Question: Most common symptom of symptom of alcohol withdrawal is

The most common withdrawal syndrome is a hangover on the next morning. Mild tremors, nausea, vomiting, weakness, irritability, insomnia and anxiety are the other common withdrawal symptoms. Sometimes the withdrawal syndrome may be more severe, characterised by one of the following three disturbances: delirium tremens, alcoholic seizures and alcoholic hallucinosis. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 37


Question: "Flash back phenomenon" is seen in

(D) Post-traumatic stress disorder # PTSD is a reaction to being exposed to an event which is outside the range of normal human experience. It is a normal human emotional reaction to an abnormal situation. It is a psychological phenomenon. It is an emotional condition, from which it is possible to make a full and complete recovery.> Symptoms may come on soon after the trauma or fifty years later. That is what is meant by the post in PTSD. It is normal too for symptoms to come up again when faced by further trauma and in very stressful times. It is normal to be affected by trauma.> Intense fear, helplessness, or horror. Repeated and distressing recollections of the event, including images, thoughts, or perceptions. Unable to distinguish between past events and reality. Such incidents are often called "flashbacks" Distressing and or frightening dreams about the event. Associating various words, happenings, or "triggers" to the actual event wnich then causes a "flashback". Avoidance of anything that may "trigger" a flashback including not talking about the attack itself. Pretending it never happened, and an inability to recall anything about the attack, "denial". A feeling of numbness, detachment or "unrealness" about everything. A lack of emotion or inability to feel love or care about anything.


Question: Baby 20 year old female complains of sudden onset palpitation and apprehension. She is sweating for last 10 minutes and fears of impending death. Diagnosis is


Question: A person is very impatient, competitive and works like a perfectionist. He or she can be best described as

Type A personality is characterized by competitive, hardworking, time bound & impatient behaviour.


Question: A 22yrs old male suffer from decreased sleep, increased sexual activity, excitement and spending excessive money for 8 days. The diagnosis is

Symptomatic profile of the patient suggests the diagnosis, Characteristic Feature of Mania: Elation of Mood Delusion of Grandeur Increased psychomotor activity (usually goal oriented) Speech and thought: More talkative Pressure of speech, use playful language Flight of ideas Reduced sleep Over activity and poor judgment - this person is involved in high risk activities like buying sprees, reckless driving, foolish business investments, distributing money or aicles of unknown persons.


Question: Drug of choice for Akathisia is

Akathisia is an extrapyramidal side effect caused by antipsychotic because of increase in cholinergic activity. Although both Beta - blockers and anticholinergics can be used Propanalol remains as the drug of choice.


Question: The primary delusion are disorder of


Question: Most effective treatment of Severe Depression is by

(B) ECT > Treatment of depression: : The most effective intervention for achieving remission and preventing relapse is medication, but combined treatment, incorporating Psychotherapy to help the patient cope with decreased self esteem and demoralization improves outcome.> In severe depression: The patient presenting as suicide/suicidal attempted/or agitation, depressive patient may come to casualty because of a refusal to eat and drink, leading to dehydration or because of refusal to take medication (E.g. Hopelessness).> ECT is at least as effective as medication, but its use is reserved for treatment-resistant cases and delusional depressions.> Severe Depression: Apart from presenting as suicide/ suicidal atemptand / or agitation, the depressive patient may come to casualty because of a refusal to eat and drink, leading to dehydration or because of refusal to take medication (e.g. hopelessness)> Behavior therapy is a type of psychotherapy (broadly defined) which is based on theories of learning, and aims at changing the maladaptive behavior and substituting it with adaptive behavior.> Although, there are many theories of learning, a majority of behavior therapy techniques are based on operant conditioning model (Skinner) and classical conditioning model (Pavlov).> Many of the ideas actually seem like common sense principles. The learning theories assume that all behavior is 'learned behavior'. The behavior that is followed by a reward is more likely to occur again (operant model), and that behavior is learned more easily if taught in small steps.> Behavior therapy is typically a short duration therapy, therapists are easy to train and it is cost-effective. The total duration of therapy is usually 6-8 weeks. Initial sessions are given daily but the later sessions are more spaced out.> A behavioral analysis is usually carried out before planning behavior therapy. One of the simplest methods of behavior analysis is called as ABC charting, i.e. a close look at the:> Antecedents (e.g. circumstances under whichthe behavior began; who, if any, were present;other details),> Behavior (description of the behavior indetail), and> Consequences (what happened afterwards;what factors helped to maintain the behavior).


Question: Naltrexone is used in opioid dependene to

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


Question: Polyuria


Question: Fluctuating level of consciousness is seen in

Delirium is characterized by an acute decline in both the level of consciousness and cognition with paicular impairment in attention. Reference: Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition, page 697.

Symptoms and signs in psychiatry and classification


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

An estimated 20 to 30 percent of patients with dementia (primarily patients with dementia of the Alzheimer's type) have hallucinations, and 30 to 40 percent have delusions, primarily of a paranoid or persecutory. In addition to psychosis and personality changes, depression and anxiety are major symptoms in an estimated 40 to 50 percent of patients with dementia. In addition to the aphasias in patients with dementia, apraxias and agnosias are common. Other neurological signs that can be associated with dementia are seizures, seen in approximately 10 percent of patients with dementia of the Alzheimer's type. Reference: Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition, page no.713.


Question: The major difference between typical and atypical antipsychotics is that

The most impoant reason to classify the antipsychotics in typical and atypical agents is the occurrence of extrapyramidal symptoms. Typical antipsychotics have significant extrapyramidal symptoms such as parkinsonism, acute muscle dystonia and tardive dyskinesia. These side-effects are negligible or minimal with atypical agents like clozapine, olanzapine and risperidone.

The latter cause minimal or no increase in prolactin

The former are available as parenteral preparations

Schizophrenia Spectrum and Other Psychotic Disorders


Question: In acute mania, the therapeutic serum level of lithium includes

(B) 0.8-1.5 mEq / L # Blood Lithium levels:> Therapeutic levels = 0.8-1.2 mEq/L For treatment of acute mania> Prophylactic levels = 0.6-1.2 mEq/L For relapse prevention in bipolar disorders> Toxic Lithium Levels > 2.0 mEq/L


Question: Severe mental retardation means IQ in the range of

ICD-10 Codes for Mental Retardation F70 Mild mental retardation IQ 50-69 F71 Moderate mental retardation IQ 35-49 F72 Severe mental retardation IQ 20-34 F73 Profound mental retardation IQ <20 Reference: Page No .3450 chap. 37 Intellectual Disability (Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 9th Edition)


