- 10:02:00 PM
- 0 Comments
- 11:58:00 PM
- 0 Comments
- 11:56:00 PM
- 0 Comments
- 11:52:00 PM
- 0 Comments
- 11:50:00 PM
- 0 Comments
 |
| SOURCE : MY NOTES FOR USMLE |
Schizophrenia is a serious brain disorder that distorts the way a person thinks, acts, expresses emotions, perceives reality, and relates to others. People with schizophrenia -- the most chronic and disabling of the major mental illnesses -- often have problems functioning in society, at work, at school, and in relationships. Schizophrenia can leave its sufferer frightened and withdrawn. It is a life-long disease that cannot be cured but can be controlled with proper treatment.
Contrary to popular belief, schizophrenia is not a split or multiple
personality. Schizophrenia is a psychosis, a type of mental illness in which a person cannot tell what is real from what is imagined. At times, people with psychotic disorders lose touch with reality. The world may seem like a jumble of confusing thoughts, images, and sounds. The behavior of people with schizophrenia may be very strange and even shocking. A sudden change in personality and behavior, which occurs when schizophrenia sufferers lose touch with reality, is called a psychotic episode.
Who Gets Schizophrenia?
Anyone can get schizophrenia. It is diagnosed all over the world and in all races and cultures. While it can occur at any age, schizophrenia typically first appears in the teenage years or early 20s. The disorder affects men and women equally, although symptoms generally appear earlier in men (in their teens or 20s) than in women (in their 20s or early 30s). Earlier onset of symptoms has been linked to a more severe course of illness. Children over the age of 5 can develop schizophrenia, but it is very rare before adolescence.
At one time, doctors classified schizophrenia based on distinct subtypes:
- Paranoid: Where someone feels he is being persecuted or spied on.
- Disorganized: Where people appear confused and incoherent.
- Catatonic: Where people can be physically immobile or unable to speak.
- Undifferentiated schizophrenia: Asubtype in which no paranoid, disorganized or catatonic features are prominent
- Residual Schizophrenia: In which psychotic symptoms are markedly diminished or no longer present
Scientists think the above distinctions are no longer as accurate or useful as once thought and therefore instead just focus on describing symptoms and their severity.
The most common symptoms of schizophrenia can be grouped into several categories including positive symptoms, cognitive symptoms, and negative symptoms.
Positive Symptoms of Schizophrenia
In this case, the word positive does not mean "good." Rather, it refers to obvious symptoms that are exaggerated forms of thinking or behavior that become irrational. These symptoms, which are sometimes referred to as psychotic symptoms, include:
- Delusions: Delusions are strange beliefs that are not based in reality and that the person refuses to give up, even when presented with factual information. For example, the person suffering from delusions may believe that people can hear his or her thoughts, that he or she is God or the devil, or that people are putting thoughts into his or her head or plotting against them.
- Hallucinations: These involve perceiving sensations that aren't real, such as seeing things that aren't there, hearing voices, smelling strange odors, having a "funny" taste in your mouth, and feeling sensations on your skin even though nothing is touching your body. Hearing voices is the most common hallucinationin people with schizophrenia. The voices may comment on the person's behavior, insult the person, or give commands.
- Catatonia (a condition in which the person becomes physically fixed in a single position for a very long time).
Disorganized symptoms of schizophrenia are a type of positive symptom that reflects the person's inability to think clearly and respond appropriately. Examples of disorganized symptoms include:
- Talking in sentences that do not make sense or using nonsense words, making it difficult for the person to communicate or engage in conversation
- Shifting quickly from one thought to the next
- Moving slowly
- Being unable to make decisions
- Writing excessively but without meaning
- Forgetting or losing things
- Repeating movements or gestures, such as pacing or walking in circles
- Having problems making sense of everyday sights, sounds, and feelings
Cognitive Symptoms of Schizophrenia
Cognitive symptoms include:
- Poor executive functioning (the ability to understand information and to use it to make decisions)
- Trouble focusing or paying attention
- Difficulty with working memory (the ability to use information immediately after learning it)
Negative Symptoms of Schizophrenia
In this case, the word negative does not mean "bad," but reflects the absence of certain normal behaviors in people with schizophrenia. Negative symptoms of schizophrenia include:
- Lack of emotion or a very limited range of emotions
- Withdrawal from family, friends, and social activities
- Reduced energy
- Reduced speech
- Lack of motivation
- Loss of pleasure or interest in life
- Poor hygiene and grooming habits
What Causes Schizophrenia?
The exact cause of schizophreniais not yet known. It is known, however, that schizophrenia -- like cancer and diabetes -- is a real illness with a biological basis. It is not the result of bad parenting or personal weakness. Researchers have uncovered a number of factors that appear to play a role in the development of schizophrenia, including:
- Genetics (heredity): Schizophrenia can run in families, which means a greater likelihood to develop schizophrenia may be passed on from parents to their children.
