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.

Erik Erikson and Daniel Levinson expanded the understanding of adult development. Erikson proposed a life-span model of human development consisting of eight successive psychosocial stages, each associated with an inherent conflict of crisis that the individual must encounter and successfully resolve to proceed with development. Levinson proposed a developmental theory consisting of universal stages of phases that extend from the infancy state to the elderly state, based on biographical interviews of 40 men in America. Both theorists maintained that personality develops in a predetermined order and builds upon each previous stage, and that failure to successfully negotiate a stage can result in a reduced ability to complete further stages and therefore a more unhealthy personality and sense of self. However, Levinson’s theory is age-based rather than event-based, and his model proposed a ‘life sequence’ consisting of a series of alternating stable (structure-building) periods and cross-era transitional (structure-changing) periods, with transitional periods typically lasting 5 years.

Elevated plasma levels of clozapine have been observed in individuals of Asian ethnicity. Conversely, younger patients, males, and smokers tend to have lower plasma levels. The use of carbamazepine can accelerate the metabolism of clozapine, resulting in decreased serum assay levels. However, it is not recommended to use carbamazepine and clozapine together due to the increased risk of bone marrow suppression.

An affect illusion is when a person’s perception is distorted by the shadow cast from a tree. Hallucinations, on the other hand, occur when there is no external stimulus present. It is important to note that a delusion is a belief, rather than a perception.

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.

Understanding the Difference between Chimeras and Mosaics

Chimeras and mosaics are two types of animals that have multiple genetically distinct populations of cells. However, it is important to understand the clear distinction between these two forms, which is often ignored of misused.

Mosaics are animals that have different cell types that all originate from a single zygote. This means that during development, some cells may acquire genetic mutations of changes that make them different from the rest of the cells in the organism. These changes can occur randomly of due to environmental factors, and can result in different physical characteristics of traits within the same individual.

On the other hand, chimeras are animals that originate from more than one zygote. This can happen when two fertilized eggs fuse together early in development, of when two embryos merge into a single individual. As a result, chimeras have distinct populations of cells with different genetic makeups, which can lead to unique physical characteristics of traits.

A plasmid is an autonomously replicating, extrachromosomal circular DNA molecule, distinct from the normal bacterial genome and nonessential for cell survival under nonselective conditions. Some plasmids are capable of integrating into the host genome. A number of artificially constructed plasmids are used as cloning vectors.
A clone is an organism that is genetically identical to the unit of individual from which it was derived.
A morula is the term given to the spherical embryonic mass of blastomeres formed before the blastula and resulting from cleavage of the fertilized ovum.

The Stroop test involves presenting words to the subject that spell a color but are written in a different color. The subject is required to identify the color of the text as quickly as possible, rather than reading the word itself. This test assesses the subject’s ability to make an appropriate response when presented with conflicting signals. This ability is believed to originate from the anterior cingulate, which is located between the left and right frontal lobes.

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.

Charpentier synthesised Chlorpromazine in 1950, and it was subsequently introduced into clinical practice in the 1950s.

A Historical Note on the Development of Zimelidine, the First Selective Serotonin Reuptake Inhibitor

In 1960s, evidence began to emerge suggesting a significant role of serotonin in depression. This led to the development of zimelidine, the first selective serotonin reuptake inhibitor (SSRI). Zimelidine was derived from pheniramine and was marketed in Europe in 1982. However, it was removed from the market in 1983 due to severe side effects such as hypersensitivity reactions and Guillain-Barre syndrome.

Despite its short-lived availability, zimelidine paved the way for the development of other SSRIs such as fluoxetine, which was approved by the FDA in 1987 and launched in the US market in 1988 under the trade name Prozac. The development of SSRIs revolutionized the treatment of depression and other mood disorders, providing a safer and more effective alternative to earlier antidepressants such as the tricyclics and MAO inhibitors.

Antipsychotics can be classified in different ways, with the most common being typical (first generation) and atypical (second generation) types. Typical antipsychotics block dopamine (D2) receptors and have varying degrees of M1, Alpha-1, and H1 receptor blockade. Atypical antipsychotics have a lower propensity for extrapyramidal side-effects and are attributed to the combination of relatively lower D2 antagonism with 5HT2A antagonism. They are also classified by structure, with examples including phenothiazines, butyrophenones, thioxanthenes, diphenylbutylpiperidine, dibenzodiazepines, benzoxazoles, thienobenzodiazepine, substituted benzamides, and arylpiperidylindole (quinolone). Studies have found little evidence to support the superiority of atypicals over typicals in terms of efficacy, discontinuation rates, of adherence, with the main difference being the side-effect profile. The Royal College also favors classification by structure.

Porphyria: The Little Imitator

Porphyria is a medical condition that is often referred to as the little imitator because it can mimic various common psychiatric presentations. This condition can be triggered by the use of certain psychotropic drugs, including barbiturates, benzodiazepines, sulpiride, and some mood stabilizers.

