Paranoia Revisited

Paranoia is derived from the Greek word ‘para’ (besides) and ‘nous’(mind) and was used in ancient Greek literature to mean ‘out of mind’, i.e. of unsound mind or insane. This broad usage was revived in the eighteenth century. The word Paranoia, from which the modern adjective paranoid derived,  has a long and chequered history as old as the term Psychiatry is.
The first stage in the development of its use in modern psychiatry can best be dated to 1818 when Heinroth described delusional states as ‘disorders of intellect’ (Verrucktheit) not fundamentally involving the other faculties of the mind, feeling and will, although they recognized that some admixture was usually present...

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OPIOIDS

Opium , derived from the ripe seed capsule of the opium poppy (Papaver somniferum), has been used for its analgesic and euphoriant effects since antiquity, with Sumerian ideograms of about 4000 BC referring to the poppy as the ‘plant of joy'.
In the developed countries the opioid drug most frequently associated with abuse and dependence is heroin. Virtually all the opioid dependence and abuse seen clinically is associated with prototypical m-agonist opioids.

Obsessive Compulsive Spectrum Disorders

Ms A, a 34-year old, single white woman presented with a chief complaint of “I’m obsessed, and I have lots of compulsive behaviors.” Since age 15, she had been preoccupied with her nose, which she thought was huge, hideous, and horrendous looking.” Because of this concern, she sometimes missed school, avoided friends, and felt suicidal. She stated at times, she realized that her view of her appearance was “probably distorted,” but at other times, especially when she was around other people, she was “absolutely, 100% convinced” that her belief was correct. Ms A was also excessively concerned about germs. She washed her hands up to 50 times a day and avoided activities that she thought might lead to contamination. In addition, she reported a history of hair pulling, which in her 20’s had resulted in noticeable hair loss. The patient’s family history was notable for Tourette’s disorder in a brother.

Non-Alzheimer’s Dementia: An Update

Dementia is a common neurodegenerative disorder involving as many as 10% of those over age 65 and substantially shortens life expectancy. The prevalence of dementia in developed countries under the age of 60 years is very low (0.3–0.7%) and increases almost exponentially with age to 42-68% in those older than 95 years (Fratiglioni et al., 2000). The incidence of dementia is about 0.1% in persons aged 60-65 years and increases to 9% in the population older than 95 years (Fratiglioni et al., 2000). Although Alzheimer’s disease (AD) is the commonest type of dementia, several other types of dementias have been described which are collectively referred to as non-Alzheimer’s disease (non-AD) dementias (Table 1). AD, because of its prevalence, has become the prototypical dementia to which all other dementias are compared. However, in the past two decades, remarkable progress in the fields of molecular genetics, biochemistry, and biophysics have permitted better distinction of the ‘other’ dementias from AD and more refined discrimination among these non-AD dementias.

Newer Antiepileptics: A Review

In many patients with epilepsy, seizures can be controlled with the established antiepilepstic drugs (Brodie et al., 1996) but 25-30% of patients continue to have seizures despite optional therapy, and other have unacceptable side effects.  Thus there is clearly a need for additional drugs as well as formant.  Strategies for preventing epilepsy.  Mechanisms is that underline seizure processes constitute potential target areas for the development of new AEDS. New antiepileptics drugs (AEDS) are being developed using two complimentary strategies.  Animal models that roughly mania human used to serene new compounds for antiseizure activity.  Alternatively, new drugs are being developed with specific cellular or molecular targets believed to be important in seizure generation.

Newer Antidepressants

Depressive disorders afflict at least 20% of women and 12% of men at some time during their lives. By the year 2020 the global burden of depression is projected to rank second only to that of ischaemic heart disease (Murray et al. 1997). However, When correctly diagnosed and aggressively managed, depression is a highly treatable disease (Angst, 1992; Burvill, 1995; Cohen & Guthrie, 1997). Pharmacotherapy represents a first line option in the management of major depressive illness (Evais et al. 1997; Brugha & Bebbington, 1992. Hence, antidepressant drugs have become an indispensable tool in modem medicine.

Neuroleptic Malignant Syndrome

Neuroleptic malignant syndrome (NMS) is a life threatening condition. A drop in its incidence as well as mortality has been attributed to increased awareness among the clinicians, early diagnosis and prompt treatment. Central dopamine blockade is considered to play the major role in pathogenesis, though a primary role of sympathoadrenal hyperactivity has also been described, along with various other theories including genetic theories. Apart from conventional neuroleptics, atypical antipsychotics, few antidepressants and many other medications have been considered to be the risk factors for NMS. Hyperthermia, altered mental status, rigidity and autonomic instability are the main clinical symptoms. It is often complicated by renal and respiratory failure. Supportive care is of utmost importance in its management, but bromocriptine, amantadine and dantrolene have been seen to hasten recovery.