Major depression is a psychiatric condition that occurs regardless of events that happen in life, while normally most people would have bereavement after death of a close person.

 Sedation, dependence, respiratory suppression, anterograde amnesia, confusion (especially pronounced in higher doses)

Major depression management: Pharmacotherapy: effective in 50 – 70%.Allow for 6 weeks to take effect, and treat for more than 6 months (SSRI, TCAs, MAOIs) Psychotherapy: psychotherapy combined with an antidepressant is more effective than either treatment alone. Electroconvulsive ( ECCT) Phototherapy: effective for a patient who has a seasonal pattern.

 Good Prognosis:
 Acute onset with obvious precipitating factors, sudden onset, less damage.
 Good premorbid personality has a general role in all psychiatric disorders.
 Mood symptom “depression”, indicates high insight & vice versa.
 Paranoid subtype , Less severe= better insight , more severe= low insight
 Poor Prognosis:
 Insidious onset with no precipitating factors gradual onset more damage

Earlier age of onset
 Family history of schizophrenia
 Hebephrenic & simple schizophrenia

Allow 2 – 6 weeks to take effect and treat for > 6 months.

 Obsessive - compulsive personality characterized mainly by perfectionism

People with this disorder have a persistent fear that they have a serious or life-threatening illness despite few or no symptoms.

Agoraphobia: fear of going out from the home.

Treatment of dementia is a cholinesterase inhibitor (galantamine, donepezil, rivastigmine, and tracing)

Insomnia in patients with heart transplantation and cardiac disease is a common problem. Organic factors, immunodepressant medication (e.g. cyclosporine and steroids) and psychological factors may account for this symptom. For short-time treatment, medication with benzodiazepine hypnotics may be useful such astemazepam, flunitrazepam, triazolam, flurazepam, midazolam, nitrazepam, and quazepam.If the problems of drug dependence and rebound insomnia are taken into consideration, treatment with non-benzodiazepine hypnotics “such as zolpidem, zaleplon zopiclone and eszopiclone” offers more safety and comfort. If insomnia is part of a depressive syndrome, pharmacotherapeutics intervention with anti-depressive sedative medication is required.

dysthymia, involves a chronic low mood lasting 2 years or more in adults, with symptoms such as low energy, poor concentration, low self-esteem, poor appetite or overeating, and sleep disturbances. This condition does not necessarily include the severe functional impairment seen in MDD but is persistent and long-lasting, as in this case.

The patient's symptoms of circumstantiality (excessive and irrelevant detail before finally returning to the main point) and loss of association (inability to connect thoughts logically) directly indicate a defect in the thought process. These features are commonly observed in psychotic disorders such as schizophrenia and other thought disorders.

Bulimia is making eating which means the patient eats a lot then does forced vomiting so there is a loss of acids & electrolytes which leads to hypokalemia & metabolic alkalosis

Sertraline is considered one of the safest SSRIs during pregnancy. It has a better safety profile compared to paroxetine and is effective in preventing relapse of depression. Switching to sertraline ensures the patient's mental health is managed while minimizing risks to the fetus.

Haloperidol is a first-generation (typical) antipsychotic and has a rapid onset of action. It is commonly used in emergency situations for managing acute psychosis or agitation due to its quick therapeutic effects, especially when given as an intramuscular injection.

SSRIs are considered first-line treatment for panic disorder and social anxiety, which seems to be the case here with fear of entering the classroom

Half-life of fluoxetine 1–3 days (acute), 4–6 days (chronic).

Beta-blockers are associated with sexual side effects such as impotence (erectile dysfunction), especially when used in combination with antipsychotic drugs

Beta-adrenergic antagonists are used to treat some physical features of anxiety (palpitation, tremor)
 The indication of antipsychotic drugs:
1) Functional Psychosis :
 Schizophrenia
 Mania
 Schizoaffective disorders
 Schizophreniform disorder
 Brief psychosis
 Delusional disorders
2) Violence, agitation, and excitement
3) Organic Psychosis
 Delirium
 Intoxication with substances
 Dementia
4) Medical uses: e.g. nausea, vomiting, poor appetite.