Question: Buprenorphine drug is a type of

Opioid receptor Agonist / Narcotics: used in pain management, treatment for opiate addiction Methadone - u agonist Buprenorphine- paial u agonist, weak kantagonist. Overdosage: can occur with Methadone, less likely with Buprenorphine (paial agonist) Drug Action Uses Buprenorphine* paial u agonist, weak k antagonist pain management opiate addiction Bupropion * Norepinephrine reuptake inhibitor Antidepressant (with minimal sexual dysfunction) , Smoking cessation Buspirone * 5-HT paial agonist, D2 agonist/antagonist Generalized anxiety disorder Opioid antagonist uses Naloxone *Inactive orally t1/2- 1hr Morphine poisoning Naltrexone Active orally t1/2- 1-3 hr Opioid, alcohol dependence Nalmefene Active orally t1/2- 8-10hr Opioid, alcohol dependence Reference: Page No.3174 31.24 Opioid Receptor Agonists: Methadone and BuprenorphineKaplan & Sadock's Comprehensive Textbook of Psychiatry, 9th Ed


Question: The newest Antidepressant is


Question: Cardinal feature of antisocial personality

These traits include callous unconcern for the feelings of others, gross and persistent attitude of irresponsibility and disregard for social norms, rules and obligations, incapacity to maintain enduring relationships, very low tolerance to frustration and a low threshold for discharge of aggression, incapacity to experience guilt and to profit from experience, paicularly punishment, and marked proneness to blame others. Eliminationg other options: option B: it is seen in Histrionic personality disorder. option C: it is seen in Boderline personality disorder.option D: not seen in personality disorder but could be seen as delusions of grandiosity in Mania. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 115


Question: Deep sleep is characterized by

Deep sleep or NREM 3 is characterized by presence of δ waves → Frequency 0-4 Hz.
Hence, NREM 3 is also called slow wave sleep.


Question: Squeeze technique is used for

(B) Premature Ejaculation[?]Specific Techniques & Exercises:Various techniques useful to treat various sexual dysfunctions.In Premature Ejaculation, useful exercise known as the squeeze technique is used to raise the threshold of penile excitability.Man or the woman stimulates the erect penis until the earliest sensations of impending ejaculation are felt.At this point, the woman forcefully squeezes the coronal ridge of the glans, the erection is diminished, and ejaculation is inhibited.This technique eventually raises the threshold of the sensation of ejaculatory inevitability and allows the man to focus on sensations of arousal without anxiety and develop confidence in his sexual performance.A variant of the exercise is the stop-start technique developed by James H. Semans, in which the woman stops all stimulation of the penis when the man first senses an impending ejaculation. No squeeze is used.Presence or absence of circumcision has no bearing on a man's ejaculatory control.Glans is equally sensitive in the two states.Sex therapy has been most successful in the treatment of premature ejaculation.A man with a sexual desire disorder or male erectile disorder is sometimes told to masturbate to prove that full erection and ejaculation are possible.Male orgasmic disorder is managed initially by extravaginal ejaculation and then by gradual vaginal entry after stimulation to a point near ejaculation.Most importantly, the early exercises forbid ejaculation to remove the pressure to climax and allow the man to immerse himself in sexual pleasuring.Behavioral Therapy for PE:Originally popular due to lack of biologically based treatments.Squeeze technique:Masters & Johnson (1970); Squeezing of the glans penisStop-Start Technique:Semans (1956; Kaplan (1983); Pause sexual stimulation at impending ejaculationFactors influencing success:Heightened male awareness of sexual sensations.Decreased emphasis on coitus.Practicing the squeeze technique when masturbating:The aim of these pelvic floor muscle exercises is to restore erectile function by strengthening the bulbocavernosus muscle & ischiocavernosus muscle.Other Options[?]Erectile Dysfunction:Oral phentolamine and apomorphine have proved effective as potency enhancers in men with minimal erectile dysfunction.Sildenafil is not effective in all cases of erectile dysfunction.Cream consists of three vasoactive substances known to be absorbed through the skin: aminophylline, isosorbide dinitrate, and co-dergocrine mesylate, which is a mixture of ergot alkaloids.Gel containing alprostadil & an additional ingredient, which temporarily makes the outer layer of the skin more permeable.[?]Retrograde Ejaculation:Retrograde ejaculation always has an organic cause. It can develop after genitourinary surgery and is also associated with medications that have anticholinergic adverse effects, such as the phenothiazines, especially thioridazine.


Question: Lithium is used in prophylaxis of

Ans. is 'd' Recurrent manic depressive attacks Lithium is used in prophylaxis of manic depressive illness.


Question: "Systematic desensitization" behavioural therapy is used to treat

(B) Anxiety disorders # SYSTEMATIC DESENSITIZATION, also known as graduated exposure therapy is a type of behavior therapy used in the field of psychology to help effectively overcome phobias and other anxiety disorders.> The process of systematic desensitization occurs in three steps.> The first step of systematic desensitization is the identification of an anxiety inducing stimulus hierarchy.> The second step is the learning of relaxation or coping techniques. Once the individual has been taught these skills, he or she must use them in the third step to react towards and overcome situations in the established hierarchy of fears.> The goal of this process is for the individual to learn how to cope with, and overcome the fear in each step of the hierarchy.

Attention deficit hyperactivity disorder


Question: Delirium is most commonly seen in

Factors precipitating delirium Drugs Primary neurologic diseases Surgery Sedative-hypnotics Narcotics Anticholinergic drugs Multiple drugsTreatment Alcohol or drug withdrawal Stroke, nondominant hemispheric Intracranial bleeding Meningitis or encephalitis Ohopedic surgery Cardiac surgery Prolonged cardiopulmonary bypass Noncardiac surgery Intercurrent Illnesses Environmental Infections Iatrogenic complications Dehydration Hypoxia Shock Anemia Fever or hypothermia Admission to ICU Use of physical restraints Use of bladder catheter Use of multiple procedures Pain Emotional stress Prolonged sleep deprivation Reference: Page No.1157 chap. 10.2 Delirium Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 9th Edition


Question: Total score in standard minimental status examination (MMSE) is

Ans. b (30) (Ref Harrison's medicine 17th/ Table 365-5)Cognitive and Neuropsvchiatric ExaminationBrief screening tools such as the mini-mental state examination (MMSE) help to confirm the presence of cognitive impairment and to follow the progression of dementia.The MMSE, an easily administered 30-point test of cognitive function, contains tests of orientation, working memory (e.g., spell world backwards), episodic memory (orientation and recall), language comprehension, naming, and copying.# In FTD, the earliest deficits often involve frontal executive or language (speech or naming) function. DLB patients have more severe deficits in visuospatial function but do better on episodic memory tasks than patients with AD.# Patients with vascular dementia often demonstrate a mixture of frontal executive and visuospatial deficits.# In delirium, deficits tend to fall in the area of attention, working memory, and frontal function.The Mini-Mental Status ExaminationPointsOrientationName: season/date/day/month/year5 (1 for each name)Name: hospital/floor/town/state/country5 (1 for each name)RegistrationIdentify three objects by name and ask patient to repeat3 (1 for each object)Attention and calculationSerial 7s; subtract from 100 (e.g., 93-86-79-72-65)5 (1 for each subtraction)RecallRecall the three objects presented earlier3 (1 for each object)LanguageName pencil and watch2 (1 for each object)Repeat "No ifs, ands, or buts"1Follow a 3-step command (e.g., "Take this paper, fold it in half, and place it on the table")3 (1 for each command)Write "close your eyes" and ask patient to obey written command1Ask patient to write a sentence1Ask patient to copy a design (e.g., intersecting pentagons)1Total30


Question: The drug of choice for obsessive compulsive disorder

Fluoxetine (Ref. Harrison Ohle p 25521The drug of choice for obsessive compulsive disorder is Fluoxetine.


