Frontal Lobe Tests

The frontal lobe is responsible for a variety of cognitive functions, including initiation, abstraction, problem-solving, decision-making, response inhibition, and set shifting. Different tests can be used to assess these functions.

Verbal and categorical fluency tests can be used to assess initiation. These tests require individuals to generate as many words of items as possible within a specific category of starting letter.

Proverbs, similarities, and cognitive estimates are examples of tests that can be used to assess abstraction. These tests require individuals to identify similarities between objects of concepts, make judgments based on incomplete information, of estimate quantities.

Tower of London, Cambridge stockings, and gambling tasks are examples of tests that can be used to assess problem-solving and decision-making. These tests require individuals to plan and execute a sequence of actions to achieve a goal of make decisions based on uncertain outcomes.

Alternating sequences, go-no-go test, Luria motor test, trail making test, Wisconsin card sorting test, and Stroop test are examples of tests that can be used to assess response inhibition and set shifting. These tests require individuals to inhibit prepotent responses, switch between tasks of mental sets, of ignore irrelevant information.

Overall, these tests can provide valuable information about an individual’s frontal lobe functioning and can be used to diagnose and treat various neurological and psychiatric conditions.

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.

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.

Historical Classification of Schizophrenia

The classification of schizophrenia has evolved over time, with various individuals contributing to its development. In 1801, Phillippe Pinel used the term ‘demencé’ to describe the loss of mental abilities in chronically ill patients. Benedict Morel coined the term ‘demencé precocé’ in 1852 to describe young patients with premature dementia. Kahlbaum was the first to describe ‘paraphrenia hebetica’ in the 1860s, which was later elaborated as ‘hebephrenia’ by Hecker in 1871.

In 1893, Emil Kraepelin used the term dementia praecox to describe the condition, emphasizing the importance of delusions, hallucinations, impaired attention, thought incoherence, stereotyped movements and expressions, deterioration of emotional life, and a loss of drive as key symptoms. In 1908, Eugen Bleuler coined the term ‘schizophrenia’ to replace dementia praecox, denoting ‘a splitting of the psychic functions.’ Bleuler expanded the concept to include presentations that did not include a ‘terminal state.’

Bleuler introduced a distinction between basic and accessory symptoms and primary and secondary symptoms. Basic symptoms are necessarily present in any case of schizophrenia, while accessory symptoms may of may not occur. The fundamental features of schizophrenia were loosening of associations, disturbances of affectivity, ambivalence, and autism. The alteration of associations is the only symptom that Bleuler regarded as both basic and primary, and can thus be described as the core disturbance in the Bleulerian conception of schizophrenia.

In 1939, Langfeldt introduced the term ‘schizophreniform psychosis’ to describe patients with Bleulerian schizophrenia who did not follow a progressively deteriorating course. In the 1960s, Rado/Meehl introduced the term ‘schizotypy’ to recognize the concept of a continuum of spectrum of schizophrenia-related phenotypes. In the 1980s, Crow proposed a subclassification of schizophrenia, dividing patients into types I and II. Type I patients present with positive symptoms such as delusions and hallucinations, while type II patients present with negative symptoms such as affective flattening and poverty of speech.

Solanezumab is a type of humanised monoclonal antibody that can bind to the central region of β-amyloid, which is believed to prevent the formation of plaques. However, current research has not yet determined whether this drug is effective in treating Alzheimer’s dementia.

Carbimazole is a medication that is commonly used to treat hyperthyroidism, a condition in which the thyroid gland produces too much thyroid hormone.

Levomilnacipran is a newly approved drug by the FDA that is used to treat major depressive disorder.

Pantoprazole is a type of proton pump inhibitor that is used to treat acid reflux disease, a condition in which stomach acid flows back into the esophagus.

Zubsolv is a recently approved drug by the FDA that is used for the maintenance treatment of opioid dependence.

