Psychiatry notes

Apr 16th, 2015
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PHYSICAL TREATMENT INPSYCHIATRYElectro convulsive therapy(ECT)An effective treatment for patient withmajor depressive illness and otherserious mental illnessPhysical rx con History-1934 Von Medura a psychitrist usedseizures treatment based on two observations(a)schizophrenic symptoms decreased after aseizure(b)schizophrenia and epilepsy it wasincorrently believed cannot coexist inthe samepatient-induction of seizure would cureschizopreniaIn April 1938 the 1st Ect ,refered to aselectroshock was done in Rome by Lucio BiniMECHANISM OF ACTION Mechanism of action unknown but there several theories(a)Neurophysiological theory-during the seizure there is increasein blood flow ,use of glucose and oxygen in the brain and alsopermeability of blood brain barrier.After the seizure there isdecrease in glucose,oxygen and permeability and this decrease isassociated with a therapeutic effect.(bNeurochemical theory-after several session of ECT there isdown regulation of neurotrasmitter recepters(post synaptic betaadrenergic receptor(c)It affect the coupling of G protein to receptor,affect activityof adenylyl cycliase and phospholipase C and the regulation ofcalcium entry into neuronsINDICATIONS 3 MAJOR CONDITIONS(A)Major depressive disorder(B) Manc episode(C) SchizophreniaINDICATION CONT Major depression-failed medication trial-have not tolerated medications-have severe psychotic symptoms-acutely suicidal or homicidalManic episode-q

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