Question: Post traumatic stress disorder is more likely to develop in

(A) Those who had experienced emotional numbness immediately after the disaster# Clinial features of PTCD:> PTSD occurs when a catastropic event (usually life threatening or potentially fatal, e.g., war, earthquake, serious accident or robbery) affects the patient or a close friend or relative.> -- Patient experiences symptoms of both hyperarousal & withdrawal.> -- Symptoms of hyperarousal include anxiety, recurrent nightmares, intrusive memories of the event (flashbacks), increased startle response, & hypervigilance.> -- Symptoms of withdrawal include numbing of affective response, survivor's guilt, dissociation, & social withdrawal.

Those who had experienced more stressful life events during the six months immediately following the disaster


Question: Treatment of choice for phobic disorder is

Behaviour therapy is a type of psychotherapy which is based on theories of learning and aim in modifying maladaptive behaviour and substituting it with adaptive behaviour. If properly planned this mode of therapy 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: Definitive treatment of phobias is

Behaviour therapy- most studied and most effective treatment for phobias. Ref- Synopsis of Psychiatry, 11e, pg 404.


Question: Pagophagia involves eating

Pica is defined as persistent eating of nonnutritive substances.It is identified only when medical problems such as intestinal obstruation, intestinal infections or poisoning arises (lead). among adults, ceain foods of pica, including geophagia (clay) and amylophagia (starch), have been repoed in pregnant women. Ref: Synopsis of Psychiatry, 11e, pg 1206


Question: Most common cause of death in Rett's syndrome is

Cardiac arrythmia is the leading cause of death in Rett's syndrome.


Question: Van Gogh Syndrome is seen in


Question: Side effects of fluoxetine are A/E

C i.e. Urinary retention SSRIs (ex. Fluoxetine) are almost devoid of sedation, hypotension, cardiac arrhythmia, seizure precipitation & anticholinergic side effectsQ, such as dry mouth, bad taste, urinary retention, constipation & epigastric distressQ when compared to tricyclic antidepressants. - Least sedative antidepressants are - Venlafaxine (atypical), Tianeptine & Citalopram (SSRI) > other SSRIs fluoxetine, fluvoxemine, paroxetine, seraline)Q. At that time (1993), Selective serotonin reuptake inhibitors fluoxetine, fluvoxamine, paroxetine, Seraline & Citolapram were the latest antidepressant. Now Venlafaxine, Nifazodone, Reboxetine, Miazapine, Tianeptine are novel antidepressants. - Fluoxetine is a longest acting SSRI (Selective serotonin reuptake inhibitor). It is devoid of anticholinergic, arrythmogenic, sedative (abuse liability) & Hypotensive side effectsQ. It has new constellation of mild S/E viz - Nervousness, Anxiety, Insomnia, Anorexia, Nausea, DiarrheaQ & Headache, Weight lossQ. Fluoxetine, by inhibiting drug metabolism can elevate drug levels of TCA & Haloperidol to dangerous level. - Gastrointestinal S/E of SSRI's are anorexia, nausea, vomiting, diarrheoa. Anorexia is most common in fluoxetine & weight loss begin as soon as drug is taken & peak at 20 weeks, after which weight often returns to baseline. Although most patient loose weight but some person gain weight while taken fluoxetine. (Kaplan & Sadock's - Synopsis of Psychiatry 9/e P. 1099) - Buprenorphine & Dextroprophoxyphene are opioids & have abuse liability. - Increased psychomotor activity like anxiety, akathesia, agitation and insomnia is seen in one quaer of persons initiating treatment with SSRIs specifically fluoxetine. Tianeptine is an antidepressant which increase rather than inhibit 5-HT (Serotonin) uptakeQ. Treatment of choice for OCD - Behaviour therapyQ. Drug of choice for OCD is fluoxetineQ > ClomipramineQ


Question: Drug of choice for resistant Schizophrenia

Clozapine is the drug of choice for resistant Schizophrenia.


Question: ECT is most useful in

(Major depression) (98- 213- NA 6th)* Panic disorders (discrete episodes of acute anxiety)* The drug of choice ofgenerilized anxiety disorders are benzodiazepines and for panic disorder (both benzodiazepines and anti depressants* Absolute indication of ECT is (1) major severe depression with suicidal risk (This is the first and most important indication for ECT) with stupur, poor intake of food and fluids, melancholia, psychotic features (2) severe catatonia (functional) (3) severe psychosis (SZP or mania)* The only absolute contraindication is the presence of raised intracranial tension* Bilateral ECT is more effective, but unilateral ECT causes less short term memory impairments


Question: Early morning awakening is a feature of

Early morning awakening is seen in depression. It is a type of insomnia patients with depression have altered dexamethasone suppression test that is no suppression of steroid in blood after administration of dexamethasone usually the steroid is produced in normal individuals at 6 Am whereas the steroids in increased amount always keeps the brain active , ruminations and decreased sleep. Different patterns of insomnia include a) difficulty falling asleep versus b) middle or terminal insomnia (early morning awakening) Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no.351


Question: Anorexia nervosa can be differentiated from bulimia by

Anorexia Nervosa Anorexia nervosa is an eating disorder characterised by the following prominent clinical features: 1. It occurs much more often in females as compared to the males. The common age of onset is adolescence (13-19 years of age). 2. There is an intense fear of becoming obese. This fear does not decrease even if the body becomes very thin and underweight. 3. There is often a body-image disturbance. The person is unable to perceive own body size accurately. 4. There is a refusal to maintain the body weight above a minimally normal weight for that age, sex and height. 5. Significant weight loss occurs, usually more than 25% of the original weight. The final weight is usually 15% less than the minimum limit of normal weight (for that age, sex and height) or a Quetelet's body-mass index (BMI) of 17.5 or less 6. No known medical illness, which can account for the weight loss, is present. 7. An absence of any other primary psychiatric disorder. 8. Amenorrhoea, primary or secondary, is often present in females. Bulimia Nervosa Bulimia nervosa is an eating disorder characterised by the following clinical features: 1. Bulimia nervosa usually has an onset in early teens or adolescence. 2. There is an intense fear of becoming obese. There may be an earlier history of anorexia nervosa. 3. There is usually body-image disturbance and the person is unable to perceive own body size accurately. 4. There is a persistent preoccupation with eating and an irresistible craving for food. There are episodes of overeating in which large amounts of food are consumed within sho periods of time (eating binges). 5. There are attempts to 'counteract' the effects of overeating by one or more of the following: self-induced vomiting, purgative abuse, periods of starvation, and/or use of drugs such as appetite suppressants. 6. No known medical illness is present which can account for the disorder. 7. An absence of any other primary psychiatric disorder. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 142, 144


