With or without behavioral disturbance eg, psychotic symptoms, mood disturbance, agitation

Severity Mild, Moderate, Severe applies to Major NCD only

Major NCD Significant cognitive decline in ≥1 domain, interferes with independence in daily activities

MCQ Point The primary discriminator between Major and Mild NCD is interference with independence in daily activities

Mild NCD Modest cognitive decline, does not interfere with independence, but may require compensatory strategies

Alzheimer's Disease

Lewy Body Disease LBD

Vascular NCD

Frontotemporal Lobar Degeneration FTLD

Prion Disease eg, CreutzfeldtJakob Disease

Huntington's Disease Neurologic

presents immediately after TBI or once consciousness recovered, then persists

Neurosyphilis

HIV

eg, Vitamin B12 deficiency

Thyroid disease

Hepatic encephalopathy

Thyroid disease

eg, meningioma MCQ Point Neoplasms are reversible causes and a key ruleout for structural neuroimaging

Major Depressive Disorder MDD 😞

Persistent Depressive Disorder Dysthymia

Disruptive Mood Dysregulation Disorder DMDD 🎭

Secondary Depressive Disorders

Overview of Bipolar Disorders

Bipolar I Disorder

Bipolar II Disorder

Cyclothymic Disorder

Secondary Bipolar Disorders

Major mood episode concurrent with schizophrenia criteria delusions or hallucinations present for 2+ weeks without mood episode

Better than schizophrenia but worse than mood disorders more psychotic symptoms predict poorer prognosis

Presence of one or more delusions for ≥1 month functioning not markedly impaired

Subtypes include erotomanic, grandiose, and persecutory treatment includes antipsychotics

Patients often resistant to treatment but prognosis better than schizophrenia

Requires ≥3 catatonic symptoms can be added to any mental disorder diagnosis

Firstline treatment is Lorazepam avoid antipsychotics until catatonia resolves

ECT may be used for refractory cases

At least two characteristic symptoms for ≥1 month delusions, hallucinations, or disorganized speech

Continuous signs of disturbance for at least 6 months

Positive Delusions, hallucinations, disorganized behavior

Negative Diminished emotional expression, social withdrawal, lack of spontaneity

Lifetime prevalence ~1% peak onset in males 1525 years and females 2535 years

Severity inversely related to age of onset negative symptoms predict poorer outcomes

Symptoms same as schizophrenia for ≥1 month but less than 6 months

Good prognosis if symptoms appear within 4 weeks of behavior change and good premorbid functioning

Over 50% may progress to schizophrenia diagnosis

Positive symptoms for ≥1 day but less than 1 month with full return to premorbid functioning

4050% may progress to another psychotic illness, commonly schizophrenia

Prominent hallucinations or delusions as a direct consequence of a medical condition

Delusions or hallucinations during or soon after substance intoxication/withdrawal

Persistent symptoms suggest primary psychotic disorder if they last ~1 month postintoxication

Definition and Characteristics

Other Specified

Unspecified

Characterized by recurrent unexpected panic attacks

Persistent concern about additional attacks or maladaptive behavioral changes

Approximately 30% experience nocturnal panic attacks

Sufferers often focus on interoceptive cues and catastrophize mild physical sensations

Risk factors include smoking and childhood abuse

Marked fear or anxiety regarding at least two situations eg, public transport, open spaces, enclosed spaces, crowds, being outside home alone

Avoidance behavior or enduring situations with dread

Excessive anxiety and worry occurring more days than not for at least six months about various events or activities

Difficulty controlling the worry, with at least three associated symptoms restlessness, fatigue, concentration difficulty, irritability, muscle tension, sleep disturbance

Marked fear or anxiety about one or more social situations where the individual may be scrutinized by others, fearing negative evaluation

Social situations are often avoided or endured with intense anxiety fear is disproportionate to the actual threat

Commonly comorbid with avoidant personality disorder

Marked fear or anxiety regarding a specific object or situation, provoking immediate fear/anxiety

