Question: Markedly inappropriate sensitivity, self impoance and suspiciousness are clinical features of


Question: Drug of choice for treatment of Acute withdrawl symptoms of Alcohol include

Chordiazepoxide is Benzodiazepine derivative that acts on GABA receptors & open chloride channels which is used to treat the acute withdrawl symptoms of alcohol.
Naltrexone, Acomprosate, Disulfirm are the drugs used for maintenance of abstinence.


Question: Expression and consequent release of previously repressed emotion is

Abreaction is a process by which repressed material is remembered back, relived again along with expression of associated emotions.
It is a type of Catharasis (purging of emotions) used as therapy in few psychiatric disorders.


Question: Obsessive Compulsive Disorder is NOT associated with

(B) Thought insertion # THOUGHT INSERTION is more commonly associated with shizophrenia.> OBSESSIVE-COMPULSIVE DISORDER (OCD) is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear or worry (obsessions), repetitive behaviors aimed at reducing the associated anxiety (compulsions), or a combination of such obsessions and compulsions.> The acts of those who have OCD may appear paranoid and potentially psychotic.


Question: Thyrotoxicosis is most commonly associated with

(A) Anxiety # ACUTE ANXIETY:# Physical Symptoms:> Motoric Symptoms: Tremors, Restlessness, Muscle twitches, Fearful facial expression> Autonomic & Visceral Symptoms: Palpitation, Tachycardia, Sweating, Flushes, Dyspnea, Hyperventilation, Dry mouth, Frequency and hesitancy of micturition.; Dizziness, Diarrhea, Mydriasis.> Psychic Symptoms: Cognitive Symptoms: Poor concentration, distractibility, Hyperarousal, Vigilance or scanning; Perceptual Symptoms: Derealization, Depersonalization; Affective Symptoms: Diffuse, unpleasant, vague sense of apprehension, Fearfulness, Inability to relax, irritability, Feeling of impending doom (When severe);> Other Symptoms: Insomnia (initial), Exaggerated striate response.


Question: Claustrophobia means

Claustrophobia refers to irrational fear of closed spaces.


Question: Most common phobia is

The phobia is defined as an irrational fear of a specific object, situation or activity, often leading to persistent avoidance of the feared object, situation or activity Types- agoraphobia, social phobia and specific phobia Agoraphobia is an example of irrational fear of situations. It is the commonest type of phobia encountered in clinical practice (Ref: A sho textbook of psychiatry, Niraj Ahuja,7th edition, pg no 92)

Anxiety disorders stress disorders and grief


Question: Cyclothymia is a type of

Persistent mood disorders are characterised by persistent mood symptoms which last for more than 2 years but are not severe enough to be labelled as even hypomania or mild depressive episode. If the symptom consists of persistent inability of mood between mild depression and mild elation, the disorder is called as cyclothymia (Ref: a sho textbook of psychiatry, Niraj Ahuja,7th edition, pg no73)


Question: Most common mental health disorder is

Tourette's disorder(Gilles de la Tourette) - combined vocal and multiple motor tic disorder. presence of both multiple motor and one or more vocal tics (>1 year) Onset <18 years involuntary, spasmodic, stereotyped movement of small groups of muscles; seen most predominantly in moments of stress or anxiety Ex: Nose twitching, Shoulder shrugging, Sustained eye closure, Tensing of abdominal or limb muscles Etiology- Neurotransmitter dysregulation in basal ganglia, striatum, and frontal lobes. Rx- Haloperidol , pimozide(first line) , Risperidone , olanzapine comorbidity- ADHD, OCD AUTO IMMUNE-PANDAS( Peadiatric Auto immune NeuroPsychiatric disorders assosiated with Streptococcus) Akathisia* Motor restlessness (unpleasant need to move), usually in the lower extremities Ballismus* Intermittent, coarse, large-amplitude, jerking, shaking, flinging movements Chorea* Irregular, spasmodic movements, usually affecting the limbs or face Tic* Non-rhythmic, Stereotyped, rapid, recurring movement, involuntary or semivoluntary, and sudden in onset. TYPES: (motor tic) or vocalization (phonic or vocal tic) Tremor* Unintentional, somewhat rhythmic, muscle movement involving oscillations of one or more pas of the body Stereotypy* Repetitive, usually meaningless, gestures, habits, or automatisms Reference: P 3617: chap 46.Tic Disorders(Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 9th Edition)P 81 DSM-5


Question: Neurofibrillary tangles are deposition of

Neurofibrillary tangles are intraneural depsition of Tau protein in highly phosphary leted form seen in Alzeihmer's disease,Normally tau protein aids microtubutes for axonal transport and hence axonal transport is interupted in Alzheimer's disease.


Question: reinforcrmrnt theory in management of behavioral issues was given by

Behavioral therapy is learning given by BF Skinner , according to him all behaviors are learned phenomenon and thus can be unlearned Positive reinforcement a type of reinforcement when a behavior is rewarded there is more chance that the behavior is repeated Negative reinforcement is that when a behavior is done and an aversive response is removed, the behavior is repeated. When I go and meet my girlfriend, she checks my messages and picks up fight (aversive response) suddenly I delete all messages one day and that day there was no fight (no aversive response) then that behavior is repeated (delete all messages before meeting my girlfriend) Extinction is the type of reinforcement where a behavior is done and a rewarding response is removed the chance is that behavior will not be repeated A child likes to play with children( reward) but when the child fights with other children( undesirable behavior) the child will be removed from playing( removing a reward) , then the child stops fighting with other children( reduction of undesirable behaviour) Ref. kaplon and sadock synopsis, 11 th edition, pg no. 845


Question: Antidepressant drug used in nocturnal eneuresis is

Adverse effects ofTCAs l. Anticholinergic - Dry mouth, bad taste, urinary retention, blurred vision, palpitation, constiPation. 2. Sedation, mental confusion, weakness. 3. Increased appetite and veigfit gain. 4. Sweating andfinc tremer. 5. Decreased seizure threshold (clomipramine, maprotiline & bupropion). 6. Postural hypotension > Marimum by amitripSline - Goodman & Gillman 11/e p. 4j3. 7. Cardiac arrythmia; Maximum by amitriptyline and dosulpin. REF : Oxford text book of psychiatry 3rd Ed.


Question: In alcohol withdrawal delirium drug of choice is

B i.e. ChlordiazepoxideTreatment of alcohol withdrawal delirium:Patients withdrawing from alcohol who exhibit withdrawal phenomena should receive a 25 to 50 mg of chlordiazepoxide every 2 to 4 hours until they seem to be out of danger.Once the delirium appears, 50 to 100 mg of chlordiazepoxide should be given every 4 hours orally, or lorazepam should be given intravenously (IV) if oral medication is not possible.


Question: Irresistable urge to do a thing repeatedly is seen in

Ans. a (Obsessive compulsive disorder). (Ref Harrison, Medicine, 18th/ch. 391)OBSESSIVE-COMPULSIVE DISORDER (OCD)# Definition- is a psychiatric disorder, specifically, an anxiety disorder. OCD is manifested in a variety of forms, but is most commonly characterized by a subject's obsessive (repetitive, distressing, intrusive) thoughts and related compulsions (tasks or rituals) which attempt to neutralize the obsessions.- Characterized by recurrent Obsessions or Compulsions that are recognized by the individual as unreasonable- Undoing = Compulsion "Acts" in Obsessive Compulsive Disorder.- Obsessions: Anxiety-Provoking & Intrusive Thoughts commonly concerning Contamination, Doubt, Guilt, Aggression & Sex- Compulsions: Peculiar Behaviors that reduce Anxiety via Hand-Washing, Organizing, Checking, Counting & Praying# Risk Factors/Etiology- Associated with abnormalities of Serotonin metabolism# Prevalence:- 2% of population.- Occurs at a 1 to 1 male-to-female ratio ***# Onset:- Insidious & occurs during childhood, adolescence or early adulthood# Physical Examination- Chapped hands when hand-washing compulsion is present# Treatment- Pharmacotherapy: SSRI (Fluoxetine or Fluvoxamine) & Clomipramine- Behavioral Psychotherapies: Relaxation Training, Guided Imagery, Exposure,- Response Prevention, Thought Stopping Techniques & Modeling


Question: The common side effect with fluoxetine therapy is

SIDE EFFECTS Paradoxical SUICIDE, this is a type of suicide where an antidepressant used to treat depression and decrease suicide increase the chance of suicidal attempt ( IT'S A PARADOX). The explanation that is given is SSRI initially activates the patient and decreases fatigue, thus patients with low mood and suicidal ideas will have more energy to act on the ideas. GIT- loose stools and ulcer thus it should not be given in an empty stomach SD- delays ejaculation. This mechanism is used for its prescription in patients with premature ejaculation ANXIETY INSOMNIA Ref.Kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 1013


Question: Akinesia and mutism is

Stupor  / semicoma is characterized by akinesia(lack of movement) and mutism(decreased nerbal response).


Question: Physical withdrawl symptoms are absent in patients abusing


Question: Type C personality disorder is

. *ANAKSTIC *Also known as OCPD( obsessive compulsive personality disorder) *Perfectionism *Rigidity *Punctuality * indecisiveness *Conscientiousness *excessive attention to detail *extreme orderliness in one area of life *ANXIOUS (AVOIDANT) PERSONALITY DISORDER *free-floating anxiety * 'born worriers'. *pervasive feelings of terror and apprehension *Unattractive * inferior avoidance of those social situations *DEPENDENT PERSONALITY DISORDER * dependence on other people *lack of self-confidence, initiative and drive *describe themselves as depressed *Needs others to assume responsibility * self pessimism * selfdoubt * self-devaluation.


Question: Confabulation is defect of

Confabulation Unconscious filling of gaps in memory by imagining experiences or events that have no basis in fact. it is commonly seen in amnestic syndromes. it is a charecterstic feuture of Koraskoff's psychosis, a condition that occurs due to thiamine deficiency the charecterstic feuture of confabulation is fluent plausible lying, that is individual is not aware that he lying and filling up the memory gaps but still speaks things in a fluent way and this is a dysfunction of memory Reference: Kaplan & Sadock's synopsis of psychiatry, 11th edition, page 1409.

Symptoms and signs in psychiatry and classification


Question: Most common delusions seen in schizophrenia are

Delusions of persecution are most common delusions in schizophrenia Bizarre delusions may also be seen in schizophrenia Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 398

Schizophrenia and other psychotic disorders


Question: Reinforcement is used in

reinforcement is a method of behavioral therapy there are various types of reinforcement namely positive reinforcement namely positive reinforcement, negative reinforcement and punishment psychonalysis is a type of psychotherapy which was introduced by FREUD Abreaction is one of the impoant step in psychoanalysis hynoanalysis is a technique which is famously called as hypnosis introduced by James Braid. it is a eye fixation ata single point and showing too much concetration on that paicular point and thus dissosiating from the rest of the world. Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 105


Question: Biochemical aetiology of Alzheimer's disease relates to

Alzheimer's disease is the commonest cause of dementia and it is not treatable disorder. Neurochemically there is a marked decrease in the brain choline acetyltransferase (CAT) with a similar decrease in brain acetylcholinesterase(AchE) (Ref: a sho textbook of psychiatry, Niraj Ahuja, 7th edition, pg no.24). The main neurotransmitter implicated in Alzheimer's disease is Acetylcholine.


