Childhood Fear: Normal Development

It is normal for children to experience fear and anxiety as they grow and develop. According to Marks’ ‘ontogenetic parade’ theory, children’s fears follow a predictable pattern throughout their development. In the preschool years, children may fear imaginary creatures, animals, strangers, and their environment. As they enter middle childhood, fears of physical danger, bodily injury, and school performance become more prominent. During adolescence, fears about social evaluations and interactions become more common.

Gullone’s research in 1999 identified specific fears that are prominent at different ages. For example, towards the end of the first year, children may fear strangers, heights, and separation anxiety. In preschool years, fears of being alone, the dark, and animals are common. During the school years, children may fear bodily injury, illness, social situations, supernatural phenomena, failure, and criticism. Finally, in adolescence, fears about death, economic and political concerns may persist.

Overall, fear and anxiety are a normal part of child development, and parents and caregivers can support children by acknowledging their fears and helping them develop coping strategies.

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.

Tricyclic antidepressants are known to cause various side effects, which can be attributed to their mechanisms of action. These include antimuscarinic effects, which can lead to dry mouth and urinary retention, antihistaminergic effects, which can cause weight gain and drowsiness, antiadrenergic effects, which can result in postural hypotension, sexual dysfunction, and cognitive impairment, and antiserotonergic effects, which can lead to weight gain. Additionally, tricyclic antidepressants can cause cardiotoxicity and reduce the seizure threshold due to their membrane stabilizing effects. Other important side effects of these drugs include arrhythmias and ECG changes, black tongue, tremor, altered liver function tests, paralytic ileus, and neuroleptic malignant syndrome. Black hairy tongue, a harmless condition where the tongue appears black and hairy due to elongated filiform papillae, is also a possible side effect of tricyclic antidepressants.

In a survey conducted by Nock et al.1, which involved interviewing more than 80,000 individuals across 17 countries regarding suicidal behaviors, it was discovered that 60% of individuals who transitioned from suicidal ideation to planning and attempting suicide did so within the first year of experiencing ideation.

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.

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.

The idea of filial imprinting was initially observed in domestic chickens by Douglas Spalding in the 1800s, and later discussed by Heinroth before being made well-known by Lorenz. Additionally, Immelmann discussed sexual imprinting, while Westermarck introduced the concept of reverse sexual imprinting, which suggests that individuals who spend their early years in close proximity are less likely to be sexually attracted to each other later in life.

Pick’s disease is characterized by swollen and enlarged neurons that have a ballooned appearance, which is why they are commonly referred to as balloon cells. It is important to note that the term ‘balloon cell’ is a general histological term used to describe swollen cells that are often observed in cerebral degeneration. While they can be seen in various conditions, they are particularly prevalent in Pick’s disease and are considered a hallmark feature of the disorder.

Frontotemporal Lobar Degeneration (FTLD) is a pathological term that refers to a group of neurodegenerative disorders that affect the frontal and temporal lobes of the brain. FTLD is classified into several subtypes based on the main protein component of neuronal and glial abnormal inclusions and their distribution. The three main proteins associated with FTLD are Tau, TDP-43, and FUS. Each FTD clinical phenotype has been associated with different proportions of these proteins. Macroscopic changes in FTLD include atrophy of the frontal and temporal lobes, with focal gyral atrophy that resembles knives. Microscopic changes in FTLD-Tau include neuronal and glial tau aggregation, with further sub-classification based on the existence of different isoforms of tau protein. FTLD-TDP is characterized by cytoplasmic inclusions of TDP-43 in neurons, while FTLD-FUS is characterized by cytoplasmic inclusions of FUS.

In addition to fluctuating cognition and visual hallucinations, Lewy body dementia often involves sensitivity to neuroleptics. Patients may also experience falls and REM sleep disorder as common symptoms.

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.

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.

Attachment Theory and Harlow’s Monkeys

Attachment theory, developed by John Bowlby, suggests that children have an innate tendency to form relationships with people around them to increase their chance of survival. This attachment is different from bonding, which concerns the mother’s feelings for her infant. Children typically single out a primary caregiver, referred to as the principle attachment figure, from about 1-3 months. The quality of a person’s early attachments is associated with their adult behavior, with poor attachments leading to withdrawn individuals who struggle to form relationships and good attachments leading to socially competent adults who can form healthy relationships.

Bowlby’s attachment model has four stages: preattachment, attachment in the making, clear-cut attachment, and formation of reciprocal attachment. The time from 6 months to 36 months is known as the critical period, during which a child is most vulnerable to interruptions in its attachment. Attachments are divided into secure and insecure types, with insecure types further divided into avoidant and ambivalent types.