Freud’s Structural Theory: Understanding the Three Areas of the Mind

According to Freud’s structural model, the human mind is divided into three distinct areas: the Id, the Ego, and the Superego. The Id is the part of the mind that contains instinctive drives and operates on the ‘pleasure principle’. It functions without a sense of time and is governed by ‘primary process thinking’. The Ego, on the other hand, attempts to modify the drives from the Id with external reality. It operates on the ‘reality principle’ and has conscious, preconscious, and unconscious aspects. It is also home to the defense mechanisms. Finally, the Superego acts as a critical agency, constantly observing a person’s behavior. Freud believed that it developed from the internalized values of a child’s main caregivers. The Superego contains the ‘ego ideal’, which represents ideal attitudes and behavior. It is often referred to as the conscience. Understanding these three areas of the mind is crucial to understanding Freud’s structural theory.

Serotonin: Synthesis and Breakdown

Serotonin, also known as 5-Hydroxytryptamine (5-HT), is synthesized in the central nervous system (CNS) in the raphe nuclei located in the brainstem, as well as in the gastrointestinal (GI) tract in enterochromaffin cells. The amino acid L-tryptophan, obtained from the diet, is used to synthesize serotonin. L-tryptophan can cross the blood-brain barrier, but serotonin cannot.

The transformation of L-tryptophan into serotonin involves two steps. First, hydroxylation to 5-hydroxytryptophan is catalyzed by tryptophan hydroxylase. Second, decarboxylation of 5-hydroxytryptophan to serotonin (5-hydroxytryptamine) is catalyzed by L-aromatic amino acid decarboxylase.

Serotonin is taken up from the synapse by a monoamine transporter (SERT). Substances that block this transporter include MDMA, amphetamine, cocaine, TCAs, and SSRIs. Serotonin is broken down by monoamine oxidase (MAO) and then by aldehyde dehydrogenase to 5-Hydroxyindoleacetic acid (5-HIAA).

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.

Gillick Competency and Fraser Guidelines

Gillick competency and Fraser guidelines refer to a legal case which looked specifically at whether doctors should be able to give contraceptive advice of treatment to under 16-year-olds without parental consent. But since then, they have been more widely used to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions.

In 1982, Mrs Victoria Gillick took her local health authority (West Norfolk and Wisbech Area Health Authority) and the Department of Health and Social Security to court in an attempt to stop doctors from giving contraceptive advice of treatment to under 16-year-olds without parental consent.

The case went to the High Court where Mr Justice Woolf dismissed Mrs Gillick’s claims. The Court of Appeal reversed this decision, but in 1985 it went to the House of Lords and the Law Lords (Lord Scarman, Lord Fraser and Lord Bridge) ruled in favour of the original judgement delivered by Mr Justice Woolf.

The Fraser Guidelines were laid down by Lord Fraser in the House of Lords’ case and state that it is lawful for doctors to provide contraceptive advice and treatment without parental consent providing that they are satisfied that:

– The young person will understand the professional’s advice
– The young person cannot be persuaded to inform their parents
– The young person is likely to begin, of to continue having, sexual intercourse with of without contraceptive treatment
– Unless the young person receives contraceptive treatment, their physical of mental health, of both, are likely to suffer
– The young person’s best interests require them to receive contraceptive advice of treatment with of without parental consent.

Immunologic Adverse Drug Reactions

Immunologic adverse drug reactions account for a small percentage of all adverse drug reactions, ranging from 5 to 10%. These reactions are classified using the Gell and Coombs system, which categorizes them into four groups: Type I, Type II, Type III, and Type IV reactions.

Type I reactions occur when a drug-IgE complex binds to mast cells, leading to the release of histamine and other inflammatory mediators. These reactions typically cause anaphylaxis, urticaria, and bronchospasm and occur within minutes to hours after exposure.

Type II reactions occur when an IgG of IgM antibody binds to a cell that has been altered by a drug-hapten. These reactions often manifest as blood abnormalities, such as thrombocytopenia and neutropenia, and their timing is variable.

Type III reactions occur when drug-antibody complexes activate the complement system, leading to fever, rash, urticaria, and vasculitis. These reactions occur 1 to 3 weeks after exposure.

Type IV reactions arise when the MHC system presents drug molecules to T cells, resulting in allergic contact dermatitis and rashes. These reactions occur 2 to 7 days after cutaneous exposure.