Question: Rathi, 26 years old female diagnosed to be suffering from depression. Now for the past 2 days had sucidal tendency, thought & ideas. The best treatment is


Question: The drug used in the treatment of cessation of smoking  & tobacco addiction

Vareniciline is a partial agonist at α4 β2 subtype of Nicotine receptor used to treat tobbacco addiction.


Question: Not a selective serotonin reuptake inhibitor

Ans:C-BuspironeBuspirone is in a class of medications called anti-anxiety medications.Buspirone is not related to other anti-anxiety medications, such as benzodiazepines, barbiturates or other sedative/ anxiolytic drugs.It is approved for the treatment of generalized anxiety disorder (GAD).


Question: Delusion is

(Thought) (60- 61- Neeraj Ahuja 6th)* Delusion is a disorder with disturbed content of thought* Hallucination & Illusion are disorders of perception* Delirium & dementia are disorders of cognition* Insight is disturbed in psychosisDELUSION - False belief based on in correct inference about external reality; not consistent with patient's intelligence and cultural back ground that cannot be corrected by reasoning


Question: Neurotransmitter related to schizophrenia pathology isa) Achb) Dopaminec) Serotonind) NA


Question: Most common psychiatry disorder is


Question: Percentage of monozygotic twins with schizophrenia

Monozygotic twin → 46-50%; and Dizygotic twin → 12%.


Question: Token economy is used in the treatment of

Token economy: It is a form of behavior modification designed to increase desirable behavior and decrease undesirable behavior with the use of tokens. Individuals receive tokens immediately after displaying desirable behavior. The tokens are collected and later exchanged for a meaningful object or privilege. The primary goal of a token economy is to increase desirable behavior and decrease undesirable behavior. Often token economies are used in institutional settings (such as psychiatric hospitals or correctional facilities) to manage the behavior of individuals who may be aggressive or unpredictable.

Schizophrenia Spectrum and Other Psychotic Disorders


Question: Not a feature of dementia

Dementia refers to a disease process marked by progressive cognitive impairment in clear consciousness. Reference: Kaplan & Sadock's synopsis of psychiatry, 11th edition, page 704.


Question: Erotomania is seen in

In erotomania, which has also been referred to as de Clerambault syndrome it is also called as psychose passionelle. here the patient has the delusional conviction that another person, usually of higher status, is in love with him or her. Besides being the key symptom in some cases of delusional disorder, it is known to occur in schizophrenia, mood disorder, and other organic disorders. the persons on which the delusions are built are stalked and there is even risk of homicide. Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th edition, Page 336.

Symptoms and signs in psychiatry and classification


Question: Lithium is treatment of choice for


Question: "I am dead" is a form of

(A) Nihilistic delusion # Delusion of control: This is a false belief that another person, group of people, or external force controls one's general thoughts, feelings, impulses, or behavior.> Nihilistic delusion: This is a false belief that one does not exist or has become deceased.> Delusional jealousy (or delusion of infidelity): A person with this delusion falsely believes that a person is lying to them or that a spouse or lover is having an affair, with no proof to back up their claim.> Delusion of guilt or sin (or delusion of self-accusation): This is a false feeling of remorse or guilt of delusional intensity.> Delusion of mind being read: The false belief that other people can know one's thoughts.> Delusion of reference: The person falsely believes that insignificant remarks, events, or objects in one's environment have personal meaning or significance.> Erotomania: A delusion where someone believes another person is in love with them.> Religious delusion: Any delusion with a religious or spiritual content. These may be combined with other delusions, such as grandiose delusions (the belief that the affected person is a god, or chosen to act as a god, for example).> Somatic delusion: A delusion whose content pertains to bodily functioning, bodily sensations, or physical appearance. Usually the false belief is that the body is somehow diseased, abnormal, or changed--for example, infested with parasites.> Delusions of parasitosis (DOP) or delusional parasitosis: a delusion in which one feels infested with an insect, bacteria, mite, spiders, lice, fleas, worms, or other organisms. Affected individuals may also report being repeatedly bitten. In some cases, entomologists are asked to investigate cases of mysterious bites. Sometimes physical manifestations may occur including skin lesions.> Delusion of poverty: The person strongly believes that he is financially incapacitated. Although this type of delusion is less common now, it was particularly widespread in the days before state support.


Question: Not a feature of heroin {smack} withdrawal

Heroin or di-acetyl-morphine is about two times more potent than morphine in injectable form. Apa from the parenteral mode of administration, heroin can also be smoked or 'chased' ( chasing the dragon), often in an impure form (called ' smack' or ' brown sugar' in India). Withdrawal SyndromeThe onset of withdrawal symptoms occurs typically within 12-24 hours, peaks within 24-72 hours, and symptoms usually subside within 7-10 days of the last dose of opioid. The characteristic symptoms include lacrimation, rhinorrhoea, pupillary dilation, sweating, diarrhoea, yawning, tachycardia, mild hypeension, insomnia, raised body temperature, muscle cramps, generalised body ache, severe anxiety, piloerection, nausea, vomiting and anorexia. There are marked individual differences in the presentation of withdrawal symptoms. Heroin withdrawal syndrome is far more severe than the withdrawal syndrome seen with morphine. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 43


Question: Morbid jealousy is most often seen in patients taking

Some Complications of Alcohol Dependence Medical Complications Central Nervous System: i. Peripheral neuropathy ii. Delirium tremens iii. Rum fits (Alcohol withdrawal seizures) iv. Alcoholic hallucinosis v. Alcoholic jealousy vi. Wernicke-Korsakoff psychosis vii. Marchiaa-Bignami disease viii. Alcoholic dementia ix. Suicide x. Cerebellar degeneration xi. Central pontine myelinosis xii. Head injury and fractures. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 39


Question: Treatment of choice for Obsessive compulsive disorder is

(B) Fluoxetine # FLUOXETINE (20-80 mg/day) is a good alternative to clomipramine & often preferred these days for its better side-effect profile in the treatment of Obsessive compulsive disorder.> Clomipramine, fluoxetine, and fluvoxamine are approved for the treatment of OCD.> Clomipramine is a TCA that is often tolerated poorly owing to anticholinergic and sedative side effects at the doses required to treat the illness (150 to 250 mg/d).> Its efficacy in OCD is unrelated to its antidepressant activity.> Fluoxetine (40 to 60 mg/d) and fluvoxamine (100 to 300 mg/d) are as effective as clomipramine and have a more benign side-effect profile.


Question: OCD is characterised by

(D) Onset late adulthood # Obsessive-Compulsive Disorder:> An obsession is defined as an idea, impulse or image which intrudes into conscious awareness repeatedly. It is recognized as one's own idea, impulse or image but is ego-alien (foreign to one's personality). It is recognized as irrationl and absurd (insight is present) Patient tries to resist against it but is unable to Failure to resist leads to marked distress.> Differentiation has to be made from delusion and thought insertion.> A delusion is recognized as one's own idea but is not recognized as ego-alien. It is strongly believed, hence it is never thought to be irrational and is never resisted.> Thought inertion is not thought of as one's own idea, but somebody else's thought being forcibly inerted into one's mind.> An obsession is usually associated with a compulsion carcinoma form of behaviour which usually follows obsessions.

Buspirone is used to augment the therapy


Question: vilazadone is a

SPARI * IMPOANCE antidepressant with anti anxiety propey * MECHANISM serotonin paial agonist and reuptake inhibitor * DRUGS Vilazodone Ref.kaplon and sadock, synopsis of sychiatry, 11 th edition, pg no. 955


Question: EEG waves prominent in occipital lobe is

Stages of Sleep Electrophysiological Criteria Stage Of Sleep 1)Voltage 2) Frequency 1)EOG 2)EMG Wakefulness (eyes closed) 1)Low-voltage2) mixed, Alpha (8-13 Hz) 1)Eye movements, blinks2)High tonic activity, voluntary movements Non Rapid Eye Movement sleep 75 %* Stage I 5 % 1)Low-voltage, 2) mixed, Theta (3-7 Hz)*, veex sharp waves 1)Slow eye movements2)Tonic activity slightly decreased stage II 45 % 1)Low-voltage2) mixed ,K-complexes* sleep spindles * (12-14 Hz bursts) 1) Low tonic activity 2)EOG None Stage III 12 % 1)High-amplitude (75 uV) 2) Slow(delta) waves * (< 2Hz) occupying 20% to 50 % of epoch Stage IV 13% 1)High-amplitude 2) Slow(delta) waves occupy >50% of epoch Rapid Eye Movements sleep 25%* 1)Low-voltage2) Mixed, Saw-tooth waves, theta activity, slow alpha activity 1)Tonic atonia* with phasic twitches 2)Rapid Eye Movements As we proceed from wakefulness to sleep, we see the EEG waves becoming slower (i.e decreasing in frequency), increasing in amplitude, heterogeneous (mixed activity) to homogenous waves. K complexes (negative sharp wave followed by a positive slow wave) EEG wave Frequency Recorded B A Te D Beta 13-30 Hz Parietally, frontally Activation of various areas of the brain Alpha 8-13 Hz Occipitally Wakefulness(eyes closed) Theta 4-8 Hz All areas Sleeping adults, children Delta 0.5-4Hz All areas Sleeping adults, infants Pneumonic BATeD waves in active brain - deep sleep Reference: P.752 24.1 Normal Sleep Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th Edition)


Question: A student unable to deliver speech before audience is suffering from

Social phobia is an example of irrational fear of activities or social interaction, characterised by an irrational fear or social interaction, characterised by an irrational fear of performing activities in the presence of other people or interacting with others. The patient is afraid of his own actions being viewed by others critically, resulting in embarrassment or humiliation. (Ref: a sho textbook of psychiatry, Niraj Ahuja,7th edition, pg no 93)

Anxiety disorders stress disorders and grief


Question: Characteristic Symptom in induced psychotic disorder is

C i.e. Accepting delusions of other person


Question: Blockers are indicated in


Question: Abnormal thought possession is found in

Normally one experience's one's thinking as being one's own, although this sense of personal possession is never in the foreground of one's consciousness. One also has the feeling that one is in control of one's thinking. This loss of control is seen in obsessions. Ref- Fish psychopathology, 3e, pg 36.


