MAJOR DEPREESIVE DISORDER INCLUDE S SCHIXOPHERNIA OBSESSIVE COMPULSIVE NEUROSIS PSYCOSIS PERSONALITY DISORDERS NEUROSIS SEVERE ANXIETY NEUROSIS MAJOR DEPRESS IVE DISORDERS.NEED URGENT CARE THSES PATIENTS HAVE GOT A KIND OF BIPOLSR DEORESDION THEY TEND TO BE ALOOF FEJECTS GLOOMY NAGATIVE ATTITUDE LAVK OF ENERGY LOSS OF INTEREDT IN EIRK LOSS OF CONFENDENCE SUSPICIIS BEHAVIOUR LAVK OF SLEEP EARLY MORNING AROUSAL LOSSNOF SECUAL INTERST.AND EVEN SUICIDAL TENDENCIES SUCH PATIENTS NEED HELP FROM FAMILY.PDYVHISTIC CONSULTATION AND L MEDECATION TO CONTROL NEURONTRAMITTER HARMONE IMBALANCE
Nice presentation:MDD is distinct entity,it does not include schizophrenia,obsessive compulsive disorders,personality disorders and anxiety neurosis and Manic depressive disorder etc .They are seperate entity and deal differently.Nice information and stepwise management.
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Very useful informative post regarding major mental disorders.
Major depressive disorders.. Nice presentation.. Useful Informative.. informative.. Thanks doctor..
ALL FORMS OF DEPRESSION WHETHER MINOR OR MAJOR MUST BE TAKEN VERY SERIOUSLY ESPECIALLY MAJOR MENTAL ILNEES PROBLEM IS DEPRESSION IS A KIND OF MASKED AILMENT PERSON WHO IS SUFFERING FROM THIS DISORDER KNOWS THE AGONISING PROBLEM ALTHOUGH NONPHYSICAL CHANGE SO PEOPLE ROUND THE DEPRESSIVE PATIENTS ARE NOT AWARE OF ONES PROBLEM DUE TO ABSENCE OF ANY PHYSICAL CHANGE UNLESS A CLOSE ONE FEELS SOME DRASTIC CHANGE LIKE MOOD SWINGS SADNESS SUDEN GLOOMY BEHAVIUIR NOT TAKING LOSS OF INTEREST IN WORK ABSTENCE FROM WORK LOSS OF CONFEDENCE NEGATIVE BEHAVIOUR INSOMNIA EARLY AROUSAL FROM.SLEEP ACHES AND PAINS IN THE BODY SUICIDAL TENDENCY THSES SYMPTOMS ARE ENOUGH FOR THE PATIENT TO SEEK THE CONSULTATION OF PDYCHIATRIST.AND TREAMENT FAMILY SUPPORT IS VERY IMPORTANT IN PATIENTS OF DEPRESSION
MDD ( Major Depressive Disorder ) is very important & Common in Developing countries due to Biological , Psychological & Social factors . Very Informative Post regarding MDD.
Very informative and educational study case. Thanks for sharing useful post
Feeling helpless,drained out... confused blank..no alert brain.. seeing the dark... not contented with what is there...it is a perception...to get out of it... vegan way of living, always smiling graciously in all circumstances... whiich is God's instructions... Needs counselling calmness symphony music lime juice pineapple with black pepper sprouts kalijeeri alkaline diet beetroot coriander juice sweet potato corn cauliflower broccoli purple cabbage cabbage juice orange juice walnuts blue berries cherries sunshine Prayers with head coverage with white cotton...God bless all with divine wisdom and happiness
MAJOR DEPRESSIVE DISORDER VERY. HELPFUL .UPDATE
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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 Likes7 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 Likes11 Answers
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33 yrs /M h/o : This all complaints from childhood when he eats some raw vegetables and after that faintness, restlessness , hyperactivity, beating all the kids, not good in studies , beats everyone after that CT was done in that some insect was found in brain the allopathic medicine was give to suppress that insect . Please suggest Now c/o 1) Mood Swings 2)Happiness and depression phase 3) loss of confidence 4) abusive 5) Negative thoughts 6) thinks of suicide 7) thinks that death is the last option He didn't try or have any history of suicidal tendency 8) when he is in a good mood he thinks positive . Please suggest diagnosis with Homoeopathic approch .Dr. Surbhi Bhargava2 Likes15 Answers
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Bipolar disorder is a mood disorder which involves periods of excitability (mania)alternating with periods of depression. The "mood swings" between mania and depression can be very abrupt. Other names for bipolar disorder are 'bipolar affective disorder', 'manic depressive disorder', and 'manic depression'. Short Title Bipolar disorder Causes The exact cause of bipolar disorder is not known. It develops in late teens or early adulthood. Prevalence is similar in men and women. It usually appears between ages 15 - 25.It is an inherited disorder. Changes in neurotransmitter in the brain can cause the disease. Hormonal imbalance can also be considered responsible for bipolar disorder. Environmental factors like stress, abuse, major loss, and trauma are the predisposing factors for developing bipolar