Question: Child was seen taking off clothes while watching TV; he suddenly closes eyes for sometime and was lethargic after sometime. He had probably

(C) Temporal lobe epilepsy# EMOTIONAL EXPERIENCES as a result of seizure, while less common, may be dramatic-fear, sadness, loneliness, anger, happiness, and sexual excitement have all been recorded.> Fear and anxiety are the most common affective experiences, while occasionally the patient describes a feeling of rage or intense anger as part of a complex partial seizure.> Ictal fear has no apparent connection to objective experience and is generally not related to the situation in which the patient finds himself during the seizure.> Each of these subjective psychic states may constitute the entire seizure or some combination may occur and immediately precedes a period of altered awareness.


Question: Drug of choice for OCD


Question: Lamotrigine and topiramate can be used for

lithium is used for EUPHORIC MANIA Valproate is used for RAPID CYCLING lamotrigine is used for BIPOLAR DEPRESSION carbamazepine causes STEVEN JOHNSONS SYNDROME topiramate causes WEIGHT LOSS AND RENAL STONES etc are used apa from lithium for bipolar disorder Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 620


Question: Pavlov's experiment is an example of

IVAN Pavlov gave the theory of classical conditioning Theory of classical conditioning leads to phobia A child who was bullied in a playground------------- develops aversion to the playground the boy who bullied him----------------------------after sometime even without the boy who bullied him the aversion and anxiety gets conditioned to the playground----------------this would be very distressing to the individual--- he will sta avoiding the situation( playground)------- he finds there is no anxiety on avoidance--------- He continues to avoid the situation as avoidance behavior acts as a negative reinforcement---- slowly after several years he presents with dysfunction (lack of extracurricular activities) Ref.Kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 398


Question: Dialectical behavior therapy is used in the management of

Dialectical behavior therapy, Transference based therapy, Mentalization therapy are used in the management of Borderline personality disorder.


Question: The treatment of Acute Manic Episodes is


Question: The main metabolite of nicotine is

Nicotine is metabolized in liver, lung and brain to cotinine by CYP2A6 enzyme. A plasma cotinine levels of >14ng/ml typically indicates smoking.

Substance Related and Addictive Disorders


Question: omission 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: Schizophrenia with early onset and poor prognosis is


Question: Schizophrenia word means

Eugen Bleuler (1911), while renaming dementia praecox as schizophrenia (meaning mental splitting), recognised that this disorder did not always have a poor prognosis as described by Kraepelin. He also recognised that schizophrenia consisted of a group of disorders rather than being a distinct entity. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 54

Schizophrenia and other psychotic disorders


Question: Otto Veraguth sign is seen in

verguath fold is a prominent fold that is present in the medial side of nasal bridge, mainly seen in DEPRESSION Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 348


Question: Leaden paralysis is seen in

Leaden paralysis is extreme heaviness in arms & legs and patient will be lying like a "log of wood", seen in Atypical depression.


Question: In depression, there is a deficiency in

SEROTONIN is produced from TRYPTOPHAN it is a neuro transmitter that controls the well being of the individual it controls drive to day to day activities, controls sleep and appetite. TRPTOPHAN helps in production of MELATONIN MELATONIN controls SLEEP A decreased level of brain 5-hydroxytryptamine (5-HT) has been theorized to be a factor in depression. The theory arose from clinical observations that drugs enhancing extracellular levels of 5-HT have antidepressant effects in many patients. Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 752


Question: Drug used for cocaine withdrawal symptoms is

Cocaine use produces a very mild physical, but a very strong psychological dependence. The management of underlying (or co-existent) psychopathology is probably the most impoant step in the management of chronic cocaine use. Ref: Sho textbook of Psychiatry by Niraj Ahuja, 7th edition, page 48.


Question: In Direct ECT, the intraocular tension is


Question: Markedly inappropriate sensitivity and suspiciousness are clinical features of

Ans:D-Paranoid Paranoid personality disorder (PPD) is a type of eccentric personality disorderAn individual with paranoid personality behavior is very suspicious of other people. They mistrust the motives of others and believe that others want to harm themSymptoms include:believing that others have hidden motives or are out to harm themdoubting the loyalty of othersbeing hypersensitive to criticismhaving trouble working with othersbeing quick to become angry and hostilebecoming detached or socially isolatedbeing argumentative and defensivehaving trouble seeing their own problemshaving trouble relaxing


Question: Schizophrenia is characterised by A/E


Question: Lithium


Question: Morbid jealousy is associated with

* JEALOUS TYPE of delusional disorder o ALSO KNOWN AS Conjugal paranoia * Othello syndrome * Marked jealousy * Pathological jealousy * Morbid jealousy o It is more common among alcoholic males ,the possible explanation that is given is alcoholic males have sexual dysfunction and that these women may sta suspecting their spouses. REf.Kaplon and Sadock, synopsis of psychiatry, 11 th edition, pg No.330

Schizophrenia and other psychotic disorders


Question: Incidence of hyperprolactinemia is highest with

Tubero infundibular To hypothalamus Regulates prolactin Dopamine decreases prolactin Galactorrhea Amenorrhea Sexual dysfunctions the maine side effects of antipsychotic depends on the site of blockage of dopaine when the dopamine is blocked in tuberoinfundibular pathway there is result of Hyperprolactinemia increased prolactin, which presents as galactorrhea, amenorrhea and sexual dysfunction. -endocrinal side effects are high with risperidone and amisulpride. Overall least EPS -Clozapine Least EPS among typical antipsychotics-thioridazine Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg: 410-412

Schizophrenia and other psychotic disorders


Question: Type D personality has been recently found to be a risk factor for

The distressed personality (Type D) is an emerging risk factor in cardiovascular disease (CVD) that incurs a risk on par with left ventricular dysfunction in patients with ischemic hea disease. Type D is defined as the co-occurring tendencies to experience increased negative emotions and to inhibit self-expression in social interactions. Evidence is accumulating that Type D may also be a risk factor for adverse outcome across CVD patient groups, including patients undergoing revascularization with drug-eluting stent implantation or bypass surgery, patients with hea failure, peripheral aerial disease, and arrhythmia. In these patient groups, Type D personality has been associated with a 2-5 fold increased risk of adverse prognosis, impaired quality of life and symptoms of anxiety and depression independent of traditional biomedical risk factors, including disease severity. Ref: Susanne S. Pedersen, Johan Denollet. Is Type D personality here to stay? Emerging evidence across cardiovascular disease patient groups. Current cardiology reviews. Vol 2, Issue 3, 2006.