Question: Catatonic schizophrenia is associated with

- Catatonic schizophrenia is a type of schizophrenia that includes extremes of behavior.- It includes motor symptoms.- At one end of the extreme the patient cannot speak, move or respond - there is a dramatic reduction in activity where viually all movement stops, as in a catatonic stupor.- At the other end of the extreme they are overexcited or hyperactive, sometimes mimicking sounds (echolalia) or movements (echopraxia) around them - often referred to as catatonic excitement.

Schizophrenia Spectrum and Other Psychotic Disorders


Question: Catastrophic reaction is feature of

Dementia is a chronic organic mental disorder. A catastrophic reaction is seen in dementia when beyond confronted with an assignment which is beyond the residual intellectual capacity, patient may go into a sudden rage. (Ref: a sho textbook of psychiatry, Niraj Ahuja, 7th edition, pg no.22)


Question: Most common complication of modified ECT

* Electro convulsive therapy (seizure) increases production of brain derived neurotrophic factor (BDNF)Q. Madsen proposed generation of new neurons in the hippocampus may be an impoant neurobiological element underlying the clinical effects of ECT. * ECT is most commonly indicated (-85% of all ECT) and most effective in treatment of major depression (with psychosis / delusions /or suicidal tendency)Q. ECT is indicated in psychotic (delusional) depressionQ because nihilistic delusions may induce suicidal tendency, whereas ECT is not indicated in neurotic depression (dysthynia), cyclothymiaQ. ECT may be useful in MDP (bipolar) in decreasing duration of depressive episode. ECT is not (or less) useful in chronic conditions like chronic schizophrenia (with negativ symptoms esp)Q. Use of ECT is not the first line (choice) of treatment in mania & schizophrenia (lithium & anti psychotics are mainstay of treatment). Panic disorder is also treated with drugs not ECT. REF : Oxford text book of psychiatry 3rd Ed.


Question: Maximum benefit of electroconvulsive therapy is in

Most important and most common indication for ECT is severe depression with suicidal risk. Indications of ECT
1. Severe depression with suicidal risk or with psychotic features or with stupor.
2. Some types of schizophrenia (catatonic or paranoid)
3. Schizophrenic or depressive stupor
4. Severe catatonia with stupor
5. Severe psychoses (schizophrenia or mania) with the risk of suicide or homicide or physical assault.


Question: The most commonly implicated neurotransmitter in the aetiology of schizophrenia is

Schizophrenia is presently thought to be probably due to a functional increase of dopamine at the postsynaptic receptor, though other neurotransmitters such as serotonin (especially 5-HT2 receptors), GABA and acetylcholine are also presumably involved. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 63

Schizophrenia and other psychotic disorders


Question: Anesthetic agent used in ECT is

Methohexitol is a barbitutate used as induction agent in ECT.


Question: Tricyclic Anti depressant are contraindicated in


Question: .Bad trips is seen in

Hallucinogens * ALSO CALLED AS Psychotomimetic/ Psychedelic * FIRST Man made HALLICINOGEN ==================== Albe Hoffman * MECHANISM OF ACTION Lysergic acid diethylamide=======serotonin * Introduced by Albe Hoffmann and he himself experienced its effects * Phencyclidine =======NMDA antagonist * Also known as angel dust * Related to ketamine=== dissociative anesthetic * Has anti-suicidal propey PSYCHIATRIC RELEVANCE FLASHBACKS====== person even after weeks of using substance may experience the same hallucinations BAD TRIPS====== bad experiences during intoxication of the substance They tend to see hallucinations and monsters and are threatened by the images Ref.kaplon and Sadock, synopsis of psychiatry, 11 th edition, pg no.649


Question: NOT an Anxiolytic drug

(A) Melatonin # ANTIANXIETY DRUGS:> Benzodiazepines: Diazepam, Chlordiazepoxide, Oxazepam, Lorazepam, Alprazolam.# Chlormethiazole:> Atypical anxiolyitcs: Buspirone, Gepirone, Ipsapirone. Typical anxiolyitc drugs act GABA receptors BZP site, whereas atypical agents are presynaptic 5HT1A receptor partial agonist and inhibits the release of 5HT.> Melatonin is effective in sleep disorders and is Possibly Effective for:> Withdrawal from drugs called benzodiazepines, High blood pressure, Insomnia, jet lag, Reducing anxiety before surgery, tumours, sunburn, thrombocytopenia.> SSRI's: like sertraline, fluoxetine, Paroxetine> TCA's: like imipramine, amitryptiline> Beta blockers: for controlling tachycardia and palpitation


Question: The most prevalent psychiatric illness in the general community is

Anxiety disorders, the most prevalent psychiatric illnesses in the general community, are present in 15- 20% of medical clinic patients there are several anxiety disorders namely panic disorder agaraphobia specific phobia obsessive compulsive disorder somatization disorder conversion disorder dissosiation disorder adjustment disorder post traumatic disorder Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 387

Anxiety disorders stress disorders and grief


Question: Best test for diagnosis of organic mental disorder


Question: For severe intractable obsessional neurosis the psychosurgery of choice is


Question: One of the following is not a compulsive and habit forming disorder

Nymphomania is the condition of excessive sexual desire in females. It is not an impulse control disorder.


Question: Drug of choice for Generalised anxiety disorder

-Selective serotonin reuptake inhibitors are the drug of choice in the treatment of generalized anxiety disorder.-Sho-acting benzodiazepines such as alprazolam are used during acute episodes.Treatment:First line:-Cognitive behavioural therapy-SSRIs or SNRIsSecond-line:- Benzodiazepines- Buspirone


Question: LSD was introducd by

Hallucinogens * ALSO CALLED AS Psychotomimetic/ Psychedelic * FIRST Man made HALLICINOGEN ==================== Albe Hoffman * MECHANISM OF ACTION Lysergic acid diethylamide=======serotonin * Introduced by Albe Hoffmann and he himself experienced its effects * Phencyclidine =======NMDA antagonist * Also known as angel dust * Related to ketamine=== dissociative anesthetic * Has anti-suicidal propey Ref.Kaplon and Sadock, synopsis of psychiatry, 11 th edition, pg no.649


Question: Kleine Levine syndrome is

Kleine Levin syndrome- is the best-recognized recurrent hypersomnia. It afflicts males in early adolescence. In its classic form, the recurrent episodes are associated with a) extreme sleepiness (18- to 20-hour sleep periods) b) voracious eating, c)hypersexuality, d) disinhibition (e.g., aggression). Episodes typically last for a few days up to several weeks and appear once to ten times per year. A monosymptomatic hypersomnolent form can occur. Reference: P 2161 chap. 20 Sleep Disorders(Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 9th Edition)


Question: Non sedating Antidepressant is


Question: Bad Prognostic factor for Schizophrenia is

A i.e. Late onset of diseaseAbsence of family history, Presence of depression and catatonic subtype are definitely good prognostic factors. And here Late onset does not mean onset after 35 years, which is a good prognostic factor. Here late onset means insidious onset, which is a bad prognostic factor.


Question: Term Psychiatry was coined by

Reil, Johann Christian (1759-1820) : Coined the Term Psychiatry Special Mention- Founded the 1st psychiatric journal Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no.244

Cognitive development and defence mechanism


Question: Early morning awakening and reduced latency of REM sleep is suggestive of

Disturbance of biological functions is common in depression, with insomnia (or sometimes increased sleep), loss of appetite and weight (or sometimes hyperphagia and weight gain), and loss of sexual drive. The somatic syndrome in depression is characterised by: a. A significant decrease in appetite or weight b. Early morning awakening, at least 2 (or more) hours before the usual time of awakening c. Diurnal variation, with depression being worst in the morning d. Pervasive loss of interest and loss of reactivity to pleasurable stimuli e. Psychomotor agitation or retardation. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no.72


Question: Therapeutic dose of Lithium is

(B) 0.8-1.2 mEq/lit # BLOOD LITHIUM LEVELS:> Therapeutic levels = 0.8-1.2 mEq/L For treatment of acute mania> Prophylactic levels = 0.6-1.2 mEq/L For relapse prevention in bipolar disorders> Toxic Lithium Levels > 2.0 mEq/L


Question: Drug of choice for rapid cycles of bipolar disorder is

LITHIUM is the drug of choice for EUPHORIC MANIA VALPROATE is the drug of choice for RAPID CYCLING DISORDER LAMOTRIGINE is the drug of choice for bipolar depression Valproate is the drug used mainly for rapid cyclers-more than 4 episodes of psychosis or depression in one yr Atypical antipsychotics -DOC -for acute mania Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 620


Question: Treatment of choice in depression with sucidal tendencies


Question: La belle indifference is seen in

A i.e. Conversion reactionLa belle indifferenceQ is in-appropiate attitude of calm or lack of concern about one's disability. It is seen in conversion (dissociative) disorderQ (but not specific), physical illness etc.


Question: Drug of choice for Narcolepsy

Modafinil is a wakefullness promoting drug,used in the treatment of Narcolepsy.


Question: Hysteria is characterized by

C i.e. Indifference to suffering- Flight of ideas & Pressure speech are features of Mania. Autism is found in Schizophrenia (Bleuler's 4-A)- La -Belle-Indifference : It is lack of concern towards the symptoms despite severe disability. It is found in Hysteria (Conversion Disorder)Q, Paial lobe lesion, Multiple Sclerosis, Dissociative DisorderQ, Physical illness.


Question: a patient had pre mature ejaculation and was staed on SSRI with a sho half life

SSRI * IMPOANCE Most widely prescribed antidepressant * MECHANISM Specifically acts on serotonin transpoers and increases serotonin in synapse. DRUGS FLUOXETINE FLUVOXAMINE DAPOXETINE CITALOPRAM ESCITALOPRAM ESCITALOPRAM SERALINE PAROXETINE USE FLUOXETINE=============CHILDHOOD DEPRESSION FLUVOXAMINE===========OCD DAPOXETINE==============PME ESCITALOPRAM===========HEA SAFE, PATHOLOGICAL EMOTIONS PAROXETINE=========SEDATING, PANIC DISORDER IMPULSE CONTROL DISORDERS PME PARAPHILIA SIDE EFFECTS Paradoxical SUICIDE, this is a type of suicide where an antidepressant used to treat depression and decrease suicide increase the chance of suicidal attempt ( IT'S A PARADOX). The explanation that is given is SSRI initially activates the patient and decreases fatigue, thus patients with low mood and suicidal ideas will have more energy to act on the ideas. GIT- thus it should not be given in an empty stomach SD- delays ejaculation. This mechanism is used for its prescription in patients with premature ejaculation ANXIETY INSOMNIA Ref. kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 955


Question: Otto Veraguth sign is found in


Question: Phobia is defined as

Phobia is defined as an irrational fear of a specific object, situation or activity, often leading o persistent avoidance of the feared object, situation or activity. Common types Agoraphobia Social phobia Specific phobia (Ref: A sho textbook of psychiatry, Niraj Ahuja,7th edition, pg no 92)

Palpitation on thinking about a definite entity

Excessive unreasonable fear about a specific situation

Anxiety disorders stress disorders and grief


Question: Biochemical abnormalities in schizophenia

Biochemical Theories Schizophrenia is presently thought to be probably due to a functional increase of dopamine at the postsynaptic receptor, though other neurotransmitters such as serotonin (especially 5-HT2 receptors), GABA and acetylcholine are also presumably involved. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 63

Increased dopamine and increased serotonin

Decreased dopamine and decreased serotonin

Schizophrenia and other psychotic disorders


Question: Drug of choice for rapid cycling MDP is

C i.e. Sodium Valproate Rapid Cycling MDP - The patient must have at least 4 episodes within 12 months of mood disturbance (that meet criteria of major depressive, manic, hypomanic or mixed episode). - It is usually due to use of conventional antidepressant especially tricyclic & presence of hypothyroidism. So antidepressants are better avoided but antipsychotics may be used.


