Assignment Code: MPC-052/ASST/TMA/July 2022-January 2023

Course Code: MPC-052

Assignment Name: Mental Disorders

Year: 2022-2023

Verification Status: Verified by Professor

SECTION-A

Answer the following questions in about 1000 words each. 3 x 15 = 45 marks

1. Describe the modern system of classification of mental disorders.

Ans) The Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases are the two classification systems. Since their initial debut, both systems have undergone a number of updates and additions. Although there were initially numerous discrepancies between the two systems, their most recent editions—ICD 10 from 1992 and DSM IV from 1994—have undergone changes, and as a result, the two are now relatively similar in terms of their core concepts. Both have international recognition. The WHO's ICD10 has gained acceptance throughout the world and is also the official diagnosis system in India. DSM IV is the official diagnostic system of the USA, and its most recent version is from 2000, known as DSM IV-TR. ICD 10 and DSM IV are both undergoing their final revisions in preparation for ICD 11 and DSM V, which are anticipated in another two to three years.

The classification using DSM and ICD is as follows:

Diagnostic and Statistical Manual (DSM)

The DSM-IV (TR) advises doctors to evaluate a person's mental health along five different axes or criteria. Together, the five axes offer a wealth of knowledge about how the person is functioning, not just a diagnosis. The following axes are present in the system.

Axis I: Clinical Disorders and Other Conditions That May Be a Focus of Clinical Attention

Anxiety disorders, mood disorders, schizophrenia and other psychotic illnesses, adjustment disorders, and diseases typically identified during infancy, youth, or adolescence are only a few of the clinical syndromes that are included in this axis (except for mental retardation, which is coded on Axis II). Relationship issues, academic or professional difficulties, and grief are also included in Axis I. These issues may be the subject of diagnosis and therapy but do not in and of themselves constitute recognised psychological illnesses. Psychological influences on physical disorders, such as anxiety that aggravates an asthmatic illness or depressive symptoms that postpone the recovery after surgery, are also coded on Axis I.

The following are the categories for Axis I clinical disorders:

1. Disorders are typically first identified throughout childhood, adolescence, or early childhood.

2. Dementia, amnesia, and other cognitive disorders, including delirium.

3. General medical conditions that cause mental disorders that are not otherwise classified.

4. disorders related to substances.

5. Other psychotic disorders, include schizophrenia.

6. Disorders of mood.

7. disorders of anxiety.

8. disorders with somatization.

9. Imaginary disorders

10. Disorders of dissociation.

11. Disorders of sexual and gender identity.

12. Mood disorders.

13. sleep problems.

14. Disorders of Impulse Control that are not else classified.

15. Disorders of adjustment.

16. Additional Conditions that Might Receive Clinical Attention.

Axis II: Personality Disorders and Mental Retardation

Personality disorders are persistent, rigid patterns of maladaptive behaviour that often harm social interaction and interpersonal relationships. These include borderline, narcissistic, paranoid, and antisocial personality disorders. The Axis II code for mental retardation refers to widespread intellectual impairment. Axis I or Axis II diagnoses, or a mix of the two where both apply, may be given to patients. Anxiety disorder (Axis I) may be diagnosed as a person's first mental health issue, while personality disorder may be identified later.

The following disorders fall under this axis:

1. Disorder of the paranoid personality.

2. Disorder of the narcissistic personality.

3. Disorder of the schizoid personality.

4. Disorder of the avoidant personality.

5. Schizophrenia-like personality disorder.

6. Disorder of the dependent personality.

7. Disorder of the antisocial personality.

8. OCD (obsessive-compulsive disorder).

9. Disorder of the borderline personality.

10. Not Otherwise Specified Personality Disorder.

11. Disorder of the histrionic personality

12. Mental Illness.

Axis III: General Medical Conditions

Axis III codes all illnesses and medical issues that can be vital to comprehending or treating a person's mental disorders. For instance, hypothyroidism would be placed under Axis III if it was the direct cause of a person's mood illness (such serious depression). On Axis III, there is also a list of medical disorders that have an impact on how a mental disorder is understood or treated but are not the disorder itself. For instance, the usage of a certain pharmacological therapy regimen with a depressed patient may depend on the presence of a heart issue.

Axis IV: Psychosocial and Environmental Problems

Axis IV refers to the psychological and environmental issues that have an impact on a mental disorder's diagnosis, course of treatment, or outcome. These include losing a job, getting divorced or separated from your spouse, being homeless or living in subpar housing, having little social support, losing a friend, being exposed to war, or other tragedies. Axis IV may also list some favourable life events, such a job advancement, but only if those occurrences cause problems for the person, like trouble adjusting to a new work.

