Differential diagnosis of paranoid states

Paranoid symptoms are found in many of the common psychiatric conditions described elsewhere in this book, including schizophrenia, affective disorders (depressive illness and mania), drug and alcohol misuse, and the dementias. The following list describes some other syndromes in which paranoid symptoms are a main feature Persistent delusional disorder (older terms include paranoid psychosis, paraphrenia, and paranoia) delusions are present, but, in contrast to paranoid schizophrenia, there are...

False beliefs delusions

The most common types of delusion in schizophrenia would probably be persecutory, but grandiose or nihilistic delusions are also common. At this point, it is worth noting that, strictly speaking, paranoid has a wider meaning than just persecutory the derivation, I understand, is from Greek words meaning 'out of mind', and paranoid has been used to cover, for example, the grandiose or sexual content of delusions also. As previously described, a delusion is a false belief that is unshakable by...

Cognitivebehavioural therapy CBT

CBT has become established as the psychotherapy of choice, being perceived as effective and cost-effective. It remains important to understand the twin strands of CBT. Behaviour therapy per se is now less prominent. However, cognitive therapists are happy to admit that their treatment involves components of behaviour therapy, such as activity scheduling, and that the term 'cognitive therapy' is effectively shorthand for CBT. The principles of cognitive therapy and behavioural therapy will now...

Cerea flexibilitas waxy flexibility

Pressure and heart disease it is also used to treat physical manifestations of anxiety, such as palpitations. Content of delusion obviously implausible in view of patient's background and culture. Reduction in range and intensity of emotional expression. French term for brief psychotic disorders. Neurological term for generalized motor slowness. Unconscious grinding of the teeth while awake or asleep associated with mental disorder. Eating disorder characterized by abnormal eating patterns,...

Antidepressants

Sedative tricyclics such as trimipramine are often given in anxiety disorders. Their full benefit may take several weeks in depression, but their useful hypnotic and anxiolytic properties are immediate and dose-related. For example, trimipra-mine 25 mg nocte regularly plus 25 mg mane p.r.n. will help sleep and make available a safe antianxiety treatment for daytime use in a patient with mild anxiety symptoms. Antidepressants are effective in panic disorder. MAOIs should be tried if other...

Psychiatric reports criminal

Court reports should be written in non-technical language, as they will be used by lawyers and other lay persons. All technical words, even those commonplace to psychiatrists, such as 'schizophrenia', should be explained. Before beginning work, the wise psychiatrist obtains the written agreement of the person requesting the report to pay his fee, as this work is not part of NHS practice. A proper letter of instruction is essential. This must set out the points on which the psychiatrist is to...

Physical somatic biological vegetative symptoms

Physical symptoms are just as common as psychological ones and often form the presenting complaint when depressed patients consult in general practice. Core symptoms of depression include pain and tiredness. These have been recognized since the early days of psychiatry. (Indeed, a more insightful way of looking at the problem would be to retreat from the somewhat arbitrary mind body split in which, at any rate in Western societies, we view the experience of distress.) Pain and fatigue and...

Antidepressants MAOI group

MAOIs (monoamine oxidase inhibitors) increase brain concentrations of monoamine neurotransmitters by inhibiting the enzymes concerned in their breakdown. They are effective for depression, anxiety, and phobic states, and sometimes achieve dramatic responses in patients who have failed to respond to tricyclics. They may have a particular place in so-called atypical depression 'with reversed biological features, e.g. increased sleep, increased appetite, mood reactivity, and rejection sensitivity'...

Chronic fatigue syndrome ICD neurasthenia F480

The term chronic fatigue syndrome may be applied to a patient whose persistent tiredness lacks a physical pathology to account for it. The diagnosis of neurasthenia was popular in the late nineteenth century, and its symptoms included fatigue after minimal effort, loss of interest, irritability, poor concentration, and sleep disturbance. Similar syndromes have attracted great interest in recent years under new names such as chronic fatigue syndrome, post-viral syndrome, and myalgic...

Chronic pain ICD F454 persistent somatoform pain disorder

This syndrome involves persistent severe pain that cannot be explained by a physical disorder. An example would be a patient who has had an operation for back pain, but still has severe pain, or a patient who has been in a minor road traffic accident and sustained whiplash injuries, but is still complaining of incapacitating neck pain years later. This can be a controversial category. In some cases, there are obvious psychological factors at play, but many of these patients vehemently deny any...

Assessing physical symptoms in psychiatric practice

The assessment depends in part upon the setting. In some cases, for example, the patient on antipsychotic medication who complains of a shakiness of the hands, the most likely diagnosis extrapyramidal side-effects of medication will be obvious. Another common instance of side-effects of medication is the patient on tricyclic antidepressants, who complains of a dry mouth. However, it is always important to remember that the emergence of a physical symptom could represent the first sign of an...

Neurochemistry

Brain concentrations of monoamine neurotransmitters, and or sensitivity of their receptor sites, appear to be altered in affective disorders. Noradrenaline NA and or 5-hydroxytryptamine 5-HT, serotonin are implicated in depressive illness dopamine is implicated in mania. Evidence for neurotransmitter involvement includes the following points Most drugs that are effective in treating depression increase the availability of NA and or 5-HT in the brain. Antihypertensive drugs, such as reserpine,...