Psychiatric disorders

Psychiatric disorders
By: * Peter Liddle * Chris Rorden

Disorders of Mind & Brain
* Mind and brain are two sides of one coin; disorders of the mind are disorders of the brain.
* Particular clusters of symptoms (syndromes) tend to occur together in various different mental illnesses
* The ways in which symptoms cluster together tells us something about the structure of the human mind and brain

Anatomy of psychiatric disorders
* Contemporary psychiatry implicates neurotransmitters rather than anatomy.
o Schizophrenia :: dopamine
o Depression :: serotonin
* To some degree, this may reflect the popular treatments – neurotransmitters specific to brain regions.

Major symptom clusters
* Reality distortion
* Disorganization
* Psychomotor poverty
* Psychomotor excitation
* Depression
* Euphoria
* Anxiety

Reality distortion

* Mismatch between representation of reality in individual’s mind and representation supported by objective evidence
* Hallucinations and delusions
* Hallucination: perception with quality of a sensory perception but nor derived form stimulation of a sense organ
* Delusion: fixed belief derived by erroneous inference or unjustified assumption that cannot be accounted for by culture or religion

Delusions
* Delusions usually false but the key issue is lack of rational grounds and fixity.
* Ability to engage in logical deduction about other issues is usually intact; certain ideas seem exempted from the need for logic.
* Non-psychotic distortions of reality (eg in OCD or in non-psychotic depression) reflect biased thinking but are less resistant to debate

Psychotic Reality Distortion
* Can occur in schizophrenia, mania, psychotic depression, brain injury or degeneration
* Themes: persecution; alien control, religion, grandiosity, guilt
* Influenced by culture, but some themes are common across cultures

Reality distortion in schizophrenia
* Characteristic forms (but not present in every case)
* Less specific but common forms:

Affective psychosis
* Mood disorder with psychotic features is diagnosed if psychotic illness is dominated by mood symptoms unless there is reality distortion without substantial mood symptoms for at least two weeks
* Delusions and hallucinations are usually mood congruent (eg guilt, worthlessness, critical voices with depressed mood; grandiose delusions and self-reinforcing halluciations in mania)
* Reality distortion shows similar response to antipsychotic medication irrespective of diagnosis

Neuropsychological correlates of reality distortion
* Reality Distortion can occur in absence of general defect in reasoning.
* Defective internal monitoring of self-generated mental activity (Frith & Done 1989; Mlakar et al, 1994)
* Jumping to conclusions – the bead test (Huq et al, 1988)
* Patients with persecutory delusions tend to attribute negative outcomes to external causes (Bentall, 1994)

Regional cerebral activity and reality distortion
Neurochemistry and pharmacology of reality distortion
Pharmacology of reality distortion
Hypothesis for generation of reality distortion
Disorganization syndrome
Neuropsychological correlates of disorganization
Regional cerebral activity and disorganization
Psychomotor poverty and excitation
Neuropsychological correlates of psychomotor poverty
Psychomotor poverty and brain structure
Neurochemistry & pharmacology of psychomotor poverty
Neurochemistry & pharmacology of psychomotor excitation
Depression & Elation
Mood disorders
Neuropsychological correlates of depression
Brain structure and mood disorders
Regional cerebral activity and depression
Regional cerebral activity associated with elation
Regional cerebral metabolism in bipolar disorder
Neurochemistry and pharmacology of mood disorders
Bipolar affective disorder
Anxiety
Regional cerebral activity associated with anxiety
Pharmacology of anxiety
Concepts of schizophrenia
Reality distortion
Characteristic time course
ICD 10 diagnostic criteria
Aetiology : predisposing factors
Brain structure in schizophrenia
Cognitive deficits in schizophrenia
Pharmacology
Bipolar mood disorder
Genetics
Aetiology of bipolar disorder
Ventricular enlargement
Anatomy of bipolar disorder
Pharmacology of bipolar disorder
Psychopathy
Aetiology of psychopathy
Cognition and information processing in psychopathy

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Rett’s Disorder

Rett’s Disorder
By:By: Natalie Sten

An Overview of Rett Syndrome for Professionals
Possibly the leading cause of mental retardation and neurodevelopmental impairment in females.

After this seminar you will be able to:

* List the warning signs and symptoms of Rett Syndrome.
* Describe how to cope with children with Rett Syndrome and what the most important aspects of treatment are.
* State how school dynamics can play a critical role in the development of children with Rett Syndrome.

GLOSSARY
* Rett Syndrome (RS): A neurodevelopmental disorder that is classified as a pervasive developmental disorder
* Pervasive Development Disorders (PDD): Refers to a group of five disorders characterized by delays in the development of multiple basic functions including socialization and communication.
* Apraxia: A neurological disorder characterized by loss of the ability to execute or carry out learned purposeful movements, despite having the desire and the physical ability to perform the movements.
* Respite Care: The provision of short-term, temporary relief to those who are caring for family members who might otherwise require permanent placement in a facility outside the home.

