It

gets better

Nsr
.
 /
-

Psychiatry /
to be concerned
Existing norms are
•

Averages do not
imply normalcy
•

Assessment
reflects only health at
•

- time
of care -

Normality 2
Information Environment Sociocultural
factors
•

, ,

£ COMPLETE ( mental )
physical social
£ 4 well-being
in
, ,

Ls
CONFORM to some standard

£ CUSTOMARY

CONTEXTUAL
(

(
acceptable )
maybe abnormal in some other contexts)

AUTO NORMAL

=
+
Cosas in ) ( Inoa )

HETERO PATHOLOGICAL
( rosins oho) ( Gastrin )

Perspectives of Normality as in

•
Health

Utopia
•

( rather Bell-shaped
Average commonly used
Psychology than
Psychiatry )
→
•
in curve
g.
e.

(rather cross-sectional) Erikson 's

Process than
before another
theory
•
→
one
e.g
.

of development
Mental
Examples of Normality
normal

§
-
above

positive psychology
-

Good Mental Health

maturity Free
from disorders
-
=

emotional
intelligence
-

subjective being
well
-
-

resilience

Abnormality = Distress
4 ↑ risk
of suffering ,
death
, pain
or
disability
☆ Not an
expected /customary response

Mental Disorders →
cognition ,
emotion
regulation ,
behavior

psycho developmental aspects

↳ * Distress
4 Dysfunctional in bio -
-

Diagnosis Differential
§
→

→
Communication DSM -5
→

Efficiency of care ICD -

10 ( 11 available )
→
Research
purpose
 ICD 10
( for classification demography )
monetary
-

, , purposes
F
;
0
Organic Disorders
-

I -
Disorders due to substance use

2
Schizophrenia delusional disorders
-
-

3 -
Mood disorders
4 -
Neurotic stress-related / form
some to

5 -
Behavioral
syndromes →
/
physio physical
6 Adults
personality Ef behavior
-

9- -
Mental retardation
8- Disorders of psychological development
9 -
Behavioral/ Emotional disorders in
childhoodadolescence
DSM -5 (
for diagnosis ) Neurosis → aware - AD

f
[
specifically SID 324] in
Psychosis →
unaware
-

Neurodevelopmental disorders Organic Neurocognitive

=

Schizophrenia & psychotic disorders =

. .
. .
due to
related disorders
Bipolar § Insight of patient
-

Depressive disorders
disorders
Anxiety
-

Substance -
related 9 addictive disorders
Neurocognitive disorders
-

Psychiatric Children & Adolescence

Disorders in

☆ Neurodevelopmental Disorders Early life onsets =

quality of
social academic occupational
functions
↳
impairs , ,
.

① Intellectual Disabilities ( I -3% )

② Autistic Spectrum Disorder (ASD) [ 0.08 -1% ]

③ Attention deficit/hyperactive Disorder (ADHD ) [ 5- or ] .

④ Specific Learning Disorder CSLD) [ ii.]

i Communication disorders
(E) Motor disorders

① Intellectual disabilities

[ Global
Intellectual
disability ( I. D.) Profound
developmental delay severe
Moderate
( also
I.D. Intellectual developmental disorder MILD
-

Deficits in both intellectual 4 adaptive functions

[

]
/ developmental 9
reasoning , problem
abstract
solving , planning fails
to meet sociocultural standards
(social)
thinking judgement ,
academic, for ( personal) independence 4
learning , experience based -

learning (
responsibility if left untreated
1 or activities such
more as

clinical assessment
Intelligence Hx
taking communication, social
participation
+
.

Test life) instead

independent living )
( Normal t.cl .
=
90
,
270 is abnormal) /
Vineland adaptive behavior scale HOME SCHOOL - -
COMMUNITY
 {
Assessment
Severity Conceptual
social Domains
Practical

MILD -

[50-55,69] ( < 70 is abnormal)

Conceptual →
Preschool
Age = No obvious
difference
School Adults academic skills
Age Difficulties learning
→ -
=

3
resulting in concrete approaches to
problems (
compared to age mates) -

Social Immature in social interactions,

judgement communication
sflanguage
→

Difficulties regulating emotions

Y behavior
→

Limited understanding of risks in social situations .