The object/situation is actively avoided or endured with intense anxiety fear is out of proportion to actual danger, persisting for at least six months

Animal

Natural environment

Bloodinjectioninjury

Situational

Other

Developmentally inappropriate and excessive fear or anxiety concerning separation from attachment figures

Can manifest in adults, such as a mother experiencing overwhelming anxiety about her schoolaged children

Definition and Characteristics

Epidemiological Insights 🧠

Neurotransmitter Involvement

Differential Diagnosis Ruleouts ⚠️

Conditions beginning early in development

Characterized by developmental deficits

Impairments in personal, social, academic, or occupational functioning

Key Diagnostic Criteria

Other Related Diagnoses

DSM5 Changes

Specifiers

Presentation Types

Severity Specifiers

Tourette's Disorder

Persistent Chronic Motor or Vocal Tic Disorder

Provisional Tic Disorder

Characterization

Types

Diagnosis Criteria

Types of Impairments

Severity

Stereotypic Movement Disorder

Neurocognitive Disorders

Resulting from exposure to a traumatic or stressful event

Development of emotional or behavioral symptoms in response to an identifiable stressor occurring within three months of its onset

Symptoms must be clinically significant marked distress or significant impairment in functioning

Key Insight 📅

Good longterm prognosis for adult onset adolescent onset may progress to major psychiatric disorders

Exposure to trauma with at least nine symptoms from five categories intrusion, negative mood, dissociative symptoms, avoidance, arousal

Duration is between three days and one month

Key Insight 🔑

Exposure to actual or threatened death, serious injury, or sexual violence, followed by symptoms from at least four clusters intrusion, avoidance, negative alterations in cognitions and mood, alterations in arousal and reactivity

Symptoms must persist for longer than one month

"With dissociative symptoms" depersonalization, derealization

"With delayed expression" full criteria not met until at least six months after trauma

Very high, with 80% of individuals experiencing at least one other mental disorder commonly comorbid with MDD, SUDs, and anxiety disorders

Increased chronic risk of suicide and violence

Defined by the presence of obsessions recurrent, intrusive thoughts and/or compulsions repetitive behaviors aimed at reducing distress

Obsessions Contamination, pathological doubt, somatic concerns, symmetry, aggressive thoughts, sexual thoughts

Compulsions Checking, washing, counting, confessing, symmetry, hoarding

Earlyonset more severe, ticlike vs lateronset

High rates of comorbidity with anxiety disorders, major depressive disorder MDD, substance use disorders SUDs, Tourette's disorder, body dysmorphic disorder, and anorexia nervosa

In patients with Tourette's, OCD is common 35-50% conversely, Tourette's is less common in OCD 57%

Preoccupation with one or more perceived defects in physical appearance not observable or appearing slight to others

Involves repetitive behaviors or mental acts in response to appearance concerns

Persistent difficulty discarding possessions due to perceived need to save them, leading to clutter that compromises intended use of living areas

Recurrent pulling out of one’s hair, resulting in hair loss repeated attempts to decrease or stop hair pulling

Recurrent skin picking resulting in skin lesions repeated attempts to decrease or stop skin picking

Disorders arising from substance use or withdrawal that mimic OCD symptoms

Common in Latin American cultures

Acute emotional disturbance

Found in Malaysia and Indonesia

Characterized by sudden shouting or mimicry

Seen in Southeast Asia

Fear of genital retraction

Involves persistent disturbance of eating or eatingrelated behavior leading to altered consumption or absorption of food, significantly impairing physical health or psychosocial functioning

High rates of mood disorders 5070%), anxiety disorders 1365%), substance use disorders 25%), and personality disorders 2080%