Harlow’s experiment with young rhesus monkeys demonstrated the importance of the need for closeness over food. The experiment involved giving the monkeys a choice between two different mothers, one made of soft terry cloth but provided no food and the other made of wire but provided food from an attached baby bottle. The baby monkeys spent significantly more time with their cloth mother than with their wire mother, showing the importance of attachment and closeness in early development.

The three major types of learning are: operant conditioning, classical conditioning, and observational learning. In operant conditioning, an individual’s behavior is instrumental in achieving a desired outcome. In classical conditioning, a neutral stimulus is paired with a stimulus that already evokes a reflex response, eventually leading to the new stimulus evoking a similar response. Observational learning involves learning through the observation of others. Shaping, a part of operant conditioning, involves reinforcing successive approximations to a desired behavior. Extinction, seen in both classical and operant conditioning, involves the observed behavior gradually stopping due to the absence of reinforcement of presentation of the stimulus alone.

BF Skinner’s theory states that behavior is influenced by its consequences, which can be positive reinforcement, negative reinforcement, of punishment. The frequency and consistency of these consequences, as determined by different reinforcement schedules, can shape and maintain behavior in various ways. Common reinforcement schedules include continuous reinforcement, fixed interval, fixed ratio, variable interval, and variable ratio.

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.

Deletion of genetic material on chromosome 7 is the underlying cause of William’s syndrome.

Trinucleotide Repeat Disorders: Understanding the Genetic Basis

Trinucleotide repeat disorders are genetic conditions that arise due to the abnormal presence of an expanded sequence of trinucleotide repeats. These disorders are characterized by the phenomenon of anticipation, which refers to the amplification of the number of repeats over successive generations. This leads to an earlier onset and often a more severe form of the disease.

The table below lists the trinucleotide repeat disorders and the specific repeat sequences involved in each condition:

Condition Repeat Sequence Involved
Fragile X Syndrome CGG
Myotonic Dystrophy CTG
Huntington’s Disease CAG
Friedreich’s Ataxia GAA
Spinocerebellar Ataxia CAG

The mutations responsible for trinucleotide repeat disorders are referred to as ‘dynamic’ mutations. This is because the number of repeats can change over time, leading to a range of clinical presentations. Understanding the genetic basis of these disorders is crucial for accurate diagnosis, genetic counseling, and the development of effective treatments.

In zero order kinetics, the elimination of a drug occurs at a constant rate regardless of its concentration in the plasma. This results in a linear relationship between the plasma concentration and time from peak concentration. Unlike drugs that follow first order kinetics, drugs that follow zero order kinetics do not have a fixed 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.

Understanding Grief: Normal and Abnormal Phases

Grief is a natural response to loss, and it is a complex process that can take different forms and durations. John Bowlby and Kubler-Ross have proposed models to describe the typical phases of grief, which can vary in intensity and duration for each individual. Bowlby’s model includes shock-numbness, yearning-searching, disorganization-despair, and reorganization, while Kubler-Ross’s model includes denial-dissociation-isolation, anger, bargaining, depression, and acceptance.

However, some people may experience abnormal grief, which can be categorized as inhibited, delayed, of chronic/prolonged. Inhibited grief refers to the absence of expected grief symptoms at any stage, while delayed grief involves avoiding painful symptoms within two weeks of loss. Chronic/prolonged grief is characterized by continued significant grief-related symptoms six months after loss.

It is important to distinguish between normal grief and major depression, as a high proportion of people may meet the criteria for major depression in the first year following bereavement. Some features that can help differentiate between the two include generalized guilt, thoughts of death unrelated to the deceased, feelings of worthlessness, psychomotor retardation, and prolonged functional impairment.

Overall, understanding the phases and types of grief can help individuals and their loved ones navigate the grieving process and seek appropriate support and resources.

The use of selective serotonin reuptake inhibitors (SSRIs) can lead to a decrease in platelet aggregation, potentially increasing the risk of bleeding. However, the discovery that other types of antidepressants may also increase the risk of bleeding was unexpected and requires further investigation.

A recent cohort study followed women who were currently using antidepressants, had used them within the past month, had used them within the past 1-5 months, of had never used them. The study found that women who had any current of recent exposure to antidepressants were at a slightly increased risk of experiencing postpartum hemorrhage (with a relative risk of 1.4-1.9).

The study was conducted in the United States and focused on women who received Medicaid, which represents approximately 40% of the US population and includes a higher proportion of economically disadvantaged and minority populations.