Buspirone is an anxiolytic medication that is commonly used as an alternative treatment for Generalized Anxiety Disorder (GAD) when SSRIs or SNRIs are not suitable.

Indications
1) Sever depression.
2) Sevre mania
3) Initial it in catatonic schizophrenia until drugs start to work.
Not less than 15-25 sec.
Ultra-short-acting anesthesia & O2 mask are needed during the procedure.
Usually given twice a week.
Total number of treatments 6-12 (to overcome the risk of relapse)
Disadvantages:
1) Expensive
2) Unacceptable to society
3) The patient needs admission
4) High risk or relapse & the patient needs many scions.

Brain tumors often present with diplopia, nausea, and vomiting, particularly if there is increased intracranial pressure.

Psychiatry typical features of aneroxia nervosa where the patient senses that he or she is fat despite being thin. Bulimia is people who vomit what they eat.

Hypochondriasis (now referred to as Illness Anxiety Disorder in DSM-5) is characterized by a preoccupation with the fear of having a serious illness despite reassurances and normal test results

A personal history of depression (before pregnancy, antepartum, or postpartum) is the major risk factor for PPD: one-half of women with PPD have onset of symptoms before or during their pregnancies.
 Other risk factors for PPD include: Marital conflict/ Stressful life events in the previous 12 months/ Lack of perceived social support from family and friends for the pregnancy / Lack of emotional and financial support from the partner / Living without a partner/ Unplanned pregnancy / Having contemplated terminating the current pregnancy / Previous miscarriage/ Family psychiatric history/ A poor relationship with one's mother/ Not breastfeeding/ Unemployment in the mother (no job to return to) or in the head of household/ A lifetime history of depression in the husband or partner/ Child-care-related stressors/ Sick leave during pregnancy related to hyperemesis, uterine irritability, or psychiatric disorder/ High number of visits to prenatal clinic/ A congenitally malformed infant/ Personality factors (high neuroticism and high introversion)/ Personal history of bipolar disorder.

Diagnostic criteria for depression “list of ten depressive symptoms”
 persistent sadness or low mood; and
 loss of interest or pleasure
 Fatigue or low-energy
 At least one of these, most days, most of the time for at least 2 weeks
 Associated symptoms
1) disturbed sleep
2) poor concentration or indecisiveness
3) low self-confidence
4) poor or increased appetite
5) suicidal thoughts or acts
6) agitation or slowing of movements
7) guilt or self-blame
 The 10 symptoms then define the degree of depression and management is based on the particular
degree
 Not depressed (fewer than four symptoms)
 Mild depression (four symptoms)
 Moderate depression (five to six symptoms)
 Severe depression (seven or more symptoms, with or without psychotic symptoms)
Symptoms should be present for a month or more and every symptom should be present for most of
every day

While hypochondriasis (or Illness Anxiety Disorder) is a possible diagnosis, it is more about preoccupation with illness in the absence of substantial physical symptoms. The patient in this case is experiencing physical symptoms (headache, tinnitus, nausea), which leads us more toward Somatic Symptom Disorder, where physical symptoms are present and lead to distress, even though they do not have a medical cause.

The most common cause of sexual dysfunction is psychological disease.
Dysthymic disorder is one of the mood disorders, that has similar symptoms of major depressive disorder, but
less in severity, present for at least 2 years. Symptom-free periods are possible but may not exceed 2
months in 2 years time frame.

Body dysmorphic disorder: persistent preoccupation with an imagined bodily defect, ugliness, or an exaggerated distortion of a minimal existing defect that the patient feels is noticeable to others. Hypochondriasis: intense concern & preoccupation with physical health and/or excessive worry about having a serious physical disease. The preoccupation persists in spite of medical reassurance, & causes social & occupational dysfunction.

Hypochondriasis appears to occur equally in men and women.

Schismatic refers to a family environment where there is severe dysfunction, conflict, and lack of emotional support. This often involves:

• Parental rejection or hostility towards the child.
• High levels of criticism or blame directed at the individual.
• Lack of understanding of the illness and its effects.