Enduring pattern of inner experience and behaviour

Deviates from cultural expectations

Pervasive and inflexible across situations

Onset in adolescence or early adulthood

Stable over time

Leads to significant distress or impairment

Not better explained by another mental disorder

Not due to a medical condition

Not due to substance effects

Retains 10 specific personality disorders from DSMIV

Grouped into three clusters

Paranoid Personality Disorder

Schizoid Personality Disorder

Schizotypal Personality Disorder

Antisocial Personality Disorder

Borderline Personality Disorder

Histrionic Personality Disorder

Narcissistic Personality Disorder

Avoidant Personality Disorder

Dependent Personality Disorder

ObsessiveCompulsive Personality Disorder

Hybrid dimensionalcategorical approach

Evaluated on a continuum mild to extreme

Selffunctioning identity and selfdirection

Interpersonal functioning empathy and intimacy

Moderate impairment required for diagnosis

Organized into five domains

For cases not meeting criteria for specific disorders

Significant impairment and pathological traits present

Persistent disturbances in sleepwake patterns causing distress or functional impairment

Affects quality of life and daily functioning

Predominant dissatisfaction with sleep quantity or quality

Difficulty initiating or maintaining sleep, or earlymorning awakening

Occurs at least 3 nights per week for a minimum of 3 months

Often coexists with medical conditions, substance use disorders, or psychiatric disorders

Treatment should address both insomnia and cooccurring conditions for effective resolution

Excessive daytime sleepiness despite a main sleep period of at least 7 hours

Prolonged nighttime sleep or difficulty being fully awake after abrupt awakening

Occurs at least 3 times per week for a minimum of 3 months

Recurrent periods of an irresistible need to sleep, lapsing into sleep, or napping during the day

Occurs at least 3 times per week for a minimum of 3 months

Presence of cataplexy or specific hypocretin deficiency findings

Associated with a deficiency in hypocretin orexin, a neuropeptide that regulates wakefulness

Includes Obstructive Sleep Apnea Hypopnea, Central Sleep Apnea, and SleepRelated Hypoventilation

Diagnosed based on polysomnographic criteria, assessing airflow and respiratory patterns during sleep

Persistent or recurrent sleep disruption due to misalignment between the required sleepwake schedule and the individual's circadian rhythm

Shift work disorder, jet lag, and delayed sleep phase disorder

Abnormal behaviors, emotions, perceptions, or dreams occurring during sleep

NonREM Sleep Arousal Disorder Includes sleepwalking and sleep terrors

REM Sleep Behavior Disorder Involves repeated episodes of arousal during sleep associated with vocalization and complex motor behaviors

Often linked to synucleinopathies such as Parkinson's disease

Sleep disturbances caused by the effects of substances or medications

Alcohol, stimulants, and certain medications that interfere with normal sleep patterns

Disorders characterized by problems in selfcontrol of emotions and behaviors

Can lead to significant social and personal issues

Pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months

Requires at least 4 symptoms eg, losing temper, easily annoyed, defying requests

Approximately 25% will not have further diagnosis

30--40% of boys with severe ODD may progress to Conduct Disorder

Repetitive and persistent pattern of behavior violating the basic rights of others or societal norms

Examples include aggression towards people or animals, destruction of property, deceitfulness, and serious rule violations

Antisocial Personality Disorder ASPD requires a childhood diagnosis of conduct disorder for its diagnosis

Recurrent behavioral outbursts representing a failure to control aggressive impulses

Outbursts are grossly out of proportion to the provocation and are not premeditated

Causes significant distress or impairment in functioning

High rates of depression, anxiety, substance use disorders, ADHD, ODD, CD, ASPD, and borderline personality disorder

Recurrent failure to resist impulses to steal objects not needed for personal use or monetary value

Increasing tension before the act and pleasure or relief during or after the act

Not committed out of anger or vengeance, and not explained by other disorders

Disruption of identity with ≥2 distinct personality states

Gaps in recall inconsistent with ordinary forgetting

DID takes precedence over other dissociative disorders if criteria are met

Types localized, selective, generalized, and continuous amnesia

Differentiation from Neurocognitive Disorder NCD based on memory orientation

Reality testing remains intact can be distressing and trigger hypochondriacal concerns