What is diagnostic criteria for Rett Syndrome?
* Diagnostic Criteria for 299.80 Rett's Disorder
All of the following:
o apparently normal prenatal and perinatal development
o apparently normal psychomotor development through the first 5 months after birth
o normal head circumference at birth
o deceleration of head growth between ages 5 and 48 months
o loss of previously acquired purposeful hand skills between 5 and 30 months with the subsequent development of stereotyped hand movements (e.g., hand-wringing or hand washing)
o loss of social engagement early in the course ( although often social interaction develops later)
o appearance of poorly coordinated gait or trunk movements
o severely impaired expressive and receptive language development with severe psychomotor retardation

RS is Associated with PDDs or Autistic Spectrum Disorder
* Autism, also called autistic disorder, is a complex developmental disability that appears in early childhood, usually before age 3.
* Autism prevents children and adolescents from interacting normally with other people and affects almost every aspect of their social and psychological development.

How is Rett Syndrome Associated with Autism?
* Girls with RS often have autistic-like characteristics (speech & emotional contact impairment/ repetitive hand gestures) at an early age but differences begin to occur as the child continues to grow.

* The critical difference is the gene mutation that is defining of RS. However, females meeting criteria for RS do not meet the symptoms for autism.

Symptoms seen in RS that are NOT seen in Autism are:
* Deceleration of the rate of head growth
* Loss of purposeful hand skills
* Mobility or the irregular breathing patterns
* Repertoire of purposeless hand stereotypes
* Children with RS almost always prefer people to objects
* Children with RS often enjoy affection

Who is affected by RS?
Warning Signs and Symptoms:
There are 4 stages in the child’s development:
* Stage 1: Early Onset (6-18 months)
* Stage 2: Rapid Destructive (1-4 yrs old)
* Stage 3: Plateau (2-10 yrs. old)
* Stage 4: Late Motor Deterioration (Usually after age 10)

Do biological factors play a role?
Rett Syndrome:
Is a neurodevelopmental disorder that is quite rare. It causes a genetic mutation, linked to the X chromosome, which affects the production of a vital protein that controls brain development.
School dynamics associated with students with RS:
* A secure emotional environment is the first, most important aspect of a teaching environment so that children feel safe.
* Children with RS could be placed in a variety of classrooms from special education units to full inclusion according to their own individual needs and abilities.
* Structured, stimulating, restrictive-free classroom environments with direction and organization are necessary.
Interventions must be created based on the individualized needs of the child!

What can families do?
Stimulating environments at home:
Can you think of some emotionally motivating movements that could occur automatically?
It’s the Law in Pennsylvania

How you can help:
Parents and professionals can expect difficulties. What can help you cope?
* Talk about it.
* Be gentle with yourself.
* Learn how to ask for help.
* Trust your instincts.
* Learn to let go and to accept what can’t be changed.
TREATMENT
Therapies Include:
* Aquatic Rehabilitation
* Hydrotherapy
* Love Therapy
* Music Therapy
* Physical Therapy
* Therapist's Role
* Behaviors
* Hippotherapy
* Motor Development
* Occupational Therapy
* Speech Therapy

Where to go for more info?
1) International Rett Syndrome Association www.rettsyndrome.org
2) NIH/National Institute of Neurological Disorders and Stroke
www.ninds.nih.gov
3) National Institute of Child Health and Human Development (NICHD)
www.nichd.nih.gov
References

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Chronic Kidney Disease

Chronic Kidney Disease
By:Justin A. Glass, MD
Emory Family Medicine

Objectives
* CKD o Definition
o Epidemiology
o Management

Literature sources
Normal Kidney Function
* Regulation of fluid / electrolyte balance
* Regulation of blood pressure
* Regulation of red cell mass
* Regulation of calcium / phosphate metabolism
* Renal hormones
o Renin
o Bradykinin
o Prostaglandins (PGE2 / PGI2)
o Erythropoietin
o Calcitriol

Definition of CKD
* Chronic Kidney Disease (CKD)
* Kidney Damage
o Proteinuria
o Abnormal urine sediment
o Abnormal serum or urine chemistries
o Abnormal imaging study

Proteinuria
Abnormal Sediment
Definition: Chronic Kidney Disease
Renal Function Measurement
Classification of CKD
* Stage 0: At risk patients
* Stage 1: Kidney damage w/ normal GFR
* Stage 2: GFR 60-89
* Stage 3: GFR 30-59
* Stage 4: GFR 15-29
* Stage 5: GFR <15 or dialysis
CKD: Burden of disease
* Definitions (expanded)
Risk Factor Modification
CKD: Cause
Prevention of progression
Complications of CKD
Anemia due to CKD
Anemia in CKD
Anemia in CKD: Treatment
Bone Disease in CKD
Hypertension in CKD
Cardiovascular Disease in CKD
CVD Prevention in CKD
When to refer?

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