Question: Absolute contraindication to ECT is

CONTRA INDICATIONS * NO ABSOLUTE Contra indication RELATIVE CONTRAINDICATION -----------------Brain tumour with midline shift / arrythmia Ref.Kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 1065


Question: Ambivalence is most commonly associated with

Eugen Bleuler's Fundamental Symptoms of Schizophrenia (Also called as 4 A's of Bleuler) 1. Ambivalence: Marked inability to decide for or against2. Autism: Withdrawal into self3. Affect disturbances: Disturbances of affect such as inappropriate affect4. Association disturbances: Loosening of associations; thought disorder Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no.55

Symptoms and signs in psychiatry and classification


Question: Hypochondriasis is

D i.e. Abnormal preoccupation with normal body functionHypochondriasis is persistent preoccupation with fear or belief of having serious disease based on person's own interpretation of normal body function ie Hypochondriasis is abnormal preoccupation about normal body functionQ.

Normal pre occupation with abnormal body functionL

Abnormal pre occupation with abnormal body function

Normal pre occupation with normal body function


Question: Memory disturbance of ECT recovers in


Question: Drug of choice for cheese reaction

Cheese reaction occurs when cheese,red wine or beer is consumed along with MAO - A inhibitors as they inhibits metabolism of tyramine present in these items.
Increase tyramine levels can rlevate blood pressure of cause hypertensive crisis which is treated by Phentolamine that blocks alpha1 and alpha2 receptors.


Question: In depression, there is deficiency of

The Karolinska Institute in Sweden first noted that low concentrations of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in the lumbar cerebrospinal fluid (CSF) were associated with suicidal behavior. CSF, neurochemical, and receptor studies suppo the hypothesis that reduced central serotonin is associated with suicide. Reference: Synopsis of Psychiatry, pages 766,767.


Question: Amotivational syndrome is seen in

Amotivational syndrome: Chronic cannabis use is postulated to cause lethargy, apathy, loss of interest, anergia, reduced drive and lack of ambition. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no.46


Question: Coical blindness with confabulation is seen in

-Anton syndrome is characterized by coical blindness and confabulation (unconscious filling of gaps in memory by imagining events). The patient denies loss of vision (known as visual anosognosia) and defends it by confabulation even when there is obvious evidence of visual loss and coical blindness.-It is due to occipital lobe damage, in addition to which, other coical centers are also affected contributing to this peculiar behaviour.-Korsakoff syndrome is characterized by predominant anterograde amnesia and some retrograde amnesia. Confabulation is present in order to cover the memory deficit.-Wernicke's encephalopathy is characterized by confusion, ophthalmoplegia, and ataxia.-Psychogenic amnesia does not present with confabulation.


Question: Early onset and bag prognosis is seen in


Question: Lithium is used in

lithium 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 Until recently, lithium carbonate was the universally preferred treatment for bipolar disorder, especially in the manic phase. With the approval of valproate, aripiprazole, olanzapine, quetiapine, risperidone, and ziprasidone for this indication, a smaller percentage of bipolar patients now receive lithium. Other Applications of lithium Recurrent endogenous depression Schizoaffective disorder, Lithium alone is rarely successful in treating schizophrenia, but adding it to an antipsychotic may salvage an otherwise treatment-resistant patient. As an adjunct to tricyclic antidepressants and SSRIs in patients with unipolar depression who do not respond fully to monotherapy with the antidepressant. Reference : Katzung 12e pg: 516


Question: Test based on the principle of suspect's reaction, if he witnesses an event then he behaves in a ceain way is

* Narcoanalysis is a test carried out on a patient or suspect when he/she, after administering truth serum, comes in a sleep like state, and his/her repressed feelings are released. * Truth serum are drugs used in narcoanalysis. Two most common drugs used in narcoanalysis are Sodium amytal, which is also known as amobarbital or amylobarbition, and Sodium Pentothal commonly known as thiopental or thiopentone * Polygraph measures and records physiological actions of human body especially autonomic nervous system while the subject is asked questions relating to the crime and he answers them. * It is based on the principle that autonomic nervous system changes are beyond reasonable control of an individual and hence autonomic nervous system response changes transpires when the subject tries to tell a lie. * Brain mapping measures the P300 evoked potential. In this test the suspect is made to sit in evoked potential recording machine and is shown objects relating to crime scene or is made to hear sounds peaining to crime site. The sensors from his head pick the event related potentials in the form of Brain Mapping only if the person has been at the site of crime. The accuracy of Brain Mapping is almost 100%.


Question: Angel dust denotes

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

Symptoms and signs in psychiatry and classification


Question: Biological Amnesia is

Thiamine deficiency, hypoglycemia, hypoxia (including carbon monoxide poisoning), and herpes simplex encephalitis all have a predilection to damage the temporal lobes, paicularly the hippocampi, and thus can be associated with the development of amnestic disorders. The below image show major causes of amnestic disorders. Reference: Kaplan and Sadock's synopsis of psychiatry, 11th edition, page 719.


Question: The term schizophrenia means

the term SCHOZPHRENIA means SPLIT MIND this was given by Eugene Bleuler it means that there is a split in the components of the mind the split is between the thoughts, cognition and behavior. Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 301


Question: Drug used for narcoanalysis is

Narcoanalysis is therapy is used in the management of dissociation. Here the patient is taken to the semiconscious stage with the help of amobarbitol and diazepam and unconscious conflict is brought into the conscious and relieved from distress. * Ref.Kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 945


Question: Mild mental retardation is characterized by


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

PTSD is characterised by recurrent and intrusive recollections of the stressful event, either in flashbacks (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 impoant clinical features of PTSD include paial amnesia for some aspects of the stressful event, feeling of numbness, and anhedonia (inability to experience pleasure). Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 112

Anxiety disorders stress disorders and grief


Question: Theory of Pshycosexual development was given by


Question: Dysthymia is

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


Question: A father forced his relictant son to bring a glass of water and the child dropped the glass on the way. This is an example of

Passive aggression is an immature defense mechanism where a person indirectly expresses anger towards others.


