There can be multiple differential diagnosis for aggression and violent behavior like 1) Adjustement disorder with problems of emtion and conduct if acute stressor is present as in ur case lockdown and when insight is present. 2) Acute and transient psychotic disorder, if acute stressor and other associated psychotic symptoms like delusions, hallucinations, absent insight. Possible in ur case if absent insight. 3) Depressive disorder, can have irritability and agression 4) Manic episode/ Bipolar disorder if aggression and violence is associated with absent insight 4) Schizophrenia 5) Impulse control disorder like intermittent explosive disorder 6) Personality disorder- borderline and antisocial 7) Substance use disorder under intoxication and withdrawal 8) episodic non goal directed aggression can be manifestation of epilepsy ( CPS) 9) Neurological condition like brain malignancy Management depends on accurate diagnosis. But in emergency its a step wise approach- 1) Verbal restraint- try to talk, establish rapport and reassure 2) if verbal restraint nt successful Chemical restraint- iv lorazepam 4mg alone/ iv haloperidol 5mg serenace+ inj phenergan 25 mg / iv haloperidol 5mg+ lorazepam 4mg 3)Physical retraint- if verbal and chemical both ineffective.
Respected Dr Khan aggresive and violent behaviour is an expression of sone mental pathology, be it a personality disorder or other due to overstimulation of amygdala and related neucluses. One should not jump to lebel one disease. I consider to switch over to pharmacological treatment by perenteral shot of either haloperidol or one benzodiazepin to let the calm first. After that detailed history taking and next course is to be determined.
Schizophrenia. No argument with pt or attendants. Reassurance and counciling required. Inj clobozam iv given stat slowly strictly under supervision and handle carefully to avoid any eventually. Psychiatrist opinion and help must .
Aggression and violent behaviour of a person suggest pt is shizophrenic and urgently need psychiatrist help Iv tranquillisers like inj clobozam and anatensol are to be given under his supervision. Followed by oral treatment
May be brief psychotic disorder. Schizophreniform disorder Schizophrenia. Schizotypal Bipolar one disorder manic episode ir depresive episode. Do IV DIAZEPAM 5M Then proceed with antipsychotic medications.
I disagree with most of the senior doctors recommending for iv haloperidol or benzodiazepine. My advice would be take detailed history give him etizolam evaluate and then proceed. consider radio imaging also
Refer the patient to the Psychiatrist for proper history taking & MSE, without doing unnecessary treatment. Correct Diagnosis is the must for any psychotherapeutic medications.
Mostly it is psychotic behavior of whatever csuse. Pl give im/iv haloperidol ,(,serenace) .agression is vontrolled in half an hour.then youcan work on case
SUGGESTIVE of SCHIZOPHRENIA.. NEEDS. FURTHER. EVALUATION
Case of Schizophrenia refer to psychiatrist
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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 Likes8 Answers
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Bi - Polar Disorder A person with bipolar disorder probably doesn’t fit the stereotype you have in mind. You might be surprised to learn that bipolar disorder isn’t just classified by out-of-control highs or suicidal lows. While these ups and downs certainly happen, there are also periods of normalcy mixed in on a regular basis. Another common misconception about people diagnosed with bipolar disorder is that they spend more time experiencing depression as opposed to mania. This is because people suffering from bipolar disorder are more likely to seek help when they are having a depressive episode than when having a manic episode. In fact, many people suffering from bipolar disorder keep their illness private for fear of judgment or punishment, especially in the workplace. What is bipolar disorder? Bipolar disorder, or “manic-depressive illness,” is a chronic mental illness. People with bipolar disorder often experience uncontrollable high and low moods known as mania and depression, respectively. A person’s medical history is important to accurately diagnose bipolar disorder because it is not a one-size-fits-all disease. People with depression only, also called “unipolar depression,” do not experience the highs and lows of mania. However, some people with depression may also experience some manic symptoms, this is known as “major depressive disorder.” The symptoms of bipolar disorder can also mimic those of other ailments, and people with bipolar disorder typically have another disorder or disease such as anxiety disorder, thyroid disease, migraines and headaches, so it can be hard for a doctor to make an accurate diagnosis. The condition can be controlled with self-management, a good treatment plan, and a high level of support. Four basic types of bipolar disorder Bipolar 1 