Manic

Mania and bipolar affective disorder

Signs of mania include

1. Mood : irritability, euphoria, lability

2. Cognition : grandiosity, flight of ideas, racing thoughts, distractibility, poor concentration, confusion, lack of insight

3. Behaviour : Rapid speech, hyperactivity, insomnia, hypersexuality, extravagance

4. Psychotic : delusions, hallucinations

*Less severe state: hypomania
*Occur alternative with depression: bipolar affective disorder

Causes:

1. Physical: Infections, hyperthyroidism, SLE, thrombotic thrombocytopenic purpura, stroke, ECT

2. Drugs : Amphetamine, cocaine, antidepressants, cimetidine, captoril, steroids, L-dopa, baclofen

Treatment:

1. Olanzapine 10mg PO / sodium valproate 250mg/8h PO: acute moderate/severe mania

2. Lithium carbonate: prophylaxis

3. If lithium doesn’t give good control; consider lamotrigine (if mostly depression) or cabamazepine (if mostly manic)

Mnemonic for bipolar diagnosis: INSPIRE

I ncrease activity
N eed for sleep is reduced
S peed of thought increase
P ressure of words
I ncrease self-esteem / grandiosity
R educed inhibition
E asily distracted

Reference:

1. Oxford Handbook of Clinical Specialty

2. Mnemonics for Medical Undergraduates (PasTest)

Schizo!

Schizophrenia

Mnemonics involving schizophrenia

1. Diagnosis of Schizophrenia: DEAD

D isordered thoughts – withdrawal, insertion, broadcasting

E xperience passivity

A uditory hallucination

D elusion

2. +ve symptoms for Schizophrenia: THREAD

T hought disorder

H allucination

R educed reality contact

E motional disturbance

A rousal

D elusion

3. –ve symptoms for Schizophrenia: LESS

L oss of activeness

E motional flatness

S peech reduced

S lowness in psychomotor

Better prognosis if: sudden onset, supportive home, no negative symptoms, marked mood disturbance

Rx: Antipsychotics [Typical: chlorpromazine, haloperidol; atypical: risperidone, olanzepine, clozapine]

Reference:

1. Oxford Handbook of Clinical Specialty

2. Mnemonic for Medical Undergraduates

3. Schizophrenia and Antipsychotic Lecture by Dr. David Hayward

Anxiety

Neurosis refers to maladaptive psychological symptoms not due to organic causes or psychosis and usually precipitated by stress.

Generalized anxiety disorder: anxiety which present for more than 6 months with associated somatic symptoms and causing functional impairment

Symptoms of anxiety include tension, agitation, and feeling of impending doom, trembling, collapse, insomnia, poor concentration, goose flesh, hyperventilation, sweating, palpitation, poor appetite, nausea, and difficulty getting to sleep.

Causes could be stress, life events, genetic predisposition or faulty learning

Treatment would involve

1. Symptom control: listening is a good way to decrease anxiety

2. Regular exercise; meditation; relaxation

3. Cognitive behavioural therapy

4. Anxiolytics – diazepam, paroxetine, buspirone, beta-blocker, SSRI

*Easy Mnemonics to remember

Patient complain of PPI:

Panic Attacks, Pervasive apprehension, Impending doom

Abnormal worry: POOR

Painful, Out of proportion, Out of control, Recognisable

Reference:

1. Oxford Handbook of Clinical Specialty

2. Neurotic Conditions Lecture by Dr. David Hayward

3. Mnemonics for Medical Undergraduates (PasTest)

Mental State Examination

Mental State Examination

1. Appearance and Behaviour
It include the physique, clothes, cleanliness, hair, makeup and whether it is appropriate for the age, sex, cultural group and social class of the patient. It is important to pick up signs of self-neglect (poor hygiene, body odour, stained clothes)
Look at the manner the patient act towards the interviewer (anxiety, friendly, cooperative, complaining, suspicious, or critical)
Take note of the psychomotor activity which includes facial expression, posture and gait. (Too little movement; too much movement; involuntary movement)

2. Speech
Look at the rate, rhythm, volume and tone of speech. Also note the quantity and quality of the speech.
Retardation is a delay in starting to speak and rate of speech. Mutism is total absence of speech. Pressure of speech describes rapid outpouring ideas that are often difficult to interrupt. Flight of ideas describes the speech of manic patient move rapidly from one subject to another, usually with some discernible association.

3. Mood and Affect
Mood is the overall impression of mood over the duration of interview while affect is moment to moment variability and responsiveness.

Subjective mood – How have you been feeling recently?
Objective mood – sadness, anxiety, or happiness conveyed through facial expression, posture and motility (weeping, euphoria, irritability)
Autonomic activity – Sweating, palpitation, dry mouth, hyperventilation, and increased frequency of micturition associated with anxiety, acute or chronic schizophrenia

4. Cognition
Orientation – Time, place, person
Attention
Concentration
Short and long term Memory
*basically use MMSE and MSQ

5. Thoughts
Suicidal ideas or self harm – ask about plans, attempts, preparation, perception of the event and perceived fatality
Flow – flight of ideas, word salad, circumstantial
Content – unusual beliefs/ overvalued ideas/ delusions
Alienation – Insertion, broadcast, withdrawal, blocking

6. Insight
Describing patient’s beliefs regarding their symptoms and treatment. It is an understanding of the presence, nature of mental illness and its causes.
*What does the patient believe is the problem? What does the patient believe will help?