Axis V: Global Assessment of Relational Functioning (GARF)

The client's present level of psychological, social, and occupational functioning is rated by the clinician on a scale of 0 to 100. Additionally, the clinician may mention the best level of functioning attained for at least a few months in the year prior. The degree of present functioning reveals the degree or type of care that is now required. The maximum level of functioning is a good indicator of the level of functioning that could be recovered. On a hypothetical continuum extending from competent, ideal relational functioning to a disturbed, dysfunctional relationship, the GARF Scale can be used to convey an overall judgement of how well a family or other continuous connection is operating.

International Classification of Diseases (ICD)

The WHO produced ICD 10. The ICD-10, which was released in 1992, is the version that is currently being used. A single letter is followed by two numbers in the lCD10's alphanumeric coding scheme for three-character codes (A00Z99). There are a total of 21 chapters in ICD-10, of which the fifth chapter, i.e., decimal numeric subdivisions at the four character level, provides further detail. The 100 categories in Chapter V (F) of the ICD-10, which deals with mental and behavioural disorders, range from F00 to F99. On the other hand, DSM IV kept the ICD-CM (International Classification of Diseases, Clinical Modification) classification from 291.00 to 319 from the preceding version. The recognised diagnosis method in India is ICD 10. The Clinical Description and Diagnostic Guidelines version of ICD-10 is the one that mental health specialists utilise in clinical settings.

2. Explain the clinical features and signs of an episode of mania and depression.

Ans) The most important consideration is to be able to differentiate between transient day-to-day feelings of being depressed/ cheerful and depression/cheerfulness as a part of distinct psychiatric disorder. the change in mood accompanied by change in the activity is the core feature of mood disorder.

Most other symptoms arise out of and can be understood in the context of these changes. The knowledge of characteristic features of episodes of depression and mania helps in making diagnosis of a mood disorder. The clinical interview is the best method to elicit symptoms in history from the informants/patients and the signs on psychiatric examination. The information from history is corroborated with findings on psychiatric examination to make diagnosis.

Manic Episode

Symptoms in history from the informants/patients: The changes in behaviour develop rapidly and are noticed by people who are in close contact with the patients. The patients may get up early in the morning and appear active and cheerful. They may start many activities together. They may start talking excessively. They are full of new and exciting ideas/plans like buying a new vehicle, helping others, earning more money, etc. They have increased self-esteem and feel confident. They may buy new clothes and eat fancy foods. They like to go out, and meet people, may talk on telephone for long time. They feel fresh and energetic even after sleeping for less time.

When the illness becomes severe, they may become very restless and be easily distractible. They talk constantly and often intrude into others’ conversation. They become irritated when others don’t agree with them or try to interrupt them. They indulge in many pleasurable activities. They may spend money without any need, sometimes incurring heavy financial losses. They wear clothes and jewellery of bright colours in unusual or eccentric combinations. They may talk with strangers as if they know them well and talk about their big ideas and plans to them.

They may show socially disinhibitory behaviour like talking rudely to elders, inappropriate advances towards opposite sex and may indulge in increased and indiscriminate sexual activities. They plan/start risky and reckless ventures, schemes and business enterprises. They may act impulsively and make rash decisions that can affect their jobs, relationships, money, health, etc. They may start or increase use of alcohol or illegal drugs. They may believe that they have special powers and abilities, often with themes of religion, politics or money. They turn angry and abusive especially when others try to counter their special ideas and plans.

If episode is not treated, patients may become severely disturbed. Their beliefs of special abilities and merits may become so fixed that they may act and behave accordingly. The mental and physical activity may become so severe that it may lead to their becoming aggressive and assaultive. Their personal care, sleep, appetite, social behaviour and interpersonal relationships, occupational functioning may be severely disturbed.

Signs on psychiatric examination: The mode of onset is often acute; sometimes it may be abrupt. They may be restless, move around more than usual, use lot of gestures to express themselves and may be easily distractible. The patients with mania show increased psychomotor activity. They may appear over familiar. They report of feeling unusually well, fresh and energetic despite sleeping less, and physical and mental overactivity. Their mood is typically cheerful/elevated/ecstatic and may have infectious quality. Mood may also be irritable or labile. They may speak spontaneously even when not asked a question and excessively. They may speak nonstop, in loud voice on any topic which comes to their mind or pick up from clues from environment.

