Question: Marijuana withdrawal syndrome is associated with

(A) Irritability# SYMPTOMS OF MARIJUANA WITHDRAWAL> Vary with an individual's level of dependency.> Mild form ofMarijuna dependence may experience minor physical and psychological discomfort, such as headaches or restlessness.> Severe forms of Marijuana addiction may endure more intense withdrawal symptoms, including sweating, fever, chills and hallucinations.# Physical Symptoms of Withdrawal: Stomach discomfort. Sweating. Tremor. Fever and chills. Headache.# Psychological Symptoms: Withdrawal for heavy marijuana users most often involves psychological symptoms that include Restlessness. Insomnia. Fatigue. Diminished appetite. Irritability. Anxiety, Depression.# Marijuana Withdrawal Timeline Day 1: Feelings such as irritability, anxiety & insomnia. Days 2-3: Typically the peak of withdrawal symptoms. Cravings can be strong, so relapse is most likely during this time & Sweating, chills and stomach pains have also been reported during this period. Days 4-14: Over the next several weeks, symptoms generally improve. However, depression can set in as brain chemistry changes and adapts to functioning without THC. Marijuana cravings may still be present as well. Days 15+: Most, if not all, symptoms should be gone by week three. Those with severe psychological addictions have reported feelings of depression and anxiety for up to several months after discontinuing marijuana use.# Treatment: Currently no medicines approved by the US Food and Drug Administration (FDA) to treat marijuana dependence.> There have been clinical trials of several drugs to find out if they can relieve withdrawal symptoms, including anti-anxiety drugs, antidepressants, sleep aids, anti-seizure drugs, mood stabilizers, and THC replacements.> Of these, the most promising results have come from the sleep aid Zolpidem, the anti-anxiety medication Buspirone, and the anti-convulsant drug Gabapentin.> These drugs relieve the insomnia and anxiety associated with marijuana withdrawal, and in the case of gabapentin, can also help to improve former users' ability to think clearly during withdrawal.> Three therapies that have been successful are: Contingency management This approach uses tangible rewards, like reward vouchers or prizes, to encourage healthy behavior, such as remaining abstinent from drugs. Motivational enhancement therapy. This behavioral treatment helps people in recovery to set concrete personal goals that they will be motivated to achieve. Counselors then help the individual to formulate a plan to meet those goals. Cognitive-behavioral therapy. This treatment uses counseling and education to help people in recovery to recognize dangerous behaviors and counteract them with healthier choices.


Question: The features of OCD are A/E


Question: Conscious simulations of signs of disease is

(A) Malingering # Exposure to life-threatening events can produce the stress-related psychiatric condition of posttraumatic stress disorder (PTSD). The nature of war can lead to genuine PTSD or the conscious simulation of symptoms of PTSD for secondary gain. Since malingering has a significant impact on the military and its mission, the importance of differentiating malinge ring from genuine PTSD. Factitious disorder was a clear sign of psychopathology, and hysteria had such clear secondary gains. Most obvious reason is that conversion disorder looks like feigning--that is, the clinical features are similar, if not identical. Inconsistent symptoms, particularly weakness or tremor that improves when distracted, are hallmarks of both conditions & in the case of these symptoms, probably reflect both conditions being a product of the voluntary motor system.


Question: Loosening of association is an example of

The disorders of form of thought include looseness of associations, derailment, incoherence, tangentiality, circumstantiality, neologisms, echolalia, verbigeration, word salad, and mutism. Loosening of assosiation is a type of formal thought disorder where the patient's thoughts are not connected and there are no meaningful connections. this is a charecterstic feuture of schizophrenia. this is one of the 4A's of schizophrenia that was given by Eugene Bleuler. 4A's that is given by schizophrenia is the most repeated question they are autism ambivalance apathy assosiation loss or loosening of assosiation Reference: Kaplan & Sadock's synopsis of psychiatry 11th edition, page 313,300

Symptoms and signs in psychiatry and classification


Question: The features of "Anankastic" personality disorder is

Anankastic personality is also known as the obsessive-compulsive personality disorder. They are very rigid and stubborn. The other characteristics are *Also known as OCPD( obsessive compulsive personality disorder) *Perfectionism *Rigidity *Punctuality * indecisiveness *Conscientiousness *excessive attention to detail *extreme orderliness in one area of life other charecterstics are Excessive doubt & caution Preoccupation with details rules,makes a lot of lists and order. There is no risk of obsessive-compulsive disorder in future but there is a risk of depression. Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 742


Question: Serum lithium levels for mania should be maintained in between

Lithium is a mood stabilizer It is used for the treatment of mania it was introduced by John F Cade it is a liver friendly drug it should not be given in patients with renal abnormalties it has a narrow thereaputic index above 0.8-1.2 meq/L it leads to lithium toxicity TOC for lithium toxicityis HEMODIALYSIS Therapeutic drug monitoring is done for lithium as it is not a safe drug its levels should be within 0.8-1.2meq/l. Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 620


Question: Modafinil is used for

(A) Narcolepsy # MODAFINIL# Narcolepsy Narcolepsy is both a disorder of the ability to sustain wakefulness voluntarily and a disorder of REM sleep regulation The classic "narcolepsy tetrad" consists of excessive daytime somnolence plus three specific symptoms related to an intrusion of REM sleep characteristics (e.g., muscle atonia, vivid dream imagery) into the transition between wakefulness and sleep# Cataplexy: sudden weakness or loss of muscle tone without loss of consciousness, often elicited by emotion. Hallucinations at sleep onset (hypnogogic hallucinations) or upon awakening (hypnopompic hallucinations); and Muscle paralysis upon awakening (sleep paralysis). Narcolepsy: Treatment The treatment of narcolepsy is symptomatic. Somnolence is treated with wake-promoting therapeutics. Modafinil is now the drug of choice, principally because it is associated with fewer side effects than older stimulants and has a long half-life; 20CM00 mg is given as a single daily dose. Modafinil, like other stimulants, increases the release of monoamines, specifically the catecholamines norepinephrine and dopamine, from the synaptic terminals. However, modafinil also elevates hypothalamic histamine levels In the United States, modafinil is approved by the U.S. Food and Drug Administration only for the treatment of narcolepsy, obstructive sleep apnea/hypopnea and shift work sleep disorder. In some countries, it is also approved for idiopathic hypersomnia (all forms of excessive daytime sleepiness where causes can't be established). Older drugs such as methylphenidate (10 mg bid to 20 mg qid) or dextroamphetamine (10 mg bid) are still used as alternatives, particularly in refractory patients.


Question: Sociopathic personality is associated with the following

(D) Drug addiction# Sociopathy, also known as psychopathy, is a personality disorder in which an individual lacks empathy and caring for people or societal norms. It is diagnosed as anti-social personality disorder or ASP, by the Diagnostic and Statistical Manual of the American Psychiatric Association.> It can lead to criminal behavior and institutionalization. No effective treatment currently exists.> The causes of sociopathy remain a mystery but scientific theories abound, including genetic mutation, abnormal nervous system development and problems in the home environment during childhood.


Question: Drug of choice in mixed mania is

(A) Lithium # Lithium has traditionally been the drug of choice for the tratment of manic episode (acute phase) as well as for prevention of bipolar mood disorder.> Lamotigine is particularly effective for bipolar depression.> Sodium Valproate is useful for acute treatment of mania & prevention of bipolar mood disorder and particularly useful in those patients who are refractory to lithium.> Carbamazepine & Oxcarbazepine are useful for acute treatment of mania & prevention of bipolar mood disorder and particularly useful in those patients who are refractory to lithium & valproate.


Question: Somatic passivity is a feature of

Somatic Passivity: The patient believes that sensation are being imposed upon his body by an outside force. Pa of Schizophrenia - First-Rank SymptomsSchizophrenia - First-Rank SymptomsDELUSIONAL PERCEPTIONAUDITORY HALLUCINATIONSDELUSIONS OF THOUGHT INTERFERENCEThought inseion (put into your head)Thought withdrawal (taken out of your head)Thought broadcasting (broadcast so that other people know what you are thinking)PASSIVITY PHENOMENON OR DELUSIONS OF CONTROLControl of the Impulses, Actions, Feelings, Sensations by an external force

Schizophrenia and other psychotic disorders


Question: Most reliable test for spinal tuberculosis


Question: The DSM IV classification of psychiatric disorder as proposed by American Psychiatry Association classifies and helps in diagnosing the patient on multiple axes. Of these, axis V represents the degree of

Axis I Axis I consists of clinical disorders and other conditions that may be a focus of clinical attention. Axis II Axis II consists of personality disorders and mental retardation. Axis III Axis III lists any physical disorder or general medical condition that is present in addition to the mental disorder. Axis IV Axis IV is used to code the psychosocial and environmental problems that contribute significantly to the development or exacerbation of the current disorder. Axis V Axis V is a global assessment of functioning (GAF) scale in which clinicians judge patients' overall levels of functioning during a paicular time. Reference: Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th Edition, page 306.

Symptoms and signs in psychiatry and classification


Question: Altruism is an example for

Altruism is a mature defense mechanism where an individual satisfies his internal needs by satisfying others.
Ex: A person who lost his son during accidents, started educating & campaigning people about road safety measures.


Question: A 40 year old male Raghu, is brought to psychiatric OPD with complaints of 6 months of odd and disorganized behavior. He also hears voices commenting about him. The likely diagnosis is

Patient has auditory hallucinations and disorganized behavior, 2 out of 5 symptoms are present according to diagnostic criteria. And the symptoms are present for past 6 months, which suggests of schizophrenia.


Question: IQ is

Intellectual Disability (ID), formerly known as Mental retardation. ID is defined as a disability characterised by significant limitations in both intellectual functioning and in adaptive behaviour that emerges before the age of 18 years. Wide acceptance of this definition has led to the international consensus that an assesment of both social adaptation and intelligenc quotient (IQ)are necessary to determine the level of intellectual disability. Ref: Synopsis of Psychiatry, 11e, pg 1118


Question: Most common psychiatric condition is

(A) Anxiety related # Anxiety is the most common feature in phobic disorders. Manifestations include the following: Elevated heart rate Elevated blood pressure Tremor Palpitations Diarrhea Sweating Dyspnea Paresthesias Dizziness> About 1 in every 10 people will have troublesome anxiety or phobias at some point in their lives.


