the hypoglossal canal. It is a motor nerve that controls tongue movement. Overall, the cranial nerves play a crucial role in controlling various functions of the head and neck, and any damage of dysfunction can have significant consequences.

Varenicline is a medication that helps people quit smoking by partially activating specific nicotine receptors in the body.

Mechanisms of Action of Different Drugs

Understanding the mechanisms of action of different drugs is crucial for medical professionals. It is a common topic in exams and can earn easy marks if studied well. This article provides a list of drugs and their mechanisms of action in different categories such as antidepressants, anti dementia drugs, mood stabilizers, anxiolytic/hypnotic drugs, antipsychotics, drugs of abuse, and other drugs. For example, mirtazapine is a noradrenaline and serotonin specific antidepressant that works as a 5HT2 antagonist, 5HT3 antagonist, H1 antagonist, alpha 1 and alpha 2 antagonist, and moderate muscarinic antagonist. Similarly, donepezil is a reversible acetylcholinesterase inhibitor used as an anti dementia drug, while valproate is a GABA agonist and NMDA antagonist used as a mood stabilizer. The article also explains the mechanisms of action of drugs such as ketamine, phencyclidine, buprenorphine, naloxone, atomoxetine, varenicline, disulfiram, acamprosate, and sildenafil.

Cerebral Asymmetry in Planum Temporale and its Implications in Language and Auditory Processing

The planum temporale, a triangular region in the posterior superior temporal gyrus, is a highly lateralized brain structure involved in language and music processing. Studies have shown that the planum temporale is up to ten times larger in the left cerebral hemisphere than the right, with this asymmetry being more prominent in men. This asymmetry can be observed in gestation and is present in up to 70% of right-handed individuals.

Recent research suggests that the planum temporale also plays an important role in auditory processing, specifically in representing the location of sounds in space. However, reduced planum temporale asymmetry has been observed in individuals with dyslexia, stuttering, and schizophrenia. These findings highlight the importance of cerebral asymmetry in the planum temporale and its implications in language and auditory processing.

The recommended treatment for emotionally unstable personality disorder (borderline type) does not involve a single psychological therapy of drug treatment as a first line of defense. However, for women who prioritize reducing self-harm, DBT is recommended. Drug treatments may be considered for comorbid conditions. According to NICE guidelines on Borderline personality disorder (BPD) (CG78), a comprehensive dialectical behaviour therapy programme should be considered for women with borderline personality disorder who prioritize reducing recurrent self-harm. Brief psychological interventions of less than 3 months’ duration should not be used specifically for borderline personality disorder of for the individual symptoms of the disorder. Drug treatment should not be used specifically for borderline personality disorder of for the individual symptoms of behavior associated with the disorder, such as repeated self-harm, marked emotional instability, risk-taking behavior, and transient psychotic symptoms. If sedatives are used for crisis intervention in a patient with EUPD, they should be prescribed for a maximum period of one week.

Periods of hypersomnia and altered behavior are characteristic of Kleine-Levin syndrome.

Kluver-Bucy Syndrome: Causes and Symptoms

Kluver-Bucy syndrome is a neurological disorder that results from bilateral medial temporal lobe dysfunction, particularly in the amygdala. This condition is characterized by a range of symptoms, including hyperorality (a tendency to explore objects with the mouth), hypersexuality, docility, visual agnosia, and dietary changes.

The most common causes of Kluver-Bucy syndrome include herpes, late-stage Alzheimer’s disease, frontotemporal dementia, trauma, and bilateral temporal lobe infarction. In some cases, the condition may be reversible with treatment, but in others, it may be permanent and require ongoing management. If you of someone you know is experiencing symptoms of Kluver-Bucy syndrome, it is important to seek medical attention promptly to determine the underlying cause and develop an appropriate treatment plan.

Huntington’s Disease: Genetics and Pathology

Huntington’s disease is a genetic disorder that follows an autosomal dominant pattern of inheritance. It is caused by a mutation in the Huntington gene, which is located on chromosome 4. The mutation involves an abnormal expansion of a trinucleotide repeat sequence (CAG), which leads to the production of a toxic protein that damages brain cells.

The severity of the disease and the age of onset are related to the number of CAG repeats. Normally, the CAG sequence is repeated less than 27 times, but in Huntington’s disease, it is repeated many more times. The disease shows anticipation, meaning that it tends to worsen with each successive generation.

The symptoms of Huntington’s disease typically begin in the third of fourth decade of life, but in rare cases, they can appear in childhood of adolescence. The most common symptoms include involuntary movements (chorea), cognitive decline, and psychiatric disturbances.