Practical Needs
support with
complex tasks
-
some

Jobs do not
emphasize conceptual skills
→
:

Might need support for healthcare legal decisions

→

MODERATE -

[35-40,50-55]
Conceptual school
lag markedly language academic shills develop slowly well
→
+
years
as as
pre
-

need
support
→

Social Marked
differences socialcommunicative behaviors ( simple language)
→
in
e.g .

limited social
judgement/decision making abilities
→
-

need
support
-

Practical →
Capable of personal needs but
through extended teaching /reminding
→
Maladaptive behavior with
required support from peers/supervisor .

[
Severe 20-25,35-40 ]
-

Conceptual →
Little
understanding of written
language as well as
concepts of numbers /time/
money
Extended
→

support needed
throughout life
Social Limited spoken language ( single words,
phrases)
→

of pleasure 4 help family

→
source =

Practical
Requires help for all daily
→ tasks
→
Supervision needed / maladaptive behavior →
self injury
-

Profound -
[ < 20 -25 ]
Conceptual -

Physical symbolic
>

social →
Gestures

Practical →
Dependent on all aspects as well as
maladaptive behavior
 Global development delay (
5g / ) by/
<
o
→
o
= Dx ID -
.

fails to meet several expected milestones of intellectual functioning ↳ Early intervention

→

→ too
young for tests -
assessments

{
Autistic disorder \
"M
②
-
" TR
Autistic Spectrum Disorder
Asperger's disorder
.

↳ Persistent
deficits in PDD Nos

Social interactions city

Flirting ≈ -

Restricted ,
communications
Y
→
repro ,
Nonverbal
, relationships
repetitive behaviors interests activities
↳ Present
Y ,

early developmental period

J
in

≥
2/4 1) stereotyped/repetitive movements /speech

2) sameness
Inflexibility to routines/behaviors
4
3) strong fixated interests that abnormal
intensity are in

4) Sensory input ( hyper/hypo )

③ Attention deficit/ Hyperactivity disorder ( ADHD )

verbal
Non
working memory g- controlling focus /remembering instructions
-

I
verbal
working memory
Emotional/ Motivational
regulations Persistent for > 6 no

Planning /problem-solving y /o
to
Prior 12 in >2
settings
Dysfunctional
3 Domains
of ADHD symptom
1) Inattention
careless mistakes fails to
finish tasks loses
things
- - -