Disorder Manic episodes lasting at least 7 days; or by symptoms so severe that the person needs immediate medical attention. Depressive episodes usually occur as well. Likely to experience depression along with the manic and depressive episodes. Bipolar II Disorder A distinct pattern of depressive and hypomaniac episodes, but not as severe as manic episodes experienced with Biopolar I. Cyclothymic Disorder Numerous periods of hypomaniac symptoms along with numerous periods of depressive symptoms lasting for at least 2 years in adults and 1 year in children and adolescents; however, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode. Other Specified and Unspecified Bipolar and Related Disorders Bipolar symptoms that do not match the criteria of Bipolar I, Bipolar II, or Cyclothymic Disorder. Mania is buying 3 new televisions on impulse; thinking you can buy your favorite restaurant; or deciding to run a 5K with no training–and insisting you will come in first. Hypomania is mania with a tether, and while it may lessen some of the financial and personal disasters sparked by unchecked mania, it can still feel like going the wrong way on a one-way road. What are the symptoms of bipolar disorder? Bipolar symptoms include extremely intense emotions/feelings, changes in activity level, disturbed sleep patterns, and other unusual behaviors. These tell-tale periods of symptoms are called “mood episodes.” To gauge the severity of a mood episode, one should compare the intensity of the attitudes and behaviors experienced during these unusual periods of time to what is typical and normal for that person. While jumping out of a moving car is not typical for most people, something like blabbering and talking fast may be normal for one person but not for another. Some people with bipolar disorder experience hypomania, a less severe form of mania. During a hypomania episode, a person may feel energized, productive, and euphoric — yet they may still feel in control. However, to others that know them well, the mood swings and fluctuations in attitudes and energy levels are very apparent and are a cause for concern. Without proper treatment, people with hypomania may develop severe mania and depression. A person with severe episodes may also experience psychotic symptoms which tend to match the extreme mood, e.g., hallucinations or delusions. A person having a manic episode may believe he is something he is not, e.g., rich or famous; while a person having a depressive episode may believe he is worthless or a failure. Sometimes a person with bipolar disorder who occasionally has psychotic symptoms may be misdiagnosed with schizophrenia. How is bipolar disorder diagnosed? No single cause has been identified for bipolar disorder. Scientists believe several factors may contribute to the illness, including genetics, stress, and the structure of the brain itself. It is important to talk to your healthcare professional(s). It is a good idea to get a complete physical and routine lab tests to rule out other conditions. If no obvious cause for the symptoms is found, a mental health professional, such as a psychiatrist who is experienced in diagnosing and treating bipolar disorder can perform a mental health evaluation. To be diagnosed with bipolar disorder, a person has to have had at least one episode of mania or hypomania. Bipolar disorder does not discriminate – it can affect anyone The average age of onset of bipolar disorder is 25. Every year, 2.9% of the U.S. population is diagnosed with bipolar disorder, with nearly 83% of cases being classified as severe. Bipolar disorder affects men and women equally. What is the treatment for bipolar disorder? Ironically, conventional drugs used to treat bipolar disorder are mostly psychotropic drugs that can induce more of the symptoms a sufferer is trying to beat, like anxiety, nervousness, impaired judgment, mania, hypomania, hallucinations, feelings of worthlessness, psychosis, and suicidal thoughts. Lithium is the best known medication for treating the disorder because it is a mood stabilizer and is effective in treating both mania and depression, as well as for preventing relapse. The bad news is that one-third of the patients who have taken lithium for over ten years have developed chronic renal failure from the drug, according to a study in the Journal of Psychopharmacology. Sometimes antidepressants are used to treat bipolar depression, but this can be controversial because of the possibility that an antidepressant can trigger a switch into mania. Behavioral or family focused therapies, as well as complementary health approaches such as meditation, faith and prayer, play a big part in developing self-management strategies for coping with bipolar disorder.Sushmita Haodijam4 Likes5 Answers