Porphyria can manifest in different ways, and it is important to be aware of the symptoms. These may include abdominal pain, mental state changes, constipation, vomiting, and muscle weakness.

APOE3 is considered to have a neutral effect on the risk of developing certain health conditions.

Genetics plays a role in the development of Alzheimer’s disease, with different genes being associated with early onset and late onset cases. Early onset Alzheimer’s, which is rare, is linked to three genes: amyloid precursor protein (APP), presenilin one (PSEN-1), and presenilin two (PSEN-2). The APP gene, located on chromosome 21, produces a protein that is a precursor to amyloid. The presenilins are enzymes that cleave APP to produce amyloid beta fragments, and alterations in the ratios of these fragments can lead to plaque formation. Late onset Alzheimer’s is associated with the apolipoprotein E (APOE) gene on chromosome 19, with the E4 variant increasing the risk of developing the disease. People with Down’s syndrome are also at high risk of developing Alzheimer’s due to inheriting an extra copy of the APP gene.

Assimilation refers to the process in which immigrants adopt the practices and values of their new culture while abandoning their own cultural heritage. Marginalization, on the other hand, occurs when immigrants neither adopt the new culture nor retain their own cultural values, resulting in social exclusion and isolation. These two outcomes are on opposite ends of the spectrum in terms of the degree of adoption and retention of cultural values.

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.

Serotonin Syndrome and Neuroleptic Malignant Syndrome are two conditions that can be difficult to differentiate. Serotonin Syndrome is caused by excess serotonergic activity in the CNS and is characterized by neuromuscular abnormalities, altered mental state, and autonomic dysfunction. On the other hand, Neuroleptic Malignant Syndrome is a rare acute disorder of thermoregulation and neuromotor control that is almost exclusively caused by antipsychotics. The symptoms of both syndromes can overlap, but there are some distinguishing clinical features. Hyper-reflexia, ocular clonus, and tremors are more prominent in Serotonin Syndrome, while Neuroleptic Malignant Syndrome is characterized by uniform ‘lead-pipe’ rigidity and hyporeflexia. Symptoms of Serotonin Syndrome usually resolve within a few days of stopping the medication, while Neuroleptic Malignant Syndrome can take up to 14 days to remit with appropriate treatment. The following table provides a useful guide to the main differentials of Serotonin Syndrome and Neuroleptic Malignant Syndrome.

Schizophrenia is a pathology that is characterized by a number of structural and functional brain alterations. Structural alterations include enlargement of the ventricles, reductions in total brain and gray matter volume, and regional reductions in the amygdala, parahippocampal gyrus, and temporal lobes. Antipsychotic treatment may be associated with gray matter loss over time, and even drug-naïve patients show volume reductions. Cerebral asymmetry is also reduced in affected individuals and healthy relatives. Functional alterations include diminished activation of frontal regions during cognitive tasks and increased activation of temporal regions during hallucinations. These findings suggest that schizophrenia is associated with both macroscopic and functional changes in the brain.

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.

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.

Electroencephalography

Electroencephalography (EEG) is a clinical test that records the brain’s spontaneous electrical activity over a short period of time using multiple electrodes placed on the scalp. It is mainly used to rule out organic conditions and can help differentiate dementia from other disorders such as metabolic encephalopathies, CJD, herpes encephalitis, and non-convulsive status epilepticus. EEG can also distinguish possible psychotic episodes and acute confusional states from non-convulsive status epilepticus.

Not all abnormal EEGs represent an underlying condition, and psychotropic medications can affect EEG findings. EEG abnormalities can also be triggered purposely by activation procedures such as hyperventilation, photic stimulation, certain drugs, and sleep deprivation.

Specific waveforms are seen in an EEG, including delta, theta, alpha, sigma, beta, and gamma waves. Delta waves are found frontally in adults and posteriorly in children during slow wave sleep, and excessive amounts when awake may indicate pathology. Theta waves are generally seen in young children, drowsy and sleeping adults, and during meditation. Alpha waves are seen posteriorly when relaxed and when the eyes are closed, and are also seen in meditation. Sigma waves are bursts of oscillatory activity that occur in stage 2 sleep. Beta waves are seen frontally when busy of concentrating, and gamma waves are seen in advanced/very experienced meditators.

Certain conditions are associated with specific EEG changes, such as nonspecific slowing in early CJD, low voltage EEG in Huntington’s, diffuse slowing in encephalopathy, and reduced alpha and beta with increased delta and theta in Alzheimer’s.

Common epileptiform patterns include spikes, spike/sharp waves, and spike-waves. Medications can have important effects on EEG findings, with clozapine decreasing alpha and increasing delta and theta, lithium increasing all waveforms, lamotrigine decreasing all waveforms, and valproate having inconclusive effects on delta and theta and increasing beta.

Overall, EEG is a useful tool in clinical contexts for ruling out organic conditions and differentiating between various disorders.

Anhedonia, a term coined by Théodule-Armand Ribot in 1896, refers to the lack of interest in experiencing pleasure. This condition is commonly linked to depression and is also observed in schizophrenia as a component of the negative symptoms of the 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.

