Dr.Shantanoo Joshi (Palkars Polyclinic)

Schizophrenia has been recognized as a mental disorder that combines symptoms like hallucinations with distorted thinking and others like fright and severe paranoia. This condition is one that gets progressively worse over time and leads to delusional thinking. Oversleeping and complaining of fatigue are usually the earliest signs of this condition's onset. Eventually, it becomes a debilitating factor in the life of the patient, who will not be able to function in a normal way due to the severe symptoms.

Read on to know more about the types and causes of this condition:

1. Genetic Causes: Schizophrenia may be caused due to genetic factors and it may be a learned or inherited disorder. It is known to affect patients who have a parent or a sibling who may have suffered from this condition. Yet, one must also remember that Schizophrenia can only be influenced by genetics, and not determined by the same.
2. Environmental Causes: When there has been an exposure to a viral infection during the pre natal stage, the patient is susceptible to this condition. Also, it may affect children who have been subject to the loss of a parent or separation at an early age. Physical and emotional abuse in one's childhood may also bring on this condition. Low level of oxygen at the time of birth is one of the causes of this condition in many patients.
3. Anomalies in Brain Structure: When the brain ventricles of the patient are enlarged, he or she may be prone to this condition. Also, anomalies in the temporal lobes and amygdala have links with the onset of this condition.
4. Types: A wide variety of mental and medical conditions can manifest with psychotic symptoms that must be considered in the differential diagnosis of schizophreniform disorder. These include psychotic disorder due to another medical condition or its treatment; delirium or major neurocognitive disorder; substance/medication-induced psychotic disorder or delirium; depressive or bipolar disorder with psychotic features; schizoaffective disorder; other specified or unspecified bipolar and related disorder; depressive or bipolar disorder with catatonic features; schizophrenia; brief psychotic disorder; delusional disorder; other specified or unspecified schizophrenia spectrum and other psychotic disorder; schizotypal, schizoid, or paranoid personality disorders; autism spectrum disorder; disorders presenting in childhood with disorganized speech; attention-deficit/hyperactivity disorder; obsessive-compulsive disorder; posttraumatic stress disorder; and traumatic brain injury.

   Since the diagnostic criteria for schizophreniform disorder and schizophrenia differ primarily in duration of illness, the discussion of the differential diagnosis of schizophrenia also applies to schizophreniform disorder. 

Brief psychotic disorder. Schizophreniform disorder differs in duration from brief psychotic disorder, which has a duration of less than 1 month.

Residual Schizophrenia is a condition where the patient does not experience the various debilitating symptoms of the condition, and is on the road to recovery. Yet, even in this type of Schizophrenia, the patient will not really show any interest in life and the activities around him or her. Finally, the last type of Schizophrenia is Schizoaffective Disorder which is characterised by the symptoms of Schizophrenia as well as the symptoms of major mood disorders. When combined, this condition can lead to major complications and complex behavior.

A patient suffering from this condition will need to see a mental health specialist like a psychiatrist or a psychologist on an immediate basis. The treatment will be carried out on a long term basis for the results to start appearing.

Knee replacement can be extremely painful. Previously, opioids or narcotics were administered for pain relief. But excessive addition of opioids is not exactly effective for controlling pain.

Multimodal pain management has become an important part of the perioperative care of patients undergoing total joint replacement. The principle of multimodal therapy is to use interventions that target several different steps of the pain pathway, allowing more effective pain control with fewer side effects. Many different protocols have shown clinical benefit. The goal of this review is to provide a concise overview of the principles and results of multimodal pain management regimens as a practical guide for the management of joint arthroplasty patients.

Multimodal denotes administering two or more than two types of medications that work with different mechanisms. The following are the techniques used:

1. Pre-operative Femoral Nerve Block: Prior to the surgery, a catheter is placed beside the femoral nerve for blocking it. This nerve is located in the upper thigh. Medication is delivered through the catheter for the nerve to be numbed for 24 hours. Thus, pain signals to the brain are blocked. This method reduces the use of narcotics and the consequent side effects.

2. Patient Controlled Analgesia (PCA): This method is also known as ‘Pain Pump’. An intravenous pump is used to administer pain relief medications, such as oxymorphone or morphine, after the surgery. The control button of the machine could be pressed, by the patient for 6 to 10 times per hour. The machine is used for two post-operative days.

3. Oral Medications: The oral medications include Non-Steroidal Anti-Inflammatory drugs or NSAID; such as Celebrex which is similar to aspirin, structurally. Alternatively, acetaminophen, such as Tylenol or its equivalent composition, can also be used.

4. Acetaminophen: It acts on the Central Prostaglandin Synthesis and relieves the patient of pain through multiple mechanisms.

5. Epidural Analgesia: It produces lower pain scores and involves less time for achieving physical therapy goals. However, this is subject to side effects such as dizziness, urinary retention and itchiness.

