Diphenhydramine is a type of antihistamine that belongs to the first generation. It is commonly used to alleviate extrapyramidal side effects (EPSE). Unlike second generation antihistamines, first generation antihistamines have anticholinergic properties and can penetrate the blood-brain barrier, resulting in sedative effects. The anticholinergic effects of first generation antihistamines are beneficial for treating EPSE, which is believed to be caused by excessive acetylcholine due to reduced dopamine activity. Dopamine normally inhibits acetylcholine, but when dopamine activity is reduced, acetylcholine levels increase, leading to EPSE.

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).

Erikson’s psychosocial theory of development includes eight stages of crises, while Freud’s psychosexual theory of development consists of five stages. However, there is some overlap between the two theories. For example, Freud’s phallic stage, which focuses on the development of sexual identity, broadly coincides with Erikson’s ‘initiative versus guilt’ stage, which focuses on the development of a sense of purpose and direction.

Erikson’s stages are as follows: trust vs. mistrust (0-18 months), autonomy vs. doubt (18-36 months), initiative vs. guilt (3-6 years), competence vs. inferiority (6-12 years), identity vs. confusion (12 years to adulthood), intimacy vs. isolation (adulthood), generativity vs. stagnation (middle-age), and integrity vs. despair (maturity).

Freud’s stages are: oral (0-18 months), anal (18-36 months), phallic (3-6 years), latency (6-12 years), and genital (12 years to adulthood).

While there are similarities between the two theories, it is important to note that they approach development from different perspectives and emphasize different aspects of human growth and development.

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

The disorder is often chronic, as the six month prevalence is only slightly lower than the lifetime prevalence. Additionally, bipolar disorder frequently co-occurs with other conditions such as substance misuse and anxiety disorders. Prevalence rates can be determined using structured diagnostic interviews like the diagnostic interview schedule (DIS), and the disorder affects both men and women equally with a lifetime risk ranging from 0.3% to 1.5%. Onset typically occurs around age 17 in community studies.

A delusion is a false and unwavering belief that is not in line with the individual’s education, cultural of social background. It is held with strong conviction. Erotomania is a type of delusional disorder where the affected person believes that someone, usually of higher status and often a stranger, is in love with them. This disorder is more common in women and can cause them to believe that someone who has no knowledge of their existence is in love with them. Nymphomania is a condition where a woman experiences uncontrollable and excessive sexual desire, while satyriasis is the male equivalent. Morbid jealousy is a disorder that can manifest in various forms, including delusions, overvalued ideas, depressive affect, of anxiety state. With this disorder, a person may believe that their partner is being unfaithful without any of little evidence to support their belief. Grandiose delusion is where a person believes they have supernatural powers of are a famous celebrity, and may think they are involved in secret missions of have connections with wealthy and famous people.

Broca’s aphasia is also known as non-fluent aphasia, while Wernicke’s aphasia is referred to as fluent aphasia.

Broca’s and Wernicke’s are two types of expressive dysphasia, which is characterized by difficulty producing speech despite intact comprehension. Dysarthria is a type of expressive dysphasia caused by damage to the speech production apparatus, while Broca’s aphasia is caused by damage to the area of the brain responsible for speech production, specifically Broca’s area located in Brodmann areas 44 and 45. On the other hand, Wernicke’s aphasia is a type of receptive of fluent aphasia caused by damage to the comprehension of speech, while the actual production of speech remains normal. Wernicke’s area is located in the posterior part of the superior temporal gyrus in the dominant hemisphere, within Brodmann area 22.

Mitmachen and Mitgehen are two types of reflexive compliance. Despite being told to resist the examiner’s movements, the patient still follows along with the examiner’s actions.

– 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.

While other conditions may also present with the same symptoms, a Kayser-Fleischer Ring, characterized by a golden-brown corneal ring due to copper deposits at the Descemet’s membrane, is considered a definitive indicator of Wilson’s disease.

Understanding Wilson’s Disease: Causes, Symptoms, and Management

Wilson’s disease, also known as hepatolenticular degeneration, is a genetic disorder that affects copper storage in the body. This condition is caused by a defect in the ATP7B gene, which leads to the accumulation of copper in the liver and brain. The onset of symptoms usually occurs between the ages of 10 and 25, with liver disease being the most common presentation in children and neurological symptoms in young adults.