Question: The eponymus Trisomy 18 is

(D) Edward's syndrome EXAMPLES OF CHROMOSOMAL DISORDERSChromosomesResult2n (46, XX)Normal female2n (46, XY)Normal maleNUMERICAL ABNORMALITIESTriploidy (3n), tetraploidy (4n)Spontaneous abortionParthenogenesis (2n from same parent)Spontaneous abortionAneuploidy (2n + specific chromosome) Trisomy 21 (47, XY,+21)Down's syndrome (characteristic facies, IQ usually < 50, congenital heart disease, reduced life expectancy)Trisomy 18 (47, XY, +18)Edwards'syndrome (characteristic skull and facies, frequent malformations of heart, kidney and other organs)Trisomy 13(47, XY,+13)Patau's syndrome (cleft lip and palate, polydactyly, small head, frequent congenital heart disease)Sex Chromosome Aneuploidies Phenotypically male 47, XXYKlinefelter's syndrome (infertility, gynaecomastia, small testes)47, XYYXYY male (usually asymptomatic, often tall)Phenotypically female 47, XXXTrisomy X (usually asymptomatic, 20% mentally handicapped)45, X0Turner's syndrome (short stature, webbed neck, primary amenorrhoea)STRUCTURAL CHROMOSOME ABERRATIONSInherited 46, XY, del(5p)Cri du chat syndrome, deletion of short arm of chromosome 545, XY,t(14;21)Fusion of 14 and 21, no essential chromosomal material lost (NORMAL, but balanced carrier of abnormal chromosome)46, XY, t(14;21)Fused 14;21 chromosome has segregated into gamete with normal chromosome 21, and fertilisation has generated trisomy 21 (Down's syndrome)AcquiredOccur in over 50% of haematological malignancies; also common in other neoplastic cells46, XY, t(9,22)Philadelphia chromosome (chronic myeloid leukaemia)46, XY, t(2,8) or t(8,14) or t(8,22)Burkitt's lymphoma


Question: Phobia is a type of

In ICD-10, neurosis, stress-related and somatoform disorders have been classified into the following types: Phobic anxiety disorders Other anxiety disorders Obsessive-compulsive disorders (Ref: a sho textbook of psychiatry, Niraj Ahuja,7th edition, pg no 89)

Anxiety disorders stress disorders and grief


Question: Drugs used in Heroin withdrawl are A/E


Question: Most common delusional disorder in male

What is a Delusion DELUSION - * false fixed firm belief, * subjective ceainity, * compelling counterargument, * impervious to other experiences and * outside socio cultural and educational background How is delusional disorder different from schizophrenia * Age of onset=====40's * They don't have hallucinations * Duration criteria for diagnosing delusional disorder is 3 months when compared to 1 month in schizophrenia * No socio occupational detion apa from the delusion Epidemiology SS 0.3%======Delusional disorder 1%========schizophrenia SS 5%======mood disorder Most common SS M.C type of delusional disorder in Men =========paranoid SS M.C type of delusional disorder in Female========erotomanic Ref. Kaplon and Sadock, Synopsis of psychiatry, 11 th edition, 335

Symptoms and signs in psychiatry and classification


Question: A person developing hatredness towards his brother starts, overcaring him and brings gifts to him.This is an example of

Reaction formation is a neurotic defense mechanism where an individual transforms his feelings into exact opposite.


Question: Narcolepsy is due to abnormality in

Narcolepsy is the prototypical example of sleepiness produced by a basic CNS dysfunction of sleep mechanisms. The etiology stems from a genetically triggered Hypocretin dysfunction and deficit. It is apparent that the hypocretin system plays a critical role in narcolepsy. The Hypocretin producing cell bodies are specific to Hypothalamus and have widespread anatomical projections. Ref: Synopsis of Psychiatry, 11e, pg 548. Ebrahim IO, Howard RS et al. The Hypocretin/ Orexin system. J R Soc Med, 2002 May, 95(5), 227-30.


Question: Antipsychotic drug with maximum hypotensive effect is

low potency antipsychotics like thioridazine and chlorpromazine are associated with lot of systemic side effects as mentioned in the below table. They have side effects like hypotension, sedation, giddiness, dryness of mouth and cardiac side effects. High potency has lot of neurological side effects. Ref.Kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 972


Question: A man hits his neighbour. Next day he feels that police is behind him and his brain is being controlled by radio waves by his neighbour. The probable diagnosis is

This patient:-

Experiences that he is being persecuted against (police are behind him, he hits the neighbours) —>Delusion of persecution.
Experiences that his actions are under the control of some external force (as his brain is being controlled by radio-waves) Passivity phenomenon.

"Delusion of persecution may occur in the context of primary delusional experiences, auditory hallucinations,
bodily hallucinations or experiences of passivity". _____________________ Fish's clinical psychopathology

Importance of history of hitting the neighbour:-

"Patient with persecutory delusions are often associated with quarrelousness and angel, and the individual who
acts out his or her anger may at times be assaultive or even homicidal". ______________ Kaplan & Sadock's


Question: Normal IQ is

IQ ranges of 70-80 Boderlline deficiency 80-90 dullness 90-110 normal/ average intelligence 110-120 superior intelliegnce 120-140 very superior intelligence >140 genius Ref: Wikipedia.


Question: "8 stages of psychosocial development" were given by

Erik erikson gave 8 stages of psychosocial / personality development where an individual experience psychological conflict in each stage.
Roger Sperry: Gave concept of "Split - brain".


Question: A clinical sign of mania is

Mania this disorder tends to occur in episodes which last 3-4months, followed by complete recovery. There is a flight of ideas(rapidly produced speech with abrupt shifts from topic to topic, using external environmental cues. Typically the connections between the shifts are apparent). When the flight becomes severe, incoherence may occur. A less severe and a more ordered flight in the absence of pressure of speech is called prolixity (Ref: a sho textbook of psychiatry, Niraj Ahuja, 7th edition,p g no.70)


Question: Shortest acting non benzodiazepine sedative is

Zaleplon is the shortest acting among the other 3 'Z' compounds given above.
Midazolam is the shortest acting sedtive among all the Benzodiazepines.


Question: Oedipus complex is seen in

Sigmund freud gave Psychosexual stages of development. It includes Oral (upto 18 months), Anal (1 to 3 years), Phallic (3 to 5 years), Latency (5-6 to 11 -13 years) & Genital (11-13 to young adulthood) phases. Oedipus complex is seen in Phallic phase. The analogous thing in girls is Electra complex. Ref: Synopsis of Psychiatry, 11e, pg 158, 160.


Question: Drug of choice for rapid cyclers is

Sodium valproate is the drug of choice for rapid cyclers.
Rapid cyclers has 4 or more than 4 episodes of mania, depression or hypomania in 1 year.


Question: A component of conversion disorder is

ICD 10 includes conversion disorders under dissociative disorders,
however, traditionally conversion disorders are known as hysteria Conversion disorder may present with
1. Hysterical fits
2. Motor symptoms like abnormal movements and gait disturbance or inability to move
3. Sensory symptoms like Blindness but walks and doesn't injure himself Tubular vision Glove stocking anesthesia Loss of sensation (not dermatomal)


Question: Topographical theory of mind was given by

Sigmund freud gave both structural & topographical theories of mind.


Question: Drug of choice in delirium tremens is

The drugs of choice for alcoholic detoxification are usually benzodiazepines. Chlordiazepoxide (80-200 mg/day in divided doses) and diazepam (40-80 mg/day in divided doses) are the most frequently used benzodiazepines. The higher limit of the normal dose range is used in delirium tremens. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no.40


Question: Delusion is not seen in

Delusion is psychotic symptom, can be associated with schizophrenia, depression with psychotic symptoms, mania with psychotic symptoms. anxiety disorder is a type of neurosis here the patients will have insight they will present with palpitations, breathlessness, ruminations, worries, distress and fear of impending doom. Diagnostic criteria for Severe Depression with psychotic symptoms: A severe depressive episode which meets the criteria given for severe depressive episode without psychotic symptoms and in which delusions, hallucinations, or depressive stupor are present. The delusions usually involve ideas of sin, povey, or imminent disasters, responsibility for which may be assumed by the patient. Reference: ICD-10 Classification of Mental and Behavioural Disorders, World Health Organization, Geneva, 1992

Symptoms and signs in psychiatry and classification


Question: Formication is seen

Formication - also know as magnan phenomenon or cocaine bugs it is tactile type of hallucination seen in cocaine intoxication Jet black pigmentation - also seen in cocaine Flashback phenomenon / run amok / amotivational syndrome - seen in cannabis Flu like syndrome (water from everywhere - lacrimation, sweating, rhinorrhea and diarrhea) seen in opioids withdrawal

Substance Related and Addictive Disorders


Question: Treatment of choice for Nocturnal enuresis is

Behavioral therapy like using alarms is the treatment of choice for Nocturnal enuresis.
Desmopressin is the drug of choice for Nocturnal enuresis although Imipramine and Oxybutynin are also used.


Question: Treatment is not required in withdrawal of


Question: Poor prognostic factor in schizophrenia is


Question: Loss of insight is seen


Question: Persistent belief of medical illness despite adequate investigation is

(A) Hypochondriasis > Hypochondriasis is a persistant preoccupation with fear or belief of having disease, based on persons own interpretation of normal body function or minor physical abnormality.> This preoccupation persists despite repeated reassurance based on appropriate clinical examination and thorough investigation.> The patient in question is persistently preoccupied about her disease (headache) despite of all normal investigations and seeks another consultation as she still insists that there is something wrong in her head.


