Suggestions by

Dr. Mohammed Zubayer

Miah

Author
Shahariar Nadim
&
Sumaiya Akter

Psychiatric Disorder-Diagnosis
and treatment
Term 02 Suggestions

"Just because no one else can heal or do your inner work for you. that doesn’t mean you can, should, or
need to do it alone." -Shahariar Nadim
 1. Write the names of five antipsychotic drugs.

2. What are the clinical features of Schizophrenia?

There is no single pathognomic sign or symptom for the diagnosis of
schizophrenia.
 There are positive & negative symptoms of schizophrenia
 Positive symptoms: Usually found in acute schizophrenia.
These are – hallucinations, delusions, disorganized or irrelevant speech,
disorganized or catatonic behaviors etc.
 Negative symptoms: Usually found in chronic schizophrenia.
These are – alogia (Decreased mental ability to think), affective flattening,
apathy, social isolation or withdrawal, avolition (lack of drive to do
anything), self-neglect, decreased speech, etc.

3. What do you mean by phobia? What are the types of phobias? How do
you manage?
Phobia: Persistent, irrational fear of a specific object, activity, or situation that
results in a compelling desire to avoid the phobic stimulus.
There are three types of phobias –
 Specific or simple phobia (e. g spider phobia, height phobia, phobia of
flying, phobia of dental chair, phobia of illness, phobia of animals, storms,
height, water, injections, blood, elevators, driving etc.).
 Social phobia (e.g. phobia in restaurants, canteen, dinner parties,
seminars, board meetings
 Agoraphobia (e.g. being on a bridge, traveling in bus or train or
automobiles or planes)

Shahariar Nadim, Sumaiya Akter 2nd Year Bsc. In Occupational Therapy 2

Fortunately, phobias are treatable, and there are several effective management
strategies:
 Exposure therapy: Gradually exposing individuals to their phobic trigger
in a safe and controlled environment can help reduce fear and anxiety.
 Cognitive-behavioral therapy (CBT): This therapy helps identify and
challenge negative thought patterns associated with the phobia and
develop coping mechanisms.
 Relaxation techniques: Techniques like deep breathing, meditation, and
yoga can help manage anxiety symptoms associated with phobias.
 Medication: In some cases, medication may be prescribed to manage
anxiety and panic attacks.

4. Write down five symptoms of a Manic episode. What are the common
side effects of antipsychotics?

Common presenting complaints

• Elated mood
• Self-important ideas
• Talkativeness
• Over activity
• Excessive expenditure
• Irritability
• Aggressive behavior occasionally
• Reduced need for sleep

Antidopaminergic Acute dystonia, akathisia, parkinsonism, tardive dyskinesia

effects
Antiadrenergic Sedation, postural hypotension, inhibition of ejaculation
effects
Anticholinergic Dry mouth, reduced sweating, urinary hesitancy and
effects retention, constipation, blurred vision
Others Cardiac arrhythmias, weight gain, amenorrhea, galactorrhea,
hypothermia, sensitivity reactions

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 5. What is the common childhood psychiatric disorders in Bangladesh?

6. What are the red flag signs of autism spectrum disorder?

The following red flags may indicate a child is at risk for an autism spectrum
disorder and needs an immediate evaluation
1. Impairment in Social Interaction:
 Lack of appropriate eye gaze
 Lack of warm, joyful expressions
 Lack of sharing interest or enjoyment
 Lack of response to name
2. Impairment in Communication:
 Lack of showing gestures
 Lack of coordination of
nonverbal communication
 Unusual prosody (little
variation in pitch, odd
intonation, irregular rhythm,
unusual voice quality)
3. Repetitive Behaviors & Restricted Interests:
 Repetitive movements with objects
 Repetitive movements or posturing of body, arms, hands, or fingers