In extreme cases, patients may have flight of ideas and pressure of speech and their speech may be full of embellishments like singing, rhyming, punning etc. They also report that their mind is full of ideas and experience subjective racing of thoughts. They are grandiose and boast of their special abilities, worth and powers; in severe cases these ideas may reach delusional level. They may have delusions of persecution, reference and auditory hallucinations. In severe cases, their judgment may be impaired and may deny any need for treatment.

Depressive Episode

Symptoms in history from the informants/patients: The changes in behaviour are initially noticed by people who are in close contact with the patients like family members, friends or teachers and are minimal like difficulty in falling asleep or getting up early, missing appointments/meals, not attentive to day to day tasks. They start feeling sad and the sadness does not get better in response to change in circumstances and may be worse in the morning.

Sometimes patients may be anxious or irritable. They worry about trivial matters and have negative thinking. They express that they are incapable of doing anything, worthless and nothing good is going to happen in future. They may express guilt about their past acts/decisions. They lose interest in day to day activities and do not enjoy previously pleasurable activities like watching television, reading newspaper, etc.

They feel tired even without doing much activity and have difficulty in carrying out day to day tasks. They complain of memory loss which is due to poor concentration. Their speech, walk and other actions become slow. They also start withdrawing from social interactions and prefer to stay alone. They express doubts regarding their capabilities to finish a task. They have recurrent thoughts of death and are preoccupied with death and dying.

They complain of physical complaints like body aches, headache, sensation of nausea, dizziness, problems of indigestion like constipation and belching. It has been observed in various studies that people from Asian countries tend to report more of physical symptoms rather than low mood when they are suffering from depressive disorder. Along with difficulties in sleeping, they also have loss of appetite and weight. They often complain of constipation. Their interest in sexual activity decreases.

Signs on psychiatric examination: They have decreased psychomotor activity. They may take long time to answer the questions asked; their speech may be of low volume, slow and monotonous. They describe their mood as depressed with distinct quality, may feel numb and devoid of all feelings. Sometimes mood may be anxious or irritable. They may appear tearful and start crying. They have anhedonia. They have anergia. They express ideas of hopelessness, helplessness and worthlessness; this triad is known as depressive cognitions. They may have ideas of guilt. They may also express death wishes and suicidal ideas.

Mixed Episode

During this episode, the person may exhibit symptoms of both depression and mania together, or there may be rapid alternation of both symptoms.

3. Discuss the elements of history taking and recording.

Ans) The elements of history taking and recording are as follows:

Identifying Data

The patient's name, age, gender, educational background, occupation, marital status, race or ethnicity, socioeconomic status, and region of residence are often included in this brief section, which is typically composed of one or two phrases. The reference source is frequently also mentioned. A thorough awareness of these factors may occasionally affect the choice of treatment. For instance, which antidepressant to prescribe to a poor patient, which drugs a young woman should not use, etc.

Source and Reliability

When others have contributed information or had records examined, it's crucial to be clear about where the information came from and how reliable the interviewer believes it to be.

Chief Complaint

The patient's issue should be stated here, ideally in their own words. The phrases "I'm sad" and "My neighbours are trying to harm me" are examples.

History of Present Illness

The current illness is a description of how the symptoms of the current episode have changed throughout time. The description should also include any other changes that have taken place in the patient's interests, interpersonal relationships, behaviours, personal habits, physical health, biofunctions, and the degree of socio occupational dysfunction throughout the course of this same time period. It's important to preserve the patient's symptom chronology. It is important to determine whether stressors are present or absent. Stressors could be problems at home, at work, in school, with the law, with medical comorbidities, or with other people.

Symptom-relieving or -exacerbating elements like medicine, support, coping mechanisms, and time of day are also crucial. What, how much, how long, and accompanying circumstances are the key questions to be addressed in the history of the current sickness. It's crucial to determine the patient's current need for assistance as well as the "precipitating" and "maintaining" elements.

Past Psychiatric History

The doctor should learn about all prior psychiatric disorders and their course over the patient's lifetime, including symptoms and treatments, from the past psychiatric history. Professionals should be aware of the signs and symptoms of various psychiatric diseases in addition to previous bouts of the same illness because comorbidity is more often than not. When describing past symptoms, be sure to note their date of occurrence, duration, frequency, and level of severity.

It is important to carefully assess previous treatment. These include other types of treatment, such as vocational training, as well as outpatient care such as psychotherapy, inpatient care, both voluntary and involuntary, depending on what led to the need for the higher level of care, and support groups. It is important to thoroughly study medications as well as additional treatment options like electroconvulsive therapy or complementary therapies.