Stevens-Johnson syndrome (SJS) is a rare but life-threatening skin reaction disease, often caused by carbamazepine. Symptoms include widespread blisters, flat atypical targets-shaped lesions, erythema, necrosis, and extensive sloughing of the epidermis. Patients may experience fever, myalgia, and general weakness for 1 to 3 days before the development of cutaneous lesions. Hospitalization may be necessary for serious dermatological reactions, which can be fatal. SJS/TEN cases typically occur within the first few months of treatment, with a median latency period of 15 days for the development of SJS with carbamazepine. These reactions are estimated to occur in 1 to 6 per 10,000 new users in countries with mainly Caucasian populations. It is important to note that skin lesions are usually preceded by fever and malaise by 1-3 days in patients newly prescribed carbamazepine. Immediate discontinuation of the causative agent is essential once identified.

Carbamazepine: Uses, Mechanism of Action, Contraindications, Warnings, and Side-Effects

Carbamazepine, also known as Tegretol, is a medication commonly used in the treatment of epilepsy, particularly partial seizures. It is also used for neuropathic pain, bipolar disorder, and other conditions. The drug works by binding to sodium channels and increasing their refractory period.

However, carbamazepine has notable contraindications, including a history of bone marrow depression and combination with monoamine oxidase inhibitors (MAOIs). It also carries warnings for serious dermatological reactions such as toxic epidermal necrolysis (TEN) and Stevens Johnson syndrome.

Common side-effects of carbamazepine include leucopenia, ataxia, dizziness, somnolence, vomiting, nausea, urticaria, and fatigue. Other side-effects include thrombocytopenia, eosinophilia, oedema, fluid retention, weight increase, hyponatraemia, and blood osmolarity decreased due to an antidiuretic hormone (ADH)-like effect, leading in rare cases to water intoxication accompanied by lethargy, vomiting, headache, confusional state, neurological disorders, diplopia, accommodation disorders (e.g. blurred vision), and dry mouth.

In summary, carbamazepine is a medication with multiple uses, but it also carries significant contraindications, warnings, and side-effects that should be carefully considered before use.

Severe depression is often characterized by early morning awakening, while schizophrenia is typically marked by primary delusions, thought withdrawal, ideas of reference, and auditory hallucinations (usually in the third person).

Antiemetic Properties of Antipsychotics

Antipsychotics are commonly used in palliative care to prevent nausea and vomiting. Chlorpromazine and haloperidol are two antipsychotics that have been found to be effective antiemetics. Chlorpromazine works by blocking histamine receptors, while haloperidol blocks dopamine receptors in the chemoreceptor trigger zone (CTZ), which influences the vomiting center. Promazine is also a potent histamine antagonist but is not commonly used as an antiemetic. However, both chlorpromazine and promazine have sedative effects.

Pimozide, on the other hand, has low affinity for histamine receptors, and pericyazine demonstrates moderate affinity. Flupenthixol is not used as an antiemetic. Overall, antipsychotics have proven to be effective in preventing nausea and vomiting in palliative care, with different mechanisms of action depending on the specific drug.

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.

Posterior inferior cerebellar artery occlusion/infarct, also known as Wallenberg’s syndrome of lateral medullary syndrome, can cause a sudden onset of dizziness and vomiting. It can also result in ipsilateral facial sensory loss, specifically for pain and temperature, and contralateral sensory loss for pain and temperature of the limbs and trunk. Nystagmus to the side of the lesion, ipsilateral limb ataxia, dysphagia, and dysarthria are also common symptoms. Additionally, this condition can cause ipsilateral pharyngeal and laryngeal paralysis.

Brain Blood Supply and Consequences of Occlusion

The brain receives blood supply from the internal carotid and vertebral arteries, which form the circle of Willis. The circle of Willis acts as a shunt system in case of vessel damage. The three main vessels arising from the circle are the anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA). Occlusion of these vessels can result in various neurological deficits. ACA occlusion may cause hemiparesis of the contralateral foot and leg, sensory loss, and frontal signs. MCA occlusion is the most common and can lead to hemiparesis, dysphasia/aphasia, neglect, and visual field defects. PCA occlusion may cause alexia, loss of sensation, hemianopia, prosopagnosia, and cranial nerve defects. It is important to recognize these consequences to provide appropriate treatment.

