Choline, which is essential for the synthesis of the neurotransmitter acetylcholine, can be obtained in significant quantities from vegetables, seeds, egg yolk, and liver. However, it is only present in small amounts in most fruits, egg whites, and many beverages.

It may be more effective to ask open-ended questions at the beginning of an interview to gather as much information as possible. Closed questions can be used later in the interview to clarify specific points. However, it is important to avoid leading questions that may influence the patient’s response. For example, instead of asking if the patient feels worse in the morning, a more open question such as Can you describe your mood throughout the day? may be more appropriate.

The symptoms exhibited by the patient are consistent with Koro, a culture-specific disorder observed primarily in males (and occasionally in females) in China and Thailand. For more information, please refer to Edwards JW’s article Indigenous Koro, a genital retraction syndrome of insular Southeast Asia: a critical review published in Cult Med Psychiatry in 1984.

Mahler’s Separation-Individuation theory of child development proposes that personality development occurs in distinct stages. The first stage, the Autistic phase, occurs during the first few weeks of life, where the child is mostly sleeping and cut off from the world. The second stage, the Symbiotic phase, lasts until around six months of age, where the child sees themselves and their mother as a single unit. The third stage, Separation-Individuation, has four subphases. The first subphase, Differentiation, occurs between six to ten months, where the child begins to see themselves as an individual and experiences separation anxiety. The second subphase, Practicing, occurs between ten to sixteen months, where the child explores connections with the external world and people other than the mother. The third subphase, Rapprochement, occurs between sixteen to twenty-four months, where the child struggles to balance their desire for independence and proximity to the mother, often resulting in tantrums and the use of transitional objects. The fourth subphase, Object constancy, occurs between twenty-four to thirty-six months, where the child accepts the idea of object constancy and is more comfortable with the mother being separate for periods of time.

The Cerebral Cortex and Neocortex

The cerebral cortex is the outermost layer of the cerebral hemispheres and is composed of three parts: the archicortex, paleocortex, and neocortex. The neocortex accounts for 90% of the cortex and is involved in higher functions such as thought and language. It is divided into 6-7 layers, with two main cell types: pyramidal cells and nonpyramidal cells. The surface of the neocortex is divided into separate areas, each given a number by Brodmann (e.g. Brodmann’s area 17 is the primary visual cortex). The surface is folded to increase surface area, with grooves called sulci and ridges called gyri. The neocortex is responsible for higher cognitive functions and is essential for human consciousness.

Anhedonia: The Inability to Experience Pleasure

Anhedonia is a negative symptom of schizophrenia that refers to the inability to experience pleasure of enjoyment from activities that are typically enjoyable. It is often described as a feeling of emotional emptiness of numbness. Anhedonia can have a significant impact on a person’s quality of life, as it can lead to social withdrawal and a lack of motivation to engage in activities that were once enjoyable. It is important for individuals with schizophrenia to receive proper treatment for anhedonia, as it can contribute to a worsening of other symptoms and overall functioning. With appropriate treatment, individuals with schizophrenia can learn to manage anhedonia and improve their quality of life.

Kluver-Bucy Syndrome: Causes and Symptoms

Kluver-Bucy syndrome is a neurological disorder that results from bilateral medial temporal lobe dysfunction, particularly in the amygdala. This condition is characterized by a range of symptoms, including hyperorality (a tendency to explore objects with the mouth), hypersexuality, docility, visual agnosia, and dietary changes.

The most common causes of Kluver-Bucy syndrome include herpes, late-stage Alzheimer’s disease, frontotemporal dementia, trauma, and bilateral temporal lobe infarction. In some cases, the condition may be reversible with treatment, but in others, it may be permanent and require ongoing management. If you of someone you know is experiencing symptoms of Kluver-Bucy syndrome, it is important to seek medical attention promptly to determine the underlying cause and develop an appropriate treatment plan.

Mental Age and IQ

The concept of mental age (MA) was introduced by Alfred Binet in 1905. It involves administering a series of tests to a person of child, which are then ranked according to the age at which people are expected to complete them. The mental age can be used to calculate the intelligence quotient (IQ) using the formula: IQ = MA/CA x 100, where CA is the chronological age. An IQ of 100 indicates that the mental and chronological ages are equal. IQ tends to remain stable throughout life. The Stanford-Binet test was the first IQ test, while the WAIS-IV (Wechsler Adult Intelligence Scale) is the most commonly used IQ test today.