Question: Delirium tremens is seen in

Delirium tremens Delirium tremens (DT) is the most severe alcohol withdrawal syndrome. It occurs usually within 2-4 days of complete or significant abstinence from heavy alcohol drinking in about 5% of patients, as compared to acute tremulousness which occurs in about 34% of patients. The course is sho, with recovery occurring within 3-7 days. This is an acute organic brain syndrome (delirium) with characteristic features of: i. Clouding of consciousness with disorientation in time and place. ii. Poor attention span and distractibility. iii. Visual (and also auditory) hallucinations and illusions, which are often vivid and very frightening. Tactile hallucinations of insects crawling over the body may occur. iv. Marked autonomic disturbance with tachycardia, fever, hypeension, sweating and pupillary dilatation. v. Psychomotor agitation and ataxia. vi. Insomnia, with a reversal of sleep-wake pattern. vii. Dehydration with electrolyte imbalance. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 38


Question: Drug for premature ejaculation

Over the past one or two decades, clinical investigators have paicipated in an increasing number of studies that are helping in our understanding of Pre Mature Ejaculation, which will undoubtedly facilitate future treatments. Apa from a number of behavioral approaches, the treatment of PE consists of primarily off-label use of oral selective serotonin reuptake inhibitors (SSRIs) either on-demand or daily delivery. However, various undesirable side-effects of these medications have led researchers to search for and develop new therapeutic approaches for Pre Mature Ejaculation. Dapoxetine is a sho-acting SSRI developed specifically for the treatment of Pre Mature Ejaculation. Early trials with dapoxetine have documented successful outcomes without serious sho- or long-term side-effects. Ref: Dapoxetine, a novel SSRI for the treatment of pre mature ejaculation. Ther Clinc Risk Manag, 2007 Jun 3(2): 277-89.


Question: ECT is not useful in treatment of


Question: Drug of choice for Obscessive Compulsive Disorder


Question: Mania is a

According to ICD-10 mood disorders are classified as Manic episodes Depressive episodes Bipolar mood disorder Recurrent depressive disorder Persistent mood disorder Other mood disorders (including mixed effective episodes and recurrent brief depressive disorder) (Ref: a sho textbook of psychiatry, Niraj Ahuja, 7th edition, pg no.69)


Question: Delusion is not present in


Question: A young lady is present with history of repeated episodes of overeating followed by purging using laxatives, she is probably suffering from

Bulimia Nervosa Bulimia nervosa is an eating disorder charac terised by the following clinical features: 1. Bulimia nervosa usually has an onset in early teens or adolescence. 2. There is an intense fear of becoming obese. There may be an earlier history of anorexia nervosa. 3. There is usually body-image disturbance and the person is unable to perceive own body size accurately. 4. There is a persistent preoccupation with eating, and an irresistible craving for food. There are episodes of overeating in which large amounts of food are consumed within sho periods of time (eating binges). 5. There are attempts to 'counteract' the effects of overeating by one or more of the following: selfinduced vomiting, purgative abuse, periods of starvation, and/or use of drugs such as appetite suppressants. 6. No known medical illness is present which can account for the disorder. 7. Absence of any other primary psychiatric disorder. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no.144


Question: The term 'schizophrenia' was coined by

Coined The Term Eugen Bleuler Schizophrenia Sigmund Freud Free association,Oedipus Complex,Penis Envy, Repression,Psychoanalysis Hecker Hebephrenia Johann Christian Reil Father of Psychiatry

Schizophrenia Spectrum and Other Psychotic Disorders


Question: Feeling of creeping insects is seen in


Question: Reduced latency of REM sleep is a feature of

Reduced latency of REM is typically seen in depression Insomnia and early morning wakening is also seen Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 604-607


Question: Duration needed to diagnose hypomania is

Symptoms of elevated mood should be present for 4 days to diagnose as hypomania.


Question: Formication and delusion of persecution occurs together in aEUR'

Cocaine psychosis (Ref. Nimboodiri 3/e p. 334; Essentials of clinical psychiatry 4/e p. 580] This question is tricky one as tactile hallucination (fornication) and delusion of persecution are seen both in cocaine as well as amphetamine abuse. Read the question carefully, examinor has asked about the presence of formication and delusion of persecution together. In amphetamine abuse these two do not occur together - Fornication (tactile hallucination) is seen in Chronic abuse. - Paranoid ideation (delusion of persecution) Acute intoxication. occurs in On the other hand both delusion of persecution and formication are seen together in chronic cocaine abuse. "Cocaine abuse can present with auditory hallucinations, tactile hallucination including fornication andparanoid delusion (delusion of persecution". -BK Puri 3/e 356


Question: Disulfiram is a type of

Disulfiram inhibits Aldehyde dehyrogenase enzyme and leads to accumulation of Acetaldehyde resulting in aversive symptoms.


Question: Pfropf's Schizophrenia

Pfropf's Schizophrenia is Schizophrenia seen in children.


Question: .Erotomania means

there are several named delusions delusion of love is called as De clerambult syndrome this is also called as delusion of love * EROTOMANIC o ALSO KNOWN AS * Declerambault syndrome * Psychose passionelle o RISK * Stalkers * Risk of homicide PRESENTATION Female from a lower socio-economic class would feel that a male celebrity is in love with her The initial proposal is from the male side The so-called paners would not have communicated in person at all Patient might feel that the perceived paner would send hidden messages that is known only to her Ref.kaplon and Sadock, synopsis of psychiatry, 11 th edition, Pg.No.333

Schizophrenia and other psychotic disorders


Question: Confabulation is seen in

Wernickes encephalopathyis a triad of GLOBAL CONFUSION, OPHTHALMOPLEGIA AND ATAXIA It is due to deficiency of thiamine It is 100% reversible Most impoant symptom needed for the diagnosis is confusion If the patients wernickes encephalopathy is not trated it would result in koraskoff's psychosis koraskoff's psychosis is a misnomer it is associated with confabulation that is fluent plausible lying, where the patient fills up with memory gaps with information and she is not aware that wat is she is saying is not truth Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 624


Question: Thoughts in mind with rhyming rather than with meaning of thoughts is

Clang association: Association or speech directed by the sound of a word rather than by its meaning; words have no logical connection. Circumstantiality: Disturbance in the associative thought and speech processes in which a patient digresses into unnecessary details and inappropriate thoughts before communicating the central idea. Flight of ideas: Rapid succession of fragmentary thoughts or speech in which content changes abruptly and speech may be incoherent. Perseveration: Pathological repetition of the same response to different stimuli, as in a repetition of the same verbal response to different questions. Reference: Kaplan & Sadock's Synopsis of psychiatry, 11th edition, pages 1409,1412,1415.

Symptoms and signs in psychiatry and classification


Question: Fixation of anal phase of Psychosexual stage of development can lead to

Anal phase (1.5-3 years) child derives pleasure by holding and releasing faeces.
Arrest or fixation of this stage can lead to obsessive compulsive disorder in future.


Question: positive reinforcrmrnt was given by

Behavioral therapy is learning given by BF Skinner , according to him all behaviors are learned phenomenon and thus can be unlearned Positive reinforcement a type of reinforcement when a behavior is rewarded there is more chance that the behavior is repeated Negative reinforcement is that when a behavior is done and an aversive response is removed, the behavior is repeated. When I go and meet my girlfriend, she checks my messages and picks up fight (aversive response) suddenly I delete all messages one day and that day there was no fight (no aversive response) then that behavior is repeated (delete all messages before meeting my girlfriend) Extinction is the type of reinforcement where a behavior is done and a rewarding response is removed the chance is that behavior will not be repeated A child likes to play with children( reward) but when the child fights with other children( undesirable behavior) the child will be removed from playing( removing a reward) , then the child stops fighting with other children( reduction of undesirable behaviour) Ref. kaplon and sadock synopsis, 11 th edition, pg no. 845


Question: EEG pattern of person at rest with eyes closed

Ans, is 'a' i.e., Alpha Beta (b) waveAlpha (a) waveTheta waveDelta waveRecorded fronry'seen ino From parietal & frontal region during specific activation of these parts of braino Seen in drowsiness & children and patients awake, at rest with eyes open.o Recorded from parieto occipital regiono Seen in almost all normal adults when they are awake and in quiet resting state of cerebrationo Seen in awake patient at rest with mind wandering and eyes closed.o Seen in hippocampuso In parietal and temporal region of normal children &drowsiness, emotional stress in adults especially disappointment and frustration.Seen in very deep NREM sleep & infant,serious organic brain disease, in subcortical transactions separating the ceberal cortex from thalamus.Frequency>14 Hz8-13 Hzo 4-7 Hzo 3-5 Hz (min.)AmplitudeLow amplitudeo High amplitudeo High amplitudeo Large amplitude (Max)Voltage o 50 micro volts (usually) to 100 o 2 to 4 times greater than most other types


Question: The following is not an atypical antipsychotic

Ans. is 'a' i.e. Thioridazine The most important distinction in modem day classification of antipsychotic drug is between the classical agents (typical) agents such as chlorpromazine, haloperidol and Zuclopenthixol and the atypical antipsychotics which include clozapine, risperidone, olanzapine and quetiapine.The atypical antipsychotics are "atypical" in their mode of action and adverse effect profile.Classical antipsychoticsAtypical antipsychotics* Acts by blocking D2 receptors* Usually do not act on D2 receptors* Highly likely to cause extra-pyramidal* Acts on 5HT2, muscarinic acetylcholinesymptomreceptors and 0 3/4 adrenoceptors * Extrapyramidal symptoms less commonExamples PhenothiazinesExamples- Chlorpromazine- Clozapine- Thioridazine- Sulpiride- Trifluoperazine- Olanzapine- Fluphenazine- RisperidoneButyrophenones- Ziprasidone- Trifluperidol- Sertindole- Droperidol- Ami sulpiride- Penfluridol Thioxanthene - Thiothixene - Flupenthixol Others - Pimozide - Reserpine

Pharmacotherapy Management of Children and Adolescents


Question: Z track technique is used for

Ans. (C) Administration of long acting depot antipsychotics(Ref: Kaplan and Sadock's Concise Text book of Clinical Psychiatry 11th Ed; Page No- 873)Guidelines for Administration of Long Acting Antipsychotic Depot Injections (LAAI)LAAIs are given to patient with psychosis or mania who have poor compliance to oral treatment.A test dose is given for all drugs except olanzapine, risperidone, paliperidone and aripiprazole.Route of administration is by intramuscular route with maximum permissible volume as given below.Deltoid2 mlDorsogluteal4 mlVentrogluteal (Safest site)4 mlRectus femoris5 mlVastus lateralis5 mlZ track technique is used for injection into all sites, except deltoid. The skin is stretched laterally from the intended site of injection and then insert the needle at 90deg angle. After 10 seconds of injecting the drug, skin is released to allow the displaced tissue to cover the needle track. It is done to maximize absorption in to muscles by preventing the drug from moving back to subcutaneous tissue.Z track technique is also used to inject iron.


Question: Wernicke&;s encephalopathy involves

Wernicke's encephalopathy : The neuropathological lesions are symmetrical and paraventricular, involving the mammillary bodies, the thalamus, the hypothalamus, the midbrain, the pons, the medulla, the fornix, and the cerebellum. Ref: Synopsis of Psychiatry, 11th edition, page 632.