Down Syndrome: Causes and Risk Factors

Down syndrome is a genetic disorder caused by the presence of extra genetic material from chromosome 21. There are three different types of Down syndrome, each with its own cause and inheritance pattern. The most common form, full trisomy 21, is not inherited and accounts for 95% of cases. It occurs when there is a failure of chromosome 21 to separate properly during cell division, resulting in an extra copy of the chromosome. This can happen randomly, with the extra chromosome coming from the mother 88% of the time and from the father 12% of the time.

The second type, translocation Down syndrome, is inherited and accounts for 2-3% of cases. It occurs when a piece of chromosome 21 breaks off and attaches to another chromosome, resulting in extra genetic material. This type of Down syndrome is caused by a balanced translocation, which means that the parent carrying the translocation has no signs of symptoms of the disorder.

The third type, mosaic Down syndrome, is not inherited and also accounts for 2-3% of cases. It occurs as a random event during cell division early in fetal development, resulting in some cells having an extra copy of chromosome 21 while others do not.

The risk of having a child with Down syndrome increases as a mother gets older. At age 35, the risk is 1 in 385; at age 40, the risk is 1 in 106; and at age 45, the risk is 1 in 30. It is important for women to be aware of these risk factors and to discuss them with their healthcare provider if they are planning to have a child.

All the other words refer to various forms of experiencing things that are not actually present, known as hallucinations.

Altered Perceptual Experiences

Disorders of perception can be categorized into sensory distortions and sensory deceptions. Sensory distortions involve changes in the intensity, spatial form, of quality of a perception. Examples include hyperaesthesia, hyperacusis, and micropsia. Sensory deceptions, on the other hand, involve new perceptions that are not based on any external stimulus. These include illusions and hallucinations.

Illusions are altered perceptions of a stimulus, while hallucinations are perceptions in the absence of a stimulus. Completion illusions, affect illusions, and pareidolic illusions are examples of illusions. Auditory, visual, gustatory, olfactory, and tactile hallucinations are different types of hallucinations. Pseudohallucinations are involuntary and vivid sensory experiences that are interpreted in a non-morbid way. They are different from true hallucinations in that the individual is able to recognize that the experience is an internally generated event.

Understanding the different types of altered perceptual experiences is important in the diagnosis and treatment of various mental health conditions.

While Mary Rothbart, Rudolf Steiner, and Jerome Kagan are known for their theories on the stability of personality traits in children, they were not involved in the New York Longitudinal Study conducted in the 1970s. However, Solomon Diamond, who focused on personality and temperament and conducted research on various animal studies, is also associated with this field.

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).

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.

Assessing Executive Function with the Hayling and Brixton Tests

The Hayling and Brixton tests are two assessments designed to evaluate executive function. The Hayling Sentence Completion Test consists of two sets of 15 sentences, with the last word missing. In the first section, participants complete the sentences, providing a measure of response initiation speed. The second part, the Hayling, requires participants to complete a sentence with a nonsense ending word, suppressing a sensible one. This provides measures of response suppression ability and thinking time. Performance on such tests has been linked to frontal lobe dysfunction and dysexecutive symptoms in everyday life.

The Brixton Test is a rule detection and rule following task. Impairments on such tasks are commonly demonstrated in individuals with dysexecutive problems. Overall, these tests provide valuable insights into executive function and can help identify areas of weakness that may require intervention.

Studies have consistently shown that migrant populations have higher rates of schizophrenia, particularly among certain minority ethnic groups. The NICE guidelines on schizophrenia (CG178) have highlighted the importance of investigating social and environmental factors that may increase the risk of developing the illness, such as urban birth and rearing, social adversity and trauma, heavy cannabis use, migration, and stressful life events. Schizophrenia is the most common form of psychotic disorder, with a mean incidence of 0.11 per 1000 (range 0.07-0.17 per 1000) reported in epidemiological studies. The average rates for men and women are similar, but the age of onset is typically 5 years later in women, resulting in a lower female rate during adolescence and a second smaller peak after menopause. The lifetime prevalence of schizophrenia ranges from 0.4 to 1.4%, and a UK survey found a population prevalence of probable psychotic disorder of 5 per 1000 in the age group of 16 to 74 years.

