) Poor toilet training. Clinical features -Enuresis may be nocturnal, diurnal or both. It is termed primary if there has been no preceding period of u

of any physical disorder Etiology - (a) Genetic factors - are thought to act through a delayed maturation of parts of the nervous system. (b) Smaller capacity of urinary bladder. (c) Environmental stresses - Enuresis sometimes starts after stressful event, such as birth of a younger sibling, conflict between parents, problems in school, etc. (d) Poor toilet training. Clinical features -Enuresis may be nocturnal, diurnal or both. It is termed primary if there has been no preceding period of urinary continence for at least one year, or secondary if there has been a preceding period of urinary continence for this duration. Treatment - (a) Counselling of parents about nature of the disorder, and about toilet training. (b) Bladder training by which the child is encouraged to increase the interval between successive acts of micturition (c) Imipramine or amitryptiline 25-50 mg at night, may be effective. FUNCTIONAL ENCOPRESIS - is defined as the involuntary passing of faeces into clothing after the age of which bowel control is usual and in absence of a known organic cause. Etiology - (a) Poor toilet training. (b) Mental retardation. (c) Environmental stress - Involuntary voiding follows stressful situation, such as birth of a younger sibling, confict between parents, illness of a parent. Clinical features - Involuntary passing of stools of normal or near-normal consistency into clothing, or in places not appropriate for that purpose in the child's socio-cultural setting. Encopresis like enuresis could be present from birth (primary), or could appear after a sustained period of continence (secondary). Treatment - (a) Counselling regarding faulty toilet training. (b) Behaviour therapy by which the child is encouraged to remain continent. 10. DRUG INDUCED PSYCHIATRIC DISORDERS Classification: 1. Behavioural toxicity (a) Drowsiness - Benzodiazepines, neuroleptics, antihistaminics, antidepress ants, antihypertensives. (b) Behavioural changes - consisting of irritability, aggressive outbursts and a generalised hostile attitude Benzodiazapines, barbiturates, levodopa, neuroleptic drugs, alcohol, drug-withdrawal states. Some tricyclic ant i depress ants, selective serotonin uptake inhibitors. 2. Delirium (Acute organic psychosis) (a) Cardiovascular drugs - Digitalis, diuretics, propranolol, pindolol, oxprenolol. (b) Anticholinergic drugs - atropine, homatropine, scopolamine, antiparkinsonian drugs, tricyclic ant i depress ants. (c) Tranquillizers and hypnotics - barbiturates, benzodiazepines, ant i depress ants, phenothiazines, bromides. (d) Antituberculous drugs - Isoniazid, rifampicin, cycloserine. (e) Anticonvulsants - Phenytoin, sodium valproate. (f) Miscellaneous drugs - Corticosteroids, insulin, disulfiram, cimetidine, chloroquine, aminophylline, oral hypoglycemic agents. (h) Drug withdrawal -Barbiturates, benzdiazepines, chlormethiazole, dextropropoxyphene, alcohol, opiates, phencyclidine. 3. Affective states - (i) Depression - (a) Ant i hypertensive agents - reserpine, alpha methyl dopa, clonidine, propranolol, pindolol (b) Corticosteroids (c) Psycho-active drugs - phenothiazines, neuroleptics, benzodiazepines. (d) Anti-parkinsonian agents - Levodopa. (e) Analgesics -Indomethacin, pentazocine. (f) Hormones - Oestrogens, oral contraceptives. (g) After withdrawal of CNS stimulants -amphetamines, cocaine. (h) Miscellaneous drugs - Ethanol, antineoplastic agents, disulfiram, tetrabonazine, phenytoin, phenobarbitone, theophylline, digoxin, danazol, cimetidine, chloroquine, cycloserine. (ii) Elation - (a) Ant i depress ants. (b) Corticosteroids. (c) Anti-parkinsonian agents - benzhexol, procyclidine, levodopa, bromocriptine (d) CNS stimulants -amphetamines, cocaine, methylphenidate. (e) Miscellaneous - Isoniazid, aminophylline, cyclizine, yohimbine, salbutamol, clonidine withdrawal. 4. Psychotic states - (a) Hallucinogens - LSD, cannabis, phencyclidine. (b) CNS stimulants - Cocaine, amphetamines. (c) Appetite suppressants - Phenmetrazine. (d) Sympathomimetics - Ephedrine, pseudoephedrine, phenylephrine. (e) Alpha-adrenergic agonists - phenylpropanaloamine. (f) Beta-adrenergic agonists - Salbutamol. (g) Beta-adrenergic antagonists - Propranolol, oxprenolol. (h) Dopaminergic drugs - Levodopa, dopamine, bromocriptine. (i) Narcotic analgesics - Pentazocine. (j) Corticosteroids (k) Nonsteroidal ant i-inflammatory agents - Indomethacin. (1) Ant i-de press ant drugs (m) Anticholinergic drugs (n) Miscellaneous - Disulfiram, anti-tuberculosis drugs, cimetidine, ant i-hist ami nics, digoxin. methyldopa, phenytoin. 5. Pseudodementia - Benzodiazapines and barbiturates, major tranquillizers, anti- hypertensive, diuretics, antiparkinsonian drugs and digoxin in the elderly, and overdose of antiepileptic drugs in some epileptics. Chronic hypoglycemia due to oral hypoglycemic drugs or insulin. 6. Neuropsychiatric states - Combinations of psychiatric and neurological symptoms and signs. Phenytoin can -induce a paranoid hallucinatory psychosis or delirium with cerebellar signs and symptoms. Neuroleptics can produce extra-pyramidal reactions like akathisia, pseudo-parkinsonism, acute dystonias and tardive dyskinesia. 11. TREATMENT METHODS IN PSYCHIATRY Broadly these can be divided into two main groups: A. Physical methods of treatment - (I) Drug therapy -Psychotropic drugs can be classified as follows - (1) ANTIPSYCHOTIC DRUGS - (a) Mechanism of action - is postulated to be