The term PrPSc originated from scrapie, a prion disease that affects sheep. In humans, the normal isoform of prion protein is PrPC, while the abnormal form is known as PrPres (protease-resistant) of PrPSc. Scrapie has been observed in sheep for over 300 years, while BSE in cattle was only identified in the 1980s. Feline spongiform encephalopathy (FSE) is a prion disease that affects cats, and Chronic wasting disease (CWD) is a similar condition that affects deer.

Lewy bodies, which are present in Parkinson’s disease, are composed of alpha-synuclein.

Genetic Contributors to Parkinson’s Disease

Genetic contributors to Parkinson’s disease can range from highly penetrant DNA variants to variants that individually increase the lifetime risk of the disease. These genetic risks are often divided into rare DNA variants with high effect sizes, typically associated with familial Parkinson’s disease, and more common, smaller effect variants, usually identified in sporadic cases. While rare variants in over 20 genes have been reported to cause Parkinson’s disease, most cases are idiopathic.

One gene implicated in Parkinson’s disease is SNCA, which codes for alpha-synuclein. Autosomal dominant mutations of SNCA have been identified in several families with inherited Parkinson’s disease. Mutant forms of alpha-synuclein aggregate and induce other proteins to incorporate into the aggregate, forming Lewy bodies, which are similar to the beta-amyloid plaques found in Alzheimer’s patients. Another gene implicated in Parkinson’s disease is the Parkin gene.

It is important to note that the known genes responsible for Parkinson’s disease are responsible for a minority of cases, with the majority being sporadic.

The two main ethical approaches in philosophy are teleological ethics, which focuses on the end result, and deontological ethics, which focuses on an individual’s actions being morally right regardless of the end result. In medicine, deontology is patient-centered, while utilitarianism is society-centered. Deontological ethics judges the moral status of actions according to rules of principles, such as the duty not to harm the patient versus the duty to help them. Kantian ethics is a strict form of deontological ethics that emphasizes behaving as though one’s behavior is creating a universal ethical rule. Utilitarianism is a teleological approach that prioritizes the action that leads to the greatest happiness of the greatest number, regardless of how it is brought about. In medicine, autonomy is one of four ethical principles, along with beneficence, non-maleficence, and justice, that enable patients to choose their own treatment and ensure fairness and equality.

This boy may need some assistance with tasks, but he is able to complete them on his own. He may take longer to reach the correct answer compared to his peers, which is indicative of a mild learning disability. Individuals with more severe learning disabilities may require more support in their daily lives, and may also experience motor deficits. IQ levels can be described as follows: profound (below 20), severe (20-34), moderate (35-49), mild (50-70), and normal range (above 70).

Perception is an active process that involves being aware of and interpreting sensations received through our sensory organs. When we perceive something, we tend to focus on patterns that stand out from their background, such as when we hear our name being mentioned in a crowded room (known as the cocktail party phenomenon). Our brain also tends to group similar items together and perceive interrupted lines as continuous (known as the law of continuity). Additionally, our eyes have the ability to adjust their focus from distant objects to closer ones (known as accommodation), which helps us perceive depth and distance. Pictorial depth, such as in a painting of photograph, can enhance our perception by providing more detailed and realistic visual cues.

History of Psychiatric Terms

In the exams, it is important to be familiar with the individuals associated with certain psychiatric terms. For example, Kraepelin is associated with dementia praecox and manic depression, while Bleuler is associated with schizophrenia. Other terms and their associated individuals include Hebephrenia (Hecker), Catatonia (Kahlbaum), Schizoaffective (Kasanin), Neurasthenia (Beard), Unipolar and bipolar (Kleist), Hypnosis (Braid), Group dynamics (Lewin), Group psychotherapy (Moreno), Psychopathic inferiority (Koch), Psychiatry (Reil), and Institutional Neurosis (Barton).

It should be noted that there is some debate over the origins of certain terms. While Kraepelin is often credited with coining the term dementia praecox, some sources suggest that it was first used in its Latin form by Arnold Pick in 1891. The original term demence precoce was first used by Morel in 1852. Despite this, the College appears to favor the Kraepelin attribution.