Question: Most common complication of electroconvulsive therapy is

Electroconvulsive therapyCentral Nervous System Effects: Headache, confusion, and delirium sholy after the seizure while the patient is coming out of anaesthesia. Memory: memory impairment is seen in 75% following ECT. Except for retrograde memory impairment, other cognitive effects generally return to pre-ECT baseline or even improve over baseline with right unilateral ECT.Other Adverse Effects: Fractures, nausea, vomitingRef: P.3300 31.34a Electroconvulsive Therapy(Kaplan & Sadock&;s Comprehensive Textbook of Psychiatry, 9th Ed)


Question: In an alcoholic man, Blackout is seen in

Acute Intoxication After a brief period of excitation, there is a generalised central nervous system depression with alcohol use. With increasing intoxication, there is increased reaction time, slowed thinking, distractibility and poor motor control. Later, dysahria, ataxia and incoordination can occur. There is a progressive loss of self-control with frank disinhibited behaviour. The duration of intoxication depends on the amount and the rapidity of ingestion of alcohol. With blood alcohol levels of 300-450 mg%, increasing drowsiness followed by coma and respiratory depression develop. Death occurs with blood alcohol levels between 400 to 800 mg%. Occasionally a small dose of alcohol may produce acute intoxication in some persons. This is known as pathological intoxication. Another feature, sometimes seen in acute intoxication, is the development of amnesia or blackouts. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 37


Question: "Wet Pillow Syndrome" is caused by

Clozapine can lead to sialorrhea or hypersalivation which is also called as "Wet pillow syndrome".


Question: The Term 'free association' was coined by

Contributor: Freud, Sigmund (1856-1939) Coined the Term: Free association, Psychoanalysis, Psychodynamics, Oedipus complex, Electra complex, Penis envy, Primal scene, Ego defence mechanisms, Repression, Psychological determinism, Pleasure principle, Reality principle Special Mention: Founder of psychoanalysis; some of the significant contributions include interpretation of dreams, theory of infantile sexuality, structural and topographical model of mind, theory of instincts, psychopathology of everyday life and stages of psychosexual development Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no.243

Cognitive development and defence mechanism


Question: In Schizophrenia early onset with poor prognosis is seen in

Ans.B i.e. HebephrenicHebephrenic (disorganized) schizophrenia - Dominated by prominent disorganization symptoms & negative symptoms.Early-onset & bad prognosis.Severe deterioration of personality (patient is not able to maintain hygiene, social interaction is inappropriate, odd behaviors are present).


Question: Awareness of having a disease is

Ans. a (Insight). (Ref. Psychiatry by Niraj Ahuja, 5th ed., 14, 41, 57, 72, 85, 95, 171)Term DefinitionPerseverationis persistent repetition of words beyond their relevance.Verbigerationis senseless repetition of same words or phrases.Delusionsare false unshakable belief in something that is not true.Insightis awareness of being diseased or sick.Insight is preserved in OCD.Insight is rated on six point scale from one to six:# Complete denial of illness# Slight awareness of being sick and need help, but denying# Awareness of being sick, but attributed to external/physical factors.# Awareness of being sick due to something unknown in itself.# Intellectual insight.# True emotional insight.


Question: Side effect of SSRI

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


Question: Microcephaly is seen in

3'M' s of Rett's disease :

Mahila (F > M).
Microcephaly.
MECP2.


Question: A young lady was admitted after taking overdose of diazepam after broken affair. She has history of slitting her wrist previously. Most likely diagnosis is

C i.e. Border line Personality disorderIn Personality disorders - that onset can be traced back atleast to adolescence or early adulthood; the behaviour detes markedly from the expectations of individual culture, is inflexible & pervasiveQ across a broad range of personal & social situations.


Question: Differentiation of hysterical fit from epileptic fit

Clinical Features Epileptic Seizures Dissociative Convulsions (Hysterical Fits) 1. Attack pattern Stereotyped, known clinical patterns Absence of any established clinical pattern. Purposive body movements occur 2. Place of occurrence Anywhere Usually indoors or at safe places 3. Warning Both prodrome and aura are stereotyped Variable 4. Time of day Anytime. Can occur during sleep Never occur during sleep 5. Tongue bite Usually present Usually absent. Cheek and lip bite may be present 6. Incontinence of urine and faeces Can occur Very rare 7. Injury Can occur Very rare. If occurs, it is minor or may be accidental 8. Speech No verbalisation during the seizure Verbalisation may occur during the fit 9. Duration Usually about 30-70 sec. (Sho) 20-800 sec. (Prolonged) 10. Head-turning Unilateral Side to side turning 11. Eye gaze Staring, if eyes are open Avoidant gaze 12. Amnesia Complete Paial 13. Neurological signs Present, e.g. up-going plantars Absent 14. Post-ictal confusion Present Absent 15. Stress Present in 25% Present much more often 16. EEG - Inter-ictal - Ictal Usually abnormal; Abnormal Usually normal Normal 17. Serum prolactin Increased in post-ictal period (15-20 minutes after seizure; returns back to normal in 1 hour) Usually normal Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 101


Question: Impaired insight is evident in


Question: NOT a paranoid symptom

(B) Delusion of infidelity# SUBTYPES SCHIZOPHRENIA SYMPTOMS:# PARANOID> Delusions of persecution or grandeur. Often accompanied by hallucinations (voices)> Older onset than other types with less regression of mental faculties and emotional response# CATATONIC> Complete stupor or pronounced decrease in spontaneous movements May be mute, Often negativism, echopraxia, automatic obedience, Rigidity of posture, can be left standing or sitting in awkward positions for long periods of time, Brief outbursts of violence without provocation, Waxy flexibility> Alternatively, can be excited and evidence extreme motor agitation Incoherent and often violent or destructive In their excitement, can hurt themselves, or collapse in exhausstion, Repetitious, stereotyped behaviors# DISORGANIZED: Incoherent, primitive, uninhibited, Unorganized behaviors and speech , Active, but aimless, Poor personal appearance , Little contact with reality, Pronounced thought disorder, Explosive laughter, Silliness, Incongruous grinning# UNDIFFERENTIATED: Psychotic symptoms. Does not fit disorganized diagnoses or catatonic, paranoid# RESIDUAL: Previous episode, but no prominent psychotic symptoms at evaluation. Some lingering negative symptoms# Othello syndrome is delusion of infidelity of a spouse or partner.> Othello syndrome affects males and, less common in females and is characterized by recurrent accusations of infidelity, searcnes for evidence, repeated interrogation of the partner, tests of their partner's fidelity, and sometime stalking.


Question: Repetitive hand washing is a symptom of

Obsessive compulsive disorder (OCD) is characterized by recurrent, irresistible, intrusive, irrelevant and EGO DYSTONIC thoughts. They present with CONTAMINATION OBSESSIONS- WASHING COMPULSIONS PATHOLOGICAL DOUBT OBSESSIONS- CHECKING COMPULSIONS Patients may present with repeated doubts of wheather they have locked the door or vehicles and to counter those obsessions they do repeated checking compulsions Sometimes they may present with obsessions of contamination and fear of di and to counter those obsessions they may present with washing compulsions. Ref- Table 10.1-4, Synopsis of psychiatry, 11e, pg 423.