The pathological hallmark of Huntington’s disease is the gross bilateral atrophy of the head of the caudate and putamen, which are regions of the brain involved in movement control. The EEG of patients with Huntington’s disease shows a flattened trace, indicating a loss of brain activity.

Macroscopic pathological findings include frontal atrophy, marked atrophy of the caudate and putamen, and enlarged ventricles. Microscopic findings include neuronal loss and gliosis in the cortex, neuronal loss in the striatum, and the presence of inclusion bodies in the neurons of the cortex and striatum.

In conclusion, Huntington’s disease is a devastating genetic disorder that affects the brain and causes a range of motor, cognitive, and psychiatric symptoms. The disease is caused by a mutation in the Huntington gene, which leads to the production of a toxic protein that damages brain cells. The pathological changes in the brain include atrophy of the caudate and putamen, neuronal loss, and the presence of inclusion bodies.

Genetic Terms

Recombination Fraction

The recombination fraction is a measure of the distance between loci on a chromosome. If two loci are on different chromosomes, they will segregate independently. However, if they are on the same chromosome, they would always segregate together were it not for the process of crossing over. The closer two loci are on a chromosome, the less likely they are to be separated by crossing over. Blocks of alleles on a chromosome tend to be transmitted as a block through pedigree, and are known as a haplotype. The recombination fraction can vary from 0% if they are extremely close and 50% if they are on different chromosomes.

Gene Mapping

Mapping the genome is done in two ways: genetic mapping and physical mapping. Genetic mapping uses techniques such as pedigree analysis, while physical mapping is a technique used to find the order and physical distance between DNA base pairs by DNA markers. Physical maps can be divided into three general types: chromosomal of cytogenetic maps, radiation hybrid (RH) maps, and sequence maps. The different types of maps vary in their degree of resolution. Both maps are a collection of genetic markers and gene loci. While the physical map could be a more ‘accurate’ representation of the genome, genetic maps often offer insights into the nature of different regions of the chromosome.

LOD Score

The LOD score (logarithm of the odds) is a method used to ascertain if there is evidence for linkage between two genes. When genes are very near to each other on a chromosome, they are unlikely to be separated during crossing over in meiosis, and such genes are said to be linked. The relative distance between two genes can be calculated by using the offspring of an organism showing two strongly linked traits, and finding the percentage of offspring where the traits do not run together. By convention, a LOD score of >3 is considered evidence for linkage, and a LOD score of <-2 excludes linkage. Epigenetic Epigenetics involves genetic control by factors other than an individual’s DNA sequence. Epigenetic changes can switch genes on of off and determine which proteins are transcribed. Penetrance Penetrance is the probability of a gene of genetic trait being expressed. ‘Complete penetrance’ means the gene of genes for a trait are expressed in all the population who have the genes. ‘Incomplete penetrance’ means the genetic trait is expressed in only part of the population. Heritability Heritability is the proportion of phenotypic variance attributable to genetic variance. Anticipation Anticipation is a phenomenon whereby the symptoms of a genetic disorder become apparent at an earlier age as it is passed on to the next generation.

Adults require a minimum effective dose of 20 mg of fluoxetine.

Antidepressants: Minimum Effective Doses

According to the Maudsley 13th, the following are the minimum effective doses for various antidepressants:

– Citalopram: 20 mg/day
– Fluoxetine: 20 mg/day
– Fluvoxamine: 50 mg/day
– Paroxetine: 20 mg/day
– Sertraline: 50 mg/day
– Mirtazapine: 30 mg/day
– Venlafaxine: 75 mg/day
– Duloxetine: 60 mg/day
– Agomelatine: 25 mg/day
– Moclobemide: 300 mg/day
– Trazodone: 150 mg/day

Note that these are minimum effective doses and may vary depending on individual factors and response to treatment. It is important to consult with a healthcare professional before starting of changing any medication regimen.

Puberty

Puberty is a natural process that occurs in both boys and girls. The age range for the onset of puberty is between 8-14 years for females and 9-14 years for males, with the mean age of onset being 11 years for girls and 12 years for boys. The duration of puberty is typically 3-4 years. The onset of puberty is marked by the appearance of secondary sex characteristics, such as breast development in females and testicular enlargement in males. These characteristics evolve over time and are rated into 5 stages according to Tanner’s criteria. The sequence of events differs between boys and girls, with the onset of breast development (thelarche) generally preceding the onset of the first period (menarche) by around 2 years in girls. The pubertal growth spurt occurs during stages 3 to 4 in most boys and during stages 2 and 3 in girls. Precocious puberty, which occurs earlier than usual, is more common in girls than in boys. The age of onset of puberty in girls has been decreasing over time, with environmental factors such as nutrition potentially playing a role in this trend.