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 7. What are the symptoms of Conduct disorder? How do you manage?
Symptoms of Conduct Disorder
1. Aggression to people and animals
1. bullies, threatens or intimidates others
2. often initiates physical fights
3. has used a weapon that could cause serious physical harm to others
(e.g., a bat, brick, broken bottle, knife, or gun)
4. is physically cruel to people or animals
5. steals from a victim while confronting them (e.g., assault)
6. forces someone into sexual activity
2. Destruction of Property
1. deliberately engaged in fire setting to cause damage
2. deliberately destroys other's property
3. Deceitfulness, lying or stealing
1. has broken into someone else's building, house, or car
2. lies to obtain goods, or favors or to avoid obligations
3. steals items without confronting a victim (e.g. shoplifting, but
without breaking)
4. Serious violations of rules
1. often stays out at night despite parental objections
2. runs away from home
3. often truant from school
Management:
Assessment and Diagnosis:
History taking, investigations (EEG, serum lead), diagnosis
Plan of treatment: Community/Outpatient department/Refer to higher
centers/special school/mainstream school
General management: Nutrition, safety
Specific management:
No pharmacological treatment:
Approaches
● Psychoeducation
● Work with the family/Family therapy for the whole group
● Behavior modification: reward for expected behavior
● Symptom management, for instance, aggression
● Remedial education ( special coaching for specific subjects)
● Treatment of physical problems

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 ● Help with socio-economic disadvantage
● Support for re-housing
● Removal from home including reception into care and/or
residential
schooling when necessary
● Ensure consistent, contingent response to behavior, i.e.
rewards for
good behavior, sanctions for bad
Pharmacological treatment
If needed use antidepressants in low doses, mood stabilizers
Follow-up: To assess the drug compliance, side effects of drugs, reduction of
symptoms with rise of new symptoms.

8. Define Delusion, Illusion, and hallucination. What are the types of

hallucination & delusion?
Delusion
It is a false unshakable belief that is not corrected by proper explanation in
contest with a person’s social, cultural, educational & religious background.
e.g.:
 Delusion of control (passivity phenomenon),
 Persecutory delusion
Illusion
It is a false perception in the presence of sensory stimuli.
Hallucination
It is a false perception in the absence of sensory stimuli. e.g.
 Auditory hallucination,
 Visual hallucination,
 Olfactory hallucination,
 and Somatic hallucination.

9. What do you mean by Conversion disorder? What are the symptoms of

conversion disorder? How do you manage?

Conversion disorder: It is a neurotic disorder in which a wide variety of somatic

and mental symptoms develop for some real or imagined gain without being
fully aware of the underlying motive.

Or, (also known as functional neurological system disorder) is a condition in

which a person experiences physical and sensory problems, such as paralysis,

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numbness, blindness, deafness or seizures, with no underlying neurologic
pathology.

Three characteristics of the symptoms :

1. They occur in the absence of physical pathology
2. They are produced unconsciously
3. They are not caused by overactivity of the sympathetic nervous system

A. Conversion symptoms (Physical symptoms)

a. Motor symptoms - These may consist of paralysis, paresis, fits, tremors,
rigidity, abnormal gait, ataxia, and fits.
b. Sensory symptom - Anesthesia, paresthesia, hyperalgesia and pains,
blindness, deafness, aphonia, loss of smell, loss of taste.
c. Visceral - Vomiting, pain, retention of urine.

B. Dissociative symptoms (Mental symptoms)

a. Amnesia - Forgetting a specific or traumatic episode in clear
consciousness and complaining that she or he knows nothing of his/her
earlier life.
b. Fugue state - It is a state of wandering away from the environment and
usually to escape from a disagreeable or threatening situation. Emotional
conflict or stress is expressed by dissociation of the mind.

Management of Conversion disorder:

Assessment and Diagnosis:
History taking, Investigations, Diagnosis
Plan of treatment: Community/Outpatient department/Indoor
admission/Refer to higher centers
General management:
Nutrition/Safety security of patients
Specific management:
Pharmacological treatment: Anxiolytic drugs, Antidepressants in
low dose
Nonpharmacological treatment: Psycho education, brief individual
psychotherapy, relaxation therapy, Cognitive therapy, behavior therapy,
rehabilitation etc.
Follow up: Drug Compliance, Assessment of the symptoms, functional
improvement.