7. Perception
*Have you heard voices of people that you couldn’t see? have you noticed any changes in yourself or your surroundings that you can’t account for?
Illusions – misinterpretation of external stimuli
Hallucination – perceptions that are not based on external stimuli; perceived as real
Pseudohallucination – lack the quality of vividness and reality that are possed by normal perceptions and hallucination; often have an ‘as if’ quality

Reference:
1. Mental State Examination Tutorial by Dr. Sharon Butler
2. Oxford Handbook of Clinical Specialties 8th Edition
3. Psychiatry in Medical Practice 3rd Edition

You are what you eat

It has been 2 beautiful weeks working with the N&D department
This is what we were taught in the first lecture:

HEALTHY DIET FOR A HEALTHY BODY

It is very simple; there is just 8 rules to follow for a healthier diet...

Rule 1
Enjoy a variety of clean, safe and adequate food.

Clean and safe food, meaning not expired and does not cause harm to your body in anyway... Eating cockroach is considered safe if there is no toxins that will harm your body.. But i don't know how nutritious cockroach are! i wouldn't eat it either

Adequate meaning not too much and not too little as well. It is very difficult to quantify the amount of food you should eat because it will take like forever for me to type out the serving sizes for the different food. So just bear in mind not to eat too much (Buffet is not a good idea)

Rule 2
Maintain Healthy body weight

Try to balance your energy intake with your physical activity. If you are a very active person you could eat more as compared to people like me who stays in the library and just sit for hours. This is called responsible eating: you eat according to how much your body need... So that the extra calories are not there to cause harm to your body.

Diabetes is not cause by the high sugar intake, but it is the excess calories that a person take everyday. Excess calories leading to obesity and increase the risk of developing diabetes mellitus.

Rule 3
Eat brown unpolished rice, wholemeal bread, and lots of fruits and vegetables

Brown rice and wholemeal bread will ensure that we have sufficient fibre intake in our daily meal. In a normal Malaysian diet, it is impossible to reach the recommended fibre intake of 20-30g if we don't change your diet...

Fruits and vegetables are rich in anti-oxidant and vitamins. Recommended to take at least 5 different colours of fruits and vegetables a day to have sufficient intake of the various nutrients.

Rule 4
Cut down the use of fats and oils

I know this rule is very VERY difficult. Cutting down fat and oil is through the cooking method of not frying as well as not to eat the skin and fat in the meat. The fats and oils is becoming the most important thing to us because of the aroma and taste that oil give. SO DELICIOUS... But it is unhealthy especially to your heart! So you have a choice of living longer or eating something nice.

* please don't get me wrong. It is ok to have unhealthy food once in a while but not frequently. How can anyone in our generation survive without fast food for like forever??? @@

This to be continued in the next post... * Too long a text is not really nice to read... So ciaoz... try to practice healthy diet!!

Give Give Give

This passage is given to me by my lovely IMU librarian.

I know it is really random that she gave me this passage but yup she gave me... Read it and enjoy it...

GIVE GIVE GIVE

Many of us have heard the expression "Giving is its own reward". And while this is certainly true, and more than reason enough to give, there is another aspect of giving that many fail to recognize.

Giving is an energy that not only helps others but creates even more for the person who is doing the giving. This is a natural law that is true regardless of whether the person who is giving wants or even realizes what is occurring.

Money is "circulation". It needs to flow. When you are frightened, selfish, or when you hoard everything for yourself, you literally stop the circulation. You create "clogged pipes," making it difficult to keep money flowing back in your direction. Any success you have is despite your lack of giving, not because of it. The way to get the flow going again is to start giving. Be generous. Pay others well, tip your waitress that extra dollar. Support several charities. Give back. Watch what happens! Things will start popping up out of nowhere.

The same dynamics is true if you want to fill your life with love or anything else worthwhile. Giving and receiving are two sides of the same coin. If you want more love, or fun, or respect, or success, or anything else, the way to get it is simple: GIVE IT AWAY. Don't worry about a thing. The universe knows what it's doing. Everything you give away will return, with interest!

H1N1

I am sure everyone is well aware of the recent H1N1 virus circulating around the world!! According to WHO the current statistics 22/05/2009 there is 11,168 person infected with 86 death. While in Malaysia is 2 reported cases and no death.

The signs and symptoms that is shown when a person is infected are as follow
1. High Fever
2. Dry cough
3. Muscle and joint pain
4. Sore Throat
5. Running Nose

Since it is influenza virus it is actually fight off by our own immune system.
It should resolve on its own in a period of 1 week. The incubation period is roughly 2 days. =)

People who are at higher risk are elderly, young children, patients who are immuno-compromised, people with diabetes and chronic heart failure.

The spread of H1N1 is by cough, droplets through sneezes. To prevent spread always wash your hands, close your mouth while sneezing and try to wear a mask if you can bare with it.

Treatment option are
1. Adamantanes: amantidine and remantadine
2. influenza neuraminidase inhibitor: zanamivir and oseltamivir

PLEASE DO TAKE CARE AND PREVENT THE SPREAD, REMEMBER YOU CAN BE INFECTED AND RESOLVE ON YOUR OWN BUT YOUR GRANDPARENTS OR YOUNG SIBLINGS OR COUSINS ARE THE VICTIM...

*******

A question for all of you, if you are free please enlighten me k?

1.
Today someone told me
"I have a crush on this boy but I don't want to start a relationship with him. Yet I want him to treat me better than anyone else, but i don't want to be in a relationship with him. I will be jealous if he treats other girls better than me. I don't want to commit into a relationship with him!"

Is it possible? Will you do it?

2.
Is it worth to go after a something that you love very much even though it is unnecessary and at the same time all the situation is just going against your effort of getting it?

Enlighten me!