Copy Number Variations

Portions of DNA can vary in number, resulting in copy number variations (CNVs). These variations can lead to additional of fewer copies of certain genes, which can affect gene expression and have significant impacts on performance and health. While most CNVs are not clinically significant, they have been linked to conditions such as autism, schizophrenia, and learning disabilities.

The Beck’s depression inventory consists of 21 questions with a maximum score of 63. Each question is scored from 0 to 3 and is used to evaluate the severity of depression. It is a self-rated assessment that covers the two weeks leading up to the evaluation.

In psychiatry, various questionnaires and interviews are used to assess different conditions and areas. It is important for candidates to know whether certain assessment tools are self-rated of require clinical assistance. The table provided by the college lists some of the commonly used assessment tools and indicates whether they are self-rated of clinician-rated. For example, the HAMD and MADRS are clinician-rated scales used to assess the severity of depression, while the GDS is a self-rated scale used to screen for depression in the elderly. The YMRS is a clinician-rated scale used to assess the severity of mania in patients with bipolar disorder, while the Y-BOCS is used to measure both the severity of OCD and the response to treatment. The GAF provides a single measure of global functioning, while the CGI requires the clinician to rate the severity of the patient’s illness at the time of assessment. The CAMDEX is a tool developed to assist in the early diagnosis and measurement of dementia in the elderly.

Heritability: Understanding the Concept

Heritability is a concept that is often misunderstood. It is not a measure of the extent to which genes cause a condition in an individual. Rather, it is the proportion of phenotypic variance attributable to genetic variance. In other words, it tells us how much of the variation in a condition seen in a population is due to genetic factors. Heritability is calculated using statistical techniques and can range from 0.0 to 1.0. For human behavior, most estimates of heritability fall in the moderate range of .30 to .60.

The quantity (1.0 – heritability) gives the environment ability of the trait. This is the proportion of phenotypic variance attributable to environmental variance. The following table provides estimates of heritability for major conditions:

Condition Heritability estimate (approx)
ADHD 85%
Autism 70%
Schizophrenia 55%
Bipolar 55%
Anorexia 35%
Alcohol dependence 35%
Major depression 30%
OCD 25%

It is important to note that heritability tells us nothing about individuals. It is a population-level measure that helps us understand the relative contributions of genetic and environmental factors to a particular condition.

Mechanisms of Action of Different Drugs

Understanding the mechanisms of action of different drugs is crucial for medical professionals. It is a common topic in exams and can earn easy marks if studied well. This article provides a list of drugs and their mechanisms of action in different categories such as antidepressants, anti dementia drugs, mood stabilizers, anxiolytic/hypnotic drugs, antipsychotics, drugs of abuse, and other drugs. For example, mirtazapine is a noradrenaline and serotonin specific antidepressant that works as a 5HT2 antagonist, 5HT3 antagonist, H1 antagonist, alpha 1 and alpha 2 antagonist, and moderate muscarinic antagonist. Similarly, donepezil is a reversible acetylcholinesterase inhibitor used as an anti dementia drug, while valproate is a GABA agonist and NMDA antagonist used as a mood stabilizer. The article also explains the mechanisms of action of drugs such as ketamine, phencyclidine, buprenorphine, naloxone, atomoxetine, varenicline, disulfiram, acamprosate, and sildenafil.

Stigma is a term used to describe the negative attitudes and beliefs that people hold towards individuals who are different from them. There are several types of stigma, including discredited and discreditable stigma, felt stigma, enacted stigma, and courtesy stigma. Discredited stigma refers to visible stigmas such as race, gender, of physical disability, while discreditable stigma refers to concealable stigmas such as mental illness of HIV infection. Felt stigma is the shame and fear of discrimination that prevents people from seeking help, while enacted stigma is the experience of unfair treatment by others. Finally, courtesy stigma refers to the stigma that attaches to those who are associated with a stigmatized person.

Sensory Distortions of Sound

Hyperacusis is a condition where an individual experiences an increased sensitivity to noise. This condition is commonly observed in people with anxiety and depressive disorders, as well as during a hangover of migraine. On the other hand, hypoacusis is a condition where an individual experiences a reduced sensitivity to sound. This condition is commonly observed in people with delirium and depression, where it is often accompanied by hyperacusis.