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 10. What are the symptoms of Major Depressive disorder? Write down the
names of five antidepressants.
Common presenting complaints
• Depressed mood or persistent sadness
• Lack of initiatives and drive (avolition)
• Easy fatigability
• Change in appetite ( mostly reduced appetite)
• Early morning awakening (sleep disturbances)
• Inability to enjoy the pleasurable activities ( anhedonia)
• Irritability
• Suicidal idea or suicidal attempt
• Decreased libido.
Anti-depressant drugs (ANY FIVE)
• Amitriptyline, imipramine, clomipramine (TCAs)
• Maprotyline
• Fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram
(SSRIs)
• Venlafaxine
• Mirtazapine
Side effects of antidepressant drugs: some common side effects may include
1. Nausea
2. Headache
3. Insomnia or drowsiness
4. Weight gain or loss
5. Sexual dysfunction
6. Dry mouth
7. Constipation
8. Blurred vision
9. Dizziness
10. Increased heart rate
11.What are the substances abused in Bangladesh? What are the causes of
drug abuse? How do you prevent it?

 Cannabis- Marijuana, gaja, chaurosh, hashish

 Stimulants - Amphetamine (Yaba)
 Opioids- Phensedyl, heroin, morphine, pethidine, tidigesic
(buprenorphine)
 Benzodiazepines- Diazepam, nitrazepam, clonazepam etc.

Shahariar Nadim, Sumaiya Akter 2nd Year Bsc. In Occupational Therapy 8

  Alcohol
 Volatile substances – Glue ( dandy)

Common causes of substance dependence

 Availability of drugs:
 Taking drugs prescribed by doctors.
 Taking drugs that can be bought legally without prescription.
 Taking drugs that can be obtained only from illicit sources (street
drugs).
 Social pressures/peer pressures:
Within the immediate social groups or friends group, there may be
pressures for a young person to take drugs
 Inability to cope with stressful situations:
Failure to academic grade, relationship breakup, separation, divorce,
extramarital relationship, etc.
 Curiosity:
Young people may be curious to have a taste or explore the secret meaning
of drugs.
 Frustration:
Maladjustment, unemployment, repeated failures, and chronic illness may
create frustration leading to substance dependence.
 Vulnerable personality:
 Many drug users, particularly younger people taking drugs, appear to
have some degree of personality vulnerability.
 Delinquency and antisocial personality are common histories among
drug abusers.
 Low self-esteem, lack of confidence, lack of efficacy and optimization.
Prevention Plan:
• Supply reduction
• Demand reduction
• Harm reduction
occupational therapist manages Drug abuse:They may focus on:
1. Education and coping skills: Occupational therapists can provide education
on healthy coping strategies and stress management techniques to help
individuals manage triggers for drug abuse.
2. Daily living skills: Occupational therapists can work with individuals to
develop or improve their daily living skills, such as time management,
organization, and self-care, which may have been impacted by substance abuse.

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3. Vocational rehabilitation: Occupational therapists can assist individuals in
identifying and pursuing meaningful employment opportunities and developing
job-related skills to support their recovery.
4. Leisure and social participation: Occupational therapists can help individuals
identify and engage in positive leisure activities and social interactions that
support recovery and reduce the risk of relapse.
5. Environmental modifications: Occupational therapists can assess an
individual's home environment and recommend modifications to support
recovery, safety, and independence.
12.What is Generalized anxiety disorder and what are the clinical features
of Generalized anxiety disorder? How do you manage it?
The free-floating anxiety, worries, or physical symptoms cause clinically
significant distress or impairment in social, occupational, or other important
areas of functioning of the person.
Or,
GAD means that you are worrying constantly and can't control the worrying.
Healthcare providers diagnose GAD when your worrying happens on most days
and for at least 6 months.
1. Psychological symptoms of GAD
Fearful anticipation, irritability,
Sensitivity to noise, restlessness,
Poor attention and concentration,
Worrying thoughts.
2. Physical symptoms of GAD
Gastrointestinal system -
Dry mouth, difficulties in swallowing, epigastric discomfort, flatulent,
constipation, frequent loose motion.
Respiratory system - Constriction in the chest, inspiratory difficulties,
over breathing.
Cardiovascular system -Palpitation, discomfort in the chest, awareness
of missed beats. Genitourinary system -Frequent / urgent micturition,
failure of erection, menstrual disturbance, amenorrhea.
Neuromuscular system -Tremor, prickling sensation, tinnitus, dizziness,
headache, muscle ache.
3.Sleep disturbance: Insomnia - early insomnia or through out
disturbances, night terror.
4.Others : Depression, obsession, depersonalization

