These patients collect clothing lints, pieces of plant debris, some times non biting arthropods, vegetable material,  skin pieces or debris material in plastic wrappings or glued on adhesive tape, or in match boxes. Patient used to say that they contain insects or parasites, however no insects are seen. This typical presentation is known as MATCH BOX SIGN. It is also known as SARAN-WRAP SIGN.

This firm belief is very common and is difficult to treat, patient also says something is moving inside his skin, they frequently visit doctors, and when explained about their symptoms, they resist, and exacerbate their discomfort by selftreatment .

This disease is a kind of dilusional infestation.

Drug of choice is Pimozide.

For more information on dilusion of parasitosis visit emedicine.medscape.com

1. Name of patient or gardian/relative (who is giving the history)
2. Relation to the patient
3. Address
4. Permanent Address

5. Name of patient (Block Letters)
6. Present Address.
7. Date of Birth
8. Approx Age:
9. Sex
10. Education: may be illeterate, literate (read and write), primary (upto 5th), middle (upto 8th), upto 10 & 12, Graduation, PG/Technical/professional
11. Occupation
12. When Last Employed:
13. Income:
14. Dependent:
15. Nationality:
16. Mother Tongue:
17. Religion:
18. Marital Status: Unmarried/ Married/ Widow/ Divorced/ Broken Relationship/ Seperated:
19. Numbers of Childer: male and females
20. Living Arrangements: Nuclear family/ joint family/ alone/  any other etc.
21. Reason for consultation:
22. Source of referral:
23. Any previous consultation: from medicine OPD, surgery OPD or any other physician or any psychiatric clinic or hospital

          You should also try to find out whether patient is having addiction to some drugs by asking following questions

1. Age:
2. sex: male or female or eunuch
3. Employment status: following points come under it like, never employed, self employed, presently unemployed, full time employed, part time
employed, student, housewife or girl, any other.

4. Marital status: all of above points you can add whether he was seperated due to drug abuse

5. Substance of abuse like taking alcohol, herion (smack, brown sugar), opium (opium, doda), other opiods like (morphin, proxyvon, parvon forte, parvon plus, parvon, parvon-n, spasmoproxyvon, fortwin etc), cannabinoids (ganja, charas), (sedatives like valium, nitravel, tablet no-10), cocaine,amphetamines,
6. hallucinogens (LSD, PCP), tobacco, or any other.

7. You should also ask have you ever used any injecting drug use, what was the route of administration, sharing of injection or syringe,  what was the name of injectable compound.

8. Have you ever had these sumptoms like, Genital Ulcer Growth, urethral discharge, vaginal discharge, burning micturation, itching around genitals
 retal pain or discharge.

9. Ever had jaundice

10. Ever had sex with sex workers.
11. Ever had HIV screening what was result positive or negative
12. concurrent psychiatric illness
13. concurrent medical illness
14. previous treatment for drug abuse, if nay
15. Ever hospitalized for treatment of drug abuse.

After that you need to take alcohol history, just 10 points you can read here on how to take alcohol history?

                                                          History of Present Illness
onset, duration, progress of each complaints
precipitating factors
late night insomnia, early morning insomnia, midnight disturbance, or normal
Appetite normal or increased or decreased.
Does he or she takes care or hygiene?
Does he or she wearing according to season?
Effect on work increase or decreased or no effect?
Effect on social activities, no effect or increased or decreased.

                      History of past illness and response to treatment
Drug history
Any comorbid illness, any treatment received
Drugs/alcohol what how much, since when.
Any suicidal attempt.
Mental retardation
Family history or mental illness, epilepsy, alcoholism, mental deficienct in family, personality of parents and other members
                                               PEDIGREE DRAWING

You should know how to draw the pedigree of patient

Personal History: premorbid personality, education, occupational, sexual, menustral, marital habits, special aptitudes.

Do the examinations of all systems.

