SCHIZOPRENIA : HYF’S AND CHANGES MADE IN NEWLY PUBLISHED DSM 5

DSM-IV-TR (published in 2000) contains diagonostic criteria for 17 major catogories of mental disorders, comprising 375 discrete illnesses. It is used to diagonose mental disorders.

Now recently DSM 5 is published to replace DSM-IV-TR

FOR DIAGONOSIS OF SCHIZOPHRENIA IN EARLIER USED DSM-IV-TR CLASSIFICATION FOLLOWING WERE REQUIRED

Criterion A symptoms are : 2 OR MORE THAN 2 REQUIRED

[a] Delusions

[b] Hallucinations

[C] Disorganised speech

[d] Grossly disorganised or catatonic behaviour

[e] Negative symptoms ( ie affective flattening, alogia, avolition)

NOTE : IF BIZZARE DELUSION OR AUDITORY HALLUCINATION OF RUNNING COMMENTRY IS PRESENT ONY ONE CRITERIA IS SUFFICIENT( THIS POINT WAS REMOVED IN RECENT DSM 5 diagonostic criteria )

Highlights of Changes from DSM-IV-TR to DSM-5 IN RELATION TO DIAGONOSIS OF SCHIZOPHRENIA

Two changes were made to DSM-IV Criterion A for schizophrenia in recent DSM 5

[1] The first change is the elimination of the special attribution of bizarre delusions and Schneiderian first-rank auditory hallucinations (e.g., two or more voices conversing). In DSM-IV, only one such symptom was needed to meet the diagnostic requirement for Criterion A, instead of two of the other listed symptoms. Therefore, in DSM-5, two Criterion A symptoms are required for any diagnosis of schizophrenia.

[2] The second change is the addition of a requirement in Criterion A that the individual must have at least one of these three symptoms: delusions, hallucinations, and disorganized speech. At least one of these core “positive symptoms” is necessary for a reliable diagnosis of schizophrenia.

Changes made in Schizophrenia subtypes:-

In DSM 5 the DSM-IV subtypes of schizophrenia (i.e., paranoid, disorganized, catatonic, undifferentiated, and residual types) are eliminated due to their limited diagnostic stability, low reliability, and poor validity. These subtypes also have not been shown to exhibit distinctive patterns of treatment response or longitudinal course. Instead, a dimensional approach to rating severity for the core symptoms of schizophrenia is included.

.

QUICK REVISION OF SOME IMPORTANT POINTS OF SCHIZHOPHRENIA

**EMIL KRAEPLIN COINED THE TERM DEMENTIA PRAECOX(AI 2008).

*EUGENE BLEULER COINED THE TERM SCHIZOPHRENIA.

*INCIDENCE OF SCHIZOPHRENIA IS 1 – 1.5 % (TN 1999).SCHIZOPHRENIC SYMPTOMS RESULT FROM INCREASED LIMBIC DOPAMINERGIC ACTIVITY(IN MESOCORTICAL PATHWAY ) and NEGETIVE SYMPTOMS RESULT FROM DECREASED DOPAMINERGIC ACTIVITY IN FRONTAL CORTEX (PGI 97, 2002).

*PARANOID SCHIZOPHRENIA MAY BE CAUSED BY AMPHETAMINE INGESTION (AIIMS 90,97 MP 98).

 *SCHIZOPHRENIA IS A FORMAL THOUGHT DISORDER ( AIIMS 94) ie primary disturbence în schizophrenia is THOUGHT DISTURBENCE

 *MOST COMMON TYPE OF SCHIZOPHRENIA IS PARANOID SCHIZOPHRENIA(PGI 2004).

*PARANOID SCHIZOPRPHRENICS USULLY HAVE PREDOMINENT FIRST TWO OF SIGNS AND SYMPTOMS ie HALLUCINATION AND DELUSION.( remember russell crowe in the ” a beautiful mind” ) .

***CHARECTERISTIC / PATHOGNOMONIC CLINICAL MANISFESTATION OF SCHIZO IS AUDITORY HALLUCINATIONS GIVING RUNNING COMMENTRY ( AIIMS 2000, DELHI 03, PGI 98).

*AUDITORY HALLUCINATION ARE MOST COMMON TYPE OF HALLUCINATION IN SCHIZOPHRENICS ( JIPMER 95) and IT IS FIRST SYMPTOM TO GO AWAY /RESPOND TO TREATMENT ( AIIMS 92 , 93 , 90).

*DELUSION OF CONTROL ,PERSECUTION AND SELF REFERENCE ARE SEEN IN PARANOID SCHIZO( PGI 97).

**NOTE THAT DISORGANISED SPEECH , BEHAVIOUR AND NEGETIVE SYMPTOMS ARE NOT PROMINENT IN PARANOID SCHIZOPHRENIA.

*IT SHOWS SECOND BEST PROGONOSIS AMONG TYPES OF SCHIZO [ BEST PROGONOSIS IS WITH CATATONIC TYPE (MP 04) ].