Question: Arrange the following subtypes of schizophrenia, in order of prognosis, with the best prognosis first and the worst prognosis last, 1. Paranoid schizophrenia2. Catatonic schizophrenia3. Simple schizophrenia4. Disorganised schizophrenia

The correct sequence is Catatonic schizophrenia followed by Paranoid schizophrenia followed by Disorganised schizophrenia followed by Simple Schizophrenia Please remember in both DSM-5 and ICD-11, these subtypes have been removed

Schizophrenia Spectrum and Other Psychotic Disorders


Question: Parkinsonism differ from atypical parkinsonism by the absence of

Atypical Parkinsonisms Characterised by Progressive supranuclear palsy Coicobasal ganglionic degeneration Frontotemporal dementia Multiple-system atrophy a)Cerebellar type (MSA-c) b)Parkinson type (MSA-p) Poor response to dopamine early loss of balance prominent intellectual changes rapid onset of progression conspicuous postural hypotension urinary & bowel incontinence Little or no tremor Reference: Chapter 372. Parkinson's Disease and Other Movement Disorders Harrison's Principles of Internal Medicine 18th edition


Question: Dementia is produced by deficiency of vitamin

(C) Thiamine # DEMENTIA is the progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal aging.> Although dementia is far more common in the geriatric population, it may occur in any stage of adulthood.> This age cutoff is by definition, as similar sets of symptoms due to organic brain dysfunction are given different names, such as developmental disorders, in populations younger than adulthood.> In dementia, affected areas in cognition may be memory, attention, language, and problem solving.> Especially in the later stages of the condition, affected persons may be disoriented in time (not knowing what day of the week, day of the month, or even what year it is), in place (not knowing where they are), and in person (not knowing who they are).> Symptoms of dementia can be classified as either reversible or irreversible depending upon the etiology of the disease. Less than 10 percent of cases of dementia are due to causes which may presently be reversed with treatment.


Question: Treatment of hyperkinetic syndrome includes

CNS stimulants are the first choice agents in that they have been shown to have greatest efficacy with generally mild tolerable side effect. Excellant safety record is documented fro sho and sustained release preparations of Methylphenidate, dextroamphetamine and dextroamphetamine and amphetamine salt combinations. Methylphenidate- 0.3-1 mg/kg tid; upto 60mg/day. Both dexamphetamine and methylphenidate act on the reticular activating system, causing stimulation of the inhibitory influences on the cerebral coex, thus decreasing hyperactivity and/or distractibility Ref: Synopsis of Psychiatry, 11e, pg 1175. A sho textbook of psychiatry, Niraj Ahuja,7th edition, pg no 167


Question: IQ range of "Imbecile" is


Question: Maximum duration of sleep is spent in


Question: Paranoid psychosis observed with cocaine abuse can be explained by


Question: M.C. psychological features of AIDS is

B i.e. Depression Depression is most common psychological feature in: AIDSQ Post paumQ/ Post myocardial infarctionQ Post surgery Myxedema OCN leads to secondary depressionQ Pseudo dementia & Nihilistic delusions are seen in depressionQ.


Question: Mood congruent delusion seen in Depression

Nihilistic delusion is seen severe depression where patient denies the existence of himself & world. Also called as "Cotard syndrome".


Question: negative 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: The most common comorbid illness with depression is

Substance use disorder is the commonest comorbid psychiatric illness. The other impoant ones are panic disorder, social anxiety and OCD. Substance use is more common in men depressives and anxiety in women depressives. Bipolar disorder patients have twice the rates of prevalence, in comparison to the unipolar depressive patients.


Question: Transmitters mainly involved in OCN is

D i.e. SerotoninOCN involves Serotonin (5-HT) system, so fluoxetine (SSRI) is DOC.DiseaseRelated NeurotransmitterAlzheimer'sdisease- Acetyl cholineQ & Nor epinephrine are hypoactive- So anticholine-esterase - TacrineQ is used in treatment.DepressionNorepinephrine, Serotonin (5-HT)Q & Dopamine are reducedOCNSerotonin (5 117)(2SchizophreniaDopamine, Serotonin & Norepinephrine are ted(2


Question: The term ‘id’ was coined by

The Id
The id is theorised to be the original state of human mental apparatus with which a newborn baby is born. It is totally unconscious, containing the basic drives and instincts concerned with survival, sexual drive and aggression.
It is characterised by primary process thinking and is based on the pleasure principle, lacking any direct link with reality.
The only urge of these drives is immediate gratification.


Question: Wechsler test is a test for

Wechsler Intelligence Scales are a series of standardized tests used to evaluate cognitive abilities and intellectual abilities in children and adults. Purpose: Wechsler Intelligence Scales for Children and Wechsler Preschool and Primary Scale of Intelligence are used as tools in school placement, in determining the presence of a learning disability or a developmental delay, in identifying giftedness, and in tracking intellectual development. Wechsler Adult Intelligence Scales (regular and revised) are used to determine vocational ability, to assess adult intellectual ability in the classroom, and to determine organic deficits. Both adult and children's Wechsler scales are often included in neuropsychological testing to assess the brain function of individuals with neurological impairments.


Question: Catatonia is most commonly seen with

Catatonic schizophrenia (Cata: disturbed, tonic: tone) is characterised by a marked disturbance of motor behaviour the charecterstic feuture of catatonia is mutism and stupour catatonia can be rated by a rating scale called as Bush Francis Catatonia Rating Scale.It can present in three clinical forms: excited catatonia, stuporous catatonia, and catatonia alternating between excitement and stupor. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 59

Symptoms and signs in psychiatry and classification


Question: 1st line treatment for smoking cessation includes

Varenicline -ALPA 4 BETA 2 paial agonist for nicotinic receptors is the new 1st line treatment for smoking dependence. Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 351


Question: Repetition of movements, actions, words, and phrases is known as

Description: Perseveration: (1)Pathological repetition of the same response to different stimuli, as in a repetition of the same verbal response to different questions. (2) Persistent repetition of specific words or concepts in the process of speaking. Seen in cognitive disorders, schizophrenia, and other mental illness. egsample: when asked where are they from, they'll answer chennai when asked the next questions, what is their educational qualification, they'll answer chennai when asked the next question, wheather they have taken break fast, they'll answer chennai thus chennai, though an appropriate answer for the first question, it is inappropriately answered for the subsequent questions. D. Characteristic of obsessive compulsive disorder {OCD} Perseveration refers to the uncontrollable repetition of a paicular response, such as a word, phrase, or gesture, despite the absence or cessation of the original stimulus. Perseverative disorders can occur with various conditions including Alzheimer's disease, aphasia, schizophrenia, Parkinson's disease, and brain injury. Ref: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 622


Question: Declerembault syndrome is

Declerembault syndrome or Erotomania: Delusion of love: is typicaly a young female of lower socioeconomic status believes that a highter socioeconomic status male is secretly in love with her, even after he denies it.


Question: Narcolepsy is due to the abnormality in

Narcolepsy: Types central nervous system dysfunction of sleep mechanisms, hypocretin dysfunction, and deficit With Cataplexy symptom tetrad (1) excessive daytime sleepiness (2) cataplexy** (3) sleep paralysis (4) hypnagogic hallucinations **Temporary sudden loss of muscle tone, causing weakness and immobilization onset second decade of life. Without Cataplexy trigger for cataplexy: Strong emotions(laughter and anger) Due To Medical Condition Nocturnal sleep-fragmented, considerable sleep disturbance is present (tumors or sarcoidosis of the hypothalamus, multiple sclerosis plaques affecting the hypothalamus, paraneoplastic syndromes) Treatment: scheduled naps, lifestyle adjustment, modafinil, SSRI Reference: P 2161 chap. 20 Sleep Disorders(Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 9th Edition)


Question: A patient with pneumonia for 5 days is admitted to the hospital in altered sensorium. He suddenly ceases to recognize the doctor and staff. He thinks that he is in jail and complains of scorpion attacking him. His probable diagnosis is

B i.e. Acute delirium Delirium Acute confusional stateQ occurring in various medical, surgical, metabolic, toxic & post operative conditions. It is characterized by acute agitation, disorientation, and inability to sustain attention, form memories or reasonQ. Characteristic features include - Clouding of consciousnessQ (ie decreased awareness & decreased ability to respond to environmental stimuli) - DisorientationQ (in time > place > person) - Hallucinations (mostly visual) & illusionsQ - Autonomic dysfunctionQ, agitation, insomnia - Carphologia/floccillation (picking movements at clothes coversheets) & occupational delirium (pantomimes as if continuing the usual occupation in hospital bed) This patient in question has - disturbance in consciousness (altered sensorium) - disorientation - to place (thinks, he is in jail) - to person ( ceases to recognize the doctor & staff) - hallucination (complains of scorpions attacking him) - after acute medical illness. All these features are consistent with the diagnosis delirium. DSM-IV-Diagnostic Criteria of Delirium d/t General Medical Condition/Substance Intoxication/ or Withdral Disturbance of Consciousness (i.e. reduced clarity of awareness of the environment) with reduced ability to focus, sustain or shift attention. Change in Cognition (such as memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance that is not better accounted for by a preexisting, established or evolving dementia. or C. Disturbance develops over a sho period of time (usually hours to days) and tends to fluctuate during the course of the day. D. There is evidence from the history, physical examination or laboratory findings that the disturbance is caused by direct physiological consequences of general medical condition/ symptoms (A, B) developed during substance intoxication and medication use is etiologically related to the disturbance /or of symptoms (A & B) developed during or sholy after a withdraw! syndrome


Question: 46 years old male Ashwath, comes to your OPD and while giving history suddenly becomes blank and blames that your stole his thoughts. Diagnosis


Question: Anaclitic depression is

Depression with increased sleep & increased appetite

Depression in child deprived of care taker


Question: Anal phase of psychosexual stages of development is seen during

Oral phase: 0-1.5 years
Anal phase: 1.5-3 years
Phallic phase: 3-5 years
Latent phase: 5-12 years
Genital phase: > 12 years


Question: A Victim of Tsunami has difficulty in overcoming the experience. She still recollects the happenings in dreams and thoughts. The most likely diagnosis is