Here are some strategies that are often used to manage GAD:
Psychotherapy:

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  Cognitive-behavioral therapy (CBT) is a highly effective form of therapy
that helps you identify and change negative thought patterns that
contribute to anxiety.
 Exposure therapy involves gradually confronting your fears in a safe and
controlled environment, which can help to reduce anxiety over time.
 Acceptance and commitment therapy (ACT) helps you accept difficult
thoughts and feelings while focusing on living a meaningful life.
Medication:
 Antidepressants and anti-anxiety medications can be helpful in managing
the physical symptoms of anxiety, such as racing heart, rapid breathing,
and muscle tension. However, it's important to discuss medication
options with a doctor or mental health professional.
Lifestyle changes:
 Regular exercise
 Healthy sleep habits
 Relaxation techniques, Healthy diet
13. Write five symptoms of a Panic attack. How do you manage it?

Panic attack: A panic attack is a sudden episode of intense fear that triggers
severe physical reactions when there is no real danger or apparent cause.
Panic attacks typically include some of these signs or symptoms:
• Sense of impending doom or danger
• Fear of loss of control or death
• Rapid, pounding heart rate
• Sweating
• Trembling or shaking
• Shortness of breath or tightness in your throat
• Hot flashes
• Nausea
• Abdominal cramping
• Chest pain
• Headache
• Dizziness, lightheadedness or faintness
• Numbness or tingling sensation
• Feeling of unreality or detachment
Or/ This is an emergency medical situation for the patient where there is an
episodic period of intense fear or discomfort, in which 4 out of 13 following
symptoms have to be present. The symptoms develop abruptly and reach a peak
within 10 minutes.
i Palpitation, pounding heart, or increased heart rate

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 ii Sweating
iii Trembling/shaking
iv Sensation of shortness of breath or smothering
v Choking feeling
vi Chest pain/discomfort
vii Nausea / abdominal distress
viii Feeling dizzy, unsteady, lightened / faint
ix Fear of losing control / going crazy
x Fear of dying
xi Numbness/tingling
Management: The panic attack patients urgently rush to emergency
services/cardiologists or physicians and often get admitted to hospital. But after
15-30 min they feel normal and seek discharge. Most of the patients apprehend
the next attack and become fearful Panic attacks and agoraphobia frequently
co-exist.

14. What are the causes of Psychiatric disorders? Why psychiatry learning
is important for an Occupational therapist?

There is rarely one single cause of a mental disorder. Most mental disorders are
caused by a combination of factors, which include:
• Biological factors
• Stressful life events
• Individual psychological factors e.g. poor self-esteem, negative
thinking
• Adverse life experiences during childhood e.g. abuse, neglect,
death of parents, or other traumatic experiences.
• Socio-economic factors.
Mental disorders are NOT the result of possession by evil spirits, curses,
astrological influences, or black magic.
Psychiatry learning and its importance for Occupational Therapists:
For Occupational Therapists (OTs), understanding psychiatry is crucial for
several reasons:
 Accurate assessment
 Effective treatment planning
 Holistic approach
 Promoting mental health wellness
 Client-Centered Care
 Mental Health Promotion and Prevention

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Community integration by continuously learning about psychiatry, OTs can
significantly enhance their ability to support and empower individuals with
mental health challenges, ultimately improving their quality of life and
functional independence

15.What is Schneider's first-rank symptoms of Schizophrenia? How do you

manage Schizophrenia?