Disruption in normal integration of consciousness, memory, identity, emotion, and behavior

Rule out medical conditions and substance use

Clinically significant disturbance in sexual response or pleasure

Relationship problems, substances, and medical conditions

Recurrent, intense sexually arousing fantasies or behaviors

Duration of ≥6 months causing distress or impairment

Overview of Paraphilic Disorders

Types of Paraphilic Disorders

Marked incongruence between experienced gender and assigned gender

Distinguishing from other disorders

Somatic symptoms causing significant distress or functional impairment

High rates of mood disorders 60% and anxiety disorders 50%

Psychological factors adversely affecting a medical condition

Distinction from malingering no external incentive for deception

Management focuses on safety and care rather than confrontation

Acute onset often linked to stressors short duration of episodes

Treatment involves suggestion therapy and ongoing CBT

Excessive healthrelated behaviors or maladaptive avoidance

Duration of ≥6 months

≥1 distressing somatic symptom with excessive thoughts or behaviors related to health concerns

Specifier "With predominant pain" when symptoms primarily involve pain

1. Tolerance

2. Withdrawal

3. Unable to Control use

4. Waste a lot of time to obtain/ use/ recover

5. Craving

6. Social occupational decline

With Melancholic Features Loss of pleasure in all/almost all activities, lack of reactivity to pleasurable stimuli

With Atypical Features Mood reactivity is key Also, ≥2 of hypersomnia, increased appetite/weight gain, leaden paralysis, sensitivity to interpersonal rejection MCQ Point Classically responds to MAOIs

With Psychotic Features Delusions or hallucinations are present Can be moodcongruent themes of guilt, deserved punishment or moodincongruent persecutory, grandiose Treatment Antidepressant + Antipsychotic or ECT

With Catatonia ≥3 catatonic symptoms eg, stupor, catalepsy, mutism, waxy flexibility, echolalia, echopraxia

With Peripartum Onset Onset during pregnancy or within 4 weeks postpartum

With Anxious Distress

With Mixed Features

Comorbidities Very high lifetime comorbidity 72% with any other mental disorder Most frequent in pediatric depression Anxiety GAD, Panic, Disruptive Behavior Disorders ODD, CD, ADHD, Substance Use Disorders

Average Age of Onset: 29 years.

Onset in Younger Populations:

Major Depressive Disorder (MDD) Onset Age detail

Distinct periods of abnormally elevated, expansive, or irritable mood and increased activity or energy 🌈

At least one manic episode required for diagnosis

Marked impairment in social or occupational functioning differentiates it from hypomania

Distinct period of elevated mood for ≥1 week or any duration requiring hospitalization

Symptoms include grandiosity, decreased sleep, talkativeness, distractibility, and increased activity

Average age of onset is 19 years significant suicide risk up to 50% attempt, 15% complete

Psychotic symptoms are common in 50% of cases

At least one hypomanic episode and one major depressive episode required

No manic episodes present

Depression is more prominent than hypomania comparable suicide rates to Bipolar I

Rapid cycling is common, indicating frequent mood changes

Numerous periods with hypomanic and depressive symptoms for ≥2 years ≥1 year for children/adolescents

Symptoms present at least half the time no major depressive, manic, or hypomanic episodes ever met 🌀

must never have been without symptoms for more than 2 months at a time

Age of onset: 15-25

Prevalence: 1% – M:F 1:1 in general population

Mood disturbance directly from substance intoxication, withdrawal, or medication use

Medications like corticosteroids, antidepressants, and stimulants can induce mania

Direct pathophysiological consequence of a medical condition eg, CVA, seizure disorders

Differentiation from primary mania based on age of onset and related medical causes

Symptoms cause distress but do not meet full criteria for specific bipolar disorders

Examples include shortduration hypomanic episodes with major depressive episodes

Adjustment Disorder: It's not just a psychological reaction to coping with a medical illness