Ans. a (Post traumatic stress disorder) (Ref: Ahuja Psychiatry 6th/pg. 263)POST TRAUMATIC STRESS DISORDER# PTSD arises as a delayed or protracted response to an exceptionally stressful or catastrophic life event such as disasters, rape, war or torture or serious accident.# The reaction may occur shortly after the trauma (acute stress disorder) or be delayed and subject to recurrence (PTSD).- Acute Stress Disorder: Anxiety lasts < 1 month (but > 2 days).- Post Traumatic Stress Disorder (PTSD): Anxiety lasts > 1 month.# In both syndromes, individuals experience associated symptoms of detachment and loss of emotional responsivity.# Women more likely to be affected than men.# Symptoms of PTSD may develop after a period of latency, within 6 months after the stress or may be delayed beyond this period.# The patient may feel depersonalized and unable to recall specific aspects of the trauma, though typically it is reexpe- rienced through intrusions in thought, dreams, or flashbacks, particularly when clues of the original event are present.# Patients often actively avoid stimuli that precipitate recollections of the trauma and demonstrate a resulting increase in vigilance, arousal, and startle response.# Risk factors for the development of PTSD include a past psychiatric history and personality characteristics of high neuroticism and extroversion. Twin studies show a substantial influence of genetics on all symptoms associated with PTSD, with less evidence for environment effect.# Etiology and Pathophysiology:- In PTSD there are excessive release of norepinephrine from the locus coeruleus in response to stress and increased noradrenergic activity at projection sites in the hippocampus and amygdala.# Rx:- Acute stress reactions are usually self-limited, and treatment typically involves the short-term use of benzodiazepines and supportive/expressive psychotherapy.# TCAs such as imipramine and amitriptyline, the MAOI phenelzine, and the SSRIs (fluoxetine, sertraline, citalopram, paroxetine) can all reduce anxiety, symptoms of intrusion, and avoidance behaviors, as can prazosin.# Trazodone, a sedating antidepressant, is frequently used at night to help with insomnia (50 to 150 mg qhs).# Carbamazepine, valproic acid, or alprazolam have also independently produced improvement in uncontrolled trials.# Psychotherapeutic strategies that encourage the patient to dismantle avoidance behaviors through stepwise focusing on the experience of the traumatic event are the most effective.


Question: Good prognostic factor in schizophrenia is

Prognostic factors in Schizophrenia Good Prognosis Poor Prognosis Age* Late onset Young onset Sex Female male Precipitating factors present Absent Mode of onset Acute onset Insidious onset Premorbid functioning Good social, sexual, and work histories Poor social, sexual, and work histories Affective symptoms* Mood disorder symptoms (especially depressive disorders) Withdrawn, autistic behaviour Marital status Married Single, divorced, or widowed Family h/o* Family history of the mood disorders Family history of schizophrenia Suppo systems Good Poor Symptoms * Positive symptoms Negative symptomsNeurological signs and symptomsHistory of perinatal traumaNo remissions in 3 yearsMany relapsesHistory of assaultiveness Reference: P.476 chap 13 SchizophreniaKaplan & Sadock's Synopsis of Psychiatry, 10th Edition


Question: The term "Dementia precox" was coined by

C i.e., Kraepelin Benedict Morel used term demence precoce (in french) for deteriorated patients whose illness began in adolescence. Emil Kraeplin translated it into dementia. PrecoxQ i.e. dementia = deteriorated cognitive process & precox = early onset Eugen Bleuler coined term schizophreniaQ Kahlbaum described catatoniaQ, Hacker decribed hebephrenia


Question: Stimulant drug is given to child for the treatment of

Stimulant medication- dextroamphetamine and methylphenidate have been traditionally used for the treatment of attention deficit hyperactivity disorder. Methylphenidate is the currently the drug of choice. it acts on the reticular activating system, causing stimulation of the inhibitory influences on the cerebral coex, thus decreasing hyperactivity and /or distractability (Ref: a sho textbook of psychiatry, Niraj Ahuja,7th edition, pg no 167)


Question: In alcohol withdrawal, drug of choice is

The usual duration of uncomplicated withdrawal syndrome is 7-14 days. The aim of detoxification is the symptomatic management of emergent withdrawal symptoms. The drugs of choice for 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. A typical dose of Chlordiazepoxide in moderate alcohol dependence is 20 mg QID (four times a day) on day 1, 15 mg QID on day 2, 10 mg QID on day 3, 5 mg QID on day 4, 5 mg BD on day 5 and none on day 6. However, in more severe dependence, higher doses are needed for longer periods (up to 10 days). These drugs are used in a standardised protocol, with the dosage steadily decreasing every day before being stopped, usually on the tenth day. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no.40


Question: Monosymptomatic hypochondriasis means

* Somatic o ALSO KNOWN AS * Monosymptomatic hypochondriacal psychosis * Delusional parasitosis * Olfactory reference syndrome o DIFFERENTIAL DIAGNOSIS * HYPOCHONDRIASIS====NOT REASSURED as in hypochondriasis Ref.Kaplon and sadock, synopsis of psychiatry,11 th edition, pg no.333

Schizophrenia and other psychotic disorders


Question: Hysteria is characterised by

(A) Indifference to suffering # The characteristics of HYSTERIA are :> Impulsive, uncontrolled behavior (impulse dyscontrol).> Manipulative, exhibitionistic, emotional, dramatic, and/or seductive behavior (histrionic personality traits).> Absence of objective signs of organic illness.> Presence of multiple vague somatic symptoms, especially in a female patient (masked depression, somatization disorder or Briquet's hysteria).> Hypochondriasis; Any mental illness.> Presence of certain symptoms which are not explainable in the context of present organic illness (functional overlay, conversion symptoms).> Difficult patient; poor doctor-patient communication.> 'Sick' role or 'abnormal illness behavior'.; Psychosomatic disorders.; Malingering. ; Psychosexual dysfunctions.


Question: Intense depression & misery, without any cause is seen in

Melancholic depression is characterized by state of intense depression and feeling of misery without any cause.


Question: Delusion of Nihilism and Early morning insomnia are characteristic features of


Question: A young male, victim of earthquake few months back, presented with complains of recurrent and intrusive recollection of the events and thoughts with anxiety causing disturbed routine life. The likely diagnosis is

Ans. a (Post-traumatic stress disorder). (Ref. Psychiatry by Niraj Ahuja, 5th ed., 115, 188)ACUTE STRESS DISORDER & POST TRAUMATIC STRESS DISORDERThese disorders are characterized by Severe Anxiety symptoms & follow a threatening event that caused feelings of Fear, Helplessness or Horror.# Acute Stress Disorder: Anxiety lasts < 1 month (but > 2 days)# Post Traumatic Stress Disorder (PTSD): Anxiety lasts > 1 month# May occur at any age# 50% of cases resolve within 3 months# symptoms begin immediately after trauma, but may occur after months / years# Re-experiencing of the Traumatic Event- Dreams, Flashbacks or Intrusive Recollections- Avoidance of Stimuli associated with the trauma or numbing of general responsiveness- Increased Arousal: Anxiety, Sleep disturbances & Hypervigilance# "Survivor guilt" - A feeling of irrational guilt about an event sometimes occurs.# Rx: Counseling after a stressful situation to prevent PTSD from developing. Group Psychotherapy with other survivors is helpful. Pharmacotherapy: ntidepressants (SSRI, TCAs) or Benzodiazepines


Question: Ekbom's syndrome is seen in

Ekbom's syndrome or Delusional parasitosis is seen in cocaine intoxication where patient feels a sensation of insects crawling over the body.


Question: Type of schizophrenia with mental retardation

Pfropf schizophrenia occurring in the presence of mental retardation .it differs from schizophrenia in only that there is often a povey of ideation and delusions are not usually very well systematised.therefore behavioural disturbances are more prominent than delusions and hallucinations Ref: A sho textbook of Psychiatry. Nihal Ahuja. Edition 7. Pg no:61

Schizophrenia and other psychotic disorders


Question: Kleptomania means

Disruptive, Impulse-Control & Conduct Disorder: include intermittent explosive disorder, pyromania, kleptomania, conduct disorder*, antisocial personality disorder* , oppositional defiant disorder*. (* - usually described as a type of personality disorders) Feature Of Impulse-Control Disorders failure to resist an impulse /drive temptation to perform the act of tension or arousal before the act Pleasure/relief after the act Regret/guilt following the act compulsive drive to reduce dysphoria Intermittent Explosive Disorder (1) repeated aggressive acts resulting in the destruction of propey, (2) the dispropoionate response to the stimulus that preceded the aggression. Kleptomania - the Pathological compulsion to steal Pyromania -a pattern of behavior, with more than one occasion of purposeful fire setting. it is not done for monetary or other gains. Pathological Gambling- Gambling with increasing amounts of money needed to achieve the same level of excitement (tolerance) and restlessness and irritability when attempting to stop or cut back on gambling (withdrawal) Impulse control disorders and obsessive compulsive disorders involves doing repeated motor acts. In impulse control disorders, there is an urge and the person is not able to control the temptation and he does the act and finally by finishing the act there is a pleasure that is experienced. in obsessive compulsive disorder there is a obsession that is denoted by recurrent, irrelevant, intrusive thought and this thought is stressful To overcome that thought the person has to do some motor acts that are called as compulsions by doing these compulsions there is no pleasure but, there is a sense of releif of tension. b Reference: Page No.925 chap 7.3 Signs and Symptoms in Psychiatry(Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 9th Edition) DSM-5 section II Disruptive, Impulse-Control & Conduct Disorder P-461


Question: A 72 yr. old male lost 10kgs since last 3 months. He had profuse guilt for the mistakes he has done in life and doesn't sleep more than 4 hrs. per day. The probable diagnosis is

Dysthymia is chronic mild depression in which person have symptoms for more than 2 yrs. Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 604-607


Question: The period of normalcy is seen between two psychotic episodes. The diagnosis is

Bipolar mood disorder earlier known as manic-depressive psychosis is characterised by recurrent episodes of mania and depression in the same patient at different times. These episodes can occur in any sequence. (Ref: a sho textbook of psychiatry, Niraj Ahuja,7th edition, pg no73)


Question: Post Traumatic stress syndrome is due to


Question: The term schizophrenia was coined by

Emil Kraepelin: Manic-Depressive Psychosis and Dementia Praecox (dementia of the young). Eugen Bleuler - schizophrenia-"splitting" of psychic functions*. His four primary symptoms (four As) were Abnormal associations, Autistic behavior, and thinking, Abnormal affect, Ambivalence. Ku Schneider First Rank Symptoms Second-Rank Symptoms Audible thoughts Voices arguing or discussing(commanding voices) Voices commenting on patient's actions (commenting voices) Made feelings Made impulses or drives Made volitional acts Thought withdrawal Thought inseion Thought broadcasting Delusional perception Somatic Passivity Other disorders of perception Sudden delusional ideas Perplexity Depressive and euphoric mood changes Feelings of emotional impoverishment and several others as well . pneumonic 3HMT-DP Reference: Page No.1434 chap 12.2 Phenomenology of Schizophrenia (Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 9th Edition)


Question: Treatment of choice for bipolar disorder is

ithium was introduced by JOHN F CADE it is used in treatment of MANIA it is a liver friendly drug it has to be used in caution with people with deranged renal parameters if the patient is on lithium, he should be warned about of intake of other meds like NSAIDS, ACE inhibitors , as it may result in toxicity if a patient develops lithium toxicity, the TREATMENT OF CHOICE IS HEMODIALYSIS Reference: p.565 chap 15.1 Depression and Bipolar Disorder


Question: Yawning is a feature of


Question: Illusion with altered sensorium is seen in


Question: Impaired "anticipatory posture" is seen in

Posture that a child assumes when he wants to get picked up is termed as anticipatory posture. Autism is characterized by poor parental attachment ,eye contact and absence of anticipatory posture.