Question: Ganser syndrome is a feature of

Dissociative Disorders Ganser's syndrome ( hysterical pseudodementia) is commonly found in prison inmates. The characteristic feature is vorbeireden, which is also called as 'approximate answers'. The answers are wrong but show that the person understands the nature of the question asked. For example; when asked the colour of a red pen, the patient calls it blue. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 102


Question: Agoraphobia is seen in patient with

Panic attack and phobia are usually seen as comorbid conditions.


Question: A schizophrenic patient on antipsychotic drugs may develop the following side effect

NAME OF THE TRACT LOCATION FUNCTION PROBLEMS WHEN BLOCKED Meso coical To prefrontal coex Controls attention, drive In patients with schizophrenia decreased dopamine in meso coical tract causes lack of drive, decreased attention Decreased attention, drive Worsens negative symptoms in schizophrenia Meso limbic To limbic system Control thoughts, emotions In patients with schizophrenia increased dopamine in mesolimbic tract causes delusions and hallucinations Decreases thoughts and emotions Improves positive symptoms in schizophrenia Nigro striatal To basal ganglia Smoothens and co-ordinates movements Extra pyramidal symptoms Tubero infundibular To hypothalamus Regulates prolactin Dopamine decreases prolactin Galactorrhea Amenorrhea Sexual dysfunctions Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 537


Question: Most common type of Delusion associated with Schizophrenia is

(A) Delusion of persecution # Most common type of delusion associated with schizophrenia involves persecutory.> It believes that he/she is being followed or is under surveillance or that he/she is being made fun of,tricked,or treated very unfairly by others.> when schizophrenics experience this type of delusion,they may feel very frightened or paranoid,as a result they will often do things to protect themselves from prosecutor.


Question: In opioid overdose treatment of choice is


Question: Naltrexone is used in opioid addiction because

Ans. is 'c' i.e. prevent relapse Naltrexone is a pure opioid antagonistIt is a competitive antagonist at all opioid receptors.It can be used orally, to assist in the rehabilitation of ex-opioid abusers who are fully withdrawn (otherwise it will induce an acute Withdrawl syndrome).A patient who then takes an opioid, fails to experience the kick or euphoria because of the opioid antagonistic actions of the Naltrexone.


Question: Kleptomania is

Kleptomania is irresistible impulse to steal.


Question: Persistent feeling of guilt is seen in

increased guilt is a carecterstic of depression DIAGNOSTIC CRITERIA FOR DEPRESSION Depressed mood most of the day Anhedonia=== loss of interest in previous pleasurable activities Fatiguability Dec sleep Dec appetite Hopelessness Suicidal ideas Ideas of guilt Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 347


Question: Night mares are seen in

Patient with post traumatic stress disorder experiences dreams about trauma called as "nightmares".


Question: Alpha rhythm in EEG is seen in

The EEG recordings show typical features of sleep which is broadly divided into two broadly different phases: 1. D-sleep (desynchronised or dreaming sleep), also called as REM- sleep (rapid eye movement sleep), active sleep, or paradoxical sleep. 2. S-sleep (synchronised sleep), also called as NREM-sleep (non-REM sleep), quiet sleep, or ohodox sleep. S-sleep or NREM-sleep is fuher divided into four stages, ranging from stages 1 to 4. As the person falls asleep, the person first passes through these stages of NREM-sleep. The EEG recording during the waking state shows alpha waves of 8-12 cycles/sec. frequency. The onset of sleep is characterised by a disappearance of the alpha-activity. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 133

Sleep with eyes closed and mind wandering


Question: In a alcoholic individual, tolerance to alcohol that disappears as rapidly as it develops is known as

Ans. b (Pharmacokinetic tolerance) (Ref. Harrison 18th/ p 2562)ALCOHOL - BEHAVIORAL EFFECTS, TOLERANCE, AND DEPENDENCE# Even though "legal intoxication" requires a blood alcohol concentration of at least 80 to 100 mg/dL, behavioral, psychomotor, and cognitive changes are seen at levels as low as 20 to 30 mg/dL.# Deep but disturbed sleep can be seen at twice the legal intoxication level, and death can occur with levels between 300 and 400 mg/dL.# Alcohol enhances GABA-A receptors and inhibits NMDA receptors.# Types of compensatory changes after repeated exposure producing tolerance of higher alcohol levels-Metabolic or pharmacokinetic tolerance# First, after 1-2 weeks of daily drinking, metabolic or pharmacokinetic tolerance can develop, with a 30% increase in the rate of hepatic alcohol metabolism.# This alteration disappears almost as rapidly as it develops.Cellular or pharmacodynamics tolerance# Second, cellular or pharmacodynamic tolerance develops through neurochemical changes that may also contribute to physical dependence.# The cellular changes caused by chronic alcohol exposure may not resolve for several weeks or longer following cessation of drinking.Behavioural tolerance# Third, individuals can develop behavioural tolerance, i.e., can learn to adapt their behaviour so that they can function better than expected under drug influence.Functional Tolerance# Humans and animals develop tolerance when their brain functions adapt to compensate for the disruption caused by alcohol in both their behavior and their bodily functions. This adaptation is called functional tolerance.Environment-dependent tolerance# The development of tolerance to alcohol's effects over several drinking sessions is accelerated if alcohol is always administered in the same environment or is accompanied by the same cues. This effect has been called environment- dependent tolerance.Learned tolerance# The development of tolerance also can be accelerated by practicing a task while under the influence of alcohol. This phenomenon is called behaviorally augmented (i.e., learned) tolerance.Educational points:EFFECTS OF BLOOD ALCOHOL LEVELS IN THE ABSENCE OF TOLERANCEBlood Level, mg/dLUsual Effect20Decreased inhibitions, a slight feeling of intoxication80Decrease in complex cognitive functions and motor performance200Obvious slurred speech, motor incoordination, irritability, and poor judgment300Light coma and depressed vital signs400Death


Question: The Rorschach Inkblot test consists of a set of .......... standardized inkblots. These vary in colour, shading, form, and complexity.

Rorschach Inkblot test- Evaluation of Personality, it contains 10 cards having ambiguous inkblot patterns and the subject has to interpret what he is seeing in the card from preselected options Extra Edge Thematic Apperception Test- Test is built on the assumption that people's stories reveal impoant aspects of their needs and self-perceptions as well as their views about significant others' in their life. In rhis 20 stimulus cards depicting a number of scenes of varying ambiguity will be shown.


Question: Phobia is


Question: Language function is preserved in

(B) Asperger's syndrome # Autism (i.e. marked impairment in reciprocal social and interpersonal interaction):i. Absent social smile,ii. Lack of eye-to-eyecontact,iii. Lack of awareness of others' existence or feelings; treats people as furniture,iv. Lack of attachment to parents and absence of separation anxiety,v. No or abnormal social play; prefers solitary games,vi. Marked impairment in making friends,vii. Lack of imitative behavior, viii. Absence of fear in presence of danger> Asperger syndrome or Asperger's syndrome or Asperger disorder is an autism spectrum disorder that is characterized by significant difficulties in social interaction, along with restricted and repetitive patterns of behavior and interests. It differs from other autism spectrum disorders by its relative preservation of linguistic and cognitive development. Although not required for diagnosis, physical clumsiness and atypical use of language are frequently reported.> Rett's syndrome is a disorder which is only reported in girls so far. After an apparently normal early development and normal head circumference at birth, there is a deceleration of head growth between the age of 5 months and 30 months. There is also a loss of purposive hand movements and acquired fine motor manipulative skills between the same ages, with the subsequent development of stereotyped movements of hands (e.g. handwringing). Later, other movement disorders also develop and severe mental handicap is invariable> Tourette's disorder is typically characterized by:1. Multiple motor tics.2. Multiple vocal tics.3. Duration of more than 1 year.4. Onset usually before 11 years of age and almost always before 21 years of age.> The disorder is usually more common (about 3 times) in males and has a prevalence rate of about 0.5 per 1000 people.


Question: Drug of choice for Obscessive Compulsive Neurosis is


Question: Anna Freud is related to

Ans) b (Psychoanalysis) RefKaplan & Sadock's Synopsis of Psychiatry, p 217Anna Freud (1895-1982)Anna Freud, the daughter of Sigmund Freud, ultimately made her own set of unique contributions to psycho- analysis. While her father focused primarily on repression as the central defense mechanism, Anna Freud greatly elaborated on individual defense mechanisms, including reaction formation, regression, undoing, introjection, identification, projection, turning against the self, reversal, and sublimation. She was also a key figure in the development of modem ego psychology in that she emphasized that there was "depth in the surface."The defenses marshaled by the ego to avoid unacceptable wishes from the id were in and of themselves complex and worthy of attention. Up to that point, the primary focus had been on uncovering unconscious sexual and aggressive wishes. She also made seminal contributions to the field of child psychoanalysis and studied the function of the ego in person-ality development. She founded the Hampstead child therapy course and clinic in London in 1947 and served as its director.


Question: "Foli a deux" is

The person with delusion influences the other to develop same delusion.
2 persons sharing same delusion  - "Foli a deux".
3 persons sharing same delusion  - "Foli a trios".
Sharing a delusion to group of people : Pseudo community.


Question: A Chronic alcoholic blames the family environment as a cause of his alcoholism. This is phenomenon of

Ans:C-RationalizationRationalization or rationalisation (also known as making excuses) is a defense mechanism in which controversial behaviors or feelings are justified and explained in a seemingly rational or logical manner to avoid the true explanation, and are made consciously tolerable--or even admirable and superior--by plausible means. It is also an informal fallacy of reasoning.


Question: A patient came with complaints of having a deformed nose and also complained that nobody takes him seriously because of the deformity of his nose. He has visited several cosmetic surgeons but they have sent him back saying that there is nothing wrong with his nose. He is probably suffering from

C i.e. Delusional disorder In Delusional dysmorphophobia (delusional disorder) patient feels his body pa or body ugly or mishappen.


Question: Most common psychiatric disorder seen with "PANDAS" is

PANDAS : Pediatric autoimmume neuropsychiatric disorder associated with streptococcal infections. Autoimmune response triggered by streptoocccal infections can lead to neuro psychiatric manifestations such as OCD and Tics.