6. Gabapentinoids: These medications include membrane stabilizers such as Gabapentin and Pregabalin.

The objective of multimodal treatments is to provide quick relief to the patient and immediately so. Earlier the rehabilitation, more successful will be the knee replacement surgery.

What Is Adjustment Disorder
Adjustment disorders are considered to be a group of conditions which usually occur when a person experiences difficulty in coping with the stressful life events. These usually include relationship issues, job issues or the demise of a loved one. The incapacity to adjust to stressful events leads to psychological and sometimes physical symptoms. 

Symptoms of Adjustment Disorder
The psychological and physical symptoms linked with adjustment disorder occur either during or instantly after a stressful event. The disorder only lasts for 6 months but the symptoms might continue if the stressor has not been removed. The symptoms might vary from person to person.

• The psychological symptoms are anxiety, crying, impulsivity, lack of concentration, low or loss of self esteem, feeling hopeless, sad or trapped, and withdrawn attitude along with suicidal tendencies.
• These physical symptoms can include trembling, twitching of the muscles, soreness, body pain, insomnia, indigestion and fatigue.
• Adjustment disorder might display psychological and physical symptoms separately or together.

Types of Adjustment Disorder

There are 6 adjustment disorders and each one of them is associated with different symptoms:
1)  Adjustment disorder with depressed mood: People diagnosed with this suffer from feelings of hopelessness and sadness and are often related with crying. Also, a person might not enjoy the activities which he earlier enjoyed.
2)  Adjustment disorder with anxiety: Symptoms of this are anxiety along with being anxious, overwhelmed, and worried. People with this show less concentration and poor memory. When diagnosed in children it is usually due to the separation anxiety from loved ones and parents.
3)  Adjustment disorder with mixed anxiety and depressed mood: In this both anxiety and depression is experienced.
4)  Adjustment disorder with disturbance of conduct: The symptoms of this disorder are more of the involvement of the behavioral issues like starting a quarrel, reckless driving, destructing property and stealing. Teens suffering from this might become absent from school.
5)  Adjustment disorder with mixed disturbance of emotions and conduct: The symptoms of anxiety, depression, and behavioral issues are observed.
6)   Adjustment disorder unspecified: The people who are diagnosed with this type of disorder usually display symptoms those are not associated with other disorders. They exhibit more of physical symptoms and problems with family and friends or at school and workplace.

Treatment of Adjustment Disorder:
If diagnosed with an adjustment disorder, a person can definitely benefit from treatment. This is usually treated with therapy or medicines or a combination of both.
-  Therapy is the first choice. A  clinical psychologist with professional training in providing psychotherapy/counseling to adjustment disorders and other psychiatric conditions can be helpful.
-  Medication like nonbenzodiazepine anxiolytic, SSRI or SNRI and benzodiazepines might be prescribed for reducing the symptoms of anxiety.

Happiness and sadness are part and parcel of life. Some things make us smile while others make us cry. While life is full of mixed emotions, being persistently sad could be a sign of depression. It is a clinical condition that needs treatment just like a fever or any other sickness.

Depression is a common mental ailment that can affect children and adults of both sexes. This is characterized by a feeling of sadness, worthless and helplessness that lasts for more than 2 weeks. Other symptoms of depression include:

1. Loss of interest in events and activities
2. Social withdrawal
3. Outbursts of irritation and frustration over small matters
4. Sleep disturbances
5. Tiredness
6. Loss of appetite
7. Unexplained weight gain or weight loss
8. Shorter attention span
9. Unexplained headaches or backaches

Though the exact cause of depression is still unknown, there are many factors that could trigger depression:

1. Fluctuating hormones: This is a very common cause of depression. This may occur during pregnancy or after delivery.
2. Thyroid problems and menopause: People with thyroid issues and women going through menopause often face the problem of depression. In some cases, a change in how neurotransmitters behave inside the brain could cause depression.
3. Genetics: It has been observed that 40% of depression cases have a genetic link. People with close relatives who suffer from depression may also suffer from the same condition.
4. Traumatic events: People who have a traumatic past such as a history of physical or sexual abuse, the death of a loved one or a difficult relationship could also trigger depression.
5. Alcohol and substance abuse: Excessive drinking and other substance abuse have been closely linked to depression.
6. Other factors: Depression can begin at any age and men are at a higher risk of suffering from this condition as compared to women. This may be because women often seek help in the early stages of depression.

People with low self-esteem and a pessimistic outlook on life have a high risk of being depressed. Treatment for cancer, heart disease and other such chronic illnesses as well as certain types of medication could also contribute to depression. 

Symptoms of depression vary from one patient to another. Hence, they can be difficult to diagnose in the early stages. Treatment typically includes medication, counselling, group therapy and a change in lifestyle habits. For example, it is imperative for depression patients to step outside their comfort zone and interact with others. For this, they may consider joining a hobby class. Regular exercise is also important as it increases production of serotonin and gives the person an opportunity to get out of the house. When it comes to depression, remember, it is very important for the patient to be supported by family and friends.