Advertisements

” out of sight is not out of mind” or object permanence in Jean piaget’s development theory [AIIMS MAY 2013]

For a younger infant whatever is ” out of sight is out of his mind ” and he/she has to operate by this perspective untill development of object permanence ie he/she now thinks that object or person continue to exist even when they are out of sight ie ” out of sight is not out of mind ”

In another way we may say that object permanence is a concept which states that ” u dont see but u know it still exists ” . The concept of object permanence was given by Jean piaget in his theory of development. According to him there are four phase of child development….

[a] sensorimotor phase ( 0-2 year )

[b] preoperational phase (2-7 year)

[c] operational /concrete phase ( 7-11 year )

[d] formal phase ( > 11 to end of adolscence)

A/C to this theory object permanence develops in sensorimotor phase ( 0-2 years)

or we may say that ” out of sight is not out of mind ” is developed in sensorimotor phase of Jean piaget’s child development theory. [ AIIMS MAY 2013]

Let us see some real life situations to understand this :

if we take away a toy from an older infant and hide it he/she starts searching the toy bcoz the toy is only out of his sight and not out of his mind . Take another example , if mother gets out of childs view he/she knows that she still exists and will cry to make her appear.

Peekaboo is a game played with small children to amuse them and it is based on object permanence. In this game one covers his/her face or hides and returns to view of the child by saying peekaboo and this delights the child bcoz of sudden appearance of the person who dissapeared magically. A/c to Nelson pediatrics, child starts playing peekaboo at 40 weeks which translates into 10 months [AI 2006] so object permanence develops around 10 months and is mastered upto 2 years .

NOTE : A/C TO JEAN PIAGET THEORY ” Before a child leaves sensorimotor phase and enters preoperational phase , object permanence must be mastered ”

Now lets learn some salient points about jean piagets development theory as they might be drafted as  ouestions in future exams …

[a] sensorimotor phase ( 0-2 year ) = object permanence is acheived.

[b] preoperational phase (2-7 year)=  phase of egocentrism ,illogical /magical thinking, animism & imminent justice.

Egocentrism = child understands everything exclusively from own perspective.

Animism= beleives that inanimate objects are alive.

Imminent justice =beleif that if i do something bad then punishment is inevitable

[c] operational /concrete phase ( 7-11 year ) = development of logical thinking and takes into consideration others view

[d] formal phase ( > 11 to end of adolscence) = hypothetical – deductive reasoning .

REFERENCES : [1] Pocket handbook of clinical psychiatry 5ed/page 353

AIIMS MAY 2013 QUESTIONS

1 KLUVER BUCY SYNDROME http://pguploads.com/2013/03/16/amygdal/

2. EYE Q = NHL OF ORBIT / METS TO ORBIT http://pguploads.com/2013/05/14/nhl-of-orbit-mets-to-orbit-aiims-may-2013/

3 . psychiatry ..jean piaget http://pguploads.com/2013/05/15/out-of-sight-is-not-out-of-mind-or-object-permanence-in-jean-piagets-development-theory-aiims-may-2003/

4. sudecks dystrophy http://pguploads.com/2013/05/15/reflex-symphathetic-dystrophy-cprs-i-sudecks-dystrophy-aiims-2013/

5 . isochromosome http://pguploads.com/2013/05/14/q-how-is-isochromosome-formed-aiims-may-2013/

6 .seizure related qs in aiims 2013 http://pguploads.com/2013/05/14/seizure-related-qs-in-aiims-may-2013/

7. PSM Q’S http://pguploads.com/2013/05/16/psm-qs-aiims-may-2013/

PSYCHIATRY Q : AIIMS NOV 2012

Q1)A young man who is a known heroin addict is brought to emergency in unconcious state.on examination his pupil is pin point.Treatment of choice in such case is..

a)oral naltrexone

b) iv naloxone

c)oral diazepam

d)oral buprenorphine

ANS [b] IV NALOXONE[ref ;pg 125 handbook of clinical psychiatry , kaplan]

ImageImage

NOTE POINTS: 1. Heroin is semisynthetic opoid and has strongest euphoriant property among opoids so it produces most craving. [2] speed ball =iv injection of heroin + any stimulant .[3] pentazocine addicted patient should be detoxified on pentazocine.

Q2] A 14 year old boy not able to get good grades in 9th standard exam ,but he is very sharp and intelligent. Best test to diagonose his problem is…

a)child behaviour checklist

b)specific learning disability test

c)bhatias battery

d)child behaviour battery

ANS [B]SPECIFIC LEARNING DISABILITY TEST{ page 352 hand book of clinical psychiatry ,kaplan}

Learning disorder is diagonosed when reading ,writing ,,mathematical skills are significantly lower than normal. The child may have normal or high intelligence. These disability prevent the child from having good grades inspite of having normal or increased intelligence. so specific learning disability test should be done in such a case.

https://pguploads.wordpress.com/2013/03/18/learning-disorder-dyslexia-reading-disorder/

above link will take u to our previous blog on dyslexia.

