convulsions may be for long standing nutritional deficiency especially vit.d, due to hypocalcaemia , hypoglycemia , vit b12 deficiency..... . the supplements with brimhana chikitsa noticing her agni is very much necessary... . alternate matrabasti with ashwagandha grhitha and brihat chagalyadi ghritha helps.
You can try with Placida. Is she married or not? How's her marital relationship?
Is part of psychosexual impulsive in unconscious mind to do not controlled desire to develop physically symptoms. Which are related to unsolved conflicts and burden of emotions stress situations. She can't easily handle with uncomfortable and can't fix it. It has intentionally and otherwise past history of unclear pictures to fight them. She has this type of behaviour accept when to deal with unconscious thought to do merged her conflicts and resolve with modify her behaviour. Don't be prescribed any medication with a examination of her mental situations and CNS. With past history. Refer to psychiatrist and counsellor.
Currently taking lot of med.She needs Clinical Psychologist reference and counseling
Dr.shadab pls don't try to give any medicine Did you just gave medicine cuz she was having difficulty in breathing and can't sleep? Look, In psychiatry case we first need to examine and test and understand everything briefly and many times cuz everything is related to our brain which is our major part of the body. I know You know that every medicine has some worse side effects and that matters. Patients think of us a second god and we cant give them so many medicine without examination and assessment and briefing and understanding the case cuz it has side effects which are worse than the disorder itself can harm patient's. We don't need to give lots of medicine in these minor matters and we shouldn't make them feel that they are sick by doing so,no matter of which path you're coming weather it's siddha or yunani or homeo, medicine's aren't the solution of everything especially minor case we don't need to give so much medicine in minor things. When patient's meet us doctors they should feel that their disease is half gone not that they should consume so many medicine in minor things. Kindly think thrice before scribbling your pen on prescription, even I observed that in your previous cases the medicines were really too much. She doesn't need any medication just refer her to a psychologist and examine her cholesterol.
I don't think so many medications are required. mostly all are of similar group. She is young. These medications interfere with higher mental functions and depress cognition. Please refer her to a psychiatrist. Check her Hb too. If she is anemic dat can be a cause of breathing difficulty.
YES , HYSTERIA IS A PSYCHOTIC DISORDER .. YOU SHOULD REFER TO PSYCHIATRIST DOCTOR'S.
Pl investigate cxr, CT brain
Do Sleep apnoea test
Psychotherapy is the best way ahead. Like pharmacotherapy given is at max level possible!
Cases that would interest you
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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 Like25 Answers
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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 Goyal4 Likes20 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 Likes16 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 Likes10 Answers
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Post stroke psychiatric syndrome A 48 years old female has brought withdisorganized behaviour/abnormal behaviour, irritability, self absorbed, irrelevant talk impaired bio-function and hallucinatory behaviour. Has history of brain stroke one month back but no history of major medical or psychiatric illness except mild raised BP .MSE reveal inattention, responding to internal cues but not cooperative for higher function. O/E no neurological deficit. Started with Risdon 2mg increase upto 6mg escitalopram 5mg with lopez 1mg sos also corrected general medical condition .After few days we review the pt and found decreased psychotic feature but still showing cognitive impairment then added citcol P BD and call pt after 2 weeks. Close follow-up every 2 weeks and titration of antipsychotic dose to effect is recommended. Reassessment for re-emergence of psychosis, repeated cognitive examination, and depression inventory at each visit are recommended. What could be your opinions Discussion Part Post-stroke psychotic disorder with delusions and hallucinations, may be difficult to clearly distinguish from Post stroke depression, and Post stroke Dementia. Psychotic symptoms include delusions, hallucinations (which may affect various sensory modalities; auditory and visual hallucinations are the most common), ideas of reference, thought disorganization, and regressed motor behaviour. Psychotic symptoms may represent PSDem with associated psychosis. Post-stroke psychotic disorder has been reported to correlate with right-sided lesions and cortical/subcortical atrophy. Any history of premorbid psychotic illness should be explored. Because of the complexity of these overlapping diagnostic possibilities, and because of the risk of dangerous and, persons with post-stroke psychosis should be referred for psychiatric care, with subsequent co management from the psychiatrist. Although somatoparaphrenia and anosognosia are sometimes classified as delusions, they are typically not included under the definition of post stroke psychosis7and were therefore excluded.The "cleanest" case of post-stroke psychosis would be a patient with no previous history of psychotic symptoms in whom psychosis develops only following stroke. It is not clear how previous psychiatric illness affects risk of post-stroke syndromes. Treatments would not differ because they are based on manifest symptoms. Lesion location: Information concerning lesion location was available in 67 studies reporting a case study or case series and included 134 patients (50.8%). A total of 106 (40.2%) patients were reported to have lesions in the right hemisphere, whereas only 19 (7.2%) patients were reported to have lesions in the left hemisphere, and 9 (3.4%) patients were reported to have bilateral lesions. The regions that were most often affected included the right frontal, temporal and parietal regions, as well as the right caudate nucleus. The right frontal region was affected in 30 (11.4%) patients, the right temporal region was affected in 26 (9.8%) patients and the right parietal region was affected in 40 (15.2%) patients. The right caudate nucleus was affected in 14 (5.3%) patients. The most common affected artery was the right middle cerebral artery, which was reported to be affected in 22 (8.3%) patients. The post-stroke patient is at significant risk for various psychiatric syndromes. The commonly most reported of these in the literature are post-stroke depression (PSD) and post-stroke dementia (PSDem), which may present simultaneously with overlapping mood and cognitive symptoms. In this article, we offer a review of current literature on post-stroke psychiatric syndromes and an integrated clinical approach to screening, diagnosis, and pharmacologic intervention. Haloperidol and risperidone were the most common types of antipsychotic medications used to treat poststroke psychosis, which were prescribed to @Dr. Gunjesh Kumar @Dr. B P Sinha @Dr Vinod Goel @Dr. Manorama RajanDr. Yusuf Khan4 Likes0 Answer