Past Medical History

The prior medical history gives details of significant ailments, surgical disorders, and past and present treatments. It's crucial to comprehend how the patient responds to these ailments and how they cope. In order to rule out certain treatment choices or restrictions, it is crucial to take the patient's past medical history into account when identifying potential causes of mental illness as well as comorbid or complicating circumstances. A medical condition may cause, mimic, or be caused by a mental health condition or its treatment, or it may have an impact on the treatment option for a mental health condition. Seizures, brain injuries, and pain disorders are among the neurological conditions that require specific attention.

Family History

A thorough study of family history is a crucial component of the psychiatric assessment because many mental diseases are hereditary. Furthermore, a complete family history aids in identifying a patient's possible risk factors for particular diseases as well as the patient's early psychosocial environment. The history of lethality, prescriptions, hospital stays, substance use disorders, and psychiatric diagnoses should all be included. The evidence that, occasionally, there appears to be a familial reaction to drugs and that a family history of suicide is a significant risk factor for suicidal behaviours in the patient serve as examples of the importance of these issues.

Personal History

The patient's life phases are included in the personal history. It is a crucial tool for putting mental symptoms and disorders into context, and it may even help pinpoint some of the key elements in the disorder's development. When gathering a social history, contemporary psychosocial pressures frequently become apparent. To make sure all the details are covered, it can frequently be helpful to examine the social history in chronological order.

It is important to record any information that is known about the prenatal or birth history and developmental milestones. Such information is not frequently available for the vast majority of adult patients, and when it is, it might not be entirely correct. It is important to record any known history of prenatal or birth complications or challenges meeting developmental milestones. Childhood memories should include information about the family members in the home and the friends one had as a child, as well as the social environment. A thorough school history should be gathered, including the patient's educational progression, age at each level, any special education needs or learning disabilities, behavioural issues at school, academic performance, and extracurricular activities. Investigations into childhood sexual and physical abuse should be thorough.

Premorbid Personality

The patient's premorbid personality frequently offers helpful insights into his or her symptoms, diagnosis, and treatment. The premorbid personality of a person should ideally be evaluated in the interview with supporting evidence. When there is no available informant and the patient's symptoms have improved, a reassessment may be necessary since patients who are ill frequently offer a deceptive account of their premorbid personality.

Substance Use/Abuse and Addictions

The psychiatric interview needs to take into account substance use, misuse, and addictions in great detail. A non-judgmental approach will elicit more accurate information; thus, the doctor should keep in mind that the patient may find it challenging to communicate this information. Specific queries may be useful if the patient appears unwilling to disclose such information. The history of use should detail the substances, including alcohol, narcotics, prescription pharmaceuticals, and routes of administration, that have been utilised. The amount and frequency of use should be decided while taking into account patients' propensity to downplay or deny use that could be viewed as improper in social situations.

SECTION-B

Answer the following questions in about 400 words. 5 x 5 = 25 marks

4. Explain the clinical features of schizophrenia.

Ans) Schizophrenia patients exhibit the typical cognitive, perceptual, and emotional problems that affect even their most basic physiological functions. Though there may be some cognitive impairments, awareness is typically maintained, and intellectual capacity is frequently preserved. Understanding of these frequent alterations aids in the diagnosis of schizophrenia by eliciting symptoms from informants and patients as well as signs on psychiatric tests.

Symptoms in history from the informants/patients

Close contacts with the patients, such as family, friends, or teachers, are more likely to notice behavioural changes. These behavioural changes may take place gradually over months or abruptly over a few days to a few weeks. It is simpler to pinpoint symptoms when there is a noticeable and abrupt change in behaviour.

Only a few changes may first be noticeable, such as trouble sleeping, irritability, staying distracted, or acting differently than usual. Some of the patients might not give accurate answers to the questions.

Patients may express opinions that are false or do not correspond to reality. If they believe there is a plan against them, that random people are talking about them, or that someone or something is in control of their actions or emotions, for instance, they may continue to believe these things in spite of evidence to the contrary. For no apparent reason, they might snort, shout, complain, or laugh aloud to themselves. Additionally, they might make inexplicable gestures in the air. They might appear to be speaking or engaging in conversation. They may appear anxious, angry, depressed, or fearful; alternatively, they may show lack of emotion and emotional reactivity. They could come out as unkempt because they don't care about their personal hygiene.