                                                                Psychiatric Examination
1. General Appearance and behaviour:
2. Personal Hygiene:
3. Psychomotor Activity:
4. Eye Contact: whether making or not
5. Appearance like tideness, facial expression, abnormality of behviour, negativism, mannerism, stereotype, muttering, casusless, laughter
, restlessness, compulsive sets, level of consciousness (clouding-Delirium-Stupor-Coma)
6. Attention and concentration: whether focused or sustained.
7. Preoccupied Fleeting
8. Speech- a) see the form like stammering, mute, absurd answers
 b) see the flow of speech, overtalkativeness, flight of ideas, circumstantiality-clabng association, rhyming,
preservation, retarted, block, mutism, laconic answers
 c)see the content of speech like irrelevant, incoherent and stereotype.
9. Thinking- like idea of reference, control, passivity feelings, depersonalisation, derealisation, obsessive idea, thought block, delusion,
phobia
10. Illusion and hallucinations
11. Emotions like apathy, depression elation, incongruity anxiety, ambivalence, indifference and apprehension.
12. whether person is oriented to time place and person or not.
13. see his memory (recent, remote, confabulations)
14. Intelligence and judgement- see dementia deficiency.
15. see insight whether partial or lacking

This much is sufficient for making diagnosis in psychiatry.

if you have 5 answers to question give (0) to the first answer (1) to the second answer (2) to the 3rd answer and (3) to the 4th answer and (4) to the fifth answer

if you have 3 answers to question give (0) to the first answer (2) to the 2nd  answer and (4) to the 3rd answer.

add the value you got, these are the scores and see results as per below lines

if you get 8-10 which indicates hazardous/ harmful alcohol consumption, and scores of 13 or more indicates the alcohol dependence.

CAGE QUESTIONNAIRE
(patient will reply in yes or no)
Have you ever felt you ought to cut down on your drinking?
have people ever annoyed you by criticizing you drinking?
Do you ever feel bad or guilty about your drinking?
Have you ever had to drink first thing in morning to get rid of hangover?

Alcohol history in medicine, psychiatric department or in de addiction department alcohol history plays a vital role in diagnosis of diseases.

Personality disorder child used to rub face on bed once in every 2 minutes

Now you see the video below how this child used to rub his face and come in opisthotonous condition.

Now read about the history this interesting case:

Patient name is Gaurav a 12 year old male, studied upto 3rd grade, discontinued his studies 2 years back, he is having rural background, lives with nuclear family.

This patient gives history of head injury after fall from first floor at home in March 2007 followed by surgery for sub dural haemorrage, after that following behavior changes were noticed

1. Increased aggressiveness towards others since feb 2008

2. Increase in irritability since feb 2008

3. Temper Tantrums

4. Self harming behaviour.

Patient was operated at St. Stephen’s Hospital for subdural haemorrage which was also accompanied with cerebral oedema for which patient was discharged after one month. After few days patient was admitted for Deep Vein Thrombosis with heparinisation.

After that patient was alright until feb 2008 with only slight behaviour problems, at times patient demands certain special things like food etc, when his demands are not met he used to cry. slowly he used to become more irritable, crying spells lasting for few minutes with increase in frequency, at times he also developed focal seizures, patient also decreased his self care, becoming more dependent on family.

Slowly he developed violent behavior like hitting family members and biting them, gradually his behaviour became more aggressive and unmanagable.

He also started self harming behaviour in August 2009 started rubbing his face on bed mostly left half of face as shown in video, during this activity he used to obtain opisthotonous condition, his body become very rigid see video how much force his mother is applying to straighten the child. So this was the case of personality change after head injury.

Complete information on Traumatic Brain Injury

repetitive hand washing, obsessive compulsive disorder

Obsessive Compulsive disorder (OCD) is a disorder belonging to the anxiety group of disorders and is characterized by obsessions and compulsions. Obsessions are repeated, recurrent thoughts and ideas that are intrusive and inappropriate. Compulsions are repeated acts that are performed by the patients in response to an obsession or according to rigid laid down rules. The main aim of compulsion is to relive the anxiety caused by the obsession.

EPIDEMIOLOGY

 Seen commonly between the ages of 20-25 years. The mean age is 19 years for male and 22 years for females.

Males are more commonly affected than males.

It runs in families and 40% of first degree relatives suffer from the disorder.

Seen increasingly as comorbidity with other anxiety disorders.

 An association has been found between OCD and motor tics and tic disorders like GILLE de la Tourette’s syndrome.

ETIOLOGY or CAUSES

Biological- there is a dysregulation of the neuronal pathways in the brain involving the serotonergic, dopaminergic and the cholinergic pathways. The basal ganglia, cingulated cortex and the caudate nucleus are the implicated structures implicated as per neuro-imaging studies.

Psychosexual Development- Freud is stated that OCD occurs as a result of a fixation at the anal stage of psychosexual development. There is a regression to the anal stage and prevention of the conflicts of the oedipal stage from resurfacing.

