Psychiatry & Deaddictio

It is characterized by sadness of mood, anhedonia, feeling of worthlessness and hopelessness, lack of energy and concentration, appetite disturbances, psychomotor agitation or retardation, sleep disturbances and suicidal thoughts. Symptoms: Aetiology: Biological factors in the form of neurotransmitter disturbances especially serotonin, hormonal disturbances, neuroanatomical disturbances. Various medical disorders predispose to depression as well most commonly- hypothyroidism, diabetes, and various vitamin and mineral deficiencies. Neuroanatomical: Decreased activity in dorsolateral prefrontal cortex and increased activity in amygdala. Genetic: there is found to a role of cAMP response element protein on chromosome 2, and serotonin transporter gene. Psychological theories: according to these negative thoughts have a central role in development of depression. It is the second most prevalent mental health disorder according to WHO with a lifetime prevalence of 12%. It affects females twice compared to males. Depression is the most common cause of suicide. Diagnosis For diagnosis minimum of 5 symptoms should persists for at least 2 weeks. Treatment Pharmacotherapy in the form of Tricyclic antidepressants, Selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors. Psychotherapy: Cognitive behaviourtherapy , interpersonal therapy. ECT in cases of suicide risk Transcranial magnetic stimulation Vagal stimulation Deep brain stimulation

Episodic illness, characterized by episodes of both mania and depression. The lifetime prevalence is 1%. Male to female prevalence is 1:1. Mean age of onset is mid 20’s. Manic episode is characterized by elevated mood, increases activity, increased talkativeness, decreased need for sleep, grandiosity, distractibility and patients may also develop psychotic symptoms. Aetiology: Neurotransmitter disturbances especially dopamine and serotonin. Psychological and social and environmental stresses are also known to precipitate the episodes. It is heritable disorders as genetics play a part in occurrence. Treatment Mood stabilizers Antidepressants Antipsychotics Psychotherapies.

The essential feature of this disorder includes recurrent obsessional thoughts and compulsive acts. Obsessions are defined by the recurrent and intrusive thoughts and images or impulses which cause marked anxiety or distress. Compulsions are repetitive behaviours or mental acts that person performs in response to obsessions. Symptoms The symptoms of obsessions and compulsions should present for at least 2 weeks for the diagnosis. Lifetime prevalence is around 2-3% Aetiology: Serotonin dysregulation, altered functioning of cortico-striatal-thalamic-cortical circuitry. Psychological and environmental stress, genetic heritability.

It encompasses behavioural dependence, physical dependence and psychological dependence. Drug Abuse and Addiction are among the most serious Public Health problems that our society is facing. The substance related disorders encompass separate psychoactive drugs which includes alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives and hypnotics, stimulants, tobacco and other substances. Aetiology: These drugs act on particular receptors and brain pathways and have found to play a central role in development of substance use disorders. Various neurotransmitters like opioids, catecholamines and GABA. There is also a role of genetic factors in development of substance disorders. Learning and conditioning is also known to contribute to these disorders. There are four important patterns of substance use disorders which may overlap each other- Acute intoxication, withdrawal state, dependence syndrome, harmful use. Treatment Immediate: completion of detoxification, in-tervention of psychosocial and medical crisis. Short-term: include management of medical and psychiatric co-morbidity and re-integration with family. Long-term: prevention of relapse, re-integration into the society, occupational rehabilitation and improvement in overall quality of life.

These are characterized by either a demonstrable cerebral disease, brain injury or any other insults leading to cerebral dysfunction. Symptoms Cognitive impairment Disturbances of consciousness Hallucinations Delusions These are classified as: Delirium, Dementia, amnestic disorders. Aetiology: Neurosurgical conditions, neuroanatomical conditions, infectious causes, metabolic causes, autoimmune causes. Treatment: Treating the underlying cause Pharmacological treatment Behavioral treatment Psychosocial intervention.

Personality disorders are the result of inflexible and maladaptive personality traits which causes significant social and occupational impairment and personal distress. The various clinical subtypes are: Cluster A: Paranoid, Schizoid, schizotypal Cluster B: Histrionic , narcissistic, antisocial, borderline Cluster C: Avoidant, dependent, anankastic The prevalence of personality disorders is 10-20% and onset is generally in adolescence or early adulthood. Diagnosis: Diagnosis is made on the basis of marked disturbance in attitude and behaviors involving several areas of functioning. Treatment: Mostly includes psychotherapy and occasional use of pharmacotherapy when required.

The various sleep disorders have been divided into Dyssomnias and Parasomnias Dyssomnia includes Insomnia, periodic limb movement disorder, restless leg syndrome. Hypersomnia, Narcolepsy, catalepsy, sleep paralysis, Kleine-Levin syndrome. Parasomnias includes Night Terrors Sleep walking Sleep related enuresis Bruxism Sleep talking Sleep disorders generally associated with many medical and psychiatric disorders. Treatment: Treating the underlying disorder Pharmacological treatment Behavior and psycho therapies.

Anorexia nervosa: It is an eating disorder. Most commonly seen in adolescent females Signs and Symptoms Disturbance of body image Excessive fear of fatness Excessive emphasis on thinness There is restriction of energy intake leading to significantly less weight. Many medical symptoms might also arise out of extreme starvation like amenorrhea, poor sexual development, lanugo, hypothermia, dependent edema, bradycardia. Subtypes Restricting: Seen in 50 % of the cases and characterized by highly restricted food intake Binge eating/purging subtype: seen in 25-50%, in this patient attempts alternate rigorous dieting with intermittent binging and purging episodes Treatment: Treatment may include hospitalization to restore nutritional status and manage complication of dehydration and electrolyte imbalances. It also focuses on combination of behavioral management, individual psychotherapy and family education. Few other eating disorders are Bulimia nervosa, obesity, Binge eating disorder.

Attention Deficit Hyperactivity Disorder: It is a common neuropsychiatric disorder of child-hood. Occurs in 3% of the school age children and affects boys more than girls. The onset occurs before the age of 7 years and a large majority of patients’ exhibit symptoms by 4 years of age There are 4 clinical subtypes: Attention deficit disorder with hyperactivity: it is characterized by poor attention span with distractibility, hyperactivity, impulsivity Attention deficit disorder without hyperactivity Residual type Hyperactivity disorder with conduct disorder. The diagnosis is made on the basis of teacher’s school report, parent’s report and clinical examination. Neurological examination may reveal soft neurological signs. Aetiology: Various factors are considered to be responsible for this disorder including minimal brain damage, maturational lag, genetics, neurotransmitters and early psychodynamic factors. Treatment: It includes Stimulant medication, non-stimulant medication, at times anti-psychotic medication. Psychosocial interventions in the form of social skill training, psychoeducation for parents, behavior therapy, and cognitive behavior therapy.