Common Psychiatric Problems in General Practice
MOOD DISORDER
What are the causes?
· Neurochemical
· Hormonal
· Genetics
· Stress
· Personality
How will we know that one has mood disorder?
§ Changes in the mood
§ Decreased interest in life
§ Lack of pleasure in life
§ Sleep disturbances
§ Appetite disturbances
§ Impaired concentration
§ Death wishes
§ Sexual disturbances
Clinical Case:
A 23 year old woman comes to the psychiatrist with major complaints of sadness of mood, decreased interest in daily activities, inability to sleep and waking up too early in the morning, loss of appetite and weight loss. She had attempted suicide by consuming half a bottle of phenyl for which she was treated in a hospital. All these complaints were present since a month after her divorce.
Diagnosis: MAJOR DEPRESSIVE DISORDER
Clinical Case:
A 32 year old man is brought to the casualty ward by the police as he was found standing in the middle of a busy highway, naked, commanding the traffic to stop. In the casualty ward he talked continuously and his mood was very happy. He said that he had spent around one lakh rupees in the last week and had gone to several sex workers since then. He says that he is not able to control his thoughts and he is the king of that place.
Diagnosis: ACUTE MANIA
How will we treat these Patients?
§ Counseling
§ Drugs: - Sertaline, Paroxetine (Pexep CR) Escitalopram (Nexito), Fluoxetine
- Imipramine, Depsonil Amitriptyline (Amixide)
- Mood stabilizer – Valpraote (Dicorate ER), Lithium (Lithosun SR)
- Carbamezapine (Zeptol)
§ ECT
ANXIETY DISORDER
Clinical Case:
A 27 year old married man complained of dizziness, sweating palms, heart palpitations and ringing in the ears for more than 18 months. He also experienced dry throat, periods of uncontrolled shaking and a constant edgy (tense/irritable) and watchful feeling that has often interfered with his ability to concentrate.
Clinical Impression: GENERALISED ANXIETY DISORDER
Clinical Case:
A 23 year old woman arrives in the casualty ward complaining that out of the blue she has got excessive fear, shortness of breath and a pounding heart. These symptoms lasted for round 10 minutes and she thought that she was dying or going crazy. She had four similar episodes during the past month and she has been worrying that the episodes will recur.
Clinical Impression: PANIC DISORDER
Clinical Case:
A 17 year old girl blushes, stammers and feels completely foolish when one of her classmates or a teacher asks her a question. She sits at the back of the class hoping not to be noticed because she is convinced that the other students think that she is unattractive and stupid.
Clinical Impression: SOCIAL PHOBIA
Clinical Case:
A 28 year old taxi driver is chronically consumed by fears of having accidentally run over a pedestrian. Although he tries to convince himself that his worry is silly, his anxiety continues to mount until he drives back to the scene of the so called accident and proves that nobody lies hurt in the street.
Clinical Impression: OBSESSIVE COMPULSIVE DISORDER
How will we treat these Patients?
§ Counseling
§ Drugs:- Bzd (Lonazep-MD), (Nexito, Paxidep-CR, Fluvoxin, Clofranil)
§ Relaxation Exercises
PSYCHOSIS
What are the causes?
· Neurochemical
· Hormonal
· Psychosocial
· Genetics
· Stress
How will we know that it is a Psychosis?
§ Fear
§ Thought Disturbances
§ Hearing Voices
§ Anger
§ Self Neglect
§ Suicidal & Homicidal feelings
Clinical Case:
A 19 year old man is brought to the physician by his parents after he called them from college, terrified that the mafia was after him. He stated that he had eaten nothing for the past 6 weeks other than canned beans because they are into everything. He is convinced that the mafia has put cameras in his hostel room and they are watching his every move. He occasionally hears the voices of two men talking about him when no one is around. His room mates say that for the past 6 months he was increasingly withdrawn and suspicious.
Clinical Impression: SCHIZOPHRENIA
How will we treat these Patients?
§ Hospitalization
§ Drugs: - Haloperidol, Resperidone (Sizodon), Olanzapine (Oleanz), Amisulpiride (Sulpitac)
§ ECT
§ Rehabilitation
HYSTERIA
· False Neurological Signs
· Over Breathing
· False Convulsions
· False Paralysis
· False Blindness
Clinical Case:
After witnessing a violent argument between her parents, a young woman develops sudden blindness, but does not appear as distraught as would be expected. Her pupils react normally to light and she manages to avoid obstacles when walking. Her parents who are in the middle of a bitter divorce, put aside their differences to focus on their daughter’s illness.
Clinical Impression: CONVERSION DISORDER
How will we treat these Patients?
- Counseling
- Social Support
- Drugs
INSOMNIA
· It is a Symptom not a Disease
· Treat the Disease
· Maintain Sleep Hygiene
· Look for Medical Problems
· Do not Prescribe Sedatives Blindly
· Sedatives should not be Prescribed for Long Duration of Time
· New Drugs: - Zopiclone (Fulnite)
SUICIDE ATTEMPTS
· Leading Killer-The Suicide Epidemic
· It is Preventable
· Patient gives Warning Signals
· Death Wish of the Patient has to be taken Seriously
· Look for Underlying Problems
Persons at Risk and Risk Factors:
· Teenage and Elderly
· Unmarried, Divorced
· Unemployed
· Unstable Family
· Poor Interpersonal Relations
· Past History Of Suicide attempts
· Mental Problems
· Family History
· Availability Of Means Of Suicide
· Substance Abuse
ADDICTION
Addiction cannot be treated at Home.
· Psychosocial
· Personality
· Underlying Depression
· Stress
· Genetics
Types
o Alcohol
o Cannabis
o Nicotine
o Opoids
o Corex
o Sedatives
Management
§ Detoxification
§ Deaddiction
§ Rehabilitation
DEMENTIA
· Forgetfulness in Old Age
· Difficulty in Day to Day Activities
· Language Disturbances
· Personality Changes
Clinical Case:
For the past 10 years the memory of a 74 year old woman had progressively declined. Lately she caused several small kitchen fires by forgetting to turn off the stove. She cannot remember how to cook her favorite recipes and she becomes disoriented and confused at night. She identifies an increasing number of objects as ‘that thing’ because she can not recall the correct names.
Clinical Impression: ALZHEIMERS DEMENTIA
Management
§ Drugs: - Donepezil, Memantine (Admenta), Rivastigmine (Rivamer)
§ Counseling and Support
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