She is suffering with Anorexia Nervosa with OCD. Needs proper Psychiatric History Taking & MSE. Treatment may be done with Antipsychotic, Antidepressants & Tranquilizers, along with CBT.
She is ok phobia of looking slim trim kindly explain BMI up to 23 ok show age chart roughly understand 45 kg ok for her
She suffers from Anorexia Nervosa Need CBT Anti depresent s Anti OCD Drugs Tranquilizer s ,and ECT.
Anorexia nervosa please do counseling and give Tranquilizers and Syrup Cypon 2 tsf bd
IT'S A..CASE OF.. ? ANOREXIA NERVOSA.. ? HYSTERIA .. ? PSYCHOTIC DISORDER..
Anorexia Nervosa, Hysteria Treat with tranquilizers and Appetizers
Anorexia Nervosa Needs counseling Sedatives
? Anorexia nervosa .. ? Mental disorders..
Anorexia nervosa..complete history regarding her mental cognitive ness evaluation is needed..tab.ciplactin will work..
OCD required antiobcessional drugs with small dose of antipsychotics
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The syndrome is associated with abdominal pain, nausea, vomiting, Obstruction and peritonitis, which depends on the size of this structure. Identify the structure and this extremely rare conditionSamarth Goyal3 Likes19 Answers
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35 year old female presented with wrist Slash, telling some one told me to do so. she is married having two children.No significant stressors.History suggestive of psychotic illness for past four years which is episodic. Poor compliance with treatment.Premorbid personality well adjusted.No history of BPAD or MDD. when the patient reported she was on olanzepine 15 mg and sertraline 50 mg from a psychiatrist when she tried self harm now for first time.Mood depressed ,no depressive ideas ,percecutary and referential ideas present along with pseudohallucination commanding to commit suicide. Also complaints of palpitations,fear , running out behaviour in response to pseudohallucination. Olanzepine uptitrated to 25 mg, Sertraline changed to desvenlafaxine 50 mg along with bzd considering associated low mood which was persisting.Parient became euthymic suicidal ideation disappeared full improvement noticed in 20 days. Suddenly next day started pseudohallucination and running out behaviour,mood changes ,dsh ideation. Considering the primary diagnosis of Psychosis , possible worsening of psychotic features with SNRI desvenlafaxine stopped.Patient returned to premorbid level in one week and discharged on olanzepine 25 mg and bzd. Due to complaints of sedation bzd tapered down next visit and within two days patient attempted suicide telling commanding hallucination. How can be proceeded with the case . Please opine. @Dr. Shama Rathod @Dr. Sumi AswinDr. Saleem Pallisserikuzhiyil3 Likes15 Answers
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14 year old girl brought with complaints of absent interactions with peers and teachers in school .Sitting eyes apparently closed inside class room .Not making eye contact with anyone. Deterioration in academic functioning also noticed. Decline started since four years which is gradual and interest in extracurricular activities is also coming down and absent now. Inside family atmosphere she functions well and takes initiatives to do outside trip to play areas,parks, cinemas. Irritability and occasional destructive behaviour also present inside house ,no change in biological functioning reported. Whenever her school mates visited her house she was in distress and there was irritability.Recently she seems to wear a scarf over head when she goes to outside house where there is likely to meet her school mates.Some excessive concern about cleanliness also noticed. Family history of depression in mother delusional disorder in father and suicide and substance use disorder in second degree relatives.Interpersonal issues between parents present. MSE revealed Poor but possible rapport, Slightly reduced range of affect, slightly reduced reactivity, low mood , sibling rivalry,no egodystonic distress regarding her problems also noticed.No hallucinations or delusion .No depressive or suicidal ideation. Unable to self appreciate fully her dysfunctions and unable to elaborate on reasons. physical examination nil significant.No history of abuse reported. How you proceed with the case ?Dr. Saleem Pallisserikuzhiyil1 Like22 Answers