Sudden delusional ideas are distinct from delusional perceptions as they do not arise from abnormal sensory experiences. There is no evidence of a paranoid environment. These delusions do not involve feeling persecuted. In persecutory delusions, the individual believes they are the object of aggression of surveillance. They may have delusions that they are in danger, insulted, ridiculed, monitored, of robbed by others who seek to harm their health, possessions, of life.

Borderline Learning Disability

Borderline learning disability is a term used to describe individuals with an IQ between 70-85. This category is not officially recognized as a diagnosis by the ICD-11. It is estimated that approximately 15% of the population falls within this range (Chaplin, 2005). Unlike mild learning disability, borderline learning disability is not typically associated with deficits in adaptive functioning, such as grooming, dressing, safety, of money management.

Codons and Amino Acids

Codons are made up of three bases and each codon codes for an amino acid. There are 64 different triplet sequences, with three of them indicating the end of the polypeptide chain. The start codon always has the code AUG in mRNA and codes for the amino acid methionine. This leaves 61 codons that code for a total of 20 different amino acids. As a result, most of the amino acids are represented by more than one codon. Amino acids are the building blocks of proteins, which can form short polymer chains called peptides of longer chains called polypeptides of proteins.

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.

In 1908, during the yearly gathering of the German Psychiatric Association in Berlin, Bleuler proposed the term schizophrenia as a more suitable replacement for Kraepelin dementia praecox. Bleuler’s reasoning was that the term schizophrenia better captured the idea of a division of fragmentation in mental functioning. Additionally, he believed that the term could be more effectively used as an adjective.

The Emergence of Social Smiling in Infants

Wormann (2014) discusses the emergence of social smiling in infants, which is usually interpreted as the first positive expression directed towards a cause. This occurs when an infant with an initially expressionless face examines the face of another person, and their face and eyes light up while the corners of their mouth pull upward. The age of the first appearance of the social smile varies across cultures, ranging from the fifth to seventh week. Additionally, there are differences in its duration and frequency between the second and seventh month of life. Understanding these milestones is important for a basic understanding of normal child development.

Child Development Milestones:
4 weeks Responds to noise (either by crying, of quieting), follows an object moved in front of eyes
6 weeks Begins social smiling*
3 months Holds head steady on sitting
6 months Rolls from stomach to back, starts babbling
7 months Transfers objects from hand to hand, looks for dropped object
9 months Sits unsupported, begins to crawl
12 months Cruising (walking by holding furniture)
18 months Walks without assistance, speaks about 10-20 words
2 years Runs, climbs up and down stairs alone, makes 2-3 word sentences
3 years Dresses self except for buttons and laces, counts to 10, feeds themself well
4 years Hops on one foot, copies a cross
5 years Copies a triangle, skips

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.

Historical Terminology and Figures in Psychiatry

Paragraph 1: The term ‘learning disability’ was first used by Samuel Kirk in 1963 during a conference in Chicago. It is important for trainees to understand the history of terminology in psychiatry, including phrases like mental handicap, retardation, and intellectual disability, as they are associated with attitudes and concepts that have shaped care styles over the last century.

Paragraph 2: James Watts was a prominent practitioner and advocate of psychosurgery, a controversial treatment that involved surgical intervention in the brain to treat mental illness. His work has had a lasting impact on the field of psychiatry.

Paragraph 3: Wilhelm Griesinger, a German psychiatrist, is credited with describing ‘primary insanity’ (primäre verrücktheit), a term used to describe mental illness that arises without any apparent physical cause.

Paragraph 4: Johann Christian Reil, another German psychiatrist, is known for coining the term ‘psychiatry’ in the late 18th century. His work helped to establish psychiatry as a distinct field of medicine.

Paragraph 5: Charles Perry, an English physician, published ‘A mechanical account and explication of the hysterical passion’ in the 17th century. This work helped to shape early understandings of hysteria, a condition that was once believed to be caused by a ‘wandering womb’ in women.

The pharmacodynamics of Mirtazapine are complex and have received conflicting feedback. However, according to the manufacturer’s leaflet and preclinical studies, Mirtazapine is a potent antagonist of 5-HT2 and 5-HT3 receptors, with no significant affinity for the 5-HT1A and 5-HT1B receptors. It is also a potent antagonist of histamine (H1) receptors, which may explain its sedative effects, and a moderate peripheral a1 adrenergic antagonist, which may cause occasional orthostatic hypotension. Additionally, it is a moderate antagonist at muscarinic receptors, which may explain the low incidence of anticholinergic side effects. Although not stated by the manufacturer, there is considerable evidence that Mirtazapine is also an alpha 2 antagonist, which was likely discovered after the preclinical studies.

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.

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.

Bupropion inhibits the reuptake of noradrenaline and dopamine, making it an NDRI.

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.

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.