The excessive deposition of copper in the tissues can cause a range of symptoms, including hepatitis, cirrhosis, basal ganglia degeneration, speech and behavioral problems, asterixis, chorea, dementia, Kayser-Fleischer rings, sunflower cataract, renal tubular acidosis, haemolysis, and blue nails. Diagnosis is based on reduced serum ceruloplasmin, reduced serum copper, and increased 24-hour urinary copper excretion.

The traditional first-line treatment for Wilson’s disease is penicillamine, which chelates copper. Trientine hydrochloride is an alternative chelating agent that may become first-line treatment in the future. Tetrathiomolybdate is a newer agent that is currently under investigation.

In summary, Wilson’s disease is a genetic disorder that affects copper storage in the body, leading to a range of symptoms that can affect the liver, brain, and eyes. Early diagnosis and treatment are essential to prevent complications and improve outcomes.

Dementia Pugilistica: A Neurodegenerative Condition Resulting from Neurotrauma

Dementia pugilistica, also known as chronic traumatic encephalopathy (CTE), is a neurodegenerative condition that results from neurotrauma. It is commonly seen in boxers and NFL players, but can also occur in anyone with neurotrauma. The condition is characterized by symptoms such as gait ataxia, slurred speech, impaired hearing, tremors, disequilibrium, neurobehavioral disturbances, and progressive cognitive decline.

Most cases of dementia pugilistica present with early onset cognitive deficits, and behavioral signs exhibited by patients include aggression, suspiciousness, paranoia, childishness, hypersexuality, depression, and restlessness. The progression of the condition leads to more prominent behavioral symptoms such as difficulty with impulse control, irritability, inappropriateness, and explosive outbursts of aggression.

Neuropathological abnormalities have been identified in CTE, with the most unique feature being the abnormal accumulation of tau in neurons and glia in an irregular, focal, perivascular distribution and at the depths of cortical sulci. Abnormalities of the septum pellucidum, such as cavum and fenestration, are also a common feature.

While the condition has become increasingly rare due to the progressive improvement in sports safety, it is important to recognize the potential long-term consequences of repeated head injuries and take steps to prevent them.

Different types of thought disorders are associated with specific personality traits of mental illnesses. Circumstantiality involves taking a long and detailed route to get to the initial point. Loosening of association makes it difficult to follow how one idea connects to the previous one, resulting in derailment. Overinclusive thinking blurs the boundaries between words and concepts, causing unrelated ideas to be associated with each other. Tangentiality involves answers that are related to the question but do not directly answer it.

Treating akathisia is a challenging task, as there are limited options available. In many cases, the only viable solution is to decrease the use of antipsychotic 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).

Understanding Incentive Salience and its Role in Addiction and Grief

Incentive salience is a process that drives the brain to desire certain things, such as drugs, and is mediated by mesolimbic dopamine systems. This process is separate from the experience of pleasure, and a person can want something they don’t necessarily like. Desire is amplified by brain states that heighten dopamine reactivity, such as stress, emotional excitement, relevant appetites, of intoxication. This state-dependent amplification of incentive salience is one reason why many addicts find it difficult to stop at just one hit.

Interestingly, grief has been hypothesized to be underpinned by a very similar process as drug addiction, referred to as the ‘incentive salience theory of grief’. Understanding the distinction between liking and wanting can help us better understand addiction and grief, and how the brain processes these experiences.

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.

In order for a patient to give consent, they must be able to communicate their decision. It is important to note that a patient’s ability to sign a form does not necessarily determine their mental capacity to consent to a treatment. It is assumed that a patient has capacity unless proven otherwise, and efforts should be made to enhance their capacity (such as considering different communication methods of involving family members of interpreters). A patient is considered to lack capacity for a specific decision if they are unable to understand, retain, weigh up, of communicate information related to that decision.

Intermediate Mechanism: Rationalisation

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

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

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

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

Developmental Psychologists and Their Contributions

Mary Ainsworth, a developmental psychologist, discovered that the interaction between a mother and her baby during the attachment years is crucial in the development of the baby’s behaviour. She identified four types of attachments: secure, anxious-resistant, anxious-avoidant, and disorganised.