 

Q3]A child is not eating vegetable .his mother starts giving a choclate each time he finishes vegetables in diet. this is known as..

a]operant conditioning

b]classical conditioning

c]social training

d] negetive reinforcement

ANS [a] ie OPERANT CONDITIONING[ kaplan handbookof clinical psychiatry pg423 ,5ed]

PGUPLOADS 3

 

Q4] Knowledge of ones own disease in mental illness is known as..

a]insight   [b] orientation [c] judgement [d] rapport

ans a= insight

 

Q5]In insomnia patient sleep is most accurately measured by…

[a]barograph

[b] kymograph

[c]actigraphy

[d] plethysmography

 

ANS [C] ACTIGRAPHY [ref; tabers cyclopedic medical dictionary 21ed page 36]

 

Q5]TRUE ABOUT FRONTOTEMPORAL DEMENTIA ALL EXCEPT..

A]steriotypic movement

B] loss of insight

C] may present in less than 65 year

D] mood changes

ANS; [A] STERIOTYPIC MOVEMENTS (Pg 69 lkaplan handbook of clinical psychiatry 5ed)

pgmee upload

NOTE;It is most common cause of dementia in < 60 years patients[0ccurs in fifth to sevent decade]. it is also known as picks disease as picks body is found which is composed of tau proteins[AI 2008]. AS it involves localised regions of frontal/insular &/ temporal lobe it is a localised regional dementia [PGI DEC 2002]. Note that in diffuse lewy body dementia lewy body is found ie made of alpha synuclein protein.

 

***BINSWANGER DISEASE =It is a type of subcortical vascular dementia ehich shows diffuse white matter involvement. It is also known as subcortical arteriosclerotic encephalopathy.

 

Q6] a male started taking alcohol 20 years back. presently he is taking 3 quartrs daily. now he complains that he gets kick in only one quarter…diagonosis is..

a] withdrawl

b]mallenby phenomena

c]reverse tolerence

d] cross tolerence

ans [c] reverse tolerence[kaplan & saddock comprehensive textbook of psychiatry 9ed page 1271]

Q what is mallenby phenomena? it denotes self perception of effects of alcohol in which a person tends to overestimate the effects of alcohol during absorption phase & underestimate their state of impairment during elimination phase.

 

 

A BEAUTIFUL MIND : PARANOID SCHIZOPHRENIA

FOR DIAGONOSIS OF SCHIZOPHRENIA AT LEAST TWO OF FOLLOWING FIVE SIGNS OR SYMPTOMS MUST BE PRESENT FOR AT LEAST 1 MONTH. 1) HALLUCINATION 2) DELUSION  3) DISORGANISED SPEECH 4) DISORGANISED BEHAVIOUR 5) NEGETIVE SYMPTOMS(eg flat affect, abulia). SCHIZOPHRENIA IS A FORMAL THOUGHT DISORDER ( AIIMS 94) ie primary disturbence în schizophrenia is THOUGHT DISTURBENCE..MOST COMMON TYPE OF SCHIZOPHRENIA IS PARANOID SCHIZOPHRENIA(PGI 2004).PARANOID SCHIZOPRPHRENICS USULLY HAVE PREDOMINENT FIRST TWO OF SIGNS AND SYMPTOMS ie HALLUCINATION AND DELUSION.( remember russell crowe in the ” a beautiful mind” ) .CHARECTERISTIC / PATHOGNOMONIC CLINICAL MANISFESTATION OF SCHIZO IS AUDITORY HALLUCINATIONS GIVING RUNNING COMMENTRY ( AIIMS 2000, DELHI 03, PGI 98). AUDITORY HALLUCINATION ARE MOST COMMON TYPE OF HALLUCINATION IN SCHIZOPHRENICS ( JIPMER 95) and IT IS FIRST SYMPTOM TO GO AWAY /RESPOND TO TREATMENT ( AIIMS 92 , 93 , 90). DELUSION OF CONTROL ,PERSECUTION AND SELF REFERENCE ARE SEEN IN PARANOID SCHIZO( PGI 97). NOTE THAT DISORGANISED SPEECH , BEHAVIOUR AND NEGETIVE SYMPTOMS ARE NOT PROMINENT IN PARANOID SCHIZOPHRENIA. IT SHOWS SECOND BEST PROGONOSIS AMONG TYPES OF SCHIZO [ BEST PROGONOSIS IS WITH CATATONIC TYPE (MP 04) ] .Image

A BEAUTIFUL MIND : SCHIZOPHRENIA (SOME IMPORTANT POINTS)

EMIL KRAEPLIN COINED THE TERM DEMENTIA PRAECOX(AI 2008) .EUGENE BLEULER COINED THE TERM SCHIZOPHRENIA. INCIDENCE OF SCHIZOPHRENIA IS 1 – 1.5 % (TN 1999).SCHIZOPHRENIC SYMPTOMS RESULT FROM INCREASED LIMBIC DOPAMINERGIC ACTIVITY(IN MESOCORTICAL PATHWAY ) and NEGETIVE SYMPTOMS RESULT FROM DECREASED DOPAMINERGIC ACTIVITY IN FRONTAL CORTEX (PGI 97, 2002).PARANOID SCHIZOPHRENIA MAY BE CAUSED BY AMPHETAMINE INGESTION (AIIMS 90,97 MP 98)Image