hard to keep attention hard to tasks

Easily distracted
-

organize
- -

not
listening
_
dislikes tales that required Forgetful
-
-

attention
2-
3) Hyperactivity Impulsivity +

{
Fidgets
-

Blurts
Noisy
- -

Leaving seats On the

Difficulty waiting Impulsivity
-

go
-
-

Running climbing/ Talks Interrupts

_ -
-

of all domains
can be
presented as each or a combination

{
Dyslexia dysedculia
,

① Specific Learning Disorder ( SLD) Learning disorder

↳
}Sisson w/0918m Afb

(
cannot Brain
efficiently process verbal Ms , :
-

verbal
non
-

information
school onset for at least 6
years
-
no

↳ NO mental disorders, uncorrected visual/auditory

I. D.
,
acuity ,

Psychosocial adversity ,
lack
of proficiency in
learning language / education

Reading slow
4 unmeaningful
→ →

→ Written expressions →
grammatical errors

Maths concepts
y
→ →
sense
?⃝
 Mental Disorder due to another medical condition

4 Delirium
Indicators
cognitive dysfunction
→

associated
somatic disease with
neuropsychiatric syndrome
→

atypical psychiatric syndrome

-

unusual
late onset
feature
L
,

→
in
responsive to treatment

cerebral
Examples of each part
of cortex

Y
their
respective tasks

① Frontal Lobe

voluntary movement problem solving planning immediate memory

-

, , ,

Temporal Lobe
hearing verbal comprehension learning memory motivation emotion
-

, , ,

③
, ,

Parietal Lobe
discrimination
somatosensory
-

,
sensory
⑥ Occipital lobe
-

Sight interpretation of visual

,
information
brain
Memory system of the

a emotional
memory
F I
Hypothalamus Peri aqueducts grey matter
r n

I I
o

t
i
2

Amygdala
- t
2 s
1 ,

&
3 C

b declarative u
T in
memory e

in g
Entorhinal u

Hippocampus cortex
p ,
Peri rhinal cortex 0
2
Parahippocampal cortex r

÷
]
3 ,
a habit
memory p c

•
,
Thalamus

-i
? 0
↑ I b-

§
i
t o
e

I s
?⃝
 Fusiform gyrus
•

↳ Facial
recognition →
Prosopagnosia Right of temporal lobe
1
Capgras disconnection
syndrome of from face recognition
→ → emotion

a
limbic
system
*
lateralization → each hemisphere excels different aspects
in

↳ Lt
[ Language Logic Analysis
. =
, ,

Rt Movement
synthesis comprehension emotional communication
=
, ,
.

Broca's ( 44,45)
aphasia Left infr frontal lobe]
e. [
g.
Dorsofztl
Anti
I
-
NMDA R
encephalitis -

prefrontal cortex, ventral tegmental area

, hippocampus

1-3 wks =
Neuropsychiatric symptoms
↓

wks
Neurologic complications
-
nos =

Recovery /Relapse prolonged deficits

→ =
mos
years
-

Delirium
criteria DSM 5
-

attention deficit
•

cognition change
•

•
rapid
withdrawal
directly consequence from physiologic changes / toxin
•
a or
 SSRI
Upregulated 51-1-1
receptors
→ • •

[ Neuron
SERT
of depressed people]

¥
Of
• % •
•

•
54T

SHT
auto receptor

receptor
a)
•
a.
• •
SERT
y
•

@ •
•
514T
& •

Mechanism
of action

Blockage of SERT
surge of 51-1-1 @
↳ todendritic some area

↳ Desensitize
4 downregulation of
" "
514T autooeceptors
↳ Turns on serotonin release @ axon terminal
=
surge of 51-1-1 @ synapse = down
regulation of 514T receptors
① Fluoxetine development of drug tolerant
( anti bulimia
effect dose )
high
-

on

51-1-12C 51-1 -12C

☆
antagonist = DA NE
,
release
Weak
☆ NE reuptake inhibition
d wks as active metabolite
Ty
☆ = 2-3 or 2

& CMP 296

NET
↳ NRI

① Sertraline

6, binding ☆
Dopamine reuptake inhibition
☆ 01
binding anxiolytic effect good
= = in
psychotic depression
? add
bupropion ( well -0ft )
2B6
DAT
DRI
-

③ Paroxetine ⑥ Fluvoxamine "'9

☆ CYPIAZ 3 At
,

inhibitor
Nos ☆
Anticholinergic =
sedating
☆ NET NRI
anxiolytic ( )
→
→ o

sexual
My
☆ NOS

R Potent CYPZDG
inhibition →

inhibitor
dysfunction 61

NET
CYPIDG
/
Atc
Prolongation
⑤ citalopram ✗ antihistamine ⑥ Escitaloprzm
Hi ☆ S R enantiomer
,
s
☆
elderly 299,344,
As 2C19 SAA 2D6
,
R
SNRI
( ↑ diffusion radius
of DA
from few neuron
after blockade
of
NETS
Y SER-1s in PFC )
Blocks reuptake of NE
Y 51-11-1
→

'

SERT
→
Boosts DA in prefrontal cortex
→
NETS have
higher affinity for DA

NET
① Venlafaxine
-

③ Desveulafaxine
☆
Anxiety ☆ Metabolite form of ①
☆
Higher degree of 51-1-1 reuptake ☆ ↑ NET inhibition vs . SERT

us . NE ☆ Vasomotor
symptoms in
peoimenopavsat
women

2. Chronic
"" pain
"
%
/ → *
/
③ Duloxetine ⑥ Milnacipran
relieve depression ↑ NET inhibition
☆
of pain
in absence vice versa ☆ us . SERT