Signs on psychiatric examination

Psychosis: The most frequent kind of hallucinations in schizophrenia are auditory. Common auditory hallucinations include thinking echoes, constant commentary, and commanding in the third person. Visual, tactile, olfactory, and gustatory hallucinations may also be present in certain patients. Somatic passivity is a unique sort of hallucination in which the patient feels like a passive recipient of somatic sensations brought on by an outside force, such as neighbours sending electric sensations to his or her body. schizophrenic patients frequently experience the following delusions:

1. Delusion of control

2. Bizarre delusions

3. Delusions of thought withdrawal and insertion

4. Delusion of thought broadcast

5. Delusional perception

6. Delusion of reference

7. Delusions of persecution

Formal thought disorder: Speech in certain schizophrenia patients may sound hazy and unfocused. It could be unclear, irrelevant, or incoherent

Catatonic signs: Catatonic symptoms, which are abnormalities with motor movements, might appear in some schizophrenia patients.

Negative signs: Negative indicators are when mental functions are lost or reduced in a patient, especially in individuals who have had a long illness.

Cognitive impairment: It is now thought that people with schizophrenia struggle with cognitive abilities like intelligence, attention, memory, decision-making, and executive functioning. Although they are the most challenging to identify, cognitive impairments have the most crippling effects on daily normal functioning.

5. Discuss the clinical features and treatment of panic disorder.

Ans) The clinical features and treatment of panic disorder are:

Clinical picture

The patient has periods of abrupt onset anxiety, palpitations, chest discomfort, a feeling of being choked, dizziness, and feelings of unreality (depersonalization and derealization), which are generally accompanied by a secondary fear of passing away, losing control, or going insane. Individual attacks often only last a few minutes, occasionally longer. The patient experiencing a panic attack experiences such intense autonomic sensations and fear that he must leave the location where he is. A persistent dread of having another attack commonly follows a panic episode. A frequent aspect of this association is depressive symptoms.

Patients with panic disorder experience frequent panic attacks. If a person experiences multiple of these attacks within a month, panic disorder is diagnosed. In accordance with DSM IV TR, someone is considered to have panic disorder if they have had repeated unexpected attacks and consistently worry about having another attack. This ailment ought to last for at least a month.

During the panic episode, the individual must experience at least four of the following signs:

1. Heart palpitations or hammering.

2. Sweating.

3. Shaking or trembling

4. Choking sensation

5. Chest discomfort or agony.

6. Respiration difficulty.

7. Becoming unsteady.

8. Nausea.

9. Fear of death

10. Depersonalization or a loss of reality

11. Fear of going insane or losing control.

12. Paresthesias.

13. Flushes of heat or cold.

Treatment

In addition to medication, psychological therapy is used to treat panic disorder. Commonly utilised psychological therapies include cognitive behaviour therapy and exposure. It is important to tell the sufferer and their loved ones that the illness is not physical, is not serious, and that the episodes end on their own after about 15–30 minutes. The patient shouldn't steer clear of any circumstances where a similar occurrence has occurred. There is no need to visit a doctor or hospital right away; a brief period of relaxation is all that is necessary. Of course, one must heed the counsel of the treating physician or psychiatrist.

Breathing exercises can be helpful for certain patients, and they can easily learn to manage their hyperventilation, which is a common symptom of panic episodes. There are numerous potent treatments for panic disorder as well. The medicine of choice is frequently a selective serotonin uptake inhibitor such as fluoxetine, sertraline, paroxetine, or escitalopram. Other medications that can be used to treat panic disorder include imipramine, a tricyclic antidepressant, and benzodiazepines like clonazepam and alprazolam. However, it has been discovered that cognitive method is more successful in maintaining the cure over the long term. It assists in detecting the person's catastrophic thoughts, which develop into automatic thinking that unconsciously cause a panic attack.

6. Explain dissociative disorders.

Ans) What was formerly referred to as hysterical neurosis is now classified as dissociative disorders. The decision to stop using the term "hysteria" was made primarily due to its ambiguous and confusing numerous meanings. In the past, the term "hysteria" has been used to denote a mental illness, a personality type, a behaviour pattern, a psychoanalytic term, a general medical diagnosis when all diagnostic tests and examinations have shown that the symptoms cannot be explained on an organic basis, and as a derogatory term.

As a result of partial or whole lack of normal integration (dissociation) between memories of the past, consciousness of identity and immediate sensations, and control of body actions, the disorder may manifest with physical or psychological symptoms. The symptoms are an outward expression of an underlying psychological need or conflict. Conflict-related anxiety is changed into a symptom via a mental conversion mechanism, which results in freedom from conflict-related anxiety, or primary gain. Secondary gain is when a patient gains benefits from his family, friends, and other relationships as a result of developing symptoms that could be incapacitating. This subsequent gain is frequently to blame for the symptoms' duration.