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ADJUSTMENT DISORDER Work problems, going away to school, an illness — any number of life changes can cause stress. Most of the time, people adjust to such changes within a few months. But if you continue to feel down or self-destructive, you may have an adjustment disorder. An adjustment disorder is a type of stress-related Mental illness. You may feel anxious or depressed, or even have thoughts of suicide. Your normal daily routines may feel overwhelming. Or you may make reckless decisions. In essence, you have a hard time adjusting to change in your life, and it has serious consequences. You don't have to tough it out on your own, though. Adjustment disorder treatment — usually brief — is likely to help you regain your emotional footing. SYMPTOMS Adjustment disorders symptoms vary from person to person. The symptoms you have may be different from those of someone else with an adjustment disorder. But for everyone, symptoms of an adjustment disorder begin within three months of a stressful event in your life. Emotional symptoms of adjustment disorders Signs and symptoms of adjustment disorder may affect how you feel and think about yourself or life, including: Sadness Hopelessness Lack of enjoyment Crying spells Nervousness Jitteriness Anxiety, which may include Separation anxiety Worry Desperation Trouble sleeping Difficulty concentrating Feeling overwhelmed Thoughts of suicide Behavioral symptoms of adjustment disorders Signs and symptoms of adjustment disorder may affect your actions or behavior, such as: Fighting Reckless driving Ignoring bills Avoiding family or friends Performing poorly in school or at work Skipping school Vandalizing property Length of symptoms How long you have symptoms of an adjustment disorder also can vary: 6 months or less (acute). In these cases, symptoms should ease once the stressor is removed. Brief professional treatment may help symptoms disappear. More than 6 months (chronic). In these cases, symptoms continue to bother you and disrupt your life. Professional treatment may help symptoms improve and prevent the condition from continuing to get worse. When to see a doctor Sometimes the stressful change in your life goes away, and your symptoms of adjustment disorder get better because the stress has eased. But often, the stressful event remains a part of your life. Or a new stressful situation comes up, and you face the same emotional struggles all over again. Talk to your doctor if you're having trouble getting through each day. You can get treatment to help you cope better with stressful events and feel better about life again. If you have suicidal thoughts If you or someone you know has thoughts of suicide, get help right away. Consider talking to your doctor, nurse, a mental health professional, a trusted family member or friend, or your faith leader. If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately. Or call a suicide hot line number. In the United States, you can call the 24-hour National Suicide Prevention Lifeline at 800-273-8255 (toll-free) to talk with a trained counselor. CAUSES Researchers are still trying to figure out what causes adjustment disorders. As with other mental disorders, the cause is likely complex and may involve genetics, your life experiences, your temperament and even changes in the natural chemicals in the brain. RISK FACTORS Although the cause of adjustment disorders is unknown, some things make you more likely to have an adjustment disorder. Among children and teenagers, both boys and girls have about the same chance of having adjustment disorders. Among adults, women are twice as likely to be diagnosed with adjustment disorders. Stressful events One or more stressful life events may put you at risk of developing an adjustment disorder. It may involve almost any type of stressful event in your life. Both positive and negative events can cause extreme stress. Some common examples include: Being diagnosed with a serious illness Problems in school Divorce or relationship breakup Job loss Having a baby Financial problems Physical assault Surviving a disaster Retirement Death of a loved one Going away to school In some cases, people who face an ongoing stressful situation — such as living in a crime-ridden neighborhood — can reach a breaking point and develop an adjustment disorder. Your life experiences If you generally don't cope well with change or you don't have a strong support system, you may be more likely to have an extreme reaction to a stressful event. Your risk of an adjustment disorder may be higher if you experienced stress in early childhood. Overprotective or abusive parenting, family disruptions, and frequent moves early in life may make you feel like you're unable to control events in your life. When difficulties then arise, you may have trouble coping. Other risk factors may include: Other mental health problems Exposure to wars or violence Difficult life circumstances COMPLICATIONS Most adults with adjustment disorder get better within six months and don't have long-term complications. However, people who also have another mental health disorder, a substance abuse