It is less common for individuals to use amphetamine abuse as a form of self-medication compared to benzodiazepines. Cannabis use is also less likely to result in the symptoms associated with benzodiazepine dependence. Codeine dependence is not as likely to cause significant anxiety and sleep disturbance as benzodiazepine misuse. Practicing doctors are unlikely to use GHB, an illegal drug, as a means of self-medication.

Operant Conditioning: Reinforcement, Punishment, and More

Operant conditioning, also known as instrumental learning, is a theory of learning developed by B.F. Skinner. It suggests that people learn by interacting with their environment. Reinforcement and punishment are key concepts in operant conditioning. A reinforcer is a stimulus of event that increases the likelihood of a behavior being repeated. Reinforcement can be positive of negative. Positive reinforcement occurs when a behavior is strengthened by adding a rewarding stimulus, while negative reinforcement occurs when a behavior is strengthened by removing an unpleasant stimulus. A punisher is a stimulus that decreases the likelihood of a behavior being repeated. Positive punishment occurs when a behavior is reduced in frequency by adding an unpleasant stimulus, while negative punishment occurs when a behavior is reduced in frequency by removing a pleasant stimulus.

Primary reinforcers are instinctual desires such as food, water, social approval, and sex. Secondary reinforcers, also known as conditioned reinforcers, are not innately appreciated and people have to learn to like them through classical conditioning of other methods. Secondary reinforcers include things such as money. Different patterns of reinforcement have different influences on the response. There are five main reinforcement schedules: fixed interval, variable interval, fixed ratio, variable ratio, and random. Variable ratio schedules are most resistant to extinction.

Shaping and chaining are techniques used when an exact behavior cannot be performed and so cannot be rewarded. Shaping involves rewarding successive, increasingly accurate approximations to the behavior, while chaining involves breaking a complex task into smaller, more manageable sections. Escape conditioning refers to a situation whereby an aversive situation is removed after a response. It is a form of negative reinforcement. Habituation refers to the phenomenon whereby there is a decrease in response to a stimulus over time. Covert sensitization is a technique used whereby someone learns to use mental imagery to associate a behavior with a negative consequence.

Agoraphobia is the most probable diagnosis, even though not all individuals with agoraphobia experience panic attacks.

With aging, there is an increase in lean body weight and body water and a decrease in the proportion of fat. As a result, water-soluble drugs are distributed to a greater extent. Lipid-soluble drugs have a lower volume of distribution in the elderly due to the lower proportion of body fat.

Prescribing medication for elderly individuals requires consideration of their unique pharmacokinetics and pharmacodynamics. As the body ages, changes in distribution, metabolism, and excretion can affect how medication is absorbed and processed. For example, reduced gastric acid secretion and motility can impact drug absorption, while a relative reduction of body water to body fat can alter the distribution of lipid soluble drugs. Additionally, hepatic metabolism of drugs decreases with age, and the kidneys become less effective, leading to potential accumulation of certain drugs.

In terms of pharmacodynamics, receptor sensitivity tends to increase during old age, meaning smaller doses may be needed. However, older individuals may also take longer to respond to treatment and have an increased incidence of side-effects. It is important to start with a lower dose and monitor closely when prescribing medication for elderly patients, especially considering the potential for interactions with other medications they may be taking.

Imipramine antidepressant effects were discovered by Kuhn. Kane introduced clozapine into clinical practice after conducting a successful double-blind multicenter trial comparing it with chlorpromazine in treatment-resistant schizophrenia. Charpentier synthesized chlorpromazine, while Klein discovered the use of iproniazid. Cade discovered the beneficial effect of lithium in treating mania.

Placebos that are inert can still cause negative effects.

Understanding the Placebo Effect

In general, a placebo is an inert substance that has no pharmacological activity but looks, smells, and tastes like the active drug it is compared to. The placebo effect is the observable improvement seen when a patient takes a placebo, which results from patient-related factors such as expectations rather than the placebo itself. Negative effects due to patient-related factors are termed the nocebo effect.

Active placebos are treatments with chemical activity that mimic the side effects of the drug being tested in a clinical trial. They are used to prevent unblinding of the drug versus the placebo control group. Placebos need not always be pharmacological and can be procedural, such as sham electroconvulsive therapy.