Conversion symptoms: Common conversion symptoms include weakness in a specific body region or location, aphonia, strange motions, and paralysis of the extremities. As a conversion symptom, sensory symptoms including patchy or diffuse anaesthesia or paraesthesia, loss of eyesight, hearing, etc. might also manifest. The patient doesn't seem to be bothered by the symptom, therefore there isn't the usual worry or concern about it. The neurological distribution pattern is not reflected in the symptoms.

Dissociative symptoms: Possession states, dissociative stupor, and pseudo seizures are frequently seen in Indian settings. Pseudo seizures are characterised by uncontrolled movements of the neck, upper and lower extremities, and lower body. The individual is nonetheless conscious of their surroundings. The episodes can last anywhere from 15-20 minutes to several hours, and they can happen when the sufferer is awake and around other people. Unlike actual epileptic seizures, there is no damage, tongue bite, or incontinence. Dissociative stupor is characterised by a severe reduction in voluntary movement or absence of movement, as well as a minimum responsiveness to external stimuli, while yet maintaining adequate breathing and cardiovascular function and the appearance of consciousness. The other prevalent presentations in our country are possession states.

Treatment: The majority of treatment is psychological. A complete physical examination ought to be performed. The patient can rest comfortable that the symptoms will go away if no major medical cause is identified, which is frequently the case. It frequently worsens rather than improves the situation to tell such patients that their symptoms are illusory. The urgent eradication of symptoms is advised by suggestion, hypnosis, medicine, and assisted interviewing if they are such that they are interfering with the patient's daily activities and appear excessively upsetting. Abreations are utilised to get rid of the symptom and identify the main sources of stress.

7. Elucidate the clinical features and treatment of sleep disorders.

Ans) Sleep disorders are a group of conditions that affect the ability to sleep well on a regular basis.

Clinical Features of Sleep Disorders

A perceived disruption in the duration or quality of sleep is known as insomnia. It includes having trouble falling asleep or staying asleep. Primary insomnia and secondary insomnia are further categories for insomnia. Primary insomnia is caused by disruption of the innate processes that control sleep. Poor sleep hygiene is a typical primary insomnia cause. Psychological insomnia is a persistent sleep disorder in which the patient typically thinks about problems before going to bed as they are lying in bed. There is a disconnect between the patient's subjective sleep experience and the objective sleep metrics in sleep state misinterpretation.

In secondary insomnia, the sleep disturbance is a result of a medical or psychiatric condition. The induction or maintenance of sleep can be disturbed by a number of medical and psychological problems. Oversleeping, extreme daytime sleepiness, or occasionally both are symptoms of hypersomnia. Even after too much sleep, the patient doesn't feel refreshed when they awaken. Similar to insomnia, hypersomnia can be divided into primary and secondary forms. Idiopathic hypersomnia is another name for primary hypersomnia. Numerous medical and psychological problems can cause secondary hypersomnia.

A dyssomnia known as periodic limb movement syndrome is characterised by regular, stereotyped limb movements while you sleep. While awake, the person's neurological condition is normal. Along with iron and vitamin B12 anaemia, it is linked to kidney illness. The uncomfortable subjective feeling of having your limbs feel like ants crawling across your skin is known as restless limbs syndrome. Moving about helps to relieve it, which is most common at night. RLS manifests in anaemia from iron or vitamin B12 deficiency, renal illness, and pregnancy.

Nightmare disorder, sleep terror disorder, sleep walking disorder, sleep talking disorder, REM sleep behaviour disorder, and sleep-related bruxism are examples of parasomnias. Individuals with nightmare disorder have vivid dreams that gradually increase in anxiety. They take place during REM sleep. These dreams are remembered by the person. Deep NREM sleep is when sleep terror disorder happens. Patients commonly scream loudly, sit up in bed with a terrified look, and occasionally awaken suddenly from their deep sleep.

Treatment

A combination of non-pharmacological and pharmaceutical methods are used to treat sleep disturbances. Describe the issue to the patient and offer assurance. All patients with sleep disorders should practise appropriate sleep hygiene. An overview of the various facets of good sleep hygiene is given in Box 1. Psychophysiological insomnia can benefit from cognitive relabelling. Similar to that, anxiety related to sleep disturbances can be treated with relaxation treatment. If there are any underlying medical or psychological causes of sleep disturbances, it is crucial to treat them.