Question: NOT seen in Narcolepsy

(C) Catalepsy # CATAPLEXY is present not catalepsy.> The classic symptoms of the disorder, often referred to as the "tetrad of narcolepsy," are cataplexy, sleep paralysis, hypnagogic hallucinations, and excessive daytime sleepiness.> Night-time sleep may be fragmented with frequent awakenings.> A second prominent symptom of narcolepsy is abnormal REM sleep.> Narcoleptics are unique in that they enter into the REM phase of sleep in the beginnings of sleep, even when sleeping during the day.


Question: Least Extrapyrimidal S/E are seen in


Question: Alcoholic blackouts are seen at levels of alcohol in blood

Acute Alcohol Intoxication:

Blood Alcohol concentration
Symptoms

20 - 30 mg / dL
Decreased concentration decreased motor performance

30 - 80 mg/dL
Signs of intoxication appears, worsening of motor symptoms and thinking ability.

80 - 200 mg /dL
Incordination

200 - 300 mg / dL
Alcohol blackout
			(Anterograde Amnesia)

> 300 mg / dL
Coma & Death.


Question: Hangover following alcohol consumption can be treated with

The most common withdrawal syndrome with alcohol is a hangover on the next morning.In patients suffering from (or likely to suffer from) delirium tremens, peripheral neuropathy, WernickeKorsakoff syndrome, and/or with other signs of vitamin B deficiency (especially thiamine and nicotinic acid), a preparation of vitamin B containing 100 mg of thiamine (vitamin B1) should be administered parenterally, twice everyday for 3-5 days. This should be followed by oral administration of vitamin B1 for at least 6 months. Reference: A Sho Textbook of Psychiatry by Niraj Ahuja page no. 37, 40.


Question: In alcohol withdrawl drug of choice is


Question: Suicide tendency are common in

B. (Depression) (236- 37 - Neeraj Ahuja 6th)SUICIDE is a type of deliberate self harm (DSH) and is defined as a human act of self - intentioned and self inflicted cessation (death) It ends with a fatal out comeRISK FACTORS FOR SUICIDE1. Age > 40 years2. Male sex3. Staying single4. Preveious suicidal attempts5. Depression (risk about 25 times more than usual)i. Presence of guilt, self - accusation agitation, nihilistic ideation, worthlessness, hypochondriacal delusions and severe insomniaii. More at the beginning or towards the end of a depressive episodes6. Suicidal preoccupation (eg a "suicide note" is written or detailed plans are made for committing suicide)7. Alcohol or drug dependence8. Severe disabling, painful or untreatable physical illness9. Recent serious-loss or major stressful life event10. Social isolation


Question: Fear to contamination, counting behaviours, and having to check and recheck are features characteristic of

An obsession is defined as an idea impulse or image which intrudes into the conscious awareness repeatedly, it is recognised as irrational and absurd, the patient tries to resist against it but is unable to, failure to resist leads to marked distress. An obsession is usually associated with compulsion and a compulsion is defined as a form of behaviour which usually follows obsession, the behaviour is not realistic and is either irrational or excessive. Compulsion may diminish the anxiety associated with obsession (Ref: a sho textbook of psychiatry, Niraj Ahuja, 7th edition, pg no.95)

Anxiety disorders stress disorders and grief


Question: The term 'id' was coined by

In 1923, in 'The Ego and The Id', Freud divided the mental apparatus into three dynamic structures: the id, the ego and the super-egoThe IdThe 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. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no.206

Cognitive development and defence mechanism


Question: Ebstein's anomaly is caused by

(A) Lithium # Environmental factors found in studies include maternal exposure to benzodiazepines.> Maternal lithium therapy can rarely lead to Ebstein's anomaly in the baby.> About 10% of cases are associated with chronic maternal lithium use.> About 20% of patients with Ebstein's anomaly have accessory electrical tissue which can cause episodes of heart racing, a condition known as Wolff-Parkinson-White syndrome (WPW).> Unusual and rare cyanotic congenital heart disease with diminished pulmonary blood flow results from an abnormality of the tricuspid valve.> Posterior as well as the septal leaflet of the tricuspid valve is displaced downwards.> Result is an attachment to the posterior wall of the right ventricle.> In addition, the leaflets are malformed and fused resulting in obstruction to flow of blood into the right ventricle.> Portion of the right ventricle above the leaflet attachment thins out and is called atrialized right ventricle.> Right ventricular contraction is also abnormal.


Question: 25 yr old gentleman has repeated thoughts that he has not locked his car door properly, frequently checks it while driving, he repeatedly checks locks in his house. Diagnosis

Obsessive Compulsive Disorder : Obsession: recurrent and persistent thoughts that are involuntary unwanted, distressing and the individual tries to neutralize them by a thought or action (compulsion). Ex: Contamination(most common), Need for symmetry, Pathological doubt, Sexual compulsion: Act aimed to reduce the anxiety arising out of obsession but fails to do so. Ex: checking(most common), washing, counting, Hoarding, counting. obsession (a door is unlocked )leads to compulsion (checking ), which tries to relieve distress but fails and the obsession-compulsion cycle repeats leading to distress, time consumption. thoughts are one's own thoughts, it may be an idea/urge/image -behavior or mental behavior. M:F- 1:1 age of onset 20-25 years 2-3% prevalence in general population Comorbidity: major depressive disorder, delusional beliefs, overvalued ideas, personality disorder Etiology Psychoanalytical concept*-regression from the oedipal phase to the anal psychosexual phase. Anatomical- altered function in the connections between orbitofrontal coex, caudate, thalamus. Biochemical-*dysregulation of serotonin. Treatment : Pharmacotherapy-Selective serotonin Reuptake InhibitorsSSRI *(fluoxetine, fluvoxamine, paroxetine, seraline) Tricyclic antidepressants TCA(clomipramine) Behavior therapy*: Desensitization, thought stopping, flooding, implosion therapy, aversive conditioning Psychotherapy Surgical cingulotomy*, capsulotomy(e.g., subcaudate tractotomy,). Nonablative surgical techniques like Deep Brain Stimulation *of basal ganglia nuclei Reference: P.605 Kaplan & Sadock's Synopsis of psychiatry clinical Psychiatry, 10th Edition16.4


Question: A lady has very unstable relationship with her husband always threatening to suicide, in fact, she had some poison, diagnosis is

The borderline type is characterised by emotional instability. In addition, patient's own self-image, aims, and internal preferences (including sexual) are often unclear or disturbed. There are usually chronic feelings of emptiness. A liability to become involved in intense and unstable relationships may cause repeated emotional crises and may be associated with excessive effos to avoid abandonment and a series of suicidal threats or acts of self-harm.The borderline type is also known as borderline personality disorder (DSM-IV-TR), the characteristic features of which include the following:1. Significant and persistent disturbance of identity of self, e.g. 'who am I'. There is marked unceainty about major issues in life.2. Unstable and intense interpersonal relationship patterns.3. Impulsivity.4. Unstable emotional responses, with rapid shifts. Anger outbursts may occur.5. Chronic feelings of boredom or emptiness with an inability to stay alone.6. Deliberate self-harm is common in the form of self-mutilation, suicidal gestures, or accident proneness. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 117


Question: Formication is seen with

Tactile hallucinations (formication), in clear consciousness, may sometimes occur in chronic amphetamine intoxication. Ref: Sho textbook of Psychiatry by Niraj Ahuja, 7th edition, page 49.