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ABC OF : MENTAL RETARDATION....... ( INTELLECTUAL DISABILITY / INTELLECTUAL DEVELOPMENTAL DISORDER). MAY BE USEFUL. *** MENTAL RETARDATION :- ** BELOW AVERAGE INTELLIGENCE (IQ) AND SET OF LIFE SKILLS PRESENT BEFORE THE AGE 18 YEARS....... ** VERY COMMON....... ** MORE THAN 10 MILLION CASES PER YEAR IN INDIA....... ** TREATMENT CAN HELP, BUT THIS CONDITION CAN'T BE CURED....... ** CHRONIC : CAN LAST FOR YEARS OR BE LIFELONG....... ** REQUIRES A MEDICAL DIAGNOSIS....... ** LABORATORY TESTS OR IMAGING RARELY REQUIRED....... *** The American Psychiatric Association (APA) is responsible for naming, defining and describing mental disorders. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the APA replaced “ MENTAL RETARDATION ” (MR) with “ INTELLECTUAL DISABILITY ( ID ) OR INTELLECTUAL DEVELOPMENTAL DISORDER ( IDD ). *** POSSIBLE CAUSES OF MR / ID :- * Down Syndrome. Down syndrome is the most common genetic condition in the United States....... * Hydrocephalus....... * Cerebral Palsy....... * Lead Poisoning....... * Fanconi Anemia....... * Phenylketonuria (PKU)....... or Tay-Sachs disease....... * Muscular Dystrophy....... * Homocystinuria....... * TRAUMA BEFORE BIRTH, such as an infection or exposure to alcohol, drugs, or other toxins....... * TRAUMA DURING BIRTH, such as oxygen deprivation or premature delivery....... * SEVERE MALNUTRITION or other dietary issues....... * EARLY CHILDHOOD ILLNESS, such as WHOOPING COUGH, MEASLES, or MENINGITIS....... * SEVERE BRAIN INJURY.......etc etc....... *** SYMPTOMS OF MR / ID :- Symptoms of ID will vary based on the child’s level of disability and may include : * Failure to meet intellectual standards....... * Sitting, crawling, or walking later than other children....... * Problems with learning to talk or trouble speaking clearly....... * Memory problems....... * Inability to understand the consequences of actions....... * Inability to think logically....... * Childish behavior inconsistent with the child’s age....... * Lack of curiosity....... * Learning difficulties....... * IQ below 70....... * Inability to lead a normal life due to challenges communicating, taking care of themselves, or interacting with others....... *** IF THE CHILD HAS MR/ID, HE/SHE WILL PROBABLY EXPERIENCE SOME OF THE FOLLOWING BEHAVIORAL ISSUES : AGGRESSION DEPENDENCY WITHDRAWAL FROM SOCIAL ACTIVITIES ATTENTION-SEEKING BEHAVIOUR DEPRESSION DURING ADOLESCENT AND TEEN YEARS LACK OF IMPULSE CONTROL PASSIVITY TENDENCY TOWARD SELF-INJURY STUBBORNNESS LOW SELF-ESTEEM LOW TOLERANCE FOR FRUSTRATION PSYCHOTIC DISORDERS DIFFICULTIES PAYING ATTENTION ** Some people with ID may also have specific physical characteristics. These can include having a short stature or facial abnormalities. *** LEVELS OF MR / ID :- MR/ID IS DIVIDED INTO FOUR LEVELS, BASED ON CHILD’S IQ AND DEGREE OF SOCIAL ADJUSTMENTS....... *** DIAGNOSIS :- HOW INTELLECTUAL DISABILITY DIAGNOSED? To be diagnosed with ID, the child must have below average intellectual and adaptive skills. THE DOCTOR WILL PERFORM A THREE-PART EVALUATION : ** INTERVIEWS WITH PARENTS ** OBSERVATIONS OF THE CHILD ** STANDARD TESTS The child will be given STANDARD INTELLIGENCE TESTS, such as the STANFORD-BINET INTELLIGENCE TEST. This will help the doctor determine the child’s IQ. The doctor may also administer other tests such as the VINELAND ADAPTIVE BEHAVIOUR SCALES. This test provides an assessment of the child’s daily living skills and social abilities, compared to other children in the same age group. ** It’s important to remember that CHILDREN FROM DIFFERENT CULTURES AND SOCIO-ECONOMIC STATUSES MAY PERFORM DIFFERENTLY ON THESE TESTS. To form a diagnosis, the child’s doctor will consider the test results, interviews with parents, and observations of the child . *** CHILD’S EVALUATION PROCESS MIGHT INCLUDE VISITS TO SPECIALISTS, WHO MAY INCLUDE: PSYCHOLOGIST SPEECH PATHOLOGIST SOCIAL WORKER PEDIATRICS NEUROLOGIST DEVELOPMENTAL PEDIATRICIAN PHYSICAL THERAPIST *** LABORATORY AND IMAGING TESTS MAY ALSO BE PERFORMED. These can HELP the child’s doctor DETECT METABOLIC AND GENETIC DISORDERS, as well as STRUCTURAL PROBLEMS with the child’s brain. ** OTHER CONDITIONS, such as hearing loss, learning disorders, neurological disorders, and emotional problems can also cause delayed development. Child’s doctor should RULE these conditions OUT BEFORE DIAGNOSING the child with ID. Parents, child’s school, and doctor will use the results of these tests and evaluations to develop a treatment and education plan for the child.......Dr. Puranjoy Saha21 Likes24 Answers