Question: The antisocial disorder is characterized by

Personality Disorders An enduring pattern of inner experience and behavior that detes markedly from the expectations of individuals' culture. manifested in cognition, affectivity, interpersonal functioning, impulse control. Cluster A Paranoid , Schizoid , Schizotypal Cluster B Anti Social , Borderline , Histrionic , Narcisstic Cluster C Avoidant , Dependant , Obsessive Compulsive Cluster B personality disorders *DISSOCIAL *Asocial, antisocial and psychopathic *Lacks empathy *Lacks guilt *Lacks shame *Cruel *Callous *Aggressive *Change of occupation *Absentism *Failed relationships EMOTIONALLY UNSTABLE *Unstable and internse relationship *Disturbance in self image *Impulsivity *Affective instability *Chronic feeling of emptiness *Suicidal behavior *Difficulty controlling anger Dissosiative symptoms *HISTIRIONIC *Theatrical behavior *Superficial charming *Life and soul of the pay *Craving for attention, appreciation and affection *Excessive reaction to minor events( over act) *Egocentricity *Seductiveness *manipulative *Difficulty sustaining long term relationships *NARCISSISTIC PERSONALITY DISORDER *grandiose sense of self-impoance *preoccupation with fantasies of unlimited success *exhibitionistic need for constant attention and admiration *anger or humiliation in response to criticism *taking advantage of other people *lack of empathy *Regards self as "special" Reference: P.645 section II DSM -5 PERSONALITY DISORDER

Unconcern for feeling for others, disregard for social norms

Self dramatization, exaggerated expression of emotions


Question: One of the impoant defence mechanism is

Repression is a primary defence mechanism and is defined as unconsciously excluding from conscious awareness of anxiety-provoking ideas and /or feelings. eg in normal life: forgetting and slips of the tongue (Ref: a sho textbook of psychiatry, Niraj Ahuja,7th edition, pg no 207)

Cognitive development and defence mechanism


Question: Schizophrenia drugs mainly act on

Dopamine Hypothesis states In schizophrenia, there is an imbalance of dopamine transmission with dopaminergic hyperactivity in subcoical regions but hypoactivity in prefrontal coical regions. Antipsychotics reduce psychotic symptoms by decreasing dopamine activity, their potency is highly correlated with the drug's affinity for D2 receptors. PET studies indicate that dopamine receptor antagonists are effective when approximately 80 percent* of D2 receptors in the striatum are occupied. Higher occupancy rates are associated with more extrapyramidal side effects*(less common with Atypical/ second generation Antipsychotics) Reference: Page No.1491 chap.12.6 Cellular and Molecular Neuropathology of Schizophrenia P.3111 chap 31.17 First-Generation Antipsychotics(Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 9th Edition)


Question: Delusion is a disorder of

Ans. is 'a' i.e. Thought Delusion is a disorder of the thought Delusion sociocultural of the patient's* A false unshakable belief which is not amenable to reasoning and is not in keeping with the patient's and educational background.(i) Because delusions are fixed, false beliefs, they cannot be corrected by the physician. Contradiction delusional belief may cause the patient to become angry and stop the interview.A-96 (ii) The physician should not pretend to agree with the delusion but should take a neutral position and continue the examination.The other thought disorder is obsessionObsessionObsessions are persistent intrusive thoughts, ideas or impulses.The patient realizes that the ideas do not make sense and are not being imposed from outside (i.e. delusion).An example is a man who is always fighting an impulse to run down die hall of the office building through a plate glass window at the end. He knows that this action is potentially life threatening and he does not want to hurt himself but he cannot stop thinking about it and feeling anxious.* Other optionsOption 'b' - The facial artery and vein do not course through the deep part of the gland. They are related to the superficial part of the gland.


Question: Disruption or disorganisation of biological rhythm is observed in

Ans. c (Depression) (Harrison's medicine 17th ed., Chapter 386)ETIOLOGY AND PATHOPHYSIOLOGY OF DEPRESSION# Although evidence for genetic transmission of unipolar depression is not as strong as in bipolar disorder, monozygotic twins have a higher concordance rate (46%) than dizygotic siblings (20%), with little support for any effect of a shared family environment. There is some evidence that a functional polymorphism in the serotonin transporter (5- HTT) gene may interact with stressful life events to markedly increase risk of depression and suicide. Positron emission tomography (PET) studies show decreased metabolic activity in the caudate nuclei and frontal lobes in depressed patients that returns to normal with recovery. Single-photon emission computed tomography (SPECT) studies show comparable changes in blood flow.# Postmortem examination of brains of suicide victims indicate altered noradrenergic activity.# Diurnal variations in symptom severity and alterations in circadian rhythmicity of a number of neurochemical and neurohumoral factors suggest that biologic differences may be secondary to a primary defect in regulation of biologic rhythms. Patients with major depression show consistent findings of a decrease in rapid eye movement (REM) sleep onset (REM latency), an increase in REM density, and, in some subjects, a decrease in stage IV delta slow-wave sleep.


Question: Repetitive irresesistable thought to do something

Ans. is 'b' i.e., Obsession Obsessive compulsive disorder (OCD) OCD is an anxiety disorder which is characterized by recurrent, unwanted thoughts (Obsessions) and repettive behaviors (compulsions). An obsession has following characteristic : - An idea, impulse or image which intrudes into the conscious awareness repeatedly. It is recognized as one's own ideas, impulse or image but is perceived as egoalien (foreign to one's personality). It is recognized as irrational and absurd (insight is present --4 Patient knows about disorder). Patient tries to resist against it but is unable to do so which leads to marked distress or anxiety. A compulsion has following characteristics :- It is repetitive, purposeful form of behavior is carried out because of strong feeling of compulsion to do so. It usually follows an obsession. ts goal is to prevent or reduce the anxiety or stress caused by obsession however it do not always succeed in doing so. It is irrational or excessive and not realistic. Insight is present. A patient with OCD may have an obsession, a compulsion or both (mostly patients have both). A patient with OCD realizes the irrationality of the obsession and experiences both the obsession and the compulsion as ego-dystonic (unwanted behavior). The person is preoccupied with details rules, list order, organisation or schedules to the extent that the major point of activity is lost. The person shows perfectionism that interfers with task completion (e.g., unable to complete project because his own ovely strict standard are not met).


Question: To diagnose depression, symptoms should last at least for

Symptoms should last for at least 2 weeks, for cyclothymia -mild form of depression, symptoms should last for 2 years Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 604-607


Question: Agarophobia is

Ans, b (Fear of crowds). (Ref Harrison, Medicine 18th/Ch. 12, 21, 391)AGORAPHOBIA# Irrational & undue phobia of a particular situation is known as agoraphobia.# This is an example of irrational fear of situation.# It is commonest type of phobia encountered in clinical practice.# Women out number men in suffering agoraphobias# It is characterized by irrational fear of being in places away from familiar setting of homes.# Although it was earlier thought to be a fear of open spaces only now it includes fear of open space, public places, crowded places, any other place where there is no escape from public view.# Infact patient is afraid of all the places or situation from where escape may be difficult or help may not be available if he suddenly develops embarrassing or incapacitating symptoms.# These embarassing or incapacitating symptoms are the classical symptoms of public phobia.# A full-blown panic attack may occur (agoraphobia with panic disorder) or only a few symptoms like dizziness or tachycardia may occur (agoraphobia without panic disorder).


Question: Fronto temporal dementias include A/E

D i.e. Alzheimer's disease Alzheimer's disease, the most common cause of dementiaQ initially presents with minor forgetfulness & gradually progressive sho term memory lossQ (making learning of new information difficult). Language is usually affected early with difficulty in finding words or naming objects, & impairments in the ability to construct fluent & informative sentences. The memory is lost for recent events first with a delayed loss of long term memory mainly affecting episodic memoryQ. It is a parieto temporal disease. Multi infarct (or vascular) dementia (or atherosclerotic psychosis), the 2,0 most common cause of dementia (not Alzheimer's disease) is caused by cerebro- vascular disease (ischemia or infarct)Q. It is characterized by an abrupt onset, acute exacerbations ((lit repeated infarcts), stepwise wise (step-ladder pattern) progressionQ (i.e. impairment of memory & intellect), fluctuating course (periods of deterioration f/b paial recovery for few months) and presence of hypeension (m.c.), cardiovascular disease & h/o previous stroke or transient ischemic attack. Lewy Body dementia, the 2,,d most common cause of degenerative dementia characteristically presents with progressive & fluctuating dementia (affecting cognition, attention & visuosptial ability), recurrent delirium like phase, systematized delusions, visual hallucinations (usually well formed & detailed), motor features of Parkinsonism (bradykinesia > tremor, rigidity), extra pyramidal symptoms, neuroleptic sensitivity syndrome (to antipsychotics)Q, together with repeated fallsQ, syncope, transient loss of consciousness, autonomic dysfunctions (eg. ohostatic hypotension) & urinary incontinence. It is (like Parkinson's disease) a ' synucleinpathy' reflecting abnormal aggregation of eosinophilic inclusion Lewy bodies (i.e. a synuclein & ubiquitin) in cytoplasm of neurons of neocoex & substantia nigra. Pick's disease (in contrast to parietal - temporal- Alzheimers ds,)Q is a prototype fronto- temporal dementia. It classically presents with insidious onset gradually progressive behavioural & personality changes (frontal lobe function) and language disorder (such as aphasia - left temporal lobe function) usually preceding or overshadowing patient's cognitive problems. Patients may show apathy (medial frontal damage), disinhibition (basal - frontal dysfunction), symptoms of kluver Bucy syndrome (i.e. hypersexuality, hyperorality, placidity, and a compulsion to attend to any visual stimulus) and loss of drive, motivation, insight and spontaneity of speech (frontal language). The striking pathological findings is Knife blade atrophy of frontal & temporal poles with Pick's cells (ballooned neurons) and Pick's inclusion body (irregular, silver staining, intracytoplasmic bodies composed of tau, ubiquitin etc that displace nucleus towards periphery). Fronto- temporal dementias include - Pick's disease, lobar atrophyQ, frontal lobe degeneration (non- Alzheimer's type), fronto temporal dementia with parkinsonism, motor neuron diseaseQ (MND) with dementia, semantic dementiaQ with aphasia & agnosia, progressive nonfluent aphasic syndromeQ. Sometimes (not always) coicobasal degeneration, progressive supranuclear palsy & parkinsonism dementia complex of Guam are also included.


Question: Korsakoff's psychosis is seen in

(C) Chronic alcoholism# Conditions resulting in the vitamin deficiency and its effects include chronic alcoholism and severe malnutrition.> Alcoholism may be an indicator of poor nutrition, which in addition to inflammation of the stomach lining, causes thiamine deficiency.> Other causes include dietary deficiencies, prolonged vomiting, eating disorders, or the effects of chemotherapy. It can also occur in pregnant women who have a form of extreme morning sickness known as hyperemesis gravid a rum. Mercury poisoning can also lead to Korsakoff's syndrome.> It has also been caused by centipede (mukade) bites in Japan.There is no specific treatment because the previous thiamine deficiency produces irreversible damage to the medial thalamic nuclei and mammillary bodies.> Mammillary body atrophy may be visible on high-resolution MRI.


