– Visual aura is not expected in temporal lobe epilepsy
– Visual aura may occur in occipital seizures
– Temporal lobe epilepsy is characterized by automatisms, altered consciousness, déjà vu, complex partial seizures, and olfactory hallucinations
– Occipital epilepsy can cause visual phenomena and headaches
– Occipital epilepsy should be differentiated from migraine

JCV is the cause of progressive multifocal leukoencephalopathy (PML) and typically affects individuals with weakened immune systems. Cryptococcus is a fungus that can lead to meningitis and meningoencephalitis in those with HIV/AIDS. CMV infection can be extremely dangerous for those who are immunocompromised. EBV is responsible for infectious mononucleosis, also known as glandular fever. Herpes simplex virus has two variations, HSV-1 and HSV-2, which can cause oral lesions (commonly known as cold sores) of genital lesions, respectively.

Autism and Macrocephaly: A Common Neurobiological Finding

Macrocephaly, of an abnormally large head circumference, is a common occurrence in individuals with idiopathic autism, with approximately 20% of individuals with autism exhibiting this trait (Fombonne, 1999). This finding has been replicated in numerous studies and is considered one of the most consistent neurobiological findings in autism. However, it is important to note that macrocephaly is typically not present at birth but rather develops during childhood.

The use of topiramate can result in metabolic acidosis due to its ability to block carbonic anhydrase. This can increase the risk of developing calcium phosphate nephrolithiasis, commonly known as kidney stones.

Topiramate is a medication used for epilepsy and bipolar affective disorder. It works by inhibiting voltage gated sodium channels and increasing GABA levels. Unlike most psychotropic drugs, it is associated with weight loss.

Norepinephrine: Synthesis, Release, and Breakdown

Norepinephrine is synthesized from tyrosine through a series of enzymatic reactions. The first step involves the conversion of tyrosine to L-DOPA by tyrosine hydroxylase. L-DOPA is then converted to dopamine by DOPA decarboxylase. Dopamine is further converted to norepinephrine by dopamine beta-hydroxylase. Finally, norepinephrine is converted to epinephrine by phenylethanolamine-N-methyltransferase.

The primary site of norepinephrine release is the locus coeruleus, also known as the blue spot, which is located in the pons. Once released, norepinephrine is broken down by two enzymes: catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO). These enzymes play a crucial role in regulating the levels of norepinephrine in the body.

Delayed language development is often linked to various factors, such as being male, belonging to a larger family, coming from a lower social class (IV and V), and experiencing neglect.

The liver contains a significant number of Cytochrome P450 proteins, which are primarily located in the endoplasmic reticulum membrane. These enzymes are responsible for metabolizing various compounds, both naturally occurring and foreign. Additionally, these proteins can be found in other cellular compartments, including the cell surface and mitochondria, and are present in other areas of the body beyond the liver.

Understanding Biotransformation: A Metabolic Process for Excretion

Biotransformation is a metabolic process that occurs primarily in the liver, but also in other organs such as the kidneys, intestine, adipose, skin, and lungs. Its main function is to facilitate the excretion of both exogenous and endogenous substances by altering their chemical structures through a series of reactions. Enzymes found in the cytoplasm, endoplasmic reticulum, and mitochondria of cells catalyze these reactions, which can cause the substrate to become inactive, active, of even toxic.

Biotransformation is divided into three phases. Phase I reactions involve oxidation, reduction, of hydrolysis of the drug, yielding a polar, water-soluble metabolite that is often still active. Phase II reactions consist of adding hydrophilic groups to the original molecule, a toxic intermediate, of a nontoxic metabolite formed in phase I, to increase its polarity. The most common method is conjugation with glucuronic acid, but other groups such as sulphate, amino acids, acetate, and methyl can also be added. Phase III reactions occur post-phase II, where a chemical substance can undergo further metabolism and excretion through active transport into the urinary of hepatobiliary system.

Understanding biotransformation is crucial in pharmacology and toxicology, as it affects the efficacy and toxicity of drugs and other substances. By facilitating the excretion of these substances, biotransformation helps maintain homeostasis in the body and prevent accumulation of potentially harmful compounds.

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.

The psychiatrist aims to encourage the patient to persist in their work by providing positive feedback.

Interview Techniques: Reinforcement

The term ‘reinforcement’ may seem vague, but it is a topic that can be tested in exams. It pertains to interview techniques that seem to enhance a particular behavior.

The term paramnesia refers to memory disorders where fantasy and reality are confused. There are various types of paramnesias, including déjà vu, jamais vu, confabulation, reduplicative paramnesia, retrospective falsification, and cryptomnesia. Reduplicative paramnesia is a subset of delusional misidentification syndromes, which include Capgras delusion, the Fregoli delusion, and others. A review of reduplicative paramnesia was conducted by Politis in 2012.