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ORS previously included in Psychotic spectrum have been moved to the OC spectrum in DSM five. Olfactory Reference Syndrome with Suicidal Attempt Treated with Pimozide and Fluvoxamine ￼ Introduction The symptoms of Olfactory Reference Syndrome (ORS) were first described in a case series of 36 patients by Pryse-Phillips in 1971. Although published literature on the subject spans more than a century, areas of controversies persist in terms of the nosology and treatment of the disease. The core symptomatology of ORS is characterized by a preoccupation with the belief that one emits an offensive odor, which is not perceived by others. Other terms that have been used in literature to describe the disease include delusions of bromosis, hallucinations of smell, chronic olfactory paranoid syndrome, olfactory delusional syndrome, monosymptomatic hypochondriacal psychosis, olfactory delusional state, olfactory hallucinatory state, and autodysomophobia. The characterization of this syndrome has been a moving target; it appears in the DSM 5 under “Other Specified Obsessive-Compulsive Disorders” as well as under the “Glossary of Cultural Concepts of Disease,” as a variant of Taijin Kyofusho, a disease characterized by “anxiety about and avoidance of interpersonal situations, due to the thought, feeling, or conviction that one’s appearance and actions in social interactions are inadequate or offensive to others.” ORS was first categorized as an atypical somatoform disorder in the DSM-III and then as a delusional disorder in DSM-IV-TR and now under Other Specified Obsessive-Compulsive Disorders in DSM 5. The controversy surrounding its classification stems from the supposed preferential response of the condition to Selective Serotonin Reuptake Inhibitors (SSRIs) suggesting a possible associational overlap with Obsessive-Compulsive Spectrum Disorders and its very strong comorbidity with depressive disorders but, despite this preference, reports of the utility of antipsychotics such as Quetiapine, Risperidone, and Pimozide have also been reported in literature. The clinical course of ORS is chronic and debilitating for the patient and their families; although the clinical presentation may be confused with primary psychotic disorder, there is no clear evidence that this disorder leads to or is associated with schizophrenia. Pryse-Phillips, in his seminal paper, highlighted the importance of depression as the most common psychiatric comorbidity with ORS but other comorbidities have also been described in literature including bipolar disorder, personality disorders, schizophrenia, hypochondriasis, alcohol and substance use disorders, Obsessive-Compulsive Disorder (OCD), and body dysmorphic disorder. Case Report A case of a 75-year-old African American woman, widow, unemployed, and domiciled with a past medical history of hypertension, osteoarthritis, and asthma. The patient was brought to the Emergency Room by Emergency Medical Services (EMS) on account of an attempted suicide due to a 3-year history of “bad odor coming from my vagina.” The patient reported that the foul smell from her vagina was making her body “rotten.” She reported that “the smell came back recently and it is stronger.” Although she has been having the odor for the last 3 years, it has only recently gotten worse, the culmination of which resulted in her attempted suicide this time. She reported that she has seen several gynecologists who have treated her to no avail and later advised her to see a psychiatrist. She stated that there is a “devil” in her body that does not let go and she said, “I need help.” The patient has a significant impairment in social functioning evidenced by a reported avoidance of social events; she could no longer go out to the store for her basic needs; according to the patient’s son, she has also stopped going out to get groceries or to the church. She reported that she has been unable to have any romantic relationships because of her “odor.” The patient stays at home all day, showers several times daily, and has tried many vaginal products and creams but all in vain. Diagnosis At the time of initial evaluation, the patient appeared paranoid, reporting that people stayed away from her because of her smell. She also endorsed ideas of reference claiming that people around her cover their noses, stand next to windows, or look at her in “a certain way” and then talk about how much she “stinks” to each other. She endorses profound feelings of hopelessness, helplessness, and guilt and was tearful during the interview. Other symptoms reported were poor sleep, feeling less energetic, decrease in concentration, and anhedonia. She also endorsed active suicidal ideation, imagining waking up dead every morning due to her odor, and attempted to stab herself in order to “end my mystery” which led to this current admission. She also reported that she had lost up to 20 pounds in last 3 months. The patient was initially diagnosed with schizophrenia but later revised to Olfactory Reference Syndrome (ORS) in view of an extensive review of her symptoms and collateral information. Treatment The patient was admitted to the inpatient psychiatric unit and placed on 1: 1 constant observation for active suicidal ideation. Laboratory