Reboxetine is classified as a selective inhibitor of noradrenaline reuptake (NRI), which means it works by preventing the reuptake of noradrenaline and increasing its levels in the body. This medication is typically prescribed as a secondary option for treating acute depressive episodes of major depression when SSRIs are ineffective of not well-tolerated.

Down Syndrome: Causes and Risk Factors

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

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

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

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

The Cerebellum: Anatomy and Function

The cerebellum is a part of the brain that consists of two hemispheres and a median vermis. It is separated from the cerebral hemispheres by the tentorium cerebelli and connected to the brain stem by the cerebellar peduncles. Anatomically, it is divided into three lobes: the flocculonodular lobe, anterior lobe, and posterior lobe. Functionally, it is divided into three regions: the vestibulocerebellum, spinocerebellum, and cerebrocerebellum.

The vestibulocerebellum, located in the flocculonodular lobe, is responsible for balance and spatial orientation. The spinocerebellum, located in the medial section of the anterior and posterior lobes, is involved in fine-tuned body movements. The cerebrocerebellum, located in the lateral section of the anterior and posterior lobes, is involved in planning movement and the conscious assessment of movement.

Overall, the cerebellum plays a crucial role in motor coordination and control. Its different regions and lobes work together to ensure smooth and precise movements of the body.

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).

Opioid dependence is characterized by a decrease in alpha activity on electroencephalography (EEG). Other drugs have distinct EEG changes, such as increased beta activity with benzodiazepines, decreased alpha activity and increased theta activity with alcohol, and increased beta activity with barbiturates. Marijuana use is associated with increased alpha activity in the frontal area of the brain and overall slow alpha activity. During opioid overdose, slow waves may be observed on EEG, while barbiturate withdrawal may result in generalized paroxysmal activity and spike discharges.

Cerebrovascular accidents (CVA), also known as strokes, are defined by the World Health Organization as a sudden onset of focal neurological symptoms lasting more than 24 hours and presumed to be of vascular origin. Strokes can be caused by either infarction of hemorrhage, with infarction being more common. Hemorrhagic strokes tend to be more severe. Intracranial hemorrhage can be primary, caused mainly by hypertension, of subarachnoid, caused by the rupture of an aneurysm of angioma. Primary intracranial hemorrhage is most common in individuals aged 60-80 and often occurs during exertion. Infarction can be caused by thrombosis of embolism, with thrombosis being more common. Atherosclerosis, often caused by hypertension, is the main cause of infarction. CT scanning is the preferred diagnostic tool during the first 48 hours after a stroke as it can distinguish between infarcts and hemorrhages. Recovery from embolism is generally quicker and more complete than from thrombosis due to the availability of collateral channels.

Schwartz et al. identified five types of errors in drug adherence. These include errors of omission, errors of purpose, errors of dosage, errors of timing and sequence, and taking additional medication not prescribed by the doctor. An example of errors of purpose is when a patient takes medication for the wrong reason. Other types of errors include not taking the medication, taking the wrong dosage, and taking medications at the wrong time and sequence.

Types of Delusions

Delusions come in many different forms. It is important to familiarize oneself with these types as they may be tested in an exam. Some of the most common types of delusions include:

– Folie a deux: a shared delusion between two or more people
– Grandiose: belief that one has special powers, beliefs, of purpose
– Hypochondriacal: belief that something is physically wrong with the patient
– Ekbom’s syndrome: belief that one has been infested with insects
– Othello syndrome: belief that a sexual partner is cheating on them
– Capgras delusion: belief that a person close to them has been replaced by a double
– Fregoli delusion: patient identifies a familiar person (usually suspected to be a persecutor) in other people they meet
– Syndrome of subjective doubles: belief that doubles of him/her exist
– Lycanthropy: belief that one has been transformed into an animal
– De Clérambault’s syndrome: false belief that a person is in love with them
– Cotard’s syndrome/nihilistic delusions: belief that they are dead of do not exist
– Referential: belief that others/TV/radio are speaking directly to of about the patient
– Delusional perception: belief that a normal percept (product of perception) has a special meaning
– Pseudocyesis: a condition whereby a woman believes herself to be pregnant when she is not. Objective signs accompany the belief such as abdominal enlargement, menstrual disturbance, apparent foetal movements, nausea, breast changes, and labour pains.

Remembering these types of delusions can be helpful in understanding and diagnosing patients with delusional disorders.

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.

Kelley’s Theory of Causal Attributions proposes that to accurately attribute a behavior, one must consider three types of causal information: consensus, consistency, and distinctiveness. Naïve psychology emphasizes the role of intentional concepts in interpreting behavior, while theory of mind is a cognitive ability that develops around age 4 and involves understanding intentional states like beliefs and desires. Correspondent inference theory suggests that people make dispositional inferences based on others’ behaviors, focusing on those that provide the most information.