Kurt Schneider (1887 – 1967): He was a German Psychiatrist who first classified
the symptoms of schizophrenia in 1938.
The presence of at least one first-rank symptom in the absence of organic illness
is usually diagnostic of schizophrenia
1. Auditory hallucination: 3rd person type, running commentary type
2. Primary delusion: Delusional perception
3. Thought insertion
4. Thought withdrawal
5. Thought broadcasting
6. Delusion of control- action, and feelings are experienced as controlled by
an external force or agency
7. Hearing of one‘s own thoughts (thought echo)
8. Somatic hallucination
Management:
Assessment and Diagnosis:
History taking, examination (general examination, systemic examination &
mental state examination), relevant investigations.

Treatment:
Pharmacological treatment:
Anti-psychotics medications
• Typical or 1st generation anti-psychotics eg. Haloperidol,
Chlorpromazine,
Trifluoperazine etc.
• Atypical or 2nd generation anti-psychotics eg . Olanzapine, Risperidone,
Aripiprazole, Quetiapine, Clozapine etc.
Other Treatment: ECT (Electroconvulsive therapy)
Non-pharmacological treatment:
Psychosocial management – Psychoeducation, family psychotherapy,
cognitive behavior therapy, social skill training, group therapy, vocational
therapy, and rehabilitation.
Hospitalization:

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Indications for hospitalization are as follows –
1) For safety (because of violent behavior, suicidal and homicidal ideation)
2) Non-compliance to treatment
3) For diagnostic purposes
Prognosis:
25% - complete remission of symptoms
35% - remission and relapse
25% - residual features 15% - debilitating course.
Follow up:
To assess drug compliance, side effects of drugs, and reduction of symptoms
with rise of new symptoms.

16. Write down the clinical features of OCD. How will you manage it?
Obsession
In obsession, the patient has recurrent and persistent thoughts, impulses, or
images- that are intrusive and inappropriate. The person attempts to suppress
such things but fails.
Compulsion
There are repetitive behaviors (like washing, ordering, checking), or mental acts
(like praying, counting, and repeating words silently). The person feels driven to
perform in response to an obsession and resists the obsession.
These are usually associated with certain degrees of anxiety and depression.

Treatment
Obsessive-compulsive disorder is typically treated by
 Psychotherapy
Cognitive behavioral therapy (CBT)
Exposure and response prevention therapy (ERP)
 medication, or
 both at the same time
 Lifestyle change

Research-backed forms of therapy for treating OCD include cognitive-

behavioral therapy (CBT) which is used to treat a range of disorders, and a
specific type of CBT called exposure and response prevention (ERP). In ERP, a
person with OCD, initially guided by a therapist, is exposed to thoughts, things,
or situations that produce anxiety or lead to obsessions and compulsions and,
in doing so, learns to not engage in habitual compulsions. This approach aims to
gradually reduce the anxiety prompted by such thoughts and encounters so that
the individual can better manage OCD symptoms.

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Medications such as serotonin reuptake inhibitors (SSRIs) and selective
serotonin reuptake inhibitors (SSRIs) are also used to treat OCD. These include
the older antidepressant clomipramine and more recently developed drugs
such as fluoxetine, fluvoxamine, and sertraline.
17. What are the causes of mental illness? how can we be aware of people
as OT? (23,21,20,19,18)
The Causes of Mental Illness:
• Biological factors
• Stressful life events
• Individual psychological factors e.g. poor self-esteem, negative
thinking
• Adverse life experiences during childhood e.g. abuse, neglect,
death of parents, or other traumatic experiences.
Social and Environmental Factors:
• Poverty and socioeconomic disadvantage
• Cultural factors
• Relationship problems
Being Aware of People as Occupational Therapists:
As occupational therapists, you can cultivate awareness in several ways:
• Actively listen
• Ask open-ended questions
• Validate their experiences
• Be empathetic
• Educate yourself
• Collaborate with other professionals
• Advocate for mental health awareness

18. Define Delirium and Dementia.

Delirium is an altered state of consciousness, characterized by episodes of

confusion, that can develop over hours or days.

Dementia is a chronic organic mental disorder characterized by impairment of

memory, intellect, and personality usually in elderly people. There is no
impairment of consciousness.

