Ajai R. Singh MD

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Psychiatric Referral Ready Reckoner

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Psychiatric Referral Ready Reckoner

As a ready reckoner for you, here is a list of the common symptom complexes and disease entities of a psychological nature where psychiatric treatment can help.

Childhood

1. Feeding problems, Food Fads, Perverted Appetite, Diminished Appetite without organic cause.

2. Bedwetting, over the age of three years.

3. Temper Tantrums: repeated uncontrolled outbursts of kicking, screaming, breath-holding etc.

4. Hyperkinetic behaviour (Also called ADHD, that is, Attention Deficit Hyperactivity Disorder): Short attention span, easy distractibility, and over activity.

5. Stammering

6. School phobia, and refusal to go to school.

7. Scholastic backwardness

8. Habitual lying, Stealing, Gambling, Running away from home or school, Obsessive Masturbation

9. Excessive day dreaming

10. Mental handicap (retardation), psychosocial complications of.

11. Epilepsy, various types, and its psychological and behavioural manifestations.

12. Recurrent headaches and /or pain in abdomen without organic cause.

13. Hysterical fits, blindness, aphonia (inability to speak), astasia abasia (inability to walk properly) etc.

14. Childhood autism.

15. Childhood schizophrenia

16. Childhood depression.

17. Examination anxiety, fear of performance before others on stage etc., developing pain in abdomen, fever, loose motions etc typically before exams.

18. Avoiding meeting new people, clinging to parents.

19. Fighting with siblings, bullying others, habitual indiscipline, frequent complaints from school about improper behaviour with peers, teachers etc.

20. Involvement with gangs, drugs, fights, antisocial activities.

 

Adolescence

 

  1. Sex anxiety, fear of loss of manhood due to spermatorrhoea (passing semen in urine), guilt associated with masturbation, premarital sex, nocturnal emissions etc
  2. Excessive withdrawal, day dreaming, problems with self identity (Who am I? Why this life? What is the purpose of living? Etc.)
  3. Generation gap and interpersonal stress, inability to get along with parents, authority figures and seniors etc.
  4. Juvenile delinquency – running away, crime, and gang involvement, habitually irresponsible and anti-social conduct.
  5. Schizophrenia. Abnormal behaviour, aggressive/assaultive behaviour, talking or laughing/crying to self, excessive mirror gazing and talking to self in mirror, gesturing to self, adopting and retaining abnormal postures for prolonged periods of time, excessive suspiciousness (paranoid delusions), hearing of voices (hallucinations), neglect of personal hygiene, withdrawal from interaction etc. Schizophrenia typically starts in Adolescence.
  6. Other disorders as in adulthood.

 

Adulthood

 