disorder. Clinical Presentation The disease can be of various types. Types of bipolar disorder are Bipolar disorder I, Bipolar disorder II, and Cyclothymia. In bipolar disorder I, there is at least one fully manic episode with periods of major depression. In the past, bipolar disorder I was called manic depression.Mania symptoms include agitation or irritation, elevated mood, inflated self-esteem (delusions of grandeur, false beliefs in special abilities), sleeplessness ,over-involvement in activities, poor temper control, tendency to be easily distracted,reckless behaviour such as binge eating, drinking, and/or drug use; unprotected sexual encounters. These symptoms of mania are seen with bipolar disorder I. In people with bipolar disorder II, hypomanic episodes involve similar symptoms that are less intense. In this, people seldom experience full-fledged mania. Instead they experience periods of hypomania. These hypomanic periods alternate with episodes of major depression.Depression symptoms such as feeling hopeless, sad, or empty, inability to experience pleasure, fatigue or loss of energy, physical and mental sluggishness, appetite or weight changes, sleep problems, difficulty concentrating, remembering, or making decisions, feelings of worthlessness or guilt. There may be withdrawal from activities that were once enjoyed, withdrawal from friends. Patient gets thoughts of death or suicide.Cyclothymia is amild form of bipolar disorder and involves periods of hypomania and mild depression, with less severe mood swings. Bipolar disorder not otherwise specified (BP-NOS)is the one in which the symptoms don't meet the diagnostic criteria of bipolar disorder I or II but the behaviour of the person is clearly an out of range behaviour. Rapid cycling bipolar disorder is a severe form of the disease in which patient has four or more episodes of major depression, mania, hypomania or mixed stated within period of one year. Investigations Medical history by the patient and Clinical examination by the psychiatrist helps in diagnosis. Positive family history helps to diagnose bipolar disorder. The diagnostic criterion is as follows - for bipolar disorder I there should have had at least one maniac or one mixed episode. For bipolar disorder II there shouldhave had at least one major depressive and one hypomaniac episode. For Cyclothymia, one has had several hypomaniac and periods of depression but never had major depression, full maniac or mixed episode. In this symptoms continue for two or more years. Treatment Psychotherapy is required for treating bipolar disorder.It involves cognitive behavioural therapy, which teaches anger management techniques, relaxation techniques. Getting enough sleep helps keep a stable mood in some patients. Medications like anti psychotics, anti-depressants, anti-anxiety drugs, mood stabilizers help in treatment of the disease.Electroconvulsive therapy (ECT)may be used to treat bipolar disorder. Individual and family and counselling will also help in managing bipolar disorder.Hospitalisation may be required in severe episodes of disease. Other Modes of Treatment The other modes of treatment can also be effective in treatingbipolar disorder.Homoeopathy is a science which deals with individualization considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treatingbipolar disorder. Complications Untreated bipolar disorder can complicate into following serious problems: Drug and alcohol abuseSuicide or suicidal attemptsLegal and social issuesFinancial problemsRelationship problemsSocial isolation and lonelinessPoor performance at work or schoolFrequent absence from work/school Prevention Strategies that can help prevent minor symptoms aggravate into bipolar disorder include paying attention to initial warning episodes of depression or mania, avoiding alcohol or drug addiction, strictly following the prescribed medication schedule, informing the physician treating the patient before any kind of changes to medications or taking any additional medications as per condition. Facts and Figures The World Health Organization lists bipolar disorder as the sixth leading cause of disability in the world. About 4% of people in world suffer from bipolar disorder.Dr. Raj Pandey Mishra5 Likes10 Answers
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Very useful info regarding psychotic disorders suggest Rx *Chief Complaints* C/o false belief, perception etc.. *History* Not significant *Vitals* Within normal limits *Physical Examination* Nuthing significantDr. Santoshkumar Choudki2 Likes6 Answers