☆ chronic somatic pain

fibromyalgia diabetic neuropathy
-

,
☆
energizing
☆
cognitive symptoms of geriatric depression

NET
pain related symptoms
→ -

TCA →
SERT
4 NET inhibition
→
some have 51-1 -12A /C antagonistic actions

↳ 2dg 249,1
AZ,
SAF

Dizziness Drowsiness drowsiness

, ,
weight gain ,
↑ ↓ BP
H' / nortriptyfine M
,
<
amitriptyline
I
21 Nat
failure of ejaculation
µ
→
, mean >

impotence postural hypoteesn

,

constipation ,
blurred vision
,

mouth, drowsiness SERT

dry ,[
urinary
retention m,
/
/ Therapeutic
/
/ NET
"
,
'É '
/
I N

É
I
'
' i
- I
1 " ± "

Therapeutic Therapeutic, sleep improves

TCA

} Hypnotics
•
Doxepin ( ↑ H
,
)
☆ Trazodone →
SARI
Mood stabilizer -
lithium

•
lithium
[ Atypical antipsychotics
Anticonvulsants
(SGA )

[ stabilize
9 protect neurons

↳
Thiazide = ↑ tubular reabsorption
Pk -
Renal excretion [No Liver metabolism) ACE Is NSAIDs = ↓ GFR
,

☆ AE GI
weight gain polyuria
tremor
:
, , ,

Hypothyroid Hyperparathyroid hypercalcemia Epstein's anomaly

effect
, ,

Arrhythmias Cognitive disturbances Teratogenic

, ,

§
Overdose / ↓ excretion
Toxicity
☆ :

Mild fatigue vomiting diarrhea check

1
: tremor, ,
nausea
, , plasma Li

moderate :
confusion , dysarthria nystagmus ataxia
, ,

severe :
renal
failure ,
seizures, coma

Hydration Hemodialysis
, ,
rid
of precipitating factors
Choice
Mania
Depression
-

Efficacy
→
Manic
, Depressed?
Drugs Treatment Prevention Treatment Prevention Response
-

Lithium ✓ ✓ condition
Existing
✓ ✓ -

✓
Valproate ✓ -
AE
,
cost
✓
carbamazepine ✓

§ shift
✓ ✓ ☆ Avoid
Lamotrigine ✓
Antidepressant Manic

Aripiprazole ✓ ✓
Monotherapy
✓ ✓
Olanzapine
✓
Risperidone
Quetiapine ✓ -
✓ _

Anxiolytic social phobia Panic GAD

, ,

* 1ˢᵗ Line
drugs
= SSRIs ¥1320s for short term use

✓
PTSD

specific phobia Behavioral therapy

addictive

§
Benzodiazepine →
GABA -
A
receptor modulator Ultrashort Ty,
→
Midazolam
/
-

anxiolytic Short -
Intermediate Alprazolam < Lorazepam
Ty, →

✗
hypnotics Long Tz Clonazepam < Diazepam chlordizzepoxide
<
-
→ -

1
↳
anti epileptics → &
hangover
-

,
m.gg, yay, ,
, * a,y,
way,,.gg,,,µ,
,,,
Duration ✗
dosage Ty , ,
redistribution
AE : Sedation, Muscle weakness ,
Ataxia

Tolerance
, dependence ,
withdrawal, cognitive impairment in
elderly
↓ ↳ duration not recommended
✗
,
long

Overdose : amnesia
,
altered mental status, dysarthria ,
ataxia, motor incoordination ,
respiratory depression ,

hypotension ,
coma

i. Do not
w/ use sedative
drugs + alcohol
Rx .
Panic disorder, GAD
Hypnotics →
hypothalamic center
* GABA → sedation
&
•
B2Ds Histamine →
wakefulness
of
& Treat
intermittent insomnia
first
-

use cause
&
wks Sleep hygiene /BT
< 2
prior to prescription
-

@ lowest effective dose *

avoid addiction
&
•
2-
drugs correspond choice to
type of insomnia

Melatonin / melatonin receptor agonist

•

Histamine H ,
antagonists
•

2-
Drugs
GABA
→
Zolpidem Zaleplow , Zopi done
,
allosteric modulator
positive
-

,
-

Efficacy ≈ BZD, but slower dependence 4 tolerance

Melatonin receptor agonist neuronal

MTI
agonist
:
promote sleep by inhibition
of suprachiasmatic nucleus
activity
-

=
good sleep
-
MT 2
agonist
:

phase shifting effects of

normal steepwzke cycle in the SCN

fast sleep
=

AE : headache
,
somnolence, dizziness

Adequate use despite no

dependence/tolerance

Histamine 71
, antagonists
-
Sedation
Most
potent drugs also receptor antagonist
potent
-
are muscarinic
↳ low dose
High-affinity drugs @ = no anti muscarinic
effect .