John Bowlby, a British psychoanalyst, studied infant attachment and separation and emphasised the importance of mother-child attachment in human interaction and later development.

Harry Harlow, an American psychologist, demonstrated the emotional and behavioural effects of isolating monkeys and preventing them from forming attachments from birth.

Donald Winnicott, an English paediatrician and psychoanalyst, developed the object relations theory, which focuses on the relationship between an infant and their primary caregiver.

BF Skinner developed the theory of learning and behaviour known as operant conditioning, which emphasises the role of reinforcement and punishment in shaping behaviour.

Assessment Tools for Schizophrenia

There are several assessment tools available for use in patients with schizophrenia. The Brief Psychiatric Rating Scale (BPRS) is a semi-structured interview that covers 18 items, including positive symptoms, general psychopathology, and affective symptoms. Another tool that can be used to assess psychotic symptoms in schizophrenia is the Positive and Negative Symptom Scale (PANSS).

The Beck Depression Inventory is a self-report questionnaire that consists of 21 items. However, it does not include any questions about psychotic symptoms. The General Health Questionnaire is a screening tool for mental illness, but the 12-item version does not contain any questions about psychosis.

The Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS) is a tool that asks about the side effects of neuroleptics, including extrapyramidal, hyperprolactinemia, and autonomic effects. Finally, the Wechsler Adult Intelligence Scale (WAIS) is an intelligence test that is specifically designed for use in adults.

DSM-IV used a multi-axial system of diagnosis, with Axis V coding the individual’s level of function. However, DSM-5, published in 2013, discarded this system and all diagnoses, including personality disorders, are now listed in section II. Axis V was completely eliminated from the diagnostic process.

The term Fregoli syndrome refers to a delusion where the patient mistakenly identifies an unfamiliar person as someone they know. This condition is named after Leopoldo Fregoli, an Italian actor who was known for his ability to quickly change his appearance during performances. Cotard syndrome is a type of delusion that occurs in cases of psychotic depression, where the patient believes that they are already dead. Capgras syndrome is another type of misidentification delusion, but in this case, the patient believes that someone they know has been replaced by an identical imposter. Charles Bonnet Syndrome is a condition that causes complex visual hallucinations. Finally, Couvade syndrome, also known as sympathetic pregnancy, is a phenomenon where men experience symptoms similar to their pregnant partners. These conditions are all well-documented in the field of psychiatry.

Anabolic Steroids: Uses, Misuse, and Complications

Anabolic steroids are synthetic derivatives of testosterone that have both anabolic and androgenic properties. They are commonly used by athletes to enhance performance and by individuals to improve physical appearance. However, their misuse is not uncommon, with nearly half of users of dedicated bodybuilding gyms admitting to taking anabolic agents. Misuse can lead to dependence, tolerance, and the development of psychiatric disorders such as aggression, psychosis, mania, and depression/anxiety.

There are three common regimes practised by steroid misusers: ‘cycling’, ‘stacking’ and ‘pyramiding’. Anabolic steroids can be taken orally, injected intramuscularly, and applied topically in the form of creams and gels. Other drugs are also used by athletes, such as clenbuterol, ephedrine, thyroxine, insulin, tamoxifen, human chorionic Gonadotropin, diuretics, and growth hormone.

Medical complications are common and can affect various systems, such as the musculoskeletal, cardiovascular, hepatic, reproductive (males and females), dermatological, and other systems. Complications include muscular hypertrophy, increased blood pressure, decreased high-density lipoprotein cholesterol and increased low-density lipoprotein cholesterol, cholestatic jaundice, benign and malignant liver tumours, testicular atrophy, sterility, gynaecomastia, breast tissue shrinkage, menstrual abnormalities, masculinisation, male-pattern baldness, acne, sleep apnoea, exacerbation of tic disorders, polycythaemia, altered immunity, and glucose intolerance.

Anabolic steroids are a class C controlled drug and can only be obtained legally through a medical prescription. It is important to educate individuals about the risks and complications associated with their misuse and to promote safe and legal use.