Question: Irresistable urge to drink alcohol is known as


Question: A young female presented with halo's abdominal pain and amnesia she is likely to be suffering from

B i.e. Dissociative disorderAmnesia is seen in dissociative disorders and Conversion disorder presents with anesthesia (sensory dysfunction) voluntary motor dysfunction or hysterical fits.Q.Autonomic system is characteristically not involved in conversion disorderQDisorder PresentationDissociative disorder****AmnesiaQFugueQ (wandering away from home)Trance & Possession disorderGanser syndrome (hysterical Pseudodementia)QConversion disorder*Hysterical fits - usually occur in safe place & infront of people - never occur during sleep - injury, incontinence & tongue bite usually absent *Motor symptoms - paralysis - abnormal movements - gait disturbance (Atasia abasia) *Sensory symptoms - blindness but walks well & does not injure himself - tubular vision, deafness - Glove stocking anesthesia Loss of all sensation Abrupt boundary Not according to dermatomes - Hemianesthesia i.e. Loss of vibration sense maintains a strict midline seperation inspite of fact that vibrationcan be perceived on other side through bone conduction.


Question: The specific laboratory finding often reflect the clinical manifestations of Neuroleptic Malignant Syndrome (NMS) is

(A) Elevated Creatine kinase # Laboratory abnormalities of NMS:> Elevated serum CK -- Laboratory findings often reflect the clinical manifestations of NMS with more severe rigidity leading to more profound creatine kinase (CK) elevation.> In NMS, CK is typically more than 1000 IU/L and can be as high as 100,000 IU/L.> Normal CK can be seen if rigidity is not clearly well developed, particularly early in the onset of the syndrome.> Elevated CK, particularly in the mild to moderate range, is not specific for NMS and is often seen in patients with acute and chronic psychosis due to intramuscular injections and physical restraints, and sometimes without specific explanation.> CK levels greater than 1000 IU/L, however, are probably more specific for NMS, and the degree of CK elevation correlates with disease severity and prognosis.> Other-- Other laboratory abnormalities are common but nonspecific.> A consistent laboratory finding is leukocytosis, with a white blood cell count typically 10,000 to 40,000/mm3 . A left shift may be present.> Mild elevations of lactate dehydrogenase, alkaline phosphatase, & liver transaminases are common.> Electrolyte abnormalities - Hypocalcemia, Hypomagnesemia, Hypo & Hypernatremia, Hyperkalemia, & Metabolic Acidosis are frequently observed.> Myoglobinuric acute renal failure can result from rhabdomyolysis.> Low serum iron concentration (mean 5.71 pmol/L; normal 11 to 32 pmol/L) is commonly seen in NMS patients and is a sensitive (92 to 100 percent) but not specific marker for NMS among acutely ill psychiatric patients> Investigations FBC often shows leukocytosis. U&Es may show metabolic disturbance due to acidosis or renal failure. Hypocalcaemia is a frequent association. Arterial blood sample to assess acid-base balance. LFTs may show elevated transaminases and lactate dehydrogenase (LDH) of muscle origin. CK is usually elevated. Urine myoglobin should be checked. Coagulation studies (particularly prothrombin time, activated partial thromboplastin time and international normalised ratio (INR)) should be checked (to detect coagulopathy). A urinary drug screen should be performed (particularly for salicylates, cocaine and amfetamines). If sepsis is suspected then blood and other relevant cultures should be taken.> Imaging may be indicated: CXR should be considered if sepsis is suspected. CT scan of the head, in order to exclude other diagnoses. Lumbar puncture may be required to exclude other diagnoses (particularly where there is fever and altered mental status). There are no significant cerebrospinal fluid (CSF) findings in neuroleptic malignant syndrome (NMS) other than raised protein.


Question:
A 16 years old female presents with recurrent abdominal pain hut biochemical assays and ultrasound abdomen is normal. After
waking up from sleep, she suddenly complains of loss of vision of bilateral eyes. Ophthalmologist finds nothing on
examination. This condition is most probably due to

A 16 years old female presents with recurrent abdominal pain but biochemical assays and ultrasound abdomen is normal. After waking up from sleep, she suddenly complains of loss of vision of bilateral eyes. Ophthalmologist finds nothing on examination.
This condition is most probably due to Malingering.
Malingering is fabricating or exaggerating the symptoms of mental or physical disorders for a variety of 'secondary gain' motives, which may include financial compensation
(often tied to fraud); avoiding school, work or military service; obtaining drugs; getting lighter criminal sentences, or simply to attract attention or sympathy.
Malingering Fabricating or exaggerating the symptoms of mental or physical disorders for a variety of ‘secondary gain' motives, which may include financial compensation (often tied to fraud);
avoiding school, work or military service; obtaining drugs: getting lighter criminal sentences: or simply to attract attention or sympathy.
Malingering can lead to abuse of the medical system, with unnecessary tests being performed and time being wasted by the clinician as opposed to those with legitimate health problems.
Malingering can exist in a variety of intensities, from pure (in which all symptoms are falsified) to partial, in which symptoms are exaggerated.
Treatment: Treatment lies in the clinician being able to detect the disorder.
Cues for the clinician include If the patient has legal problems Potential for financial reward,
antisocial personality disorder If the patient’s story is in congruent with known facts or other informant accounts If the patient will not cooperate while being evaluated Psychological evaluation is
also recommended as a way to diagnose malingering, in particular, the Minnesota Multiphasic Personality Inventory (MMPI-2) as this measure has validity scales of value for this purpose.
The MMPI-2 provides objective, scientifically based information about whether an individual has responded honestly to the test,
or whether he or she has exaggerated or minimized psychological problems (possibly to obtain an external incentive, such as money damages in a personal injury lawsuit).


Question: Neurotransmitter changes proposed in cases of Anxiety

There are various neurotransmitters that is studied under the neurobiology of anxiety they are mainly as follows decreased GABA, hence benzodiazepines which acts on GABA is a onderful anti anxiety drug decrased serotonin , hence SSRI are used in management of all anxiety disorders increased norepinephrine, thus proponolol which is a beta blocker is used in the management of anxiety especially in social anxiety disorders. Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 387

Increased NE, and decreased GABA and serotonin

Decreased NE and serotonin, and increased Ach

Increased serotonin, and decreased NE and GABA


Question: The most common disorder associated with Panic Attack is

(B) Post-traumatic stress disorder# 17 symptoms have been identified that make up PTSD.> These 17 symptoms are divided into three separate clusters.> Three PTSD symptom clusters, and the specific symptoms that make up these clusters, are described below.> Re-Experiencing Symptoms Frequently having upsetting thoughts or memories about a traumatic event. Having recurrent nightmares. Acting or feeling as though the traumatic event were happening again, sometimes called a "flashback."> Having very strong feelings of distress when reminded of the traumatic event. Being physically responsive, such as experiencing a surge in your heart rate or sweating, to reminders of the traumatic event.# Avoidance Symptoms: Making an effort to avoid thoughts, feelings, or conversations about the traumatic event. Making an ef- fort to avoid places or people that remind you of the traumatic event. Having a difficult time remembering important parts of the traumatic event.> A loss of interest in important, once positive, activities. Feeling distant from others. Experiencing difficulties having positive feelings, such as happiness or love. Feeling as though your life may be cut short.# Hyperarousal Symptoms> Having a difficult time falling or staying asleep.> Feeling more irritable or having outbursts of anger.> Having difficulty concentrating.> Feeling constantly "on guard" or like danger is lurking around every corner.> Being "jumpy" or easily startled. Emotional numbing symptoms are part of the avoidance cluster of PTSD symptoms. Emotional numbing symptoms generally refer to those symptoms that reflect difficulties in experiencing positive emotions.> The specific symptoms that make up the emotional numbing symptoms are: A loss of interest in important, once positive, activities. Feeling distant from others. Experiencing difficulties having positive feelings, such as happiness or love.> PTSD is characterized by recurrent and intrusive recollections of the stressful event either in flash-backs (images, thoughts, or perceptions) and/or in dreams.> There is an associated sense of re-experiencing of the stressful event.> There is marked avoidance of the events or situations that arouse recollections of the stressful event, along with marked symptoms of anxiety and increased arousal.> The other important clinical features of PTSD include partial amnesia for some aspects of the stressful event, feeling of numbness, and anhedonia (inability to experience pleasure).


Question: Drug most useful in the treatment of obsessive compulsive disorder is


Question: The technique of Psychological autopsy is useful in studying the causation of

Etiology: Some of the common causes of suicide are: Psychiatric Disorders are a major cause of suicide. Some common causes are: Depression: Major depression Depression secondary to serious physical illness. Reactive depression, secondary to life stressors, e.g. family and/or marital disputes, failure in goal achievement, occupational and financial difficulties, and death of significant others. Alcoholism and drug dependence Schizophrenia Genetic factors (a concordance rate of 18% in monozygotic twins) and biochemical factors (low levels of 5-HIAA) are impoant in some case of suicide.


Question: Ailurophobia is

Acrophobia : Fear of height.
Hydrophobia : Fear of water.
Ailurophobia : Fear of cats.
Xenophobia : Fear of strangers.