Antipsychotics =
Neuroleptic / mj Tranquilizer .

FG As
[ High potency { Conventional traditional Typical
•
= = =

Low
•
SG As =
Atypical antipsychotics →
oral
disintegrating tablets available

Conventional Antipsychotics
High potency low
potency
Haloperidol -
D2 antagonist chlorpromazine →

BY other
antagonist
↳ EPs d Motor, Sedation Orthostatic BP↓ M £
, , ,

Atypical Antipsychotics
51-1-12A
4 % antagonist High affinity for Y in turn lower
for Dz than FGA
→
5HTeA .

ʰ
I loosely
cortical
antagonist ↓ DA
Nigrostriatal
↑ 51-1-12A in
pathways
= = meso
,

↓ ↓
Less to ↓
no EPs
negative symptom
(
Tuberofundibufzr to
hyper prolzctinemia )
=

51-1 -11A ↑ DA
prefrontal cortex Y ↓ Glu release = 1 ( Ziprasi ) DONE
=
in

2 ( Auetia doze ) PINES

,
 Classification
Chemical
by
-
structure
Phenothiazine chlorpromazine , thioridzzine fluphenazine
→
,

perphenazine tsifluoperzzine ,

Thio xanthene -
Flupentixof Ludo pentixot ,

Butyrophenone Haloperidol →

Diphenylbutylpiperidine Pimozidr →

Di benzodiazepine -
The PINES →
Clozapine
Bewzisoxzzofe _
The DONES →
Risperidone
Dihydro quinoline -

Aripiprzzole

The National List

Drug
-

n :
FGAS →
Chlorpromazine , Haloperidol + The LINES

r :
Risperidone
M :
clozapine , f-lupentixof pimozide , ,
thioridazine
,
zudopeutixof
g :
Qwetiapine
Non ED
- :
Olanzapine, quetiapine paliperi done
, ,
lurasidone, 2/ president eoipiprazole
,

Pk
→
Lipid soluble 4 rival

Protein bound
glycoprotein )
(2
Highly
→ -

,
→
CYPIA 2 3. At, 2136
,

metabolite
→ Active =
new
drug in some
drugs
& Eliminated by urine
Ty it -
so hrs .

Formulations tablets capsules oral

disintegrating tablets,
liquid salt
:
,
,
1M N
, ,

immediate/
L
long acting
deoanoahi
1-
palmitate
Acute/chronic
Rx
psychosis
•
.

schizoaffective disorder
•

•
Manic bipolar disorders
•

Bipolar depression
Tourette
syndrome risperidone haloperidol
• :
,
•
Disruptive behavior from autism :
risperidone , aoipiprezoh
Antiemetic phenothiazine ( Dz block antihistamine)
prochlorperzj.ir
• : : :

•
Intractable hiccup : chlorpromazine

ADRs olanzapine clozapine in anti 51-1 -12A effect

: >

4 dose dependent
& time
EPS =

Acute
dystonia ( his days) Rx antihistamine/mliehohiurgir
•
- .

Days Whs)
Ahathisia (
esp ofleg
restlessness ↓ done
•
Rx
drug change p blocker BZDS
-
-
. . -

,
.
, ,

•
Parkinsonism ( wks ) Rx ↓ done 1- anticholinergic drug change
-
nos .
, ,

Tardive dyskinesia esp

of math Cmos yrs) Rx drug cessation / supportive
• -

. . care
n n

Neuroleptic malignant syndrome ANYTIME Dzntrolene

• → -

\
↳
predictive factor bromoeriptine

[
initiated treatment
prior NMS recently
→

dehydration aggressive dosing

, ,
IV 1M
,

acute medical illness .