Taste disturbance is known as Dysgeusia in medical terminology and can be caused by various medications. Lithium is a frequently encountered culprit, but other drugs such as certain antidepressants, benzodiazepines, z-drugs, and opiates can also lead to this condition. Additionally, any medication that causes dry mouth may result in taste disturbance. This information is sourced from D Kaufman’s book, Clinical neurology for psychiatrists, published in 2007 on page 38.

Lithium – Pharmacology

Pharmacokinetics:
Lithium salts are rapidly absorbed following oral administration and are almost exclusively excreted by the kidneys unchanged. Blood samples for lithium should be taken 12 hours post-dose.

Ebstein’s:
Ebstein’s anomaly is a congenital malformation consisting of a prolapse of the tricuspid valve into the right ventricle. It occurs in 1:20,000 of the general population. Initial data suggested it was more common in those using lithium but this had not held to be true.

Contraindications:
Addison’s disease, Brugada syndrome, cardiac disease associated with rhythm disorders, clinically significant renal impairment, untreated of untreatable hypothyroidism, low sodium levels.

Side-effects:
Common side effects include nausea, tremor, polyuria/polydipsia, rash/dermatitis, blurred vision, dizziness, decreased appetite, drowsiness, metallic taste, and diarrhea. Side-effects are often dose-related.

Long-term use is associated with hypothyroidism, hyperthyroidism, hypercalcemia/hyperparathyroidism, irreversible nephrogenic diabetes insipidus, and reduced GFR.

Lithium-induced diabetes insipidus:
Treatment options include stopping lithium (if feasible), keeping levels within 0.4-0.8 mmol/L, once-daily dose of the drug taken at bedtime, amiloride, thiazide diuretics, indomethacin, and desmopressin.

Toxicity:
Lithium salts have a narrow therapeutic/toxic ratio. Risk factors for lithium toxicity include drugs altering renal function, decreased circulating volume, infections, fever, decreased oral intake of water, renal insufficiency, and nephrogenic diabetes insipidus. Features of lithium toxicity include GI symptoms and neuro symptoms.

Pre-prescribing:
Before prescribing lithium, renal function, cardiac function, thyroid function, FBC, and BMI should be checked. Women of childbearing age should be advised regarding contraception, and information about toxicity should be provided.

Monitoring:
Lithium blood levels should be checked weekly until stable, and then every 3-6 months once stable. Thyroid and renal function should be checked every 6 months. Patients should be issued with an information booklet, alert card, and record book.

The Wechsler Adult Intelligence Scale (WAIS) is a widely used intelligence test in clinical settings, designed for individuals aged 16 to 90. Its counterpart for children is the Wechsler Intelligence Scale for Children (WISC). The current version of WAIS, WAIS-IV, consists of four index scores, each comprising several subsets. These are the Verbal Comprehension Index, Perceptual Reasoning Index, Working Memory Index, and Processing Speed Index. The results are presented as two scores: Full Scale IQ and General Ability Index. The average score is 100, with a standard deviation of 15. However, the test becomes less accurate at the extremes of IQ (70-130). About 3% of people score below 70, which is the general cut-off for a significant learning disability.

The strongest association with HIV dementia is the infiltration of monocytes and activation of microglia in the brain. While the presence of HIV encephalopathy is somewhat linked to HIV associated dementia, the extent of monocyte infiltration and microglial activation is the best indicator of AIDS dementia. Microglia can cause damage to neurons by releasing oxidative radicals, nitric oxide, and cytokines. The correlation between viral load and HAD is not significant. Astrocytes have limited susceptibility to HIV infection, and neuronal infection is rare and unlikely to have a significant impact on HIV-related CNS disorders.

Antidepressants typically interfere with the natural pattern of sleep, especially by reducing REM sleep. However, Agomelatine has been found to enhance disrupted sleep-wake cycles in individuals with major depressive disorder.