Question: Microcephaly is related to

(D) Schizophrenia # MICROENCEPHALY:> This is a disorder characterized by a small head and may be caused by a disturbance in the rapid growing of nerve cells. The term "microencephaly" is used to specifically denote a small brain. Relation has been found between schizophrenia, deletions of chromosomes and microcephaly> Microcephaly can also be associated with other conditions that are only indirectly associated with the nervous system: Alcoholism (which can result in the fetal alcohol syndrome disability); Diabetes; Varicella zoster virus (Chickenpox); Rubella (German measles); Radiation. After the dropping of atomic bombs on Hiroshima and Nagasaki, several women in close proximity to Ground Zero who had been pregnant at the time gave birth to children with microcephaly> Many genetic conditions are associated with MACROCEPHALY, including familial macrocephaly, autism, PTEN mutations such as Cowden disease, neurofibromatosis type 1, and tuberous sclerosis; overgrowth syndromes such as Sotos syndrome (cerebral gigantism), Weaver syndrome, Simpson-Golabi-Behmel syndrome (Bulldog syndrome), and macrocephaly-capillary malformation (M-CMTC) syndrome; neuro-cardio-facial-cutaneous syndromes such as Noonan syndrome, Costello syndrome, and cardiofaciocutaneous syndrome; Fragile X syndrome; leukodystrophies (brain white matter degeneration) such as Alexander disease, Canavan disease, and megalencephalic leukoencephalopathy with subcortical cysts; and glutaric aciduria type 1 and D-2-hydroxyglutahc aciduria.> Cowden syndrome (also known as "Cowden's disease," and "Multiple hamartoma syndrome" is a rare autosomal dominar t inherited disorder characterized by multiple tumor-like growths called hamartomas and an increased risk of certain form;; of cancer.> Clinical features of Cowden syndrome are diverse, including breast, endometrial, thyroid, kidney and colorectal cancers, dermatologic features such as oral and skin papillomas, trichilemmomas, gastrointestinal features such as mixed polyposis including hamartomas, and neurologic features such as autism and Lhermitte Duclos disease.> Tuberous sclerosis or tuberous sclerosis complex (TSC) is a rare multi-system genetic disease that causes non-malignant tumors to grow in the brain and on other vital organs such as the kidneys, heart, eyes, lungs, and skin.> A combination of symptoms may include seizures, developmental delay, behavioral problems, skin abnormalities, lung and kidney disease.> TSC is caused by a mutation of either of two genes, TSC1 and TSC2, which code for the proteins hamartin and tuberin respectively. These proteins act as tumor growth suppressors, agents that regulate cell proliferation and differentiation.> Alexander disease is a slowly progressing and fatal neurodegenerative disease. It is a very rare disorder which results from a genetic mutation and mostly affects infants and children, causing developmental delay and changes in physical characteristics. Delays in development of some physical, psychological and behavioral skills, progressive enlargement of the head (macrocephaly), seizures, spasticity, in some cases also hydrocephalus, dementia


Question: Semen squeeze

* Squeeze Technique: * Variation of the Masters and Johnson method. * As a man approaches climax, either he or his paner squeezes the tip of the penis just below the head of the penis as he approaches the point of climax. * Pressure is held there until the sensation of impending orgasm diminishes. * This pressure can even be held until there is some reduction in erection. * The process can then be staed over again so that over time a man prolongs the time period until he reaches ejaculation. * Useful to treat cases of premature ejaculation REF : HARRISON 21ST ED


Question: Behaviour Therapy is not useful in

B i.e. Hysteria (This is a relative answer because cognitive therapy mostly use behaviour components also and are k/a cognitive behaviour therapy (C.B.T) )Some common clinical applications of behaviour therapy are agoraphobiaQ, other phobias, obscessive compulsive disorderQ (obscessive thoughts that accompany rituals), alcohol (drug) dependence, eating disorders (anorexia and bulimia nervosa), type A behaviour, sexual dysfunctions (impotence, premature ejaculation), paraphilias, shy bladder (enuresis), encompresis, hyperventilation and Schizophrenia (tocken economy for desired behavior). - Kaplan's 957Cognitive therapy is used in depression, panic disorder, GADQ, obscessive compulsive disorder, personality disorder and somatoform disorder (hysteria)Q. - Kaplan-958Stuttering is treated by combinations of behaviour distraction, relaxation techniques and directed speech modification therapy. Most modern treatments of stuttering include components that target stuttering as, in pa, a learned behaviour that can be modified through behaviour techniques eg self therapy proposed by speech foundation of America. It is based on premise that stuttering is not a symptom, but a behaviour that can be modified. - Kplan's -1188Somatization disorder combined with conversion disorder was earlier referred to as hysteria (conversion reaction or dissociative reaction). Somatization disorder is treated with cognitive behaviour therapy (CBT), brief psychodynamic psychotherapyQ and antidepressants. (Kaplan-638, New oxford-1006). Evidence based psychological treatment of conversion disorder, involve CBT or interpersonal therapy discouraging, 'maintaining factors' such as excessive bed rest and challenging patient's negative or false beliefs (New Oxford-1019). Resolution of conversion disorder is facilitated by insight oriented suppoive or behaviour therapy (i.e. CBT). Hypnosis, anxiolytics, & behaviour relaxation exercises are effective in some cases. Psychodynamic approaches include psychoanalysis & insight oriented psychotherapy, in which patients explore intrapsychic conflictsQ and the symbolism of conversion disorder symptoms. (Kaplan's - 641-42)


Question: Most common hereditary cause of mental retardation

Fragile X-syndrome is the most common "hereditary" cause of mental retardation.
Ovarall most common cause : "Down's syndrome".


Question: A patient with pneumonia for 5 days is admitted to the hospital now with an altered sensorium. He suddenly ceases to recognize the doctor and staff. He thinks that he is in jail and complains of scorpion attacking him. His probable diagnosis is

Ans.B. i.e. Acute deliriumDeliriumAcute confusional state occurring in various medical, surgical, metabolic, toxic & post-operative conditions. It is characterized by acute agitation, disorientation, and inability to sustain attention, form memories or reason. Characteristic features include- Clouding of consciousness (i.e, decreased awareness & decreased ability to respond to environmental stimuli)- Disorientation (in time > place > person)- Hallucinations (mostly visual) & illusions- Autonomic dysfunction, agitation, insomnia- Carphologia/floccilation (picking movements at clothes coversheets) & occupational delirium (pantomimes as if continuing the usual occupation in a hospital bed)This patient in question has- disturbance in consciousness (altered sensorium) - disorientation - to place (thinks, he is in jail)- ceases to recognize the doctor & staff- hallucination (complaints of scorpions attacking him) - after an acute medical illness.All these features are consistent with the diagnosis delirium.


Question: Total score in Mini Mental Status Examination (MMS

Ans. is 'b' i.e., 30 Mini-mental status examination (MMSE)o The mini-mental status examination offers a quick and simple way to quantify congnitive function and screen for cognitive impairement It helps to confirm the presence of cognitive impairment and to follow the progression of dementia. It tests individual's orientation, attention, calculation, recall, language, and motor skills. Each section of test involves a related series of questions or commands. The individual receives one point for each correct answer. The individual can receive a maximum score of 30 points, i.e., MMSE is 30 point programme to evaluate cognitive function.QuestionsPointsOrientationo Name : season/date/dav/month/yearo Name : Hospital'fooritowfrstate,''country5 (1 for each name)5 (1 for each name)Registrationo Identify three objects by name and ask the patient to repeat3 (1 for each object)Attention & calculationo Serial 7s; subtract from 100(e.g., 93-86-79-72-65)5 (1 for each substruction)Recallo Recall the three objects presented earliero Languageo Name pencil and watcho Repeat "No ifs and, or buts"o Follow a 3 step command (e.g., "Take this paper, fold it in half, and place it on table'')o Write "close your eyes'' and ask the patient in obey written commando Ask patient to write a sentenceo Ask patient to copy a design (e.g., intersecting pentagons)3 (1 for each object)1 (1 for each object)13 (1 for each command)111Total30o A score of 25 or above suggests normal cognition. A score below 25 suggests possible cognitive impairment and a score below 20 indicates definite impairment.


Question: Rorschach test measures

this is Rorschach Test. it was given by Herman Rorschach, a Swiss psychiatrist. it was developed 1910. The Rorschach test is the most frequently used projective personality instrument. it has in total of 10 cards 5 cards are black and white as mentioned in the image 2 cards are black and red and 3 cards are multicoloured cards based on the response a individul given , the patients personality is assessed. Reference: Kaplon and Sadock, synopsis of psychiatry, 11 th edition, page number:249

Symptoms and signs in psychiatry and classification


Question: Methylphenindate is drug of choice for

Ans. b (ADHD). (Ref. Pharmacology by KD Tripathi 5th/- 436; Harrison 18th/27, 369)Drugs used for ADHD# Methylphenidate# Amphetamine# PimolineMethylphenidate acts by releasing NA & dopamine in brain. It is preferred because it causes less tachycardia & growth retardation.

ADHD (attention deficit hypersensitivity disorder)


Question: Child not eating vegetables. His mother stas giving a chocolate each time he finishes vegetables in the diet. The condition is


Question: The major risk factor for bipolar disorder is

There are several factors that is said to be a causation for bipolar disorders they can be classified under nature versus nuure hypothesis natural causes plays a impoant role and one of the impoant cause among them is family history or high genetic loadine more the number of genes more is the risk of bipolar disorder in a person Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 355


Question: Pathognomonic of maniac episode is

Mania tends to occur in episodes lasting 3-4 months followed by complete clinical cure In mania, there can be delusions of grandeur(grandiosity) with markedly inflated self-esteem. A delusion of persecution may sometimes develop secondary to a delusion of grandeur. (Ref: a sho textbook of psychiatry, Niraj Ahuja, 7th edition, pg no.69)


Question: Erotomanic delusion is seen in

(A) de Clerambault's syndrome # EROTOMANIA is a type of delusion in which the affected person believes that another person, usually a stranger, high-stalus or famous person, is in love with him or her. The illness often occurs during psychosis, especially in patients with schizophrenia, delusional disorder or bipolar mania.During an erotomanic episode, the patient believes that a "secret admirer" is declaring his or her affection to the patient, often by special glances, signals, telepathy, or messages through the media. Usually the patient then returns the perceived affection by means of letters, phone calls, gifts, and visits to the unwitting recipient. Even though these advances are unexpected and unwanted, any denial of affection by the object of this delusional love is dismissed by the patent as a ploy to conceal the forbidden love from the rest of the world.> The term erotomania is often confused with "obsessive love", obsession with unrequited love, or hypersexuality. Obsessive love is not erotomania by definition. Erotomania is also called de Clerambault's syndrome, after the French psychiatrist Gaetan Gatian de Clerambault (1872-1934), who published a comprehensive review paper on the subject (Les Psychoses Passionelles) in 1921.