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).

The management plan will include all options, including contacting the police, and may involve admission under the Mental Health Act depending on the level of immediate risk. Morbid jealousy is a highly dangerous condition, with 17% of homicides in the UK linked to it. Studies have shown that 14% of those suffering from it have attempted to harm their partner, with over 50% having assaulted them, often while under the influence of alcohol. While the patient may be threatening only the other man, their partner is the most likely person to be harmed. Both men and women can pose a risk to their partners, but men are more likely to cause severe injuries. It is important to note that the duty of confidentiality does not override the duty to prevent foreseeable harm.

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.

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.

Erving Goffman was a prominent sociologist who made significant contributions to the field. He is well-known for his works such as The Presentation of Self in Everyday Life, Asylums, and Stigma. In fact, he is credited with introducing the term stigma into the sociological lexicon. Goffman’s ideas and theories have had a lasting impact on the study of sociology and continue to be studied and applied today.

The typical EEG pattern for CJD includes periodic sharp wave complexes, which is a diagnostic criterion. Lewy body dementia may show generalized slow wave activity, but if it is more prominent in the temporal and parietal regions, it may indicate Alzheimer’s disease. Toxic encephalopathies, such as lithium toxicity, may show periodic triphasic waves on EEG. For more information, see Smith SJ’s article EEG in neurological conditions other than epilepsy: when does it help, what does it add? (2005).

Patients with renal impairment should avoid taking amisulpride and sulpiride. This is because amisulpride is eliminated through the kidneys, and in cases of renal insufficiency, the dosage should be reduced, and intermittent treatment should be considered.

Prescribing medication for elderly individuals requires consideration of their unique pharmacokinetics and pharmacodynamics. As the body ages, changes in distribution, metabolism, and excretion can affect how medication is absorbed and processed. For example, reduced gastric acid secretion and motility can impact drug absorption, while a relative reduction of body water to body fat can alter the distribution of lipid soluble drugs. Additionally, hepatic metabolism of drugs decreases with age, and the kidneys become less effective, leading to potential accumulation of certain drugs.

In terms of pharmacodynamics, receptor sensitivity tends to increase during old age, meaning smaller doses may be needed. However, older individuals may also take longer to respond to treatment and have an increased incidence of side-effects. It is important to start with a lower dose and monitor closely when prescribing medication for elderly patients, especially considering the potential for interactions with other medications they may be taking.

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.

René Spitz coined the term anaclitic depression to describe the negative impact on children who are separated from their primary caregiver, such as during a hospital stay. In extreme cases, this can lead to hospitalism. Although this type of depression can hinder a child’s development, recovery is likely if the separation from the mother does not exceed three months. Ainsworth is known for her work on the strange situation procedure, while Bowlby focused on attachment and maternal deprivation. Main is associated with the adult attachment interview, and Rutter distinguished between privation and deprivation, with the former referring to a failure to form attachments.

Fragile X syndrome is inherited in an X-linked manner and is caused by a mutation in the FMR1 gene. The condition is characterized by excessive trinucleotide repeats (CGG). While women can be mildly affected, the severity of cognitive impairment is directly related to the length of the trinucleotide repeat sequence.

Fragile X Syndrome: A Genetic Disorder Causing Learning Disability and Psychiatric Symptoms

Fragile X Syndrome is a genetic disorder that causes mental retardation, an elongated face, large protruding ears, and large testicles in men. Individuals with this syndrome tend to be shy, avoid eye contact, and have difficulties reading facial expressions. They also display stereotypic movements such as hand flapping. Fragile X Syndrome is the most common inherited cause of learning disability.

The speech of affected individuals is often abnormal, with abnormalities of fluency. This disorder is caused by the amplification of a CGG repeat in the 5 untranslated region of the fragile X mental retardation 1 gene (FMR1). These CGG repeats disrupt synthesis of the fragile X protein (FMRP), which is essential for brain function and growth. The gene is located at Xq27. The greater number of repeats, the more severe the condition, as with other trinucleotide repeat disorders.

The fragile X phenotype typically involves a variety of psychiatric symptoms, including features of autism, attention deficit/hyperactivity disorder, anxiety, and aggression. Both males and females can be affected, but males are more severely affected because they have only one X chromosome. The prevalence estimate of Fragile X Syndrome is 1/3600-4000.

According to Freud, the mind can be divided into three parts: the id, the ego, and the superego. The id is a collection of instinctual drives that are not organized and are controlled by the primary process. The id lacks the ability to delay of modify these instinctual drives that an infant is born with. The ego operates in all three dimensions of the mind: conscious, preconscious, and unconscious. The ego is responsible for logical and abstract thinking, as well as verbal expression in the conscious and preconscious parts of the mind. The superego is responsible for creating and maintaining an individual’s moral conscience based on a complex system of values and ideals that are internalized from parents. The terms unconscious and preconscious refer to Freud’s model of the mind, which includes the unconscious, preconscious, and conscious parts.