Agomelatine: A New Drug for Depression Treatment

Agomelatine is a recently developed medication that is used to treat depression. Its mechanism of action involves acting as an agonist at melatonin M1 and M2 receptors, while also acting as an antagonist at 5HT2C receptors. The effects of melatonin appear to promote sleep, while the 5HT2C antagonism leads to the release of dopamine and norepinephrine in the frontal cortex. Interestingly, serotonin levels do not appear to be affected by this medication.

Developmental Stages

There are four main developmental models that are important to understand: Freud’s theory of psychosexual development, Erikson’s theory of psychosocial development, Piaget’s theory of cognitive development, and Kohlberg’s theory of moral development.

Freud’s theory of psychosexual development includes five stages: oral, anal, phallic, latency, and genital. These stages occur from birth to adulthood and are characterized by different areas of focus and pleasure.

Erikson’s theory of psychosocial development includes eight stages, each with a specific crisis to be resolved. These stages occur from infancy to old age and are focused on developing a sense of self and relationships with others.

Piaget’s theory of cognitive development includes four stages: sensorimotor, preoperational, concrete operational, and formal operational. These stages occur from birth to adulthood and are focused on the development of cognitive abilities such as perception, memory, and problem-solving.

Kohlberg’s theory of moral development includes three stages: preconventional, conventional, and postconventional. These stages occur from childhood to adulthood and are focused on the development of moral reasoning and decision-making.

Understanding these developmental models can help individuals better understand themselves and others, as well as provide insight into how to support healthy development at each stage.

It is not typical for 16 month old children to have already mastered the skill of combining words with meaning.

Linguistic Development and Risk Factors for Delayed Speech and Language

The development of language skills is an important aspect of a child’s growth. The prelinguistic period, from birth to 12 months, is marked by crying, babbling, and echolalia. From 6 to 12 months, a child responds to their name and can differentiate between angry and friendly tones. By 18 to 24 months, a child can use up to 40-50 words, mainly nouns, and starts to combine words in short phrases. By 36 to 48 months, a child has a vocabulary of 900-1000 words, can use plurals and past tense, and can handle three-word sentences easily.

However, there are risk factors associated with delayed speech and language development. These include a positive family history, male gender, twins, lower maternal education, childhood illness, being born late in the family order, young mother at birth, and low socioeconomic status. of these, a positive family history is considered the most reliable risk factor. It is important to monitor a child’s language development and seek professional help if there are concerns about delayed speech and language.

Koro and Kuru are two distinct conditions that should not be mistaken for each other. While Kuru is a prion disease that is well-known for its association with cannibalism in Papua New Guinea, Koro is a different condition altogether.

Culture bound illnesses are psychiatric conditions that are specific to one particular culture. There are many different types of culture bound illnesses, including Amok, Shenjing shuairuo, Ataque de nervios, Bilis, colera, Bouffee delirante, Brain fag, Dhat, Falling-out, blacking out, Ghost sickness, Hwa-byung, wool-hwa-byung, Koro, Latah, Locura, Mal de ojo, Nervios, Rootwork, Pibloktoq, Qi-gong psychotic reaction, Sangue dormido, Shen-k’uei, shenkui, Shin-byung, Taijin kyofusho, Spell, Susto, Zar, and Wendigo.

Some of the most commonly discussed culture bound illnesses include Amok, which is confined to males in the Philippines and Malaysia who experience blind, murderous violence after a real of imagined insult. Ataque de nervios is a condition that occurs in those of Latino descent and is characterized by intense emotional upset, shouting uncontrollably, aggression, dissociation, seizure-like episodes, and suicidal gestures. Brain fag is a form of psychological distress first identified in Nigerian students in the 1960s but reported more generally in the African diaspora. It consists of a variety of cognitive and sensory disturbances that occur during periods of intense intellectual activity. Koro is a condition that affects Chinese patients who believe that their penis is withdrawing inside their abdomen, resulting in panic and the belief that they will die. Taijin kyofusho is a Japanese culture bound illness characterized by anxiety about and avoidance of interpersonal situations due to the thought, feeling, of conviction that one’s appearance and actions in social interactions are inadequate of offensive to others. Finally, Wendigo is a culture bound illness that occurs in Native American tribes during severe winters and scarcity of food, characterized by a distaste for food that leads to anxiety and the belief that one is turning into a cannibalistic ice spirit.

– 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.