- Brain chemistry and circuits: People with schizophrenia may have abnormal regulation of certain chemicals (neurotransmitters) in the brain, related to specific pathways or "circuits" of nerve cells that affect thinking and behavior. Different brain circuits form networks for communication throughout the brain. Scientists think that problems with how these circuits operate may result from trouble with certain receptors on nerve cells for key neurotransmitters (like glutamate, GABA, or dopamine), or with other cells in the nervous system (called "glia") that provide support to nerve cells within brain circuits. The illness is not believed to be simply a deficiency or "imbalance" of brain chemicals, as was once thought.
- Brain abnormality: Research has found abnormal brain structure and function in people with schizophrenia. However, this type of abnormality doesn't happen in all schizophrenics and can occur in people without the disease.
- Environmental factors: Evidence suggests that certain environmental factors, such as a viral infection, extensive exposure to toxins like marijuana, or highly stressful situations, may trigger schizophrenia in people who have inherited a tendency to develop the disorder. Schizophrenia more often surfaces when the body is undergoing hormonal and physical changes, such as those that occur during the teen and young adult years.
How Do Doctors Diagnose Schizophrenia?
There’s no simple test to find out if someone you love has schizophrenia. It’s a severe mental illness that is very hard to diagnose. It affects the way a person thinks, processes emotions, maintains relationships, and makes decisions.
It’s especially hard to diagnose in teenagers because many of the first signs of schizophrenia in young people, such as bad grades, sleeping too much, or withdrawal from friends, can at first seem like typical problems. But schizophrenia is much more than that.
Is It Schizophrenia?
If you think someone you know may have schizophrenia, reach out to your doctor or psychiatrist. Tell them what you have noticed and ask them what steps you should take, especially if the person isn’t interested in getting help.
The first thing they will want to do is a psychological evaluation and a complete medical exam. This will allow the doctor or specialist to track your loved one’s symptoms over about six months to rule out other possible conditions, such as bipolar disorder, and other possible causes.
The doctor may also want to do a blood test to make sure that alcohol or drug abuse isn’t causing the symptoms. And a test that scans the body and brain, such as an MRI or CT scan, might also help eliminate other problems like a brain tumor.
Making the Diagnosis
To get an official diagnosis of schizophrenia, your loved one has to show at least two of the following symptoms most of the time for a month, and some mental disturbance over six months:
- Delusions (false beliefs that the person won’t give up, even when they get proof that they’re not true)
- Hallucinations (hearing or seeing things that aren’t there)
- Disorganized speech and behavior
- Catatonic or coma-like daze
- Bizarre or hyperactive behavior
Getting the diagnosis as early as possible will improve your loved one’s chances of managing the illness. If he gets the proper care, which will probably include medication and psychotherapy, a kind of talk therapy, he is likely to do better.
SOURCE : WEBMD
SOURCE : WEBMD
- 11:13:00 PM
- 0 Comments
- 5:31:00 PM
- 0 Comments
OMG, FINALLY I'M HERE ! THE PSYCHIATRIC POSTING !
Tak sabar rasanya nak pergi melawat ward psychiatric. I already started to love this posting as Prof. Dr. Nawan is so cute and semangat gila bagi lecture. Today is the 2nd day of posting, and tomorrow we will start to visit the ward and clerking patient. Nina and Audi went for a visit just now (I and Liyana went to Merbau Printing House to photostat the textbooks) and Nina kinda devastated to see the ward. She was scared. With the patient. Geez, I hope I'm okay with them. I'm not sure, but certainly memang akan ada rasa takut deep inside my heart. Hahaha. I hope no patient will attached to me, and so do I toward them. I love this posting because it allow you to understand and study thoughts of human. You got access to it. You can study how come this patient think differently, unlike the rest of other normal people. Why are they being like that and what are the turning point? What happen exactly?
Actually, I was drafting a novel since last year, a psychiatry type of story. It's about a girl, working as a doctor at psychiatric department facing some hardship in life and she encounters so many mysterious event regarding patient bed number 13. But funny is nobody knew the patient. They could not read the file as if the chief wanted to keep it from others confidential so badly. So yeah. The tittle is ADELIA. Still drafting and I hope I can finish it by this year? Hahaha, maybe. We'll see.
Actually, I was drafting a novel since last year, a psychiatry type of story. It's about a girl, working as a doctor at psychiatric department facing some hardship in life and she encounters so many mysterious event regarding patient bed number 13. But funny is nobody knew the patient. They could not read the file as if the chief wanted to keep it from others confidential so badly. So yeah. The tittle is ADELIA. Still drafting and I hope I can finish it by this year? Hahaha, maybe. We'll see.
Do you know that in early days, abnormal
behavior was always thought as evil spirits trying to get out. Trephining
was often used. And what was this Trephning thing? Yup, digging inside the brain to see what happen.
And today, we were taught about so many interesting ideas and terminologies that need to be know, memorize it by heart. Phenomenology/Psychopathology was cool. We learnt to differentiate hallucination, illusion and delusion.