Question: Erotomania is a

Erotomania: Synonym for delusions of love. Erotomanic (De Clerambault syndrome): In erotomania, is also referred to as de Clerambault syndrome it is also called as psychose passionelle. here the patient has the delusional conviction that another person the person on whom the patient has a delusion is usally from a higher status or a celebrity the patient is usually socio economically deprived the patient beleives that person in the higher status usally initiates the love proposal. inspite of the patient and the person not having any contacy, patient beleives that the person sends hidden messages that the patient alone can understand the persons on which the delusions are built are stalked and there is even risk of homicide. Besides being the key symptom in some cases of delusional disorder, it is known to occur in schizophrenia, mood disorder, and other organic disorders. Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th edition, Page 336.


Question: In ADHD the comorbid condition is

Ans: a (Learning disability)ADHD :Cardinal features- Extreme and persistant restlessness,- Sustained and prolonged motor activity,- Difficulty in maintaining attention,- Impulsiveness and difficulty in withholding responses.Symptoms should atleast last for 6 monthsICD 10 requires that symptom should start before 6 yrs of ageComorbidityConduct disorder,Depressive disorder,Anxiety disorder,Learning disabilityLanguage impairmentTreatment1. Support and psychological Rx2. Medicationsstimulant drugs- if severe restlessness and attention deficitMethyl phenidates/e - irritablity .depression, poor appetite, insomnia, slowing of growthAmoxetines/e- nausea,abd pain,loss of apetite, sleep disturbance, severe liver damage


Question: Active substance in Hashish is


Question: Clang associations are seen in

Patient adds rhyming words in a sentence even though they are meaningless.
Example : I ate dosa, bosa is in mosa.


Question: Well dressed man comes with a feeling of women trapped in his body, he is suffering from

GENDER IDENTITY DISORDERSThese disorders are characterised by the disturbance in gender identity, i.e. the sense of one's masculinity or femininity is disturbed. This group includes:1. Transsexualism: Male and female; primary and secondary.2. Gender identity disorder of childhood.3. Dual-role transvestism.4. Intersexuality. TranssexualismTranssexualism, the severest form of gender identity disorders, is characterised by the following clinical features: 1. Normal anatomic sex.2. The persistent and significant sense of discomfo regarding one's anatomic sex and a feeling that it is inappropriate to one's perceived-gender.3. Marked preoccupation with the wish to get rid of one's genitals and secondary sex characteristics, and to adopt sex characteristics of the other sex (perceived-gender).4. Diagnosis is made after pubey. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 121


Question: The term "Dementia praecox" was coined by

Although earlier descriptions of schizophrenia-like illness are recorded in the literature (such as in Ayurveda; Kahlbaum's description of catatonia; Hecker's description of hebephrenia), the scientific study of the disorder began with the description of dementia praecox by Emil Kraepelin. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 54

Schizophrenia and other psychotic disorders


Question: Disorientation occurs in


Question: A 40 years old female presented with agitated depression, attempted to suicide, feeling of guilt The First line of treatment includes

(A) Pentotal interview to resolve guilt # Important Steps for Preventing Suicide include:1. Take all the suicidal threats, gestures and/or attempts seriously and notify a psychiatrist or a mental health professional.2. Psychiatrist (or a mental health professional) should quantify the seriousness of the situation (a proper risk assessment).and take remedial precautionary measures, i. Inspect physical surroundings and remove all means of committing suicide, like sharp objects, ropes, drugs, firearms etc. Also, search the patient thoroughly, ii. Surveillance, depending on the severity of risk.3. Acute psychiatric emergency interview.4. Counseling and guidance i. to deal with the desire to attempt suicide, ii. to deal with ongoing life stressors, and teaching coping skills and interpersonal skills.5. Treatment of the psychiatric disorder(s) with medication, psychotherapy and/or ECT. ECT is the treatment of choice for patients with major depression with suicidal risk. It should also be used for the treatment of suicidal risk associated with psychotic disorders.6. Follow-up care is very important to prevent future suicidal attempts or suicide.


Question: Folie a deux is

Shared psychotic disorder or folie a deux, the characteristic feature is the transmission of delusions from "inducer" (primary patient), who is the "originally" ill patient and suffers from a psychotic disorder to another person who may share the inducer's delusions in entirety or in pa. the person who receives the delusion is usually financially dependent on the inducer person the person who receives the delusion is intellectually less normal and tend to beleive everything that the inducer person tells. both the person who induces and receives the delusion live in close proximity they live in social isolation with less contact with the outside world as they remain together delusion system perpetutes. treament of choice for such patients is seperation of the receiver of delusion from the inducer and the symptom of delusion reduces. Depending on whether the delusions are shared among two, three, four, five and even twelve people, it is called as folie a deux, folie a trios, folie a quatre, folie a cinq and folie a douze. Shared psychotic disorder is mostly observed among people who live in close proximity and in close relationships. Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 390


Question: Not a feature of Wernicke's Korsakoff Syndrome


Question: Classical triad of global confusion, ataxia and ophthalmoplegia is seen in

Wernicke&;s encephalopathy is an acute reaction to a severe deficiency of thiamine, the commonest cause being chronic alcohol use. Impoant clinical signs: Ocular signs- coarse nystagmus and ophthalmoplegia with bilateral external rectus paralysis occurring early. Higher mental function disturbances-disorientation, confusion, recent memory disturbances, poor attention span and distractibility are quite common. Other early symptoms are apathy and ataxia (Ref: a sho textbook of psychiatry, Niraj Ahuja, 7th edition, pg no.38)


Question: The prophylactic blood level of Lithium is

The prophylactic blood level of Lithium is 0.5 - 0.8 mEq/L.


Question: Drug of therapeutic benefit in Schizophrenia is


Question: Not affected by Wernicke&;s disease

In Wernicke&;s disease, neuropathologically, neuronal degeneration and haemorrhage are seen in thalamus, hypothalamus, mammillary bodies and midbrain. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no.38


Question: Most common cause dementia in an adult is

Dementia is a chronic organic mental disorder characterised by impairment of intellectual function, impairment of memory, deterioration of personality with lack of personal care Alzheimer&;s is the commonest cause of dementia seen in about 70% of all cases of dementia in USA. It is more commonly seen in women (Ref: a sho textbook of psychiatry, Niraj Ahuja,7th edition, pg no23)


Question: Maximum benefit of Electro Convulsive Therapy is in

Ans.C i.e. Depression with suicidal tendencyElectroconvulsive therapyProduces grand mal seizure in an anesthetized patient.Mechanism of action:- The ability of the brain to form and reorganize synaptic connections, especially in response to learning or experience or following injury.- Increases levels of Brain-Derived Growth Factor and Vascular Endothelial Growth FactorIndications:- Treatment-resistant depression- Severe depression with suicidal risk(most common indication)-Depression with psychotic featuresEmergency:- Refusal to eat or drink- The imminent risk for suicide- Neuroleptic malignant syndrome- Catatonia and catatonic schizophrenia- Severe agitated depression


Question: A 16 year old girl was brought to the psychiatric emergency after she slashed her wrist in an attempt to commit suicide. On enquiry her father revealed that she had made several such attempts of wrist slashing in the past, mostly in response to trivial fights in her house. Further she had marked fluctuations in her mood with a pervasive pattern of unable interpersonal relationship. The most probable diagnosis is

Self inflicted injury, suicidal attempt, unstable mood (fluctuating mood) and unstable interpersonal relationship suggest the diagnosis of borderline personality disorder.


Question: Nihilistic ideas are seen in

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 a charecterstic delusion that is present in sever depression Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th edition, Page 336.

Symptoms and signs in psychiatry and classification


Question: Defense mechanism in depression

Defence mechanism in disease Disease Defence mechanism Psychosis Projection Neurosis Repression Phobia Displacement Inhibition Depression Introjection OCD Undoing Reaction formation


Question: Person always has sexual thoughts & unacceptable sexual desire. He became a painter & picturized his thoughts by making nude paintings and sold them. This is an example of

Sublimation is a maure defense mechanism where unacceptable feelings are expressed in a socially acceptable manner.


Question: Punch drunk is boxers is a type of

Punch drunk syndrome: Head injury is a risk factor for Dementia. People who take pa in boxing are at a risk of developing Dementia. This is due to repeated minor traumas to the coex, basal ganglia, cerebellum resulting beta-amyloid deposition in the brain Reference: P no. 110 chap.7 Factors influencing risk of Dementia Handbook of Dementia, Kar& Jolley


Question: The difference between malingering and hysteria is

D i.e. Conscious motive in malingeringThe most impoant difference between hysteria & malingering is that- In Malingering patient intentionally produces symptoms (conscious motive)Q.In Hysteria (conversion disorder), patient does not intentionally produces symptomsQ.


Question: Congenital Anomaly produced by lithium therapy is


Question: The term "id" in the structural model of the mind refers to

sigmund Freud was a pioneer in psychiatry he introduced the new school called PSYCHOANALYSIS he introduced the TOPOGRAPHICAL THEORY OF MIND he gave the concept of structural theory of mind he gave the concept of interpretation of dreams Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 447


Question: Biochemical etiology of Alzheimer's disease relates to

Neurotransmitters, which are decreased in Alzheimer's disease:- Acetylcholine (most important), norepinephrine, somatostatin, corticotropin.


Question: Flight of idea is seen in


Question: Alpha wave on EEG represent

Awake with eyes closed with mind wandering


Question: Symptomatic treatment is not required in withdrawal of


Question: Not a feature of Korsakoff Psychosis is


Question: Mode of action of fluoxetine is

C i.e. Inhibition of axonal uptake of 5 HT


Question: Positive symptoms in Schizophrenia is because of

a) ↑ dopaminergic activity in mesolimbic pathway → positive symptoms
b) ↓ dopaminergic activity in mescortical pathway → Negative symtoms
c) ↓ dopaminergic activity in nigrostriatal parthway → Paskinsonism
d) Tuberoinfundibular pathway regulates prolactin secretion.

Increased dopaminergic activity in Mesolimbic Pathway

Decreased dopaminergic activity in Mesocortical Pathway

Decreased dopaminergic activity in Nigrostriatal pathway

Increased dopaminergic activity in tuberoinfundibular pathway.