investigations including urine toxicology, liver function, urea, creatinine, electrolytes, and antinuclear antibodies, syphilis, and human immunodeficiency virus serology were all within normal limits or negative. She was started on Risperdal 2 mg PO twice daily for psychosis, Escitalopram 20 mg PO daily for depression, and Trazodone 50 mg PO HS for sleep. Neurological and gynecological consults were sought and the MRI of the brain obtained revealed no significant findings and was otherwise unremarkable. After a week, the patient’s delusions about her vaginal smell got even worse. She would not go outside of her room even for meals which were offered to her in the room because she thought that people could smell her vaginal odor. She also spent very long hours in the showers and demanded to take showers several times daily; her requests put a strain on the staff of the unit and on other patients who needed to use the same facilities. The patient’s medications were reviewed and she was started on Pimozide 1 mg PO twice daily and Fluvoxamine 25 mg PO daily based on the revision of her diagnosis to ORS. Risperdal, Citalopram, and Trazodone were discontinued. The patient made remarkable progress in the next few days. Pimozide was optimized to 2 mg PO twice daily and Fluvoxamine to 75 mg PO daily during the course of her hospitalization. She remained adherent with her medications and no side effects were noted. The patient and nursing staff agreed to a 70% symptomatic improvement in the patient’s symptoms; her affect was brighter; she was able to go outside of her room for meals and group therapy and socialize with other patients and staff. She became amenable to dissuasion regarding her previously held delusions and denied any depressive symptoms and no longer needed 1: 1 constant observation as she was no longer suicidal. She appeared future-oriented and motivated to go back home and resume her social life again. She was discharged back to her apartment and was provided with an outpatient appointment for aftercare. The team followed up with the patient patients several months after her discharge and she continued to maintain a remission of her symptoms. Discussion This patient believed that her vagina was emitting such a strong odor that she attempted to take her own life after 3 years of significant distress. Her belief was accompanied by ideas of reference; that is, she thought that other people took special notice of the odor in a negative way; she performed repetitive behaviors of multiple daily showers and use of vaginal washing soaps daily. Although not an official diagnostic criterion, our patient met the provisional criteria set by the DSM-5 Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorders Work Group criteria for Olfactory Reference Syndrome : (A)Preoccupation exists with the belief that one emits a foul or offensive body odor, which is not perceived by others. (B)The preoccupation causes clinically significant distress (e.g., depressed mood, anxiety, and shame) or impairment in social, occupational, or other important areas of functioning. (C)The symptoms are not a symptom of schizophrenia or another psychotic disorder and are not owing to the direct physiological effects of a substance (e.g., drug abuse or medication) or a general medical condition. The comorbidity with Major Depressive Disorder in our patient is of particular significance. The importance of this comorbidity is well known and has been reported in the literature. In this case, our patient reported several symptoms suggestive of Major Depressive Disorder evidenced by her profound feeling of hopelessness and guilt; she has lost interest in everything; she reported insomnia and poor appetite with a significant amount of weight loss. All the patient’s symptoms, although rooted in the context of her perception that she was smelling, were nonetheless significant to the point that she attempted suicide. The use of Pimozide and SSRIs in the treatment of monosymptomatic hypochondriacal states has been consistently reported in the literature. The combination of these medications in the index case yielded excellent results. Although the reliability of the diagnostic criteria is not yet established and ORS is not a stand-alone diagnosis in the DSM-5, it merits consideration in patients who present with monosymptomatic hypochondriacal illnesses, as this diagnostic consideration may influence the treatment and eventually the potential course of the illness as with our patient who after three years of a distressing illness is currently in remission with proper treatment. Keywords Olfactory Reference Syndrome, suicide attempt, Pimozide, Fluvoxamine Author : Jegede, et al.Dr. Saleem Pallisserikuzhiyil9 Likes9 Answers