COnference:

High acitviation of amyg. will emeit fear which will be radiated to other s brain
area-> VMPC
--------------------------------

Biological attributes of BAD & Demenria:

Dr. Colm Mcdonald:
Brain dysconnectivity in BAD:
--> GM increassed in pt. when proporation using Li increased **
] look for the article: Meta analysis Databases meta regression 98pt structial
imaging studies of B.A.D
Keep in mind about the heterogenity of the data ' also the clinical pic. and medic.
esponse ' Also genetics
****Galway Biplar Disorder Study*** 50 Euth v.s Normal control
--Structual MRI BAD : intrenaltional collaborative Mega-analyis of individual
aadult pt. data 'Biol Psych 2011'
---Enlarged rt. late. vent + lft. Temp.***
---ENIGMA Meta Analysis of B.A.D*** ' Molec.Psych 2016
--look at Wise et al Biol Psych 2016 ' DTI Meta analysis B.A.D'
**** Neurobiological trait abn. in B.A.D ' REview by the speaker '
'Efficient networks properties' --low energy, transmission?

-GM changes oculd be reveresed by Li

-WM abnormality might be a triat abn. in BAD [Disorg.Long.Commiss.Antt limbic' -->
even in Euthymics
-Impairedd segregation and integration of the neuroanatomical networks ' not
efficient networks in comprison to healthy ocntrol even in euthymic states '
***Good Question from Dr. Zirak: does the change and decrease of Hippocamplus make
B.A.D more labile to develop Alz. disease? the answer was ' it's a differet
pathology, and the shrunking vol. in B.A.D is not the same as it happens with Alz.

--------------------------------------------------------

-Multi-morbidity in Dementia 'Sube Banerjee '

GCC has low # of Dementia case ' young soc.
- Although elders suffer form multipe cause of pain, they recieve less pain-relief.
agents tha others, because they ' ask less for it in comapred to other population '
-->Demen./Express it in the form
of Agitation -->will recieve PRNs>Analgesia

Most common 3 Behavioral symptoms in Patients with Dementia : 1:Apathy 2: Agitation

3: Anxiety
Deprssion + Dementia response to ttt with Anti-Depress --> Similar to placebo????
in comparison to ttt of Depress. alone? and the same wiht psychosis ttt? ' IS it
pharmacokinetic or dusnamic????

The management role in Dementia care :

ttt of (condition1 +Condition 2 + Condition 3) =X tt of Cond 1 + tttX of Cond2 +
tttX of Cond 3

-the reasn why dement --> Delerium ' less cogntivie reserve *** '

-----------------------------------------------------------
Autism v.s Speech delay:
How to pick up early cases of autism:
6 months motor till 1.5 years social abilities' -->3years ' receptive expressive
language '3 words ' after that -->Cognitive abilities ' academic acheivements
3 yrs draw a circle
4 yrs Square
5 yrs Ttriangle

--Neurdevleopmental disorder ' DSM5' starts with defects in these dev. abilities
-Autism -->Communication skills eye ocntact, social smile, response to name,
gestures, ***shared joint attnetion, ***pointing , imitation, showing, giving
Speech delay-->social skills good no normlaity
ASD: speech xxx + ' and even if they have verbal abilities, they will not be able
to use it in a normal way ' Ecolalia ' ' whats' your name -- will answer: what's
your name '.
GDD global devleopmental delay ' starts since the beginnning '.
Joint attention: XXX -> deficit in developing , maintaining , understanding social
relationships
-Some cases of speech delaymight show features of autistic spectrums
***Autistic odd patterjs of behavior, interest, activity:
insensitivity to pain, tiptoe walking, side vision, **inappropriate laughing or
crying

***abilities to focus on
1) independent in daily life abilities : eat , drink.
Preverbal communication:
2) improving some social skills
M-CHAT & CHAT ' checklist for autism in toddlers' could be used by parents
**Joint attention:
testing joint attention at 18 months: Does he/she look? whan sees somehting
attractive to him, does he invite you to this? Does he look at x when you point to
something? **PATHOGNOMONIC
does he use imitation ' ASD have difficulty doing such skills '

------------------------------------------------------------
*** Memory clinic v.s. traditional community psych service:
memory clinics were first introduced in 1980s 'Ass. with stigma, but less than
psych '
------------------------------------------------------------
2nd Day:
Quality of life & care in Dementia: Dr. Banerjee.
3 good reason to be chearful in Dementia care:
1: We know so mcuh more about dementia 2: the increased prevalence of demen. is due
the sucess in managing and preventing deahths 3: Better prevention measures ' we
can make difference '
ONE DEMENTIA CASE IN EVERY 3 SECONDS IN THE WORLD!!!!
Alz.co.uk/worldreport2015
Chiho ::: Dementia in japanese means ' Stupidity & Idiocy '
Nin-chisho!!! was changed in 2004 by the japanese gov.
----------------------------------------------------------------
The last session:

Update on shcizophrenia 'Coln McDonald'

wow.. the docncept of relating inbetween multi-personality and schizoph.

**TTogo-Shitcho-sho : the disintegration syndrome

psscyhosis susceptibility sund, salience dysregulation syndro , bleuler's synd,
integration synd ' SOME OTHER SUGGESTED NAMES OF SCHIZPH'
***rare denovo mutations ' copy number variants ' 5% of schizoph
*****Non-genetic RF in shcizophrenia: 'OR 1.5-4'
-winter birth? urban birht, perinatal complication 2X, increased maternal age,
intrauternie infections, childhood diversity ' emotional sexual abuse '
immigrations. ***cannabis misuse***
read Howes & Murray , lancet 2014 ***** VIP
Haiima et al Scz Bulletin 2013 the largest Meta-analysis in Schiz. medicated
patients

neuroanatomical abnormalities in Schiz are thoght to be static, but NO it's found

ot be progressive

Read OWen et al Lancet 2016 ' patho-physiology in Scz'

Wykes et al Am J psych 2011 ' meta analysis of non-pharmacological intervenstions
in Schizoph'

-------------------------------------------------------
Dr. N.Shuriquie
ttt resistant depression ' inlcuding Ketamine expeerience in Jordan ':
the goal of treating depression is = recovery: restoration of pre-symptomatic level
of fucntioning
-Augmentation: adding a non-FDA to antidepressant, combination= adding an FDA
antidepressant

Mirta + Venlafaxine = ROCKET FUEL FOR TTT RESISTANT DEPRESSION ' assess for Manic
transformation '
Abilify = FDA approved combination for ttt resis
** PUT IN MIND EFORE AUGMENTING WITH ANTI-PSYCH:
do they prevent relapse? difference in efficacy for effect of augmentation?
**** Ketamine therapy: decerease suicidal thoughts in b.a.d
-this happens with sub-anesthetic doses ' effect lasts for upto 1 week, more
effective than ECT
Al-Rashid Ketamine Study n=73 patients
somatic and melancholic features showed resistance to Ketamine ttt

---------------------------------------------------------
*Psychotic experiences in the general population ' Prof. McGrath of 'Queensland'
is it a psychometric naisance or an informative measure?
attenuate psychosis syndrome?
**JAMA Psych 2015 The epidemiology of psychotic experiences ********
==when cognitive capabilities declines, psychotic phenomena reaches in the
surface / psychotic release phenomena
it occurs with most ' if not all ' the psychiatric problems, inclduing anxiety,
eating disorders
-Are psychotic experiences associated with suicidal ideations???? YES!!!, with a
worrying dose responce
***CONCLUSION: psychotic expereinces are common, have a wide age of onset, they
have a bidrectional relationship with mental disorders
+++with sexual abuse, anxiety