Melatonin and hypnotic drugs are frequently used to treat insomnia. For tiredness during the day, stimulants are utilised. A frequent treatment for narcolepsy is modafinil. Given their propensity for abuse, it is crucial to guarantee the reasonable and controlled prescription of these drugs.

8. Explain special methods to assess mental health.

Ans) The special methods to assess mental health are:

Interviewing Schedules

These are interviews that are structured or semi-structured that are used to identify mental health issues. They are more frequently employed in research activities than in clinical practise. These consist of:

Researchers can identify psychiatric diseases in line with the DSM-IV using the Mini-International Neuropsychiatric Interview (MINI), a succinct, structured clinical interview. The interview's administration time is roughly 20 minutes.

A set of psychiatric diagnostic standards and symptom rating scales known as the Schedule for Affective Disorders and Schizophrenia (SADS) was released in 1978. The interview covers a limited number of other diagnoses in addition to schizophrenia, schizoaffective disorder, major depressive disorder, bipolar disorder, and anxiety disorders.

The WHO developed Schedules for Clinical Assessment in Neuropsychiatry (SCAN), a series of instruments for identifying and quantifying mental disease that may develop in adulthood. It can be applied to both DSM-IV and ICD-10 systems. There are 1,872 total items in the SCAN interview, broken down into 28 divisions. However, the majority of patients will only require a portion of the interview, and it is determined at the start of each session whether it is genuinely pertinent.

A diagnostic test used to identify DSM-IV Axis I disorders, and Axis II disorders is called the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). A clinician or qualified mental health professional, such as a psychologist or social worker, was intended to administer the instrument. This person should ideally have experience doing diagnostic examinations with unstructured, open-ended questions.

A structured interview for psychiatric diseases is the Composite International Diagnostic Interview (CIDI) from the World Health Organization. The interview can be conducted by persons without clinical training and can be finished quickly because it was created for epidemiological investigations.

Psychological Tests

In evaluating mental health, psychological examinations have a special significance. While these should be used in addition to a thorough mental state evaluation, they frequently offer insightful information about the patient's psychopathology.

Psychological assessments are very helpful in the following clinical situations:

1. When the patient is reserved about his or her internal experiences or pressures.

2. For differential diagnosis cases.

Rating Scales

Tools that could be used to longitudinally track mental health

A wide range of questionnaires, interviews, checklists, outcome assessments, and other tools are referred to as "psychiatric rating scales" and can be used to guide psychiatric practise, research, and administration. Many of these scales are helpful in psychiatric treatment to evaluate the seriousness of psychopathology, to follow patients over time, or to provide information that is more thorough than what is often learned in a typical clinical interview. These scales offer the benefit of assessing a variety of disorders that may occasionally be missed in a clinical interview. However, it is important to keep in mind that these are merely supplemental and cannot take the place of a thorough mental state evaluation.

SECTION-C

Answer the following questions in about 50 words. 10 x 3 = 30 marks

9. Principles for classification of mental disorder

Ans) The creation of classification schemes and their ensuing updates reflect the state of knowledge regarding mental disease today. Since we are unsure of the exact aetiology and pathophysiology of psychiatric disorders, its classification has mostly been based on the clinical presentation of the illness and its progress. The basis for categorization frequently stems from the clustering of various clinical symptoms in various domains of psychological functioning, their intensity, and the course, as was originally done by Kraepelin.

The division of mental diseases into organic and functional, followed by psychotic and neurotic disorders, is the easiest. While "neuroses" are psychiatric disorders of lesser severity where anxiety is the predominant feature and may be felt directly or on being altered into other symptoms by mental defence mechanisms, "psychoses" refer to severe psychiatric disorders marked by grossly disturbed behaviour, loss of contact with reality, lack of insight, and inability to meet the general demands of life.

10. Cognitive behaviour therapy for depression

Ans) Short-term, goal-oriented, problem-focused cognitive behaviour therapy is available.

It is predicated on the idea that negative thought patterns can cause depression. It aids individuals in changing their thoughts, feelings, and behaviours. It emphasises the challenges that exist right now. It lasts for 15–25 weeks with weekly sessions. The cognitive strategies include eliciting automatic thoughts, testing them, finding maladaptive assumptions, and determining if those assumptions are true. The patients develop new coping mechanisms and become aware of the errors in their cognitive assumptions with the use of behavioural approaches. In between sessions, "homework" is assigned. Patients are expected to adhere to a set daily schedule. Once taught, the procedures must be used by the individuals anytime symptoms arise. Cognitive behaviour therapy is effective for treating mild to moderate depression.