  1. Hypochondriasis: Preoccupation with bodily functions.
  2. Anxiety Neurosis:  Palpitations, Tremulousness, Apprehensiveness, Sweating of palms and soles
  3. Phobic Neurosis: Irrational fears of objects, situations or animals e.g. fear of heights, plane travel, closed spaces (like lifts, closed room), open areas, spiders, cockroaches, meeting people, strangers, speaking in public etc.
  4. Obsessions and Compulsions: Repetitive thoughts, impulses, and actions to think/act in a ritualized manner e.g. repeated hand washing and bathing, checking and rechecking of locks and doors, counting of steps, perfect in dress, language, work and behaviour to an extent that one cannot carry it out, or becomes a nuisance to others.
  5. Neurasthenia: Chronic fatigue and feeling of weakness
  6. Hysteria: Paralysis, tremors of hands and feet, anaesthesia, blindness, aphonia (inability to speak), fits, fainting, loss of memory, dual personality, etc. of a functional nature (that is, without any organic deficit responsible for it).
  7. Malingering: Acting out the sick role for personal gains, compensation, continue to remain in hospital, etc.
  8. Depression: Sadness of Mood, Psychomotor retardation (Slowing down of thought and action), Poverty of ideas, Crying spells, Suicidal thoughts and behaviour, Thought that life is not worth living, feeling of helplessness and hopelessness, pathological grief reaction (extending beyond six months) etc.
  9. Mania: Elated mood, grandiose ideas, reckless behaviour (overspending, reckless investments, increased sexual appetite and casual liaisons etc.), lack of sleep, highly increased appetite, great over activity, great irritability- coming in an episodic form.
  10.  Manic Depressive Psychosis: When Manic and Depressive symptom described above come in repeated cycles, one after the other (mania>depression>mania>depression etc.), or repeat of the same sickness (depression>depression>depression; or mania>mania>mania) etc.
  11. Schizophrenia: Major disturbance of thought, behaviour and will, excessiveness suspiciousness (fear that people are after him, police is chasing him, T.V news reader has some special communication for him, thoughts are implanted/ withdrawn from his mind, thoughts are known by others even without his telling them), withdrawal from contact with others (not going out of a room, not meeting anyone, neglect of personal hygiene: not bathing for days, growing an unkept beard, wearing the same soiled clothes for days), talking and laughing/crying to self, mirror gazing and laughing, holding the body in abnormal postures for hours, gradual deterioration of self starting from adolescence and progressing insidiously to lead to academic/professional  incompetence and loss of touch with reality.
  12. Psychosis: Schizophrenia, Manic Depressive, Mania, And Major Depression. Also Drug induced psychosis (steroids, cannabis, LSD, cocaine etc), Alcoholic (Delirium tremens following alcohol withdrawal, or during intercurrent sickness), Post-partum (following delivery), Organic Brain Syndrome (following structural disorder in the brain resulting in memory loss, disorientation to time, place person, incontinence-lack of control over bowel and bladder functions, epileptic fits etc.
  13. Personality Disorders: Lifelong inadequacy, Passively expressed aggression (self hurt in behaviour and thought, sulking, stopping communication with one or more for days together), Excessive emotional display, Histrionic and attention seeking behaviour, Antisocial behaviour, Habitual irresponsibility and aggression towards authority, Proneness to sudden violent outbursts which are regretted later, Habitual suspiciousness of the motives of others, Pessimistic outlook towards everything.
  14. Drug Addiction: Morphine, Pethidine, LSD, Charas, Ganja, Bhang (All forms of Marijuana), Barbiturates, Tranquillizers, Alcohol.
  15. Alcohol: Alcohol dependence (increase in drink quota, daytime drinking, blackouts after drinks, abusive assaultive behaviour after drinks, amnesia for what one talks or does after drinks, neglect of work, family, relationships due to preoccupation with drink and its procurement), Delirium Tremens (delirious, tremulous, hallucinating, terrorized, sleepless alcoholic due to stoppage of drink, or infection or unexplained reasons), Episodic excessive drinking, Alcohol induced Psychosis (suspiciousness, especially of spouse, hallucinations etc), Korsakoff’s Psychosis, Wernicke’s Encephalopathy.
  16. Sexual disturbances: Impotence, Premature Ejaculation, Frigidity (absence of sexual desire in female), Vaginismus (muscles around the vagina, including sometimes thighs, involuntarily closing shut to prevent penile entry), Dyspareunia (painful intercourse), Unconsummated Marriage, Egodystonic Homosexuality (person does not want to yet carries out homosexual acts; ambivalence about sexual identity), Transexuality (strong belief in a anatomical male that he is a female, or vice versa), Incest etc.
  17. Psychosomatic Disorders: Psychosocial factors in Obesity, Neurodermatitis, Peptic Ulcer, Tension Headache, Bronchial Asthma, Hyperventilation, Accident Proneness, Essential Hypertension (Blood pressure of unknown cause), Chorea, Coronary Artery Disease, Angina and Myocardial Infarction.
  18. Epilepsy, and psychological disturbance in patient, and family, due to epilepsy.
  19. Pregnancy and Childbirth: Fear of pregnancy, of childbirth, Post-partum (after child birth) Psychosis and Depression, Habitual abortion due to or following emotional disturbance, failure to conceive due to or following emotional disturbance.

 

 

Middle Age

 

 

  1. Depression in Middle age (Involutional Depression or Melancholia), Paranoid Psychosis (Involutional Psychosis) – Depression and Paranoid psychosis starting for the first time in middle age.
  2. Menopausal Distress, problems with femininity and attractiveness following stoppage of the menstrual cycle.
  3. Other disorders, as in Adulthood.
  4. Extramarital liaison, 7 year itch, fear of, or actual, loss of sexual prowess.
  5. Retirement blues, professional burnouts, “Empty nest syndrome”
  6. Interpersonal stress – with spouse, young or adolescent children, daughter-in-law, employer/employees, etc.
  7. Psychological distress associated with debilitating or crippling illness, with metabolic, cardiovascular, cardio respiratory and chronic gastrointestinal upsets which commonly tend to start in middle age.
  8. Grief on loss of life partner, or young son/daughter.
  9. Coping with chronic illness (e.g. cancer) in spouse or self.

 

 

Old Age

 

 

  1. Diminishing memory and intelligence
  2. Lack of moral and ethical standards (induced due to brain disease)
  3. Psychotic behaviour, lack of personal hygiene, suspicious and hallucinating, restless and sleepless.
  4. Suicidal behaviour, social isolation, loneliness due to loss of spouse and/or uncaring children.
  5. Depression and agitation (Agitated Depression)
  6. Pathological Grief Reaction following loss of spouse or near and dear one.
  7. Psychological disturbance associated with infirmity, chronic metabolic/respiratory/neurological sickness, loss of mobility, lack of social interaction, lack of friends, no one to talk to or listening, lack of opportunities to make productive use of time etc.
  8. Anxiety and depression, fear of death etc. on hearing of death of people of same age.
  9. Embarrassment due to lack of bowel/bladder control, being a burden on others, loss of vision and hearing, financial insecurity, lack of funds, taunts/criticisms of near and dear ones.
  10. Depression due to chronic debilitating illness, which imposes great burden on care givers.

 

 

 

                                                                        Dr. Ajai R. Singh

                                                                                 M.D.                                      

 

 

Ajai R. Singh M.D.
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