Stye : External Hordeolum

An External hordeolum
Sty



is an acute small staphylococcal abscess of a lash follicle and its associated gland of Zeis or moll.

Signs:
Tender Inflamed swelling in the lid Margin, which points anteriorly thought the skin.
More than one lesion may be present and occasionally minute abscess may involve the entire lid margin.
In severe case a mild preseptal cellulitis may be present.

Treatment:
No treatment is required in most cases because styes frequently resove spontaneously or discharge anteriorly
Hot compresses
Epilation
Systemic Antibiotics may be necessary.

Schizophrenia: A short summary

Historical Background: in 1896, Emil Kraepelin differentiated psychiatric illness into 2 major groups.

• Dementia Precox
• Mani depressive illness( psychosis)

Eugen Bleuer's Fundamental Symptoms of Schizophremi: Ambivalence Autism Affective Flattening Association disorder

First Rank symptoms
I. Hallucinations
1. Audible thoughts/thought echo 2. Voices heard arguing 3. Voices giving running commentary II. Thought Alienation Phenomenon a) Thought withdrawal b) Thought insertion c) Thought broadcasting
III. Passivity Phenomenon A. Made feelings B. Made volition C. Made impulses IV. Delusional Perception

Epidemiology; Point prevalence of Schizophrenia is 0.5 to 1 %. The Incidence is about 0.5 in 1000 persons

Clinical features Thought and speech Disorders Autistic thinking, loosening of association, thought blocking, neologism, paraphasias, mutism, perseveration, verbigeration Delusions: primary and secondary Disorders Of Perception Hallucinations Disorders of Affect Disorders of Motor Behaviour Negative Symptoms Suicidal Tendency

Clinical types: Simple Schizophrenia Hebephrenic Schizophrenia Catatonic Schizophrenia Residual Schicophrenia Undifferentiated Schizophrenia Post-schizophrenic depression Others

Bad Prognostic Factors Male Negative Symptoms Early Onset Insidious progression Chronic Course

Diagnostic Criteria: According to DSM IV TR 2 or more of the following is required with 6 months of duration of disease with at least 1 month of Active symptoms 1. Delusion Hallucinations Bizzare Behaviour Bizzare thoughts

MANAGEMENT: 1. Pharmacological Treatment: Generally the treatment is continued for 6 months to 1 year for the first episode, for 1-2 year for subsequent episodes. Fluphenazine 25-30 mg IM every 2-3 weeks Penfluridol Flupenthixol Haloperidol ECT ( Electroconvulsive Therapy) Miscellaneous Treatments Limbic Leucotomy Psychosocial Treatment.

Organic Metal Disorders and Delirium

Organic Mental Disorders are behavioral or psychological disorders associated with permanent or transient brain dysfunction and include only those mental and behavioral disorders that are due to demonstrable cerebral disease or disorders, either primary or secondary. Sub Categories of Organic Mental Disorders: OMD are

• Delirium
• Dementia
• Organic Amnestic Syndrome
• Other organic mental disorders

Delirium:
commonest type
synonyms: Acute Confusional state, acute brain syndrome, acute organic reaction, toxic psychosis, metabolic encephalopathy.

Clinical Features:
1. A relative Acute Onset
2. Clouding of Consciousness
3.Disorientation to time place and person.
other: Disturbed sleep-wake sleep cycle
sun downing( aggravated in the evening and night)
Motor disturbances- asterixis,Carphologia. etc
Psychomotor disturbances

Diagnosis:
According to ICD10
Symptoms should be present in each one area:
1. Impairment of attention and consciousness
2.Global disturbance of cognition
3. Psychomotor disturances
4.Disturbed slepp wake sleep cycle
5. Emotional disturbances.

Important causes of Delirium are:

1. Metabolic causes: hypoxia, narcosis,hypoglycemia, CCF, Metabolic acidosis or alkalosis, fever , anemia, shock.
2. Endocrine : Hypo/hyper thyroid,adrenal,pituitary and parathyroid.
3. Drug: Digitalis, quinidine, alcohol, anti hypertensives, sedatives,barbiturates,TCA, Antipsychotics.
4. Nutritional deficiency: Thiamin, Niacin, Pyridoxine, folic acid, B12
5. Systemic Infections.
6. Intracranial causes: Epilepsy, tumors, migraine, head injury, infections
7. post operative

Management of Delirium:
Ix: CBC, BGA, Sugar level, po2 and co2, TFT, serum b1 and foalte, toxic screen, csf, etc
Identificaton of the cause and its immediate correction.
Symptomatic measures
Supportive medical and nursing ccare.