problem or a chronic adjustment disorder are more likely to have long-term mental health problems, which may include: Depression Alcohol and Drug addiction Suicidal thoughts and behavior Compared with adults, teenagers with adjustment disorder — especially chronic adjustment disorder marked by behavioral problems — are at significantly increased risk of long-term problems. In addition to Depression, substance abuse and suicidal behavior, teenagers with adjustment disorder are at risk of developing psychiatric disorders such as: Schizophrenia Bipolar disorder Antisocial personality disorder PREPARING FOR YOUR APPOINTMENT If you have symptoms of an adjustment disorder, make an appointment with your primary care doctor. While adjustment disorders resolve on their own in most cases, your doctor may be able to recommend coping strategies or treatments that help you feel better sooner. What you can do To prepare for your appointment, make a list of: Any symptoms you've been experiencing,and for how long Key personal information, including any major stresses or recent life changes, both positive and negative Medical information, including other physical or mental health conditions, and names and dosages of any medications or supplements you're taking Questions to ask your doctor so that you can make the most of your appointment Ask a family member or friend to go with you to the appointment, if possible. Someone who accompanies you can help remember what the doctor says. For adjustment disorder, some basic questions to ask your doctor include: What do you think is causing my symptoms? Are there any other possible causes? How will you determine my diagnosis? Is my condition likely temporary or long term (chronic)? Do you recommend treatment? If yes, with what approach? How soon do you expect my symptoms to improve? Should I see a mental health specialist? Do you recommend any temporary changes at home, work or school to help me recover? Should people at my work or school be made aware of my diagnosis? Are there any brochures or other printed material that I can have? What websites do you recommend? Don't hesitate to ask questions during your appointment anytime you don't understand something. What to expect from your doctor Be ready to answer your doctor's questions so you have time to focus on your priorities. Your doctor may ask: What are your symptoms? When did you or your loved ones first notice your symptoms? What major changes have recently occurred in your life, both positive and negative? Have you talked with friends or family about these changes? How often do you feel sad or depressed? Do you have thoughts of suicide? How often do you feel anxious or worried? Are you having trouble sleeping? Do you have difficulty finishing tasks at home, work or school that previously felt manageable to you? Are you avoiding social or family events? Have you been having any problems at school or work? Have you made any impulsive decisions or engaged in reckless behavior that doesn't seem like you? What other symptoms or behaviors are causing you or your loved ones distress? Do you drink alcohol or use illegal drugs? How often? Have you been treated for other psychiatric symptoms or Mental illness in the past? If yes, what type of therapy was most helpful? TESTS AND DIAGNOSIS Adjustment disorders are diagnosed based on signs and symptoms and a thorough psychological evaluation. To be diagnosed with adjustment disorder, you must meet criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual, published by the American Psychiatric Association, is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment. For an adjustment disorder to be diagnosed, several criteria must be met, including: Having emotional or behavioral symptoms within three months of a specific stressor occurring in your life Experiencing more stress than would normally be expected in response to the stressor, or having stress that causes significant problems in your relationships, at work or at school — or having both of these criteria An improvement of symptoms within six months after the stressful event ends The symptoms are not the result of another diagnosis Types of adjustment disorders Your doctor may ask detailed questions about how you feel and how you spend your time. This will help pinpoint which type of adjustment disorder you have. There are six main types. Although they're all related, each type has certain signs and symptoms: Adjustment disorder with depressed mood.Symptoms mainly include feeling sad, tearful and hopeless, and experiencing a lack of pleasure in the things you used to enjoy. Adjustment disorder with anxiety.Symptoms mainly include nervousness, worry, difficulty concentrating or remembering things, and feeling overwhelmed. Children who have adjustment disorder with anxiety may strongly fear being separated from their parents and loved ones. Adjustment disorder with mixed anxiety and depressed mood. Symptoms include a mix of Depression