 Lithium-induced nephrogenic DI may be effectively managed with the administration of amiloride, a potassium-sparing diuretic often used in conjunction with thiazide or loop diuretics.

Antipsychotic drugs are modestly useful in reducing aggression and psychosis in Alzheimer's patients with behavioral problems.

Alzheimer's dementia: most common cause of dementia. Age and family history are risk factors for AD. Etiology unknown but toxic b-amyloid deposit in brain. Present with amnesia for newly acquired information is usually the first presentation, followed by language deficit, acalculia, depression,agitation, and finally apraxia (inability to perform skilled movement). Diagnosis by exclusion that can be definitive diagnosis only on autopsy: suggested by clinical feature and by progressive cognitive course without substantial motor impairment. MRI & CT may show atrophy, and ventricular enlargement and can rule out other causes. On brain microscopy amyloid plaques and neurofibrillary tangle. Death
usually occurs secondary to aspiration pneumonia.

Alprazolam is recommended for the short-term treatment (2–4 weeks) of severe acute anxiety
 

This is a case of conversion disorder:
 

since he is jaundiced , This is a clue for liver disease

Alzheimer's case

Clozapine is primarily used for treatment-resistant schizophrenia but may also be prescribed off-label for severe depression with psychotic features.

Note: hallucination: False perception for which no external stimuli exist illusion: It is a false perception with an external stimulus.

Or Psychotherapy

The most common cause of excessive daytime sleepiness is poor sleep quality, often due to insomnia. People with insomnia have difficulty initiating or maintaining sleep at night, which leads to insufficient rest and daytime sleepiness.

Narcolepsy is a chronic neurological disorder that affects the brain's ability to control sleep-wake cycles. 

chizoaffective disorder is a mental health condition that is marked by a mix of schizophrenia symptoms, such as hallucinations and delusions, and mood disorder symptoms, such as depression, mania and a milder form of mania called hypomania.

The primary mechanism of OCD drugs is increasing serotonin availability to normalize activity in brain circuits implicated in obsessive thoughts and compulsive behaviors. This helps reduce symptom severity over time.

Acute Psychotic Disorder is a short-term condition often triggered by a major stressor, such as the death of a loved one. Symptoms may include delusions, hallucinations, and bizarre behavior lasting less than a month. The patient typically recovers completely and may have little or no recollection of the episode.

 There was significant optimism when they were first developed and it was thought that they
represented a breakthrough in the treatment of schizophrenia due to having less extra-pyramidal side
effects at therapeutic doses. The extrapyramidal side effect has been the one significant set of side
effects that have led to poor compliance with antipsychotic medication.
The common atypical antipsychotic drugs include risperidone, olanzapine, quetiapine, aripiprazole,
ziprasidone, clozapine, and amisulpride.
Antipsychotic drug side effect for onset: 4 hours: Acute dystonia, 4 days: Akinesia, 4 weeks:
Akathisia, 4 months: Tardive dyskinesia (often permanent).

If zolpidem is in choice it is more accurate.

Elimination of lithium is through renal pathway.

Agoraphobia often develops after a panic attack. Patients avoid situations or places where they fear they might experience another attack or find it difficult to escape or get help. In this case, the fear of returning to the lecture room fits this diagnosis.

 All choices are true.

Chronic Fatigue Syndrome: characterized by profound mental and physical exhaustion. In association with multiple systems and neurotic symptoms that last at least 6 months. Must be new (not life-long), must not be relieved by rest, and must result in a greater than 50% reduction in the previous activity. Presentation with 4 or more of the following: poor memory/concentration, myalgia, arthralgia, sorethroat, tender lymph node, recent onset headache, unrefreshing sleep, excessive tiredness with exercise. Treatment by cognitive and exercise therapy. Also, diet, physiotherapy, dietary supplements& antidepressants.

Dizziness can be a common side effect when starting an antidepressant, particularly SSRIs (Selective Serotonin Reuptake Inhibitors), especially during the first few days of treatment. These symptoms are often transient and resolve as the body adjusts to the medication.