Question

Case report: Major Depression: Mrs. Carr, a 58 year old widow, was brought to the emergency department by her daughter who found her in bed in the middle of the day. For a period of months, Mrs. Carr had become increasingly withdrawn and without any precipitating events. She had become progressively less active and even required encouragement to eat and perform her daily tasks. Her daughter and son-in-law became alarmed but did not know what to do. Mrs. Carr's medical history was unremarkable, but her psychiatric history revealed an episode of postpartum depression after the birth of one of her children On examination, the ER physician noted that Mrs. Carr was withdrawn and negativistic, refusing to cooperate with the examination, and even refusing to open her mouth. There were signs of acute dehydration and decline in personal hygiene and grooming. Further questioning of her daughter revealed that Mrs. Carr had become increasingly paranoid and had delusions of sinfulness and guilt. Recently, she had shown signs of increasing mutism

Answer 1

1) Postpartum depression

Depression that occurs after childbirth. It is severe and long lasting. Its sometimes a complication of giving birth. Occur within first few weeks after giving birth and may last up to a year.Its symptoms are : depressed mood, excessive crying, difficulty bonding with baby, withdrawing from family, loss of appetite or eating more, inability to sleep or sleeping too much, fatigue, reduced interest, irritability and anger, fear of not being a good mother, feeling of guilt, recurrent thoughts of death.It can be managed by antidepressants, counseling, caring and loving.

2) Negativism is a behavior characterized by tendency to resist direction from others, and refusal to comply with requests..Negativistic is the habit of being skeptical, pessimistic towards suggestions or views of others.It is a behavior characterized by persistent refusal without reason, to carry out orders from others.

3) Acute dehydration

It is the depletion of body water and electrolytes, can occur with decreased fluid intake ,increased fluid loss like vomiting or diarrhea, or fluid shifts due to burns or ascites. When body doesn't have enough fluid to carry out normal functions or when fluid lost is not replaced dehydration occurs.Dehydration shows symptoms like dry mouth, eyes stop making tears, muscle cramps, dry skin, sunken eyes, very dark yellow pee or not urinating, sweating may stop, heart palpitations, weakness. Untreated dehydration can lead to hypovolemic shock ,damage to organs like kidney,liver and brain and even death may occur.Dehydration must be treated by replenishing fluid level in body by consuming clear fluids,intravenous fluid administration.

4) Paranoid condition is a personality disorder in which one exhibits odd or eccentric ways of thinking.It involves anxious or fearful feelings and thoughts related to persecution, threat or conspiracy, doubting loyalty of others, becoming detached, having difficulty to work with others, hypersensitive to criticism. Drug abuse, psychological dysfunction cause paranoid state.No complete cure for paranoid but treatment can help person to deal with symptoms and live a more happier life.

5) Deluison is rigid system of belief with which a person is preoccupied and to which person firmly holds,despite logical absurdity and lack of evidence. Occurs due to neurological problem or mental illness, substance abuse.A person with delusion may be high functional in daily life.It is difficult to treat and use of antipsychotics, mood stabilizers medication are done.

6) Mutism is an anxiety disorder in which a person who is normally capable of speech cannot speak in specific situations .It occur due to neurogenic causes like surgery, brain trauma, mental I'll ess,seizures,or occur due to stress ,sudden life changes or feeling threatened. It is treated by behavioral strategies and cognitive behavioral therapy reducing anxiety.

7) Antipsychotics are drugs known as major tranquilizers used for managing psychotic conditions in schizophrenia and bipolar disorder. It is effective in reducing symptoms of psychosis in a short time. Commonly used drugs are haldol, l'occitane, serentil, navame etc.

8) Anti depressants are drugs that help relieve symptoms of depression, social anxiety.Alsomused in OCD, post traumatic stress disorder. They work by increasing neurotransmitters level like serotonin , noradrenaline which are linked to mood and emotions. Main types of antidepressants are selective serotonin reuptake inhibitors like sertraline. Serotonin and norepinephrine reuptake inhibitors like venlafaxine and norepinephrine and dopamine reuptake inhibitors like bupropion.

9) Electroconvulsive therapy or shock therapy where seizure are electrically induced in patients to provide relief from mental disorders.