11. Treatment of posttraumatic stress disorder

Ans) Cognitive behaviour therapy, stress management, and supportive counselling are all effective psychological treatments. The goal of cognitive therapy is to identify and correct the patient's misunderstandings that cause them to exaggerate the threat. PTSD patients may occasionally feel guilty and blame themselves. Techniques for managing stress including progressive muscle relaxation, practise with calm abdominal breathing, keeping undesired thoughts from entering the mind, and training in positive thinking may be beneficial. It is crucial to work with the family as a whole to help everyone cope with the traumatic incident and empower family members to support and assist one another.

12. Management of personality disorders

Ans) Information from several sources should be included in the clinical examination for personality disorders. These people frequently turn to independent resources for assistance with their personality issues. They frequently complain of co-morbid psychiatric conditions when they first come. Additionally, important others can ask for assistance from them due to problems they are having with them. There are many evaluation tools available for the diagnosis and measurement of personality disorders. These include the Personality Assessment Inventory, the Millon Clinical Multiaxial Inventory, the International Personality Disorder Examination, and the Personality Disorder Questionnaire. People with personality problems have a high prevalence of mental co-morbidity.

13. Closing of interview

Ans) The final five to ten minutes of the interview are crucial, but novice interviewers sometimes don't pay them enough attention. Having at least a little period to identify the issue is helpful because patients frequently save significant issues or questions for the end of the interview. If there needs to be another session, the psychiatrist can either tell the patient to bring up the subject then or say it will be discussed at the start of the following session. Allowing the patient to ask questions can be helpful as well.

14. Case formulation and diagnosis

Ans) Formulation: It's critical to create a formulation, a diagnosis, recommendations, and a treatment plan after data collection is complete. The collection of data is replaced by data processing in this stage of the evaluation process, where the numerous themes help to comprehend the patient's illness from a biopsychosocial perspective.

Diagnosis: The patient's diagnosis has a number of implications. First, it's an effort to describe what's wrong with them in a few common terms. It significantly affects the clinician's comprehension of the patient's prognosis and course of treatment. Therefore, a diagnosis must be made cautiously and only after a thorough and sufficient evaluation.

15. Conduct disorder

Ans) Children with conduct disorder are occasionally labelled as "bad kids" due to their delinquent behaviour and refusal to adhere to rules. Boys outweigh girls four to one in those with CD, which is thought to affect 5% of 10-year-olds. About one-third of CD children experience attention deficit hyperactivity disorder. A child with CD may repeatedly disobey their parents or other authority figures, skip school frequently, have a tendency to use drugs and alcohol at a young age, lack empathy for others, be aggressive toward people and animals, engage in sadistic behaviours like bullying and physical or sexual abuse, start physical fights easily.

16. Course of substance use disorders

Ans) People who suffer from drug use disorders, such as alcoholism, nicotine addiction, etc., exhibit a distinctive pattern of behaviour that puts their health and well-being at danger. No matter what drugs are utilised, this pattern often takes the same path. The usage of these substances typically begins throughout the adolescent years. Most people begin by consuming widely used and legally accessible substances like cigarettes and alcohol. Some persons who are prone to substance use disorders keep abusing the substances they are already reliant on a regular basis for a few years before developing addictions to them.

17. Catatonic behaviour in various psychiatric illnesses

Ans) Catatonia is another type of motor and behavioural abnormalities present in many psychiatric diseases. A change in bodily tone is called catatonia. A general word used to represent a number of movement problems is catatonia. For instance, people who are in catatonic stupor are quiet and immobilised despite being cognizant. They might have waxy flexibility, which means that you can move the patient's limbs into different positions, and they'll stay in those positions like a wax doll. These postures can also be maintained by using a psychological pillow. When the arm is elevated high and the examiner takes his hand away, the patient keeps the arm raised even though it hurts.

18. Conation

Ans) Conation is derived from the Latin word "conatus," which means "any natural propensity, urge, or purposeful effort." Cognition, emotion, and conation make up the three parts of the human brain, which is tripartite. Conation is outward, intentional behaviour that derives from feelings, preferences, or beliefs as well as from acquired knowledge and abilities. Conational behaviours and responses are voluntary, or intentional, as opposed to a reflexive physical activity. A person decides to "become conative"—actually reach down and grab the glass—when he is thirsty, sees a glass of water, and wants to drink it. When a person exercises self-control over these instinct-driven patterns of behaviour, conative activities turn into acts of will.