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 19. Write down the difference between Delirium and Dementia. Give the
management (including OT)
Delirium vs. Dementia: Key Differences:
Feature Delirium Dementia
Onset Sudden and rapid (hours or Gradual and progressive
days) (months or years)
Cognition It primarily affects attention It affects all cognitive domains,
and awareness, followed by including memory, thinking,
memory, thinking, and language, judgment, and
perception visuospatial abilities
Causes Medical conditions, Underlying neurodegenerative
medications, infections, diseases (Alzheimer's,
substance Parkinson's, Lewy body
intoxication/withdrawal dementia)
Fluctuations Fluctuating symptoms Stable or gradually worsening
throughout the day (hours or symptoms
minutes)
Duration Usually resolves within days or Progressive and irreversible
weeks (if the underlying cause
is treated)

Management:
 OTs can help with activities of daily living, cognitive retraining, and
sensory stimulation.
 OTs can adapt daily activities, promote independence, and facilitate
participation in meaningful occupations.
 Functional assessment
 Adaptive equipment
 Environmental modifications
 Community reintegration: Support participation in meaningful activities
and social interaction.

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 20. What is the difference between psychosis and neurosis?
Key Differences:
Feature Psychosis Neurosis
Contact with reality Loss of touch with reality Maintains contact with reality

Symptoms Hallucinations, delusions, Anxiety, obsessions, phobias,

disorganized thinking depression
Causes Primarily biological Primarily psychological and
social
Treatment Medication and psychotherapy Psychotherapy, medication
(limited use)

21. What are the difference between epileptic fit and Conversion disorder?
Difference between epileptic fit and fit from conversion disorder
Epilepsy/True Seizure Conversion
disorder/Pseudoseizure
Consciousness Real loss No real loss
Fits alone / during sleep Yes No
Every fit same as the other Same in each situation Different in each situation
Movement of the limbs Yes, in typical fashion Yes, but variable
Tongue bite Present Absent
Incontinence of urine and Present Absent
faeces
History of fall and injury Present & Genuine This may be present due
to constant friction over
the ground

22. What are the components of a mental state examination?

The components of the Mental State Examination typically include:
1. Appearance and Behavior:
• Appearance: Observations about the individual's physical
appearance, hygiene, grooming, and any unusual features.
• Behavior: Descriptions of the person's behavior, including any
observable signs of agitation, restlessness, or unusual movements.
2. Speech:
• Rate: The speed at which the individual speaks (e.g., rapid, slow).
• Volume: The loudness or softness of the person's speech.
• Clarity: The coherence and intelligibility of speech.

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 3. Mood:
• Subjective Mood: How the individual describes their emotional
state.
• Objective Mood: The examiner's observation of the person's mood
based on facial expressions, tone of voice, and overall demeanor.
4. Thought Content:
• Obsessions/Compulsions
• Delusions
5. Perception:
• Hallucinations
• Illusions
6. Cognition:
• Orientation
• Memory
• Concentration and Attention
7. Insight and Judgment
8. Suicidality/Homicidal

23. Define Personality disorder. Classify personality disorder according to

DSM-5.
Personality disorders are long-term patterns of behavior and inner experiences
that differ significantly from what is expected. They affect at least two of these
areas: Way of thinking about oneself and others. Way of responding
emotionally. Way of relating to other people.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies

personality disorders into three clusters based on shared characteristics:
Cluster A: Odd or Eccentric Disorders:
 Paranoid personality disorder
 Schizoid personality disorder
 Schizotypal personality disorder
Cluster B: Dramatic, Emotional, or Erratic Disorders:
 Antisocial personality disorder
 Borderline personality disorder
 Histrionic personality disorder
 Narcissistic personality disorder
Cluster C: Anxious or Fearful Disorders:
 Avoidant personality disorder
 Dependent personality disorder
 Obsessive-compulsive personality disorder