 Premorbid Personality- obsessive compulsive or obsessoid personalities characterized by punctuality, regularity, cleanliness, obedience, religiosity and a tendency to insist on deadliness. They demand a particular type of behavior form others and are restless, always worrying about the future. They are engaged in unnecessary naturals, wishing to appease to all gods and follow a chain pattern of activity but may go backward and forward in their activity at times. They are very stubborn and refusing to listen and yield at all times.

The Superego- the patient with OCD has a tyrannical superego that dominates all activities and the patient suffers when he is not allowed to carry out his compulsive activity.

 Stressful Events- anxiety is very marked in these cases and any stressful event can precipitate the OCD.

 Mental mechanisms and Defenses used- there is marked anxiety as a result of a stressor that increases and undergoes isolation. An effort is used reduce this anxiety and cause an undoing of what has been done. This causes a result formatting result in the carrying out of the compulsive activity. At the same time the attitude of all these actions are ambivalent and magical thinking serves to reduce anxiety but complicates the overall picture.

 Streptococci Hypothesis- Sydenham”s chorea seen in rheumatic heart disease has symptoms of OCD seen with it. This has resulted in the causative organisms for rheumatic fever being implicated as a cause of OCD.

To Know Sign & Symptoms, & Treatment of Obsessive Compulsive Disorder read here

Image Soucre http://www.nature.com/nature/journal/v448/n7156/images/448871a-i1.0.jpg

Depression

Signs and symptoms of depression

Persistent sad, anxious or “empty” feelings

Feelings of hopelessness and/or pessimism

Feelings of guilt, worthlessness and/or helplessness

Irritability, restlessness

Loss of interest in activities or hobbies once pleasurable, including sex

Fatigue and decreased energy

Difficulty concentrating, remembering details and making decisions

Insomnia, early-morning wakefulness, or excessive sleeping

Overeating, or appetite loss

Thoughts of suicide, suicide attempts

Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment

Different forms of depression

^{Some types of depression tend to run in families, suggesting a genetic link. However, depression can occur in people without family histories of depression as well.9 Genetics research indicates that risk for depression results from the influence of multiple genes acting together with environmental or other factors.}

^{What causes depression?}

^{What illnesses often co-exist with depression?}

How is depression detected and treated?

Some regimens are short-term (10 to 20 weeks) and other regimens are longer-term, depending on the needs of the individual. Two main types of psychotherapies-cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT)-have been shown to be effective in treating depression. By teaching new ways of thinking and behaving, CBT helps people change negative styles of thinking and behaving that may contribute to their depression. IPT helps people understand and work through troubled personal relationships that may cause their depression or make it worse.

For mild to moderate depression, psychotherapy may be the best treatment option. However, for major depression or for certain people, psychotherapy may not be enough. Studies have indicated that for adolescents, a combination of medication and psychotherapy may be the most effective approach to treating major depression and reducing the likelihood for recurrence.Similarly, a study examining depression treatment among older adults found that patients who responded to initial treatment of medication and IPT were less likely to have recurring depression if they continued their combination treatment for at least two years.

Watch out video animation of how depression effects brain

Credit to Above Picture goes to suescheff.org

Depression, even the most severe cases, is a highly treatable disorder. As with many illnesses, the earlier that treatment can begin, the more effective it is and the greater the likelihood that recurrence can be prevented.

The first step to getting appropriate treatment is to visit a doctor. Certain medications, and some medical conditions such as viruses or a thyroid disorder, can cause the same symptoms as depression. A doctor can rule out these possibilities by conducting a physical examination, interview and lab tests. If the doctor can eliminate a medical condition as a cause, he or she should conduct a psychological evaluation or refer the patient to a mental health professional.

Once diagnosed, a person with depression can be treated with a number of methods. The most common treatments are medication and psychotherapy.

Antidepressants work to normalize naturally occurring brain chemicals called neurotransmitters, notably serotonin and norepinephrine. Other antidepressants work on the neurotransmitter dopamine. Scientists studying depression have found that these particular chemicals are involved in regulating mood, but they are unsure of the exact ways in which they work.

In addition, if one medication does not work, patients should be open to trying another. NIMH-funded research has shown that patients who did not get well after taking a first medication increased their chances of becoming symptom-free after they switched to a different medication or added another medication to their existing one.