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 parahippocampal gyrus is located surrounding the hippocampus and is involved in memory processing. Asymmetry in this area has also been observed in individuals with schizophrenia.

Aphasia is a language impairment that affects the production of comprehension of speech, as well as the ability to read of write. The areas involved in language are situated around the Sylvian fissure, referred to as the ‘perisylvian language area’. For repetition, the primary auditory cortex, Wernicke, Broca via the Arcuate fasciculus (AF), Broca recodes into articulatory plan, primary motor cortex, and pyramidal system to cranial nerves are involved. For oral reading, the visual cortex to Wernicke and the same processes as for repetition follows. For writing, Wernicke via AF to premotor cortex for arm and hand, movement planned, sent to motor cortex. The classification of aphasia is complex and imprecise, with the Boston Group classification and Luria’s aphasia interpretation being the most influential. The important subtypes of aphasia include global aphasia, Broca’s aphasia, Wernicke’s aphasia, conduction aphasia, anomic aphasia, transcortical motor aphasia, and transcortical sensory aphasia. Additional syndromes include alexia without agraphia, alexia with agraphia, and pure word deafness.

Development of the cerebellum commences from the metencephalon in the sixth week.

Neurodevelopment: Understanding Brain Development

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

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

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

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

Pseudohallucinations are often distinguished from true hallucinations by their lack of a genuine perceptual quality, although this distinction can be challenging to apply in practice. True hallucinations can be induced by illicit drug use. extracampine hallucinations, which are typically visual and occur outside of the normal sensory field, are considered true hallucinations. Pseudohallucinations are not exclusive to schizophrenia and can manifest in various sensory modalities.

Cognitive Dissonance is a term used to describe the uncomfortable feeling that arises when there is a conflict between an individual’s attitudes, beliefs, of behaviors. This feeling can lead to a change in behavior of beliefs. The theory of cognitive dissonance suggests that people have an inner drive to maintain cognitive consistency and avoid dissonance. This drive can result in irrational of maladaptive behaviors. Dissonance can be reduced by changing attitudes, behaviors, of beliefs, acquiring new information, of reducing the importance of the cognitions. Overall, cognitive dissonance plays a significant role in shaping human behavior and decision-making.

Flooding as a Treatment for Phobias

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

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.

The therapists in the Tarasoff case were faulted for placing greater importance on maintaining the patient’s confidentiality, thereby prioritizing the principle of beneficence over the rights of the potential victim. As a result, they were deemed to have failed in their duty to consider the principle of non-maleficence.

Double Agentry in Psychiatry

Double agentry is a term used to describe a situation where a psychiatrist’s conflict of interest interferes with their ability to act in the best interests of their patient. Psychiatrists often have to balance the interests of multiple parties, such as the patient, family, society, and hospital commissioners, which is known as multiagency.

The Tarasoff case is a prime example of double agentry in psychiatry. Two therapists failed to warn a woman that their patient had expressed an intention to kill her. They chose not to do so to respect the patient’s confidentiality, but failed to recognize their duty of care to both the patient and the potential victim. Unfortunately, the woman was eventually murdered by the patient.

This case, which occurred in California, led to a change in the law that now requires therapists to have a legal duty to both their patients and potential victims. It highlights the importance of psychiatrists being aware of their responsibilities to all parties involved and ensuring that they act in the best interests of their patients while also fulfilling their duty of care to others.

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.

Theories of Emotion

In membership exams, four main theories of emotion are commonly discussed: James-Lange theory, Cannon-Bard theory, Singer-Schachter theory, and Lazarus theory. The key to understanding the differences between these theories is to identify where the stimulus for the emotion arises.

According to the James-Lange theory, emotions occur as a result of bodily sensations. For instance, if you see a big dog, your heart races, and you feel afraid. This theory proposes that certain external stimuli stimulate specific sensory organs, leading to a particular emotion. The sequence of events suggested by this theory is as follows: event – arousal – interpretation – emotion. In other words, the stimulus for emotion arises from physical sensations.

The Cannon-Bard theory, also known as the thalami theory, proposes that when an event occurs, one experiences an emotion at the same time as physiological changes. The stimulus for emotion arises simultaneously in the body and the mind.

The Singer-Schachter theory, also known as the two-factor theory, suggests that emotions result from both physiological changes and the context. For example, if your heart is racing, and you are about to have an exam, you label yourself as afraid. However, if your heart is racing, and you are about to kiss your partner, you label your emotional state as excited. The stimulus for emotion arises via a combination of physical sensations and the mind’s appraisal of them.

Finally, the Lazarus theory proposes that a thought is required before an emotion occurs. For instance, if you see a big dog, you think it is going to bite you, and you feel afraid. The stimulus for emotion arises from the mind.

In summary, these theories offer different perspectives on the relationship between physical sensations, cognitive processes, and emotions.