The placebo effect is influenced by factors such as the perceived strength of the treatment, the status of the treating professional, and the branding of the compound. The placebo response is greater in mild illness, and the response rate is increasing over time. Placebo response is usually short-lived, and repeated use can lead to a diminished effect, known as placebo sag.

It is difficult to separate placebo effects from spontaneous remission, and patients who enter clinical trials generally do so when acutely unwell, making it challenging to show treatment effects. Breaking the blind may influence the outcome, and the expectancy effect may explain why active placebos are more effective than inert placebos. Overall, understanding the placebo effect is crucial in clinical trials and personalized medicine.

Neurotransmitters are substances used by neurons to communicate with each other and with target tissues. They are synthesized and released from nerve endings into the synaptic cleft, where they bind to receptor proteins in the cellular membrane of the target tissue. Neurotransmitters can be classified into different types, including small molecules (such as acetylcholine, dopamine, norepinephrine, serotonin, and GABA) and large molecules (such as neuropeptides). They can also be classified as excitatory or inhibitory. Receptors can be ionotropic or metabotropic, and the effects of neurotransmitters can be fast of slow. Some important neurotransmitters include acetylcholine, dopamine, GABA, norepinephrine, and serotonin. Each neurotransmitter has a specific synthesis, breakdown, and receptor type. Understanding neurotransmitters is important for understanding the function of the nervous system and for developing treatments for neurological and psychiatric disorders.

Electroencephalography

Electroencephalography (EEG) is a clinical test that records the brain’s spontaneous electrical activity over a short period of time using multiple electrodes placed on the scalp. It is mainly used to rule out organic conditions and can help differentiate dementia from other disorders such as metabolic encephalopathies, CJD, herpes encephalitis, and non-convulsive status epilepticus. EEG can also distinguish possible psychotic episodes and acute confusional states from non-convulsive status epilepticus.

Not all abnormal EEGs represent an underlying condition, and psychotropic medications can affect EEG findings. EEG abnormalities can also be triggered purposely by activation procedures such as hyperventilation, photic stimulation, certain drugs, and sleep deprivation.

Specific waveforms are seen in an EEG, including delta, theta, alpha, sigma, beta, and gamma waves. Delta waves are found frontally in adults and posteriorly in children during slow wave sleep, and excessive amounts when awake may indicate pathology. Theta waves are generally seen in young children, drowsy and sleeping adults, and during meditation. Alpha waves are seen posteriorly when relaxed and when the eyes are closed, and are also seen in meditation. Sigma waves are bursts of oscillatory activity that occur in stage 2 sleep. Beta waves are seen frontally when busy of concentrating, and gamma waves are seen in advanced/very experienced meditators.

Certain conditions are associated with specific EEG changes, such as nonspecific slowing in early CJD, low voltage EEG in Huntington’s, diffuse slowing in encephalopathy, and reduced alpha and beta with increased delta and theta in Alzheimer’s.

Common epileptiform patterns include spikes, spike/sharp waves, and spike-waves. Medications can have important effects on EEG findings, with clozapine decreasing alpha and increasing delta and theta, lithium increasing all waveforms, lamotrigine decreasing all waveforms, and valproate having inconclusive effects on delta and theta and increasing beta.

Overall, EEG is a useful tool in clinical contexts for ruling out organic conditions and differentiating between various disorders.

Vigabatrin is known to cause visual field constriction in approximately 30% of its users. Although the majority of cases are asymptomatic, as the drug primarily affects peripheral fields and not central visual acuity, the effects are typically irreversible of only partially reversible after discontinuation of the medication. Patients who are over the age of 10 and are prescribed vigabatrin should undergo baseline threshold visual field testing and follow-up every six months. It is important for patients to report any new vision problems, such as blurring, double vision, of signs of peripheral vision impairment. Vigabatrin is only recommended for specialist use and is indicated for epilepsy that is not adequately controlled by other medications.

Macrocytic anaemia is the type that is commonly associated with valproate.

Valproate: Forms, Doses, and Adverse Effects

Valproate comes in three forms: semi-sodium valproate, valproic acid, and sodium valproate. Semi-sodium valproate is a mix of sodium valproate and valproic acid and is licensed for acute mania associated with bipolar disorder. Valproic acid is also licensed for acute mania, but this is not consistent with the Maudsley Guidelines. Sodium valproate is licensed for epilepsy. It is important to note that doses of sodium valproate and semi-sodium valproate are not the same, with a slightly higher dose required for sodium valproate.

