17 - Kurt Schneider Criteria for Schizophrenia

*Kurt Schneider (1887-1967). Schneider contributed a description of first-rank symptoms, which, he stressed, were not specific for schizophrenia and were not to be rigidly applied but were useful for making diagnoses.

*He emphasized that in patients who showed no first-rank symptoms, the disorder could be diagnosed exclusively on the basis of second-rank symptoms and an otherwise typical clinical appearance.

*Clinicians frequently ignore his warnings and sometimes see the absence of first-rank symptoms during a single interview as evidence that a person does not have schizophrenia.

1. First-rank symptoms
   1. Audible thoughts
   2. Voices arguing or discussing or both
   3. Voices commenting
   4. Somatic passivity experiences
   5. Thought withdrawal and other experiences of influenced thought
   6. Thought broadcasting
   7. Delusional perceptions
   8. All other experiences involving volition made affects, and made impulses
   
   
2. Second-rank symptoms
   1. Other disorders of perception
   2. Sudden delusional ideas
   3. Perplexity
   4. Depressive and euphoric mood changes
   5. Feelings of emotional impoverishment
   
   
   *A memory device that is frequently used to remember the first rank symptoms is ABCD: Auditory hallucinations, Broadcasting of thought, Controlled thought (delusions of control),Delusional perception.

16 - Halstead - Reitan Battery of Neuro-psychological tests

*The Halstead - Reitan Battery of Neuro-psychological tests include 10 tests, which are used to determine the location and effect of specific brain lesion. These 10 tests are :

1. Aphasia screening test
2. Critical flicker frequency
3. Category test
4. Rhythm test
5. Tactual perfomance test
6. Speech sounds perception test
7. Sensory perceptual tests
8. Finger oscillation test
9. Trail making test
10. Time sense test

15 - Hallucination

*Hallucination is a false sensory perception not associated with real external stimuli.

*The sensory system (eg:auditory, visual, taste, olfactory or tactile ) is involved.

*It occurs in inner subjective space (rather than as imagined) or experienced as originating in the outside world.

*It is independent of the will of the observer.

*It is as vivid as true sense perception and may be frightening.

*HYPNAGOGIC hallucinations (occuring while falling asleep) and HYPNOPOMPIC hallucinations (occuring while awakening from sleep) are generally considered non-pathological and are common in narcolepsy.

*Gustatory hallucinations (unpleasant taste) occur in uncinate seizure.

*Tactile (haptic) hallucinations are formication are seen in cocaine abuse.

*Release hallucinations are due to sensory pathway disease as optic neuritis, otosclerosis etc.
(Hallucinations that develop after partial loss of sight or hearing, and represent images or sounds formed from memory traces rather than present sensory input. They are called "release" hallucinations because they would ordinarily be blocked by incoming sensory data.)

*Most common non-organic hallucination is auditory.

*Most common organic hallucination is visual.

14 - Disorders of perception

*DISORDERS OF PERCEPTION ARE :

1. Hallucination : Perception without stimulus
2. Illusion/Misinterpretation : Misinterpretation of stimuli. eg: On seeing a rope, he thinks it is a snake.
3. Somate passivity phenomenon : Presence of some external agency with patient being a passive recipient.
4. Depersonalization : Is the feeling that the body or person self is strange or unreal.
5. Derealization : Is the perception of objects in the external world as strange and unreal.

13 - Drugs of choice in Psychiatric disorders

1. Body dysmorphic disorder - Fluoxetine
2. Obsessive Compulsive disorder - Fluoxetine/Clomipramine
3. Depression with cardiac disease - Fluoxetine, Mianserine.
4. Trichotillomania - Fluoxetine

5. Nocturnal enuresis - Imipramine
6. Panic disorder - Imipramine
7. Panic attack/disorder - Imipramine

8. Suicidal depression - ElectroConvulsive Therapy (ECT)
9. Catatonic Schizophrenia - ElectroConvulsive Therapy (ECT)

10. Manic depressive psychosis (Bipolar disorder) - Lithium carbonate
11. Pregnancy with Bipolar disorder - Carbamazepine
12. Rapid cycling Bipolar disorder - Sodium valproate

13. Gilles de la tourette syndrome - Haloperidol

14. Attention Deficit Hyperactivity Disorder (ADHD) - Methylphenidate
15. Narcolepsy - Methylphenidate (amphetamine)

16. Monosymptomatic hypochondriacal psychosis - pimozide.
17. Somatization disorder - amitriggtilline
18. Depression with acid peptic disease - doxepin

19. Generalized Anxiety Disorder (GAD) - Benzodiazepines, Buspirone
20. Borderline Personality Disorder - Antidepressants, Fluoxetine
21.  Phobias - MAO inhibitors, Paroxetine
22. Delusional disorder - Antipsychotics

12 - Tests in Psychiatry