A limitation of the ACE-III is that it does not have a dedicated assessment for evaluating reasoning and decision-making abilities.

The Addenbrooke’s Cognitive Exam: A Brief Screening Tool for Dementia

The Addenbrooke’s cognitive examination (ACE) is a cognitive screening tool developed to detect dementia and differentiate Alzheimer’s dementia from frontotemporal dementia. It was created to address the limitations of the MMSE, which lacked sensitivity for frontal-executive dysfunction and visuospatial defects. The ACE is a brief test that takes 15-20 minutes to administer and is divided into five domains: attention and orientation, memory, verbal fluency, language, and visuospatial abilities. The total score is based on a maximum score of 100, with higher scores indicating better cognitive functioning.

The ACE has been shown to be a valid tool for detecting dementia, with two cut-off points often used depending on the required sensitivity and specificity. A score of less than 88 has 100% sensitivity for detecting dementia, while a score of less than 82 has 93% sensitivity and 100% specificity. It has also been useful in differentiating dementia from pseudo dementia and detecting cognitive impairment in atypical Parkinson syndromes. However, while the test has shown 100% sensitivity and specificity in studies, its performance may vary in clinical practice.

Operant Conditioning: Reinforcement, Punishment, and More

Operant conditioning, also known as instrumental learning, is a theory of learning developed by B.F. Skinner. It suggests that people learn by interacting with their environment. Reinforcement and punishment are key concepts in operant conditioning. A reinforcer is a stimulus of event that increases the likelihood of a behavior being repeated. Reinforcement can be positive of negative. Positive reinforcement occurs when a behavior is strengthened by adding a rewarding stimulus, while negative reinforcement occurs when a behavior is strengthened by removing an unpleasant stimulus. A punisher is a stimulus that decreases the likelihood of a behavior being repeated. Positive punishment occurs when a behavior is reduced in frequency by adding an unpleasant stimulus, while negative punishment occurs when a behavior is reduced in frequency by removing a pleasant stimulus.

Primary reinforcers are instinctual desires such as food, water, social approval, and sex. Secondary reinforcers, also known as conditioned reinforcers, are not innately appreciated and people have to learn to like them through classical conditioning of other methods. Secondary reinforcers include things such as money. Different patterns of reinforcement have different influences on the response. There are five main reinforcement schedules: fixed interval, variable interval, fixed ratio, variable ratio, and random. Variable ratio schedules are most resistant to extinction.

Shaping and chaining are techniques used when an exact behavior cannot be performed and so cannot be rewarded. Shaping involves rewarding successive, increasingly accurate approximations to the behavior, while chaining involves breaking a complex task into smaller, more manageable sections. Escape conditioning refers to a situation whereby an aversive situation is removed after a response. It is a form of negative reinforcement. Habituation refers to the phenomenon whereby there is a decrease in response to a stimulus over time. Covert sensitization is a technique used whereby someone learns to use mental imagery to associate a behavior with a negative consequence.

Cerebellar signs are evident in cases of lithium toxicity, which can manifest as slurred speech, a broad-based gait, and an intention tremor. The latter is characterized by a coarse appearance and a frequency of 2-3Hz (equivalent to 2 waves per second).

Types of Tremor

Essential Tremor

Otherwise known as benign essential tremor, this is the most common type of tremor. It is not associated with any underlying pathology. It usually begins in the 40’s, affects mainly the hands, and is slowly progressive. It tends to worsen with heightened emotion. It usually presents with unilateral upper limb involvement then progresses to both limbs.

Parkinsonian Tremor

This tremor is associated with Parkinson’s disease. It is classically described as ‘pill rolling’ due to the characteristic appearance of the fingers.

Cerebellar Tremor

Otherwise known as an intention tremor. This is a slow, coarse tremor which gets worse with purposeful movement. This is seen in lithium toxicity (note that the tremor seen as a side effect of long term lithium is fine and classed as physiological).

Psychogenic Tremor

Also known as a hysterical tremor. This type of tremor tends to appear and disappear suddenly and is hard to characterise due to its changeable nature. It tends to improve with distraction.

Physiologic Tremor

This is a very-low-amplitude fine tremor that is barely visible to the naked eye. It is present in every normal person while maintaining a posture of movement. It becomes enhanced and visible in many conditions such as anxiety, hyperthyroidism, alcohol withdrawal, and as drug induced side effects.

It is useful to have a basic idea about the frequencies of different types of tremor.

Type of Tremor Frequency

Intention 2-3Hz

Parkinsonian 5Hz

Essential 7Hz

Physiological 10Hz

Psychogenic variable