Question: Treatment modality NOT used in ADHD includes

(D) Haloperidol # Stimulant medication Dextroamphetamine (10-40 mg/day) and methylphenidate (10-60 mg/day) are the drugs of choice in the treatment of hyperkinetic disorder, with a response rate of nearly 90%. They act on the reticular activating system causing stimulation of the inhibitory influences on the cerebral cortex, thus decreasing hyperactivity and/or distractibility> Others:1. When stimulant medication is not available is not effective, other drugs can be used after careful individual consideration of the risks and benefits in the individual patient. These include clonidine, imipramine, bupropion, venlafaxine chlorpromazine, thioridazine, and lithium carbonate. Atomoxetine may be an alternative for children who do not respond to stimulants. Barbiturates are contmindicated in ADD as they increase hyperactivity.2. Behavior modification3. Counseling and supportive psychotherapy Behavior modification and counseling are very important in the successful management of ADD and can be used along with drug therapy.


Question: Pseudodementia is seen in

Depressive pseudodementia- depression in the elderly people may mimic dementia clinically. Identification of depression is very impoant as it is far more easily treatable than dementia. (Ref: a sho textbook of psychiatry, Niraj Ahuja, 7th edition, pg no.23)


Question: Visual analogue scale (VAS) most widely used to measure


Question: Drug of choice in depression in old person is

Elderly are at greater risk of developing adverse events while taking any medication. always in elderly management for psychiatric disorder we follow the principle of STA LOW AND GO SLOW amitriptilline and imipramine a tricyclic antidepressent which has lot of adverse effects like exacerbation of glaucoma, ECG changes like prolonged QTc intervel, urinary retention. Buspirone is 5HT1A paial agonist that has anti anti anxiety effects and is used for anxiety disorders and for augmentation agent for depression and not as first line mangement for depression. Newer, non-tricyclic antidepressants are often claimed to be as effective as but safer than tricyclic antidepressants and hence drugs of choice in elderly people Fluoxetine is also effective in treating elderly patients with dementia and depressive symptoms Ref: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 1334


Question: Type C personality disorder

Cluster C has disorders considered "anxious and fearful" and characterised by "introversion". These include Anxious (Avoidant), Dependent and Obsessive Compulsive (or Anankastic) personality disorders. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 113


Question: ECT is absolutely contraindicated in

(A) Raised ICT # ECT is treatment of choice in severe depression.# indication of ECT in depression are:> Depression with suicidal risk> Severe refractory depression> Delusional depression> Depression with significant antidepressant side effects.> The response is rapid. Usually 6-8 ECTs are given three times a week along with antidepressants.# Contraindications of ECT:> The only absolute contraindication is the presence of raised intracranial tension.> Relative contraindications are: Recent myocardial infarction, Severe hypertension, Cerebrovascular accident, Severe pulmo iary disease, Retinal detachment, Pheochromocytoma.


Question: Counteransference is

TRANSFERENCE============during therapy unconscious direction of feelings from the patient to the therapist COUNTER TRANSFERENCE==== during therapy unconscious direction of feelings from the therapist to the patient Ref.Kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 845

Psychic connection between patient and disease


Question: The bad prognostic factors of schizophrenia include

Age below 18years early age of onset, poor compliance to medications, poor insight, poor knowledge, attitude and practice among family members, expressed emotions among family members , male gender, insidious onset of illness , simple and hebephrenic type of schizophrenia are usually bad prognostic factors for schizophrenia Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg: 370

Schizophrenia and other psychotic disorders


Question: Durg of choice in Delirium tremens is

Ans. C i.e. ChlordiazepoxideTreatment of deliriumHospitalization, preferably in an ICU, is indicated and treatment should be directed at the underlying cause.Metabolic abnormalities are corrected and hydration and nutrition cared for.Medicines are essential to control psychotic symptoms, agitation, and restlessness.Drugs used are:Antipsychotics (Neuroleptic) - Drugs of choice.Typical antipsychotics: - Haloperldol (Drug of choice), Thioridazine, Chlorpromazine,Atypical antipsychotics - Risperidone, Quetiapine, Olanzapine.Benzodiazepines: Used for delifium related to alcohol (delirium tremens):Chlordiazepoxide, Diazepam, Lorazepam, Clonazepam.


Question: Dementia of Alzheimer&;s type is not associated with one of the following

Dementia is a chronic organic mental disorder, characterized by the following main clinical features: 1. Impairment of intellectual functions, 2. Impairment of memory (predominantly of recent memory, especially in early stages), 3. Deterioration of personality with lack of personal care. Reference: A sho textbook of Psychiatry by Niraj Ahuja, page no.22.


Question: Duration required for the diagnosis of acute and transient psychosis is

If symptoms are for less than 1 months, it is a transient psychotic disorder or brief psychotic disorder as per DSM. As per ICD 10, acute psychosis is less than 2 weeks duration. Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 340


Question: Psychosurgery is used in

Psychosurgery can be used in the treatment of OCD that has become intractable and is not responding to other methods of treatment. The best responders are usually those who have significantly associated depression, although pure obsessives also respond. The main benefit is the marked reduction in associated distress and severe anxiety. (Ref: a sho textbook of psychiatry, Niraj Ahuja, 7th edition, pg no.98)


Question: The most common complication of modified ECT

Ans:D i.e. AmnesiaModified ECT-Both electricity and anesthetic agents and muscle relaxants are used to cause the convulsions. Methohexital is the most commonly used anesthetic.Common Complications:Memory disturbances-Retrograde amnesia(M/C)Headaches, muscle aches, fractures, tooth dislocationsProlonged seizures>180seconds


Question: Most common type of schizophrenia is

Most common-paranoid Best prognosis-catatonic Worst prognosis-simple Personality deterioration-hebephrenic Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 365-370

Schizophrenia and other psychotic disorders


Question: Amnesia is found in

A i.e. Head injury Amnesia can be seen after head injuryQ either as a pa of concussion injury or as an organic brain syndrome. Other causes of amnesia are Organic amnestic syndromes - Dementia, delirium, Korsakoff"s syndromeQ Dissociative disorder Transient global amnesia Type of memory loss in different Organic mental disorders Memory Delirium Dementia Organic Amnestic syndrome Immediate memory Normal Normal Disturbed Recent memory Disturbed Disturbed Disturbed Remote memory Normal Disturbed Disturbed


Question: A 30 year old manic patient was prescribed Haloperidol one week back. For the last two days he has become restless and kept pacing in the room for a day. On examinarion he was found to have tremors of hand. He is most likely suffering from


Question: Coprolalia is seen in

coprolalia-involuntary use of vulgar or obscene language. Observed in some cases of schizophrenia and in Tourette's syndrome. coprophagia- Eating of filth or feces. The echolalia-psychopathological repeating of words or phrases of one person by another; tends to be repetitive and persistent. Seen in catatonic schizophrenia. Reference: Page No 922 signs and symptoms in psychiatry(Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 9th Edition)


Question: Onanism is a disorder of


Question: Cotard's syndrome has

In the 19th century, the French psychiatrist Jules Cotard described several patients with a syndrome called delire de negation. sometimes referred to as nihilistic delusional disorder or Cotard syndrome. Patients with the syndrome complain of having lost not only possessions, status, and strength but also their hea, blood, and intestines. this is more commonly seen in depression. persecutory and referential delusions are common in psychosis like schizophrenia delusion of marital infedility is common in othello syndrome Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th edition, Page 336,307

Symptoms and signs in psychiatry and classification


Question: Borderline personality disorder

Borderline personality disorder The central feature of borderline personality disorder is a pervasive pattern of unstable and intense interpersonal relationship, self perception and mood The patient make recurrent suicidal threats and gesture and a small propoion of patients carry out the act or self multilation like cutting or burning The patients have difficulty in controlling their anger and impulsitivity. There is unceainty about personal identity *EMOTIONALLY UNSTABLE *Unstable and internse relationship *Disturbance in self image *Impulsivity *Affective instability *Chronic feeling of emptiness *Suicidal behavior *Difficulty controlling anger Dissosiative symptoms Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 868


Question: Slow waves in EEG is seen in

schizophrenia: widespread slow activity, dysrhythmia, spikes, and spike-wave complexes) generally have been regarded as nonspecific. mood disorders : depression: an increase of alpha and/or beta activity left frontal regions in depressed patients. ( decreased left frontal activation) manic episode: Less alpha power and higher EEG frequencies in manic patients with respect to healthy subjects have been interpreted as a sign of overarousal Delirium: diffuse slowing of the background rhythms from alpha (8 to 13 Hz) to theta (4.0 to 7.5 Hz) activity. Delta activity (<3.5 Hz) usually does not become prominent until the patient approaches non-responsiveness. The typical changes are slowing or even loss of the posterior dominant rhythm, slow wave increase, reduced reactivity to eye-opening, and intermittent, especially frontally located, rhythmic delta activity (FIRDA). EEG changes in mood disorders, schizophrenia are non-specific. The changes in delirium are consistent than other conditions. Considering the best answer to go with D) Delirium Reference: Page No.237 1.15 Applied Electrophysiology CTP


Question: Prophylactic maintenance serum level of lihium is


Question: Most specific of psychosis


Question: Treatment of Choice in Phobic disorder


Question: In a young male, history of firm unshakable belief of hands passing through the body & gripping his lungs indicates

This patient has :-

False but firm belief → Delusion.
Hand passing through the body & gripping his lungs → delusion is bizarre (belief that is impossible):

Bizarre delusions are seen in schizophrenia.


Question: Used for aveing smoking habit is

Bupropion (also called as amfebutamone a NDRI antidepressant )and varenicline are pharmacological agents recently used in promoting smoking cessation as adjuvant to behavioural or cognitive behaviour treatment (Ref: a sho textbook of psychiatry, Niraj Ahuja,7th edition, page no.52)


Question: Psychodynamic theory of mental illness is based on

Psychodynamic theory concentrates on unresolved childhood conflicts leading to adult symptoms. Like in case of Specific phpbia, A symbolic basis for a fear rooted in some unresolved early trauma. Ref: Basics of Psychotherapy: A practical guide to improving clinical success, 1e, Pg 41.

Focus on teaching patient to restrain absurd thoughts

Cognitive development and defence mechanism


Question: Opiate withdrawal is treated with

The withdrawal symptoms can be managed by one of the following methods: 1. Use of substitution drugs such as methadone to ameliorate the withdrawal symptoms. 2. Clonidine is a a2 agonist that acts by inhibiting norepinephrine release at presynaptic a2 receptors. 3. Naltrexone with Clonidine: Naltrexone is an orally available narcotic antagonist which, when given to an opioid-dependent individual, causes withdrawal symptoms. These symptoms are managed with the addition of clonidine for 10-14 days after which clonidine is withdrawn and the patient has continued on naltrexone alone. 4. Other Drugs: The other detoxification agents include LAAM ( Levo-alpha-acetyl-Metha dol), propoxyphene, diphenoxylate, buprenorphine (long-acting synthetic paial m-agonist which can be administered sublingually), and lofexidine (a2 agonist, similar to clonidine). In paicular, Buprenorphine has recently been used widely for detoxification as well as for maintenance treatment in many pas of the World. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 44