Valproate is associated with many adverse effects, including nausea, tremor, liver injury, vomiting/diarrhea, gingival hyperplasia, memory impairment/confusional state, somnolence, weight gain, anaemia/thrombocytopenia, alopecia (with curly regrowth), severe liver damage, and pancreatitis. Increased liver enzymes are common, particularly at the beginning of therapy, and tend to be transient. Vomiting and diarrhea tend to occur at the start of treatment and remit after a few days. Severe liver damage is most likely to occur in the first six months of therapy, with the maximum risk being between two and twelve weeks. The risk also declines with advancing age.

Valproate is a teratogen and should not be initiated in women of childbearing potential. Approximately 10% of children exposed to valproate monotherapy during pregnancy suffer from congenital malformations, with the risk being dose-dependent. The most common malformations are neural tube defects, facial dysmorphism, cleft lip and palate, craniostenosis, cardiac, renal and urogenital defects, and limb defects. There is also a dose-dependent relationship between valproate and developmental delay, with approximately 30-40% of children exposed in utero experiencing delay in their early development, such as talking and walking later, lower intellectual abilities, poor language skills, and memory problems. There is also a thought to be a 3-fold increase of autism in children exposed in utero.

Anton’s syndrome, also known as Anton-Babinski syndrome, is a condition that results from damage to the occipital lobe. People with this syndrome are cortically blind, but they are not aware of it and deny having any problem, a condition known as anosognosia. They may start falling over furniture as they cannot see, but they believe they can still see and describe their surroundings in detail, even though their descriptions are incorrect (confabulation). This syndrome is characterized by a lack of awareness of visual impairment, which can lead to significant difficulties in daily life.

Maslow’s Hierarchy of Needs is a theory of motivation introduced by Abraham Maslow. The hierarchy consists of five levels, with the most basic needs at the bottom and the most advanced needs at the top. Maslow proposed that a person would only become concerned with the needs of a particular level when all the needs of the lower levels had been satisfied. The levels include physiological needs, safety needs, social needs, esteem needs, and self-actualization needs. Maslow also made a distinction between D-needs (deficiency needs) and B-needs (being needs), with B-needs allowing us to reach our full potential but only after D-needs have been satisfied. Later in life, Maslow expanded upon the model and included cognitive, aesthetic, and transcendence needs, resulting in an eight-staged model. The cognitive needs include knowledge and understanding, while aesthetic needs involve appreciation and search for beauty. Transcendence needs are motivated by values that transcend beyond the personal self.

Kluver-Bucy syndrome is a neurological disorder that results from dysfunction in both the right and left medial temporal lobes of the brain. This condition is characterized by a range of symptoms, including docility, altered dietary habits, hyperorality, and changes in sexual behavior. Additionally, individuals with Kluver-Bucy syndrome may experience visual agnosia, which is a condition that impairs their ability to recognize and interpret visual stimuli.

The medulla governs the rhythm of the heart and respiration. The amygdala regulates emotional reactions and the ability to perceive the emotions of others. The midbrain is linked to vision, hearing, motor coordination, sleep patterns, alertness, and temperature regulation. The cerebellum manages voluntary movement and balance. The thalamus transmits sensory and motor signals to the cerebral cortex.

The disorder is often chronic, as the six month prevalence is only slightly lower than the lifetime prevalence. Additionally, bipolar disorder frequently co-occurs with other conditions such as substance misuse and anxiety disorders. Prevalence rates can be determined using structured diagnostic interviews like the diagnostic interview schedule (DIS), and the disorder affects both men and women equally with a lifetime risk ranging from 0.3% to 1.5%. Onset typically occurs around age 17 in community studies.

Schwartz et al. identified five types of errors in drug adherence. These include errors of omission, errors of purpose, errors of dosage, errors of timing and sequence, and taking additional medication not prescribed by the doctor. An example of errors of purpose is when a patient takes medication for the wrong reason. Other types of errors include not taking the medication, taking the wrong dosage, and taking medications at the wrong time and sequence.