Prof taught us with so many funny examples and ways to tackle the patient's attention when we're clerking them. Lets hope this 4 weeks of posting will be the best one in 3rd year of medical school.
Oh by the way, we 're using few textbooks that were recommended by our lecturer.
- 5:07:00 PM
- 0 Comments
 |
| credit: pinterest |
B R E A S T . F E E D I N G
 |
| credit: pinterest |
 |
| credit: pinterest |
- 6:26:00 PM
- 0 Comments
Definition of
Gestational Diabetes Mellitus
The WHO has defined
Diabetes Mellitus as either a raised fasting blood glucose level of > 7.8
mmol/L or a level of > 11.0 mmol/L 2 hours following a 75 g oral glucose
load.
Pathogenesis of
Gestational Diabetes Mellitus
Fetal hyperinsulinemia
Effects of Fetal
Hyperinsulinemia
1. Reduced lung
surfactant à
Respiratory Distress Syndrome (RDS)
2. Increased
erythropoiesis can leads to jaundice or hyperviscosity syndrome. Hyperviscosity
syndrome will later develops into necrotizing colitis or renal vein thrombosis.
3. Increased fetal
metabolism which will increases O2 demand. Low O2 supply from the mother can
leads to intrauterine death.
4. Macrosomia à shoulder dystocia
5. Hypoglycaemia
6. Hypertrophic
myocardiopathy
Effects of Diabetes on
Pregnancy
1. Increased
miscarriage rate
2. Increased perinatal
loss due to intrauterine death (IUD)
3. Macrosomic baby
hence is at risk of dystocia
4. Fetal lung
maturation may be delayed; if the fetus was delivered prematurely, the risk of
getting RDS is increased
5. Risk of
preeclampsia
6. Risk of
polyhydramnios
7. Susceptible to
infections; mainly UTI and candida vaginitis
Management of Diabetes
A.
Pre pregnancy
The women who are known
to be diabetic and women who have had gestational diabetes should seek medical
attention before they get pregnant. This consultation offers opportunities in
explaining to them about;
1. The reason for
meticulously maintaining her blood glucose at normal level before conception
2. The need of taking
folic acid to reduce the risk of neural tube defects
This consultation can
also be used as an assessment for the presence of any complication related to
diabetes, such as diabetic retinopathy and nephropathy. Women who are on oral
hypoglycemic drugs should preferably be changed to insulin therapy. We should
check for her glycosylated Hemoglobin, HbA1c that reflects her glucose control
over the previous 10 weeks. High levels of HbA1c are associated with an increased
rate of fetal abnormality.
B. Pregnancy
Euglycemic state
should be maintained; with fasting glucose less than 5.3mmol/L and 2 hour post
prandial blood glucose should be less than 6.7 mmol/L. Blood sugar profile
should be checked before or after each meal; preprandial or postprandial
glucose level and the result should be less than 6 mmol/L or 6.7mmol/L,
respectively. Normal blood glucose level should be maintained with a mixture of
short and medium-acting insulin. Ultrasound scan that was done during the first
12 weeks of pregnancy provides accurate estimation of the period of gestation.
Meanwhile, scanning between 18– 20 weeks of gestation allows exclusion of any
major malformations and around 34 weeks of gestation, it permits assessment of
fetal growth. Regular assessment of fetal growth and wellbeing should be
performed.
C. Timing of Delivery
Delivery at up to 40
weeks of gestation is possible if the sugar control is good. But if there is
inadequate blood glucose control, or the presence of polyhydramnios, fetal
macrosomia or maternal obesity delivery at 38 weeks of gestation is indicated.
Delivery at earlier than 38 weeks is not really indicated to prevent
Respiratory Distress Syndrome in the premature baby.
Management of Labour
The intention is to achieve vaginal delivery.
Labour can be induced by doses of oxytocin. An artificial rupture of membrane
(ARM) should be performed. Blood glucose level needs to be monitored at
frequent intervals; mostly done at 2hourly. The fetus should be monitored
throughout labour and during vaginal delivery shoulder dystocia should be
anticipated. On the other hand, a caesarean section may be performed if there
is significant petal macrosomia or poor fetal status (CTG), or if labour fails
to progress satisfactorily. Uncomplicated diabetes not an indication for
operative delivery.
Follow Up of Women Who
Have Had Gestational Diabetes Mellitus
Follow up is important
as up to 50% of women with Gestational Diabetes Mellitus may develop overt
diabetes; mainly Type II. At the follow up visits, we should encourage her to
follow a diet which is appropriate for a diabetic. She should also be advised
to take these following measures;
1. Avoid becoming
obese
2. Take regular
exercises
3. Avoid cigarette
smoking
4. Checked annually
for hypertension
These women have a 50%
chance of developing Gestational Diabetes Mellitus in the future pregnancy. If
she intend to become pregnant again, testing for hyperglycaemia before
conception or in early pregnancy is recommended.
- 12:34:00 PM
- 0 Comments