and anxiety. Adjustment disorder with disturbance of conduct. Symptoms mainly involve behavioral problems, such as fighting or reckless driving. Youths may skip school or vandalize property. Adjustment disorder with mixed disturbance of emotions and conduct. Symptoms include a mix of Depression and anxiety as well as behavioral problems. Adjustment disorder unspecified.Symptoms don't fit the other types of adjustment disorders, but often include physical problems, problems with family or friends, or work or school problems. TREATMENTS AND DRUGS Most people find treatment of adjustment disorder helpful, and they often need only brief treatment. Others may benefit from longer treatment. There are two main types of treatment for adjustment disorder — psychotherapy and medications. Psychotherapy The main treatment for adjustment disorders is psychotherapy, also called counseling or talk therapy. You may attend individual therapy, group therapy or family therapy. Therapy can provide emotional support and help you get back to your normal routine. It can also help you learn why the stressful event affected you so much. As you understand more about this connection, you can learn healthy coping skills to help you deal with other stressful events that may arise. Medications In some cases, medications may help, too. Medications can help with such symptoms as Depression, anxiety and suicidal thoughts. Antidepressants and anti-anxiety medications are the medications most often used to treat adjustment disorders. As with therapy, you may need medications only for a few months, but don't stop taking any medication without talking with your doctor first. If stopped suddenly, some medications, such as certain antidepressants, may cause withdrawal symptoms. LIFESTYLE AND HOME REMEDIES There are no guaranteed ways to prevent adjustment disorder. But developing healthy coping skills and learning to be resilient may help you during times of high stress. Resilience is the ability to adapt well to stress, adversity, Trauma or tragedy. Some of the ways you can improve your resilience are: Having a good support network Seeking out humor or laughter Living a healthy lifestyle Learning how to think positively about yourself If you know that a stressful situation is coming up — such as a move or retirement — call on your inner strength in advance. Remind yourself that you can get through it. In addition, consider checking in with your doctor or mental health provider to review healthy ways to manage your stress.Dr. Mohd Shafi10 Likes10 Answers
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#CAP2020 DSM 5 CRITERIA FOR ADHD:- People with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development: Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level: Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities. Often has trouble holding attention on tasks or play activities. Often does not seem to listen when spoken to directly. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked). Often has trouble organizing tasks and activities. Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework). Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones). Is often easily distracted Is often forgetful in daily activities. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level: Often fidgets with or taps hands or feet, or squirms in seat. Often leaves seat in situations when remaining seated is expected. Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless). Often unable to play or take part in leisure activities quietly. Is often “on the go” acting as if “driven by a motor”. Often talks excessively. Often blurts out an answer before a question has been completed. Often has trouble waiting his/her turn. Often interrupts or intrudes on others (e.g., butts into conversations or games) In addition, the following conditions must be met: Several inattentive or hyperactive-impulsive symptoms were present before age 12 years. Several symptoms are present in two or more setting, (e.g., at home, school or work; with friends or relatives; in other activities). There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning. The symptoms do not happen only during the course of schizophrenia or another psychotic disorder. The symptoms are not better explained by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder). Based on the types of symptoms, three kinds (presentations) of ADHD can occur: Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity but not inattention were present for the past six months. Because symptoms can change over time, the presentation may change over time as well. REFERENCE(S) :- 1. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32279-7/fulltext 2. https://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_ADHD.pdf 3. https://www.ncbi.nlm.nih.gov/books/NBK223473/Dr. Jayita Tyagi1 Like1 Answer
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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