Question: Double depression is

(B) Depression with Dysthymia > An episode of major depression may become superimposed on an underlying neurotic depression. This is known as double depression.> Neurotic depression has been renamed as dysthymia or dysthymic disorder in DSM-IV-TR and ICD-10.> This category does not requi presence of stress as a precipitating factor, & does not put emphasis on the presence of other neurotic symptoms or traits.> Dysthymia is defined as any mild depression which is not severe enough to be called a depressive episode, and lasts for two years or more. This is more common in females, with an average age of on in late third decade.


Question: Confabulation means

Striking feature of Korsakoff's psychosis is tendency to confabulate, which has been defined as falsification of memory in clear consciousness. It probably results from an inability to distinguish the temporal sequence of past events. The choice A means illusion and B and D means hallucination. Confabulation: As recent memory is more severely disturbed, very remote events are better remembered, especially in the initial stages. Recent memory impairment also leads to disorientation in time and place. To fill in the memory gaps, patient uses imaginary events in the early phase of illness (confabulation). With the progression of the disease, confabulation disappears.

Misinterpretation of stimulus by any of the special sense organs

Making stories to fill in the gaps caused by memory loss

Substance Related and Addictive Disorders


Question: Not a feature of mania

B i.e. DisorientationDSM - IV Diagnostic criteria of Mania (episode)Abnormally & persistently elevated, expansive, or irritable mood lasting for at least 1 week (or any duration if need hospitalization).are neededInflated self esteem or grandiosityQDecreased need for sleepQ (3 hours)More talkative or pressure to keep talkingQFlight of ideas or subjective experience that thoughts are racingDistractibilityQ (i.e. attention too easily drawn to unimpoant or irrelevant external stimuli)Increase in goal-directed activity (social, spiritual, religious, sexual)Q or psychomotor agitation Excessive involvement in pleasurable activities (eg unrestrained buying sprees, foolish business investments, donations or sexual indiscretions)Q that have a high potential for painful consequences.


Question: Antipsychotic drugs act through

(B) Dopamine D2 receptor blockade # Antipsychotics work by blocking a specific subtype of the dopamine receptor, referred to as the D2 receptor.> Older antipsychotics, known as conventional antipsychotics, block the D2 receptor and improve positive symptoms.> Second generation of antipsychotics or Atypical antipsychotics, block D2 receptors as well as a specific subtype of serotonin receptor, the 5HT2A receptor.> It is believed that this combined action at D2 and 5HT2A receptors treats both the positive and the negative symptoms.> Atypical antipsychotics include clozapine, risperidone, olanzapine, quetiapine, paliperidone and ziprasidone.


Question: The term 'free association' is coined by

A. i.e. Freud Psychoanalysis Credit for invention of psychoanalysis belongs to Sigmund FreudQ, (born on 6 may 1956 in Freiburg, Czech Republic spent most of life in Vienna (Austria) & died in Lndon in 1939)Q Principles of role of meaning, free association, resistance, transference, counter transference and parapraxes are at the core of psychoanalysis as a treatmentQ. Other tenets (principles) include unconscious mental activity, role of childhood experiences in shaping adult personality and notion of psychic determination. Concept of psychic determinism means that all mental activity is purposeful & meaningful (not accidental)Q, though unconscious, & is linked with previous experiences of life. Role of meaning - means all symptoms, thoughts, feelings & behaviours are final common pathways of meaningful psychological processes. Many of which were unconscious. So even content of auditory hallucinations (produced by biological factors) is meaningful & shows psychological characteristics unique to that patients. Free association is a technique when patient is asked to say whatever came to mind. Freud recognized that patients often resist the physician's effo to heal reflected by mundane behaviours such as unable to follow suggestions, missing medication or scheduled appointment; all reflecting unconscious resistance to getting better. Parapraxes or slips of tongue, often reveal unconscious intent that is outside the individual's awareness. Transference is patient's displacement of early wishes & feelings toward persons from past onto the analyst or physician. It is influenced by analyst's real characteristics as it is an admixture of figures from the patient's past & the real relationship with the clinician in present. Counter transference is the flip side of transference - the clinician's feelings towards the patientQ, based on mixture of real characteristics of patient and qualities associated with figures from the clinician's past. In classical psychoanalysis, no detailed history taking, mental status examination or formalized diagnosis is attempted. The patient is allowed to communicate unguidedQ, by using free association. Therapist constantly challenges existing defences & interprets resistances and transference (patient's feeling, behaviour & relationship with the therapist)Q. The physician remains passive & his approach is non-directive i.e. no direct advice is ever givenQ to the patient. The crux of therapy is on interpretation.


Question: A 31 year old male, with mood disorder, on 30 mg of haloperidol and 100 mg of lithium, is brought to the hospital emergency room with history of acute onset of fever, excessive sweating, confusion, rigidity of limbs and decreased communication for a day. Examination reveals tachycardia and labile blood pressure and investigations reveal increased CPK enzyme levels and lecocytosis. He is likely to have developed.


Question: Concrete thinking stage of cognitive development is

Stages of Intellectual development was postulated by Jean Piaget. 0- 1.5 yrs Senosorimotor 2- 7 yrs Preoperational 7- 11 yrs Concrete operation 11 to end of adolescence Formal operation Concrete operation is so named because in this period child operates and acts on concrete, real and perceivable world of objects and events. Ref: Synopsis of Psychiatry, 11e, pg 94.

Cognitive development and defence mechanism


Question: Risk factor for suicide

some of the risk factors for suicide are male gender substance abuse recent stressor family history of attempted or completed suicide past history of attempted or completed suicide personality--- Borderline personality disorder charecterstic---impulsivity unmarried umemployed lack of spouse lack of soial suppo Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 307


Question: DSM IV criteria for depression is

DURATION CRITERIA FOR DEPRESSION======14 DAYS DURATION CRITERIA FOR MANIA==========7 DAYS DURATION CRITERIA FOR HYPOMANIA======4 DAYS DURATION CRITERIA FOR DYSTHYMIA======2 YEARS DSM-IV-TR Criteria for Major Depressive Episode A. Atleast 1 symptom B.5 or more symptoms i)depressed mood ii)loss of interest or pleasure depressed mood markedly diminished interest/pleasure significant weight loss/ weight gain. insomnia or hypersomnia psychomotor agitation or retardation fatigue or loss of energy wohlessness or inappropriate guilt inability to think or concentrate recurrent thoughts of death , suicidal idea, suicide attempt A+B have been present during the same 2-week period and represent a change from previous functioning. Reference: p.535 chap 15.1 Depression and Bipolar Disorder


Question: Repetition of movements, actions, words and phrases beyond point of relevance

Perseveration: (1) Pathological repetition of the same response to different stimuli, as in a repetition of the same verbal response to different questions. (2) Persistent repetition of specific words or concepts in the process of speaking. Seen in cognitive disorders, schizophrenia, and other mental illness. egsample: when asked where are they from, they'll answer chennai when asked the next questions, what is their educational qualification, they'll answer chennai when asked the next question, wheather they have taken break fast, they'll answer chennai thus chennai, though an appropriate answer for the first question, it is inappropriately answered for the subsequent questions. Reference: Kaplan & Sadock's synopsis of psychiatry, 11th edition, page 1415.

Symptoms and signs in psychiatry and classification


Question: Beta Wave tracing in EEG is found in

EEG waves wave frequency condition beta > 13Hz during cognitive effos, drowsiness and light sleep alpha 8-13Hz relaxed wakefulness with eyes closed theta 4-7.5Hz deep sleep, hyperventillation delta 0.1-3.5Hz drowsiness, deep sleep Ref: Standard EEG in clinical psychiatry, Wiley-blackwell, 1e, pg 34.


Question: The maximum DALY loss is for the following disease

DALY is called as Disability Adjusted Life year it was given by WHO to quantify the burden of various disorders it is studied as sum of years of life lost due to premature death plus years lost due to dysability it has been found that mood disorders and alcohol use disorder ranks highest in the DALY Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 1400


Question: The site of lesion in Korsakoff's psychosis is


Question: Features of serotonin syndrome associated with SSRI and MAOIs are

Co-prescription of serotonergic drugs with other serotonergic agents and especially MAOIs can lead to serotonin syndrome.it is characterised by classic triad of mental status changes,neuromuscular abnormalities and autonomic hyperactivity.these include anxiety, agitation, confusion, clonus, hyperreflexia, myoclonus, rigidity, increased hea rate, tremor, flushing, hypehermia and excessive sweating. Death can occur in severe serotonin syndrome. (Ref: a sho textbook of psychiatry, Niraj Ahuja, 7th edition, pg no185)


Question: Most common psychiatric disorder in community is

(A) Depression # DEPRESSION is the most common psychiatric illness in India.> Neurotic depression is far common than psychotic depression.> Neurotic depression is followed by anxiety neurosis is prevalence.> This is in contrast to West, where anxiety neurosis is the commonest.


Question: Desensitization is a type of

BEHAVIOUR THERAPY : Systematic Desensitization, Therapeutic-Graded Exposure, flooding, Paicipant, Modeling, Asseiveness Training, Social Skills Training, Aversion Therapy, Eye Movement Desensitization and Reprocessing(EMDR)* Systematic Desensitization (Wolpe) based on counterconditioning, therapy for all types of phobia is exposure it can be done by several means systemic sensitization works on the mechanism of graded exposure along with relaxation flooding is a technique involved sudden and reapid exposure and extinction of phobia in systemic desensitization, the main steps that are invoved are mainly introducing a step ladder and combining it with relaxation and hence helps them to overcome that paicular phobia this method of systemic desensitization was given by Joseph Wolpe a person overcomes maladaptive anxiety elicited by a situation or an object by approaching the feared situation gradually in a state of complete relaxation and are then exposed to the stimulus that elicits the anxiety response. The negative reaction of anxiety is inhibited by the relaxed state, a process called reciprocal inhibition. Indications: Phobias, obsessions, compulsions, and ceain sexual disorders Reference: P.2789 30.3 Behavior Therapy(Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 9th Edition)


Question: Antisocial behaviour/ Dissocial personality is characterised by

1. Callous inconcern for the feelings of others. 2. Gross and persistent attitude of irresponsibility and disregard for social norms, rules and regulations, 3. incapacity to maintain enduring relationships, though having no difficulty in establishing them 4. very low tolerance to frustration and a low threshold for discharge of aggression, including violence. 5. incapacity to experience guilt or to profit from experience, paicularly punishment. 6. marked proneness to blame others, or to offer plausible rationlisations, for the behaviour that has brought patient into conflict with society. Ref: ICD-10, CDDG, pg 159.