Alcohol: Most common legal depressant;

Benzodiazepines

Barbiturates: Known depressants

Hypnotics: Can lead to low mood; withdrawal can cause depression

Opioids/Opiates

Gammahydroxybutyrate (GHB)

Stimulants (mainly during withdrawal)

Nicotine (withdrawal)

Antihypertensive Agents

Hormonal agent

Antimicrobial

If symptoms persist for a substantial period (e.g., about 1 month) after cessation of acute withdrawal or severe intoxication, it strongly suggests an independent depressive disorder rather than purely substance-induced. This distinction is frequently tested.

Prominent and persistent depressed mood

Diminished interest or pleasure in activities

Direct pathophysiological consequence of another medical condition

Not better explained by another mental disorder

Does not occur exclusively in delirium

Neurosyphilis

AIDS

Brain tumors

Pancreatic cancer

Paraneoplastic syndromes

AIDS

Systemic lupus erythematosus

Poststroke

Postmyocardial infarction MI

Coronary heart disease

Thyroid disease

Cushing’s syndrome

Multiple sclerosis

Epilepsy

Parkinson’s disease

Huntington’s disease

Alzheimer’s disease

Traumatic brain injury

Stroke

Obstructive sleep apnea

Prominent and persistent depressed mood

Symptoms develop during or within a month of substance use

Substance capable of producing depressive symptoms

Illicit drugs

Prescription medications

A mental state with grossly distorted reality, leading to delusions, hallucinations, and thought disorder

1 Delusions

2 Hallucinations

3 Disorganized Thinking Speech

4 Grossly Disorganized or Abnormal Motor Behaviour including Catatonia

5 Negative Symptoms

Fixed, false beliefs resistant to change despite evidence

Common Types

Perceptual experiences without external stimuli

Types

Deficits in normal functioning, often treatmentresistant

Key "A"s Four As

Neuropsychiatric syndrome with psychomotor disturbances

Manifestations

Chronic disorder with thought, emotion, and behavior abnormalities

Diagnostic Criteria DSM5

Persistent disability for 2+ years, with negative symptoms predominating

Concurrent symptoms of schizophrenia and a major mood episode

Presence of 1+ delusions for 1+ month without core schizophrenic symptoms

A Paranoid Subtype Best Prognosis

B Other Subtypes

A Good Prognostic Factors

B Poor Prognostic Factors

A First Rank Symptoms FRS

B Positive response to placebo

C Being female

Best outcomes associated with

Typical onset late teens to mid30s earlier onset indicates poorer prognosis

56% complete suicide up to 20% attempt

Young Age

Male Gender

High Premorbid Functioning

Poor Compliance with Treatment

Comorbid Depression

Command Hallucinations

Recent Psychotic Episode

Unemployment

Greater Insight into Illness

Lack of Social Support

presence of delusions without other prominent psychotic symptoms like hallucinations (if present, they are related to the delusion and not prominent), disorganized speech, or negative symptoms,

Urge to move legs with uncomfortable sensations

Onset/Worsening at Rest

Relief by Movement

Diurnal Pattern

Frequency and Duration

Exclusionary Criteria

Firstline Agents FDA Approved Dopamine Agonists

Severe Cases Treatment

Secondline Agents

Avoidance Strategies

Considerations

also be due to genetic and autoimmune diseases

Leading to Low serum calcium levels

Paresthesia

Muscle cramps

Tetany

Extrapyramidal symptoms

Increased intracranial pressure

Basal ganglia calcifications

Cardiac arrhythmias

Skin changes

Mood Disorders:

Anxiety Syndromes:

Psychotic Features:

Cognitive Disorders

Psychiatric symptoms usually improve rapidly or resolve with treatment of the underlying hypoparathyroidism and normalisation of calcium levels

If psychotic symptoms persist after addressing the hypoparathyroidism, consider Adjunctive Treatment: adding an antipsychotic like haloperidol