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 Short Note
Attention deficit hyperactivity disorder (ADHD)
Clinical features:
Hyperactivity is the accompanying sense of restlessness, which is not task-
related and has an irritating, disruptive quality that is annoying to other people.
Impulsivity
Impulsivity, that is the inability to delay a response or more overtly intrusive
behavior, is irritating to peers and adults whether it occurs at school, at home
or in the community.
Distractibility
Inability to focus attention on study or anything.
Secondary problems
Learning disorders: Many children with hyperkinetic syndrome or ADHD show
evidence of generalized or specific learning disabilities.
Management:
Medications
• Methylphenidate
• Clonidine,
• Atomoxetine
• Risperidone
• Haloperidol
Dietary measures
Advice to parents for additive-free and artificial coloring-free products diet for
the child.
Parental counseling:
Common topics for discussion include :
● counseling about the basis of the child‘s behavior
● discussion about the management of behavior
● the opportunity to talk about parents‘ own anxieties and concerns
Behavior modification
Rewarding expected behavior and overlooking unwanted behavior at home or
school.
Environmental manipulation
Advice to teachers or parents about changes in the child‘s routine or overall
environment at home or at school can be useful. Examples include:
● placement of the child in a small, stable teaching group
● time limitation for individual activities
Remedial education: Individual remedial programs for general and specific
learning difficulties are necessary for many children.

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 Au�sm Spectrum Disorder (ASD)
Autism spectrum disorder (ASD) is a neurodevelopmental disease typically
diagnosed during childhood. The former name of ASD is autism, and many
people still use the term. But ASD includes several conditions within the
spectrum. ASD changes the way your child interacts and communicates. There
is no cure for autism, but the symptoms may lessen over time.

Types of ASD:
1. Au�s�c Disorder
2. Asperger Syndrome
3. Pervasive Developmental Disorder

Symptoms of Au�sm spectrum disorder (ASD)

• Delayed language skills
• Delayed movement skills
• Delayed cognitive or learning skills
• Hyperactive, impulsive, and/or inattentive behavior
• Epilepsy or seizure disorder
• Unusual eating and sleeping habits
• Gastrointestinal issues (for example, constipation)
• Unusual mood or emotional reactions
• Anxiety, stress, or excessive worry
• Lack of fear or more fear than expected

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 Bipolar Mood Disorder
Presence of two distinct phases of mood in the patient, one is the manic phase
and another is a depressive phase with good inter-episodic functioning.

Common presenting complaints

• Elated mood
• Self important ideas
• Talkativeness
• Over activity
• Excessive expenditure
• Irritability
• Aggressive behavior occasionally
• Reduced need for sleep

Management:
Assessment and Diagnosis:
History taking, Mental State Examination, Investigations Diagnosis
Treatment:
Pharmacological treatment:
A. Acute phase
1. Anti-psychotic drugs: Typical or atypical anti-psychotic drugs to reduce
the hyperactivity, violent behavior, and delusion of patients.
2. Mood stabilizers: Lithium carbonate, Sodium valproate,
Carbamazepine, Lamotrigine, etc.
3. Benzodiazepine: Lorazepam, Clonazepam, Diazepam etc for sedation
initially.

B. Maintenance phase
Mood stabilizers only.
Non-pharmacological treatment:
Psychosocial management – Family psychotherapy, interpersonal
psychotherapy and
rehabilitation.
Hospitalization:
Indications for hospitalization are as follows –
1. For safety ( because of violent behavior, suicidal and
homicidal ideation) 2) Non-compliance to treatment
Follow Up

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 Sexual dysfunctions
Sexual dysfunction refers to a person‘s inability ―to participate in a sexual
relationship as he or she wishes.
Common sexual dysfunctions found are –
In Male - Premature ejaculation, Erectile disorder, Hypoactive sexual desire
disorder, Dhat syndrome
In Female – Female sexual arousal disorder, Orgasmic disorder, Vaginismus,
Dyspareunia
Premature ejaculation
Habitual ejaculation before penetration or so soon afterwards that the woman
has not experienced pleasure.
It is usually occurs in young male persons.
Causes: performance anxiety, lack of sex knowledge, cultural factors, relational
problems, stressful marriage etc.
Treatment:
 Advice & reassurance
 Sex education
 Couple psychotherapy to improve relational problem.
 Behavioural approaches – Start- stop method, Squeeze technique
 Pharmacological approach - SSRIs .
24.

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