Unconcern for feelings of others, disregard for social norms

Self dramatization and exaggerated expression of emotions


Question: Delusion of doubles is found in

CAPGRAS' SYNDROME (THE DELUSION OF DOUBLES) Capgras' syndrome is a syndrome that is closely related to delusional disorders and is characterised by a delusional conviction that other persons in the environment are not their real selves but are their own doubles. It is one of the several delusional misidentification syndromes, of which there are four types described: 1. Typical Capgras' syndrome ( Illusion des sosies): Here the patient sees a familiar person as a complete stranger who is imposing on him as a familiar person. 2. Illusion de Fregoli: The patient falsely identifies stranger(s) as a familiar person(s). 3. Syndrome of subjective doubles: The patient's own self is perceived as being replaced by a double. 4. Intermetamorphosis: Here the patient's misidentification is complete and the patient misidentifies not only the 'external appearance' (as in the previous three types) but also the complete personality. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 87

Schizophrenia and other psychotic disorders


Question: The AUDIT questionnaire is used for detection of

Alcohol Use Disorders Identification Test (AUDIT) was developed by the World Health Organization (WHO) as a simple method of screening for excessive drinking and to assist in brief assessment. It is a screening tool it has 10 items it was developed by WHO( world health organisation) it assess alcohol consumption, drinking behaviors, and alcohol-related problems A score of 8 or more is considered to indicate hazardous or harmful alcohol use maximum score is 40 Ref: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 624


Question: "Magical thinking" is seen in

Patients with schizotypal personality disorder will have odd & eccentric thoughts & magical thining, that is he believes that his thinking can influence external world.


Question: Deficiency of hypocretin leads to

Hypocretin is a neurotransmitter that promotes wakefulness and it's deficiency leads to Narcolepsy.


Question: Drug of choice for delirium tremens is

Alcohol Withdrawal: * when there is Cessation of (or reduction in) alcohol use that has been heavy and prolonged. Two (or more) of the following, develop increased hand tremor insomnia Anxiety grand mal seizures nausea vomiting psychomotor agitation hallucinations or illusions transient visual, tactile,auditory autonomic hyperactivity The classic sign of alcohol withdrawal is tremulousness Alcohol Withdrawal Delirium(Delirium Tremens*): alcohol intoxication/withdrawal is associated with agitated confusion, tactile or visual hallucinations, delusions, seizures. *Rum Fits -During withdrawal causes one or several grand mal convulsions. Treatment of delirium tremens: benzodiazepines, antipsychotic agents(haloperidol). Reference: P.396 397 chap 12.2 - Alcohol-Related DisordersSuicide Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th Edition


Question: Most useful drug in Enuresis is

C i.e. TrimipramineNocturnal eneuresis can be managed by behavior therapy eg classic conditioning with eneuresis alarm (method of choice)Q, desmopressin, (drug of choice)Q & tricyclic antidepressant imipramineQ.Behavioral Therapy- Behavioral therapy eg classic conditioning with the bell (or buzzer) & pad apparatus (=Enuresis alrm system) is the most effective treatment for enuresis with minimum relapse.- Enuresis alarm system (i.e. classic conditioning behavioral therapy) is the method/treatment of choice. It is equally effective in children with or without concomitant mental disorders.Other Behavioral Modification & Motivation Therapy- Restriction of fluid intake after 8 p.m.- Interruption of sleep before the expected time of bed wetting- Bladder training aimed at increasing the holding time ofbladder, encouragement or reward for delaying micturation for increasing times during waking hours has also been used.- These behavioral modifications and motivational therapy (reward for being dry at night) may although sometimes be effective, these methods are decidedly inferior to the bell and pad.PsychotherapySuppoive psychotherapy to child & parents may deal with coexisting secondary emotional & family difficulties but is not effective alone in the sho term treatment of enuresis.PharmacotherapyMedication is considered when problem interfers significantly with child's functioning causing impairment in social, family, & school function & behavioral and fluid restriction have not been efficacious. Although the problem often recurres as soon as the medication is withdrawn. Approved drugs include - Desmopressin (DDAVP, an antidiuretic compound available as an intranasal spray) is the drug of choice.- Reboxetine, a norepinephrine reuptake inhibitor (non cardiotoxic)- Tricyclic antidepressant imipramineQ (not preferred d/t risk of sudden death in children with ADHD). -Anticholinergics, amphetamines, diazepam (no beneficial response)


Question: Flooding is a treatment modality used in

Phobia is treated by behaviour therapy. If properly planned, this mode of treatment is usually successful. Impoant techniques are flooding, systemic desensitisation, exposure and response prevention, relaxation technique (Ref: a sho textbook of psychiatry, Niraj Ahuja, 7th edition, pg no.94)

Anxiety disorders stress disorders and grief


Question: A lady used to repeatedly wash her hands due to the fear of acquiring AIDS is due to

(A) OCD # Obsessive-compulsive disorder (OCD) is a psychiatric anxiety disorder most commonly characterized by a subject's obsessive, distressing, intrusive thoughts and related compulsions (tasks or "rituals") which attempt to neutralize the obsessions.# Obsessions are defined by:> Recurrent and persistent thoughts, impulses, or images that are experienced at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress.> Thoughts, impulses, or images are not simply excessive worries about real-life problems.> Person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action.> Person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind, and are not based in reality.> Tendency to haggle over small details that the viewer is unable to fix or change in any way. This begins a mental pre-occupation with that which is inevitable.# Compulsions are defined by:> Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly.> The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.


Question: Frued is known for

Ans. a (Psychoanalysis) (Ref. Neeraj Ahuja, 5th/pg.55, 210)Psychoanalysis was first described by Sigmund Freud (1856-1939).Psychoanalysis encomprises of:1. A psychological theory of mind and personality development based primarily on the concept of intrapsychic conflict.2. A procedure for the investigation of unconscious psychic processes otherwise inaccessible3. A therapeutic technique of treating psychiatric disorder by psychological means.NAMECOMMENTSEugen Bleuler- Named schizophrenia, and held that its defining characteristic was a disorder of the thinking process.- First introduced the term autism in 1911.- Coined the term ambivalence (the coexistence of two opposing drives, desires, feelings or emotions towards the same person, object or goal) to designate one of the major symptoms of schizophrenia.Kraeplin- Coined the term 'dementia precox'.Sigmond Freud- 'Psychotherapy' is after his name.- Invention of 'psychoanalysis'


Question: Sigmund Freud divided "Id, Ego and Superego" as 3 components of mind according to

Structural theory of mind: Includes Ig, Ego and Superego
Topographical theory of mind: Includes Unconscious, Preconscious and Conscious as 3 parts of mind.


Question: Stereotypic moments are

Stereotypic movements are seen in catatonic type of schizophrenia.

Repetitive, spontaneous, nonfunctional movements


Question: Patient with IQ of 60 has

Mental Retardation Level IQ Range 1. Mild 50-70* 2. Moderate 35-50* 3. Severe 20-35* 4. Profound <20* Reference: A Sho Textbook of Psychiatry by Niraj Ahuja page no.156.


Question: Rorschach test is done with

The Rorschach Inkblot Test is a projective psychological test consisting of 10 symmetric inkblots printed on cards (5 colour and 5 black and white). This test is often employed in diagnosing underlying thought disorders and differentiating psychotic from non-psychotic thinking Ref: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 217

Symptoms and signs in psychiatry and classification


Question: In mood disorder, rapid cyclers are defined as

(A) 4 or more episodes per year# Rapid cycling:> Most people who meet criteria for bipolar disorder experience a number of episodes, on average 0.4 to 0.7 per year, lasting three to six months.> Rapid cycling, however, is a course specifier that may be applied to any of the above subtypes. It is defined as having four or more episodes per year and is found in a significant fraction of individuals with bipolar disorder. The definition of rapid cycling most frequently cited in the literature (including the DSM) is that of Dunner and Fieve: at least four major depressive, manic, hypomanic or mixed episodes are required to have occurred during a 12-month period.There are references that describe very rapid (ultra-rapid) or extremely rapid (ultra-ultra or ultradian) cycling. One definition of ultra-ultra rapid cycling is defining distinct shifts in mood within a 24-48-hour period.


Question: The percentage of Schizophrenia in First degree relatives is

(C) 6.4% # Genetic factors are involved in at least a subset of individuals who develop schizophrenia. Schizophrenia is observe d in 6.6% of all first-degree relatives of an affected proband. If both parents are affected, the risk for offspring is 40%. The concordance rate for monozygotic twins is 50%, compared to 10% for dizygotic twins.


Question: A homosexual person feels that he is imposed by a female body & persistent discomfo with his sex, diagnosis is


Question: A patient has a fear that his penis will retract into abdomen and  that may result in his death. Diagnosis

It is a culture bound delusional disorder where a person believes his sex organs retract, disappear & lead to death.


Question: "Chasing the dragon" phenomena occurs with

"Chasing the dragon" refers to inhaling the vapour from a heated solution of morphine, heroin. The "chasing" occurs as the user gingerly keeps the liquid moving in order to keep it from overheating and burning up too quickly, on a heat conducting material such as aluminium foil. The moving smoke is chased after with a tube through which the user inhales. Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 659


Question: Postponing paying attention of conscious impulse or conflict is mature defence mechanism known as

Sublimation: Gratification of an impulse whose goal is retained but whose aim or object is changed from a socially objectionable one to a socially valued one. Suppression: Conscious or semiconscious decision to postpone attention to a conscious impulse or conflict. Humour:ove expression of feelings without personal discomfo and without unpleasant effo on others. Anticipation: Realistic anticipation of or planning for future inner discomfo. Ref: Synopsis of Psychiatry, 11e, pg 161.

Cognitive development and defence mechanism


Question: 45 years old Chandu is always preoccupied with feeling of illness. The diagnosis is


Question: Delirium is distinguished from dementia by the presence of

Ans.C. Clouding of consciousnessThe hallmark of delirium is fluctuation in the level of consciousness.Periods of lucency may be interspersed with periods of marked unresponsiveness.Another distinguishing feature is that the onset of delirium usually occurs within hours or days, whereas the onset of dementia may be insidious throughout weeks to months.


Question: side effect of bupropion is

NDRI * IMPOANCE Anti-depressant which does not deal with serotonin neurotransmission Also called as Zyban * MECHANISM Prevents reuptake of nor adrenaline and dopamine * DRUGS Bupropion * USE ADHD SMOKING CESSATION HYPOACTIVE SEXUAL DESIRE DISORDER * SIDE EFFECTS seizures ref, kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 955