Low vitamin D

high po4

low ca

Subtopic

And scrub

C on cheek

T on Arm BP cuff

Crab is equal to cramp

Ants and stars paresthesia

Rope on the neck show laryngospasm)

Rope on the wrist show carpopedal spasm)

1 Proof of excessive catecholamine release before anatomical localization

1 Plasma Free Metanephrines

1 Fractionated 24hour Urine Metanephrines

1 Drug Interference

2 Preparation for Testing

3 Physical Activity

1 Episodic headache

2 Sweating diaphoresis/hyperhidrosis

3 Tachycardia

1 Labile hypertension

2 Severe, variable hypertension

3 Difficulttomanage hypertension

4 Norepinephrinesecreting tumors causing baseline hypertension

1 Symptoms mimic panic attacks or generalized anxiety disorder GAD

2 Key Discriminator Panic attacks with headache, palpitations, blood pressure abnormalities, diaphoresis

1 Nervousness, tremulousness

2 Hyperglycaemia

3 Abdominal or chest pain

4 Nausea, vomiting, weakness

5 Pallor rarely flushing

1 Postural changes

2 Abdominal compression or tumor palpation

3 Emotional trauma

4 Induction of anesthesia

5 Unopposed beta blockade

6 Urination if bladder tumor

7 Certain medications or foods high in tyramine

1 Onethird of cases part of hereditary syndromes eg, MEN2, vHL, NF1

1 Imaging studies performed to localize the tumor after biochemical confirmation

1 CT Scan

2 MRI

1 123IMIBG scintigraphy or PET scanning for occult or metastatic tumors

Understanding the timeline and symptoms is essential for effective management

Onset.. 6 to 24 hours after the last drink

Timing and Incidence

Types of Seizures

Progression to DTs

Visual hallucinations

Auditory hallucination

Tactile sensation

Chronic alcohol exposure leads to

Cessation of alcohol results in CNS hyperactivity due to the lack of opposition to excitatory states

DTs usually begin 72 to 96 hours. 3 to 4 days. after cessation of alcohol/// but can appear up to 10 days later

90% of cases occur within 7 days following the last drink

DTs is classified as a medical emergency with a mortality rate of up to 20% if untreated

Hyperactive Delirium with Psychosis

Importance of hydration and cautious use of neuroleptics and restraints

Arrhythmia

Hyperthermia

Electrolyte and fluid abnormality

Essential to administer thiamine 100 mg IM/IV before glucose to prevent Wernicke's encephalopathy

Lookout for //// Wernicke's encephalopathy can be precipitated by glucose in thiamine deficient states

CIWA Scale

Primary treatment for both alcohol withdrawal seizures and DTs

Used for

Preference for "Out The Liver" benzodiazepines

Usually during the First week

Disulfiram

Naltrexone

Acamprosate

Alcohol Anonymous

1. Tolerance

2. Withdrawal

3. Unable to Control use

4. Waste a lot of time to obtain/ use/ recover

5. Craving

6. Social occupational decline

Psychological stages of change when trying to quit substance abuse

Serum blood alcohol concentration

CJD Insidious onset and rapid progression Motor features myoclonus, ataxia MCQ Point Fast polyphasic waves on EEG and CSF 1433 protein assay are supportive Always fatal, no accepted treatment

Affects temporal lobes, often resulting in residual amnesia.

Can cause Klüver-Bucy Syndrome (bilateral medial temporal lobe dysfunction affecting amygdala, leading to hyperorality, hypersexuality, docility, visual agnosia).

Core Diagnostic Principle

Neuroimaging

Wernicke's Encephalopathy Overview

Differential Diagnosis

. Amnestic Syndromes

Defect in copper transporter gene on chromosome 13

Copper accumulation in brain, liver, and other tissues

Typically before age 40

Can begin as early as 3 years old

Parkinsonism

Dysarthria

Gait changes

Tremor

Dystonia

Involuntary movements

Cognitive decline and dementia