Question: Suicidal tendencies are least common in

suicide is a psychiatric emergency there are several causes for suicide schneidmann was called as father of suicidology theories of suicide was given by Durkheim *Egoistic--------------not strongly integrated into any social group *Altruistic--------------their excessive integration into social group *Anomic--------------integration into society is disturbed *Fatalistic----------rules and regulations excessively regulate the individual.Eg.slaves, Variables Enhancing Risk of Suicide among Vulnerable Group Adolescence and late-life Family history of suicide Sexual abuse Male sex Impulsivity Severe psychiatric illness Borderline personality nonreligious status Suicide epidemics Divorced, separated Physical illness unemployment Early loss of parents Previous suicidal attempts Unmarried Ref: P.902 chap34.1 Suicide Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th Edition)


Question: Father of modern psychiatry is

Ref: The "father of modern psychiatry". Phillippe Pinel's "release from chains" of 1973 and the beginning of the "science of Psychiatry". Dtsch Med Wochenschr. 1994 Apr 15;119(15):566-9. Father of Indian Psychiatry: N N Wig

Cognitive development and defence mechanism


Question: The most impoant feature of delirium

The most conspicuous feature is a clouding of consciousness which ranges from mild dulling to deep coma delirium is a type of ORGANIC BRAIN SYNDROME it presents with clouding of consiousness the main cognitive function that is altered is attention impairment and disorientation the main hallucinations that presents in delirium is visual hallucinations the visual hallucinations sometimes presents lilliputian hallucinations, that is they can see small miniature animals and humans hitting them they have a phenomenon called as sun downing phenomenon, that is worsening of symptoms in the evening and night the delirium that is cahrecterstic of alcohol withdrawl is hyper active delirium it is also called as delirium tremens as it is assosiated with tremors.


Question: Schizophrenia with late onset and good prognosis


Question: Negative symptoms of schizophrenia is

(D) Avolition> Negative symptoms are so-named because they are considered to be the loss or absence of normal traits or abilities, and include features such as flat or blunted affect and emotion, poverty of speech (alogia), inability to experience pleasure (anhedonia), and lack of motivation (avolition).


Question:
A person aged 36 years is having firm belief that his wife is having affair. He often sits alone, muttering himself and hears voices commenting about him. He was absolutely normal 2 weeks before.
Most likely diagnosis is

The patient has paranoid delusion & hallucination, 2 out of 5 symptoms are present. But the complaints are from post 2 weeks. Hence, the diagnosis is Acute Psychosis not Schizophrenia (according to ICD - 10) symptoms should be present for atleast 1 month).


Question: Specific θ waves are seen in

θ waves are seen in both NREM 1 & REM.
But specific θ waves indicate hippocampal activity seen in REM phase of sleep.


Question: Drug of choice for Restless leg syndrome

Ropinirole which is a dopamine agonist is the drug of choice for Restless leg syndrome.


Question: Detoxification treatment for alcohol intoxication is with

treatment of alcohol dependence works under 2 steps namely detoxification and deaddiction detoxification is helping the patient acheive a smooth withdrawl deaddiction is a method that is used in alcohol detoxified patients thus helping them to prevent using substances in the future the drug which helps in alcohol withdrawl is benzodiazepines the choice of benzodiazepine is also impoant if the patients liver function test is within normal limits then it is better to choose CHLORDIAZEPOXIDE if the patients liver function test is deranged then it is wise to choose LORAZEPAM BZDs are drug of choice and they have to be given ideally for 1-2 weeks Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 331


Question: Morbid jealousy is seen with

Alcohol-induced jealousy: patients suspect their spouses of infidelity and the belief is morbid enough to influence various aspects of personal and social life. Reference: P.105 chap.5 Substance use disorders textbook of postgraduate psychiatry Nivas &ahuja


Question: Jamais vu is

deja vu=== feeling of familiarity to a novel stimulus jamais vu==feeling of unfamiliarity to a familiar stimulus Reference.Kaplon and sadock, synopsis of psychiatry, 11th edition, pg No.194

Illusion that what one is hearing, one has heard previously

A unfamiliar thought regarded as repetition of a previous thought

Unfamiliar situations or events feel strangely familiar

Feeling of strangeness to familiar situation

Symptoms and signs in psychiatry and classification


Question: A middle aged person repoed to Psychiatric OPD with the complaints of fear of leaving home, fear of travelling alone and fear of being in a crowd. He develops marked anxiety with palpitations and swelling if he is in these situations. He often avoids public transpo to go his place of work. The most likely diagnosis is

D i.e. Agoraphobia Agoraphobia Patients with agoraphobia rigidly, avoid situations in which it would be difficult to escape or obtain help. They prefer to be accompanied by a friend or family member in busy streets, crowded stores, closed in places (eg. tunnels, bridges, and elevators), closed in vehicles (eg subways, buses, & air planes)Q. Patients may insist that they be accompanied every time they leave the house. Severely affected patient may refuse to leave house. The behaviour may result in marital discord. The situations are avoided (eg. travel is restricted) or else are endured with marked distress or anxiety about having a panic attack or panic like symptomsQ. The anxiety or phobic avoidance is not better accounted for by another mental disorder, such as social phobia (eg. avoidance limited to social situations because of fear of embarrassment), specific phobias (eg. avoidance limited to single situation like elevators), OCD (eg avoidance of di in some one with an obscession about contamination), post traumatic stress disorder (eg avoidance of stimuli associated with severe stressor), or separation anxiety disorder (eg avoidance of leaving home or relatives), Agoraphobia is usually associated with panic disorder. Agoraphobia without a h/o panic disorder is often incapacitating & chronic, and depressive disorder and alcohol dependence often complicates its curse. Treatment of panic disorder, treats agoraphobia. Treatment is staed with SSRIs (paroxetine, seraline, or fluvoxamine). Benzodiazepines have the most rapid onset of action against panic, within first week. BDZs can reasonably be used as first agent while a SSRI is being slowly titrated to a therapeutic dose (after 4 -12 weeks it can be tapered).