Question: Gegenhalten is

Paratonic rigidity or Gegenhalten: an erratic, fluctuating, "pseudoactive" increase in resistance to passive movement.On repeated flexing and extending the patient's arm at the elbow, on abruptly ceasing the arm is extended and continues the sequence by flexion(facilitory paratonia) Clasp-knife rigidity: increased tension in the extensor of a joint when it is passively flexed, giving way suddenly on exeion of fuher pressure; seen in upper motor neuron disease. cogwheel rigidity: tension in a muscle that gives way in little jerks when the muscle is passively stretched Leadpipe Rigidity: posture adopted when the rigidity of the limb is maintained equally throughout the passive flexion. Hysterical rigidity: seen in hysterical patients the resistance to passive movement increases in propoion to the effo applied by the examiner rigidity reflex: the state of immobility generated in female animals, especially those in estrus, when they make physical contact with a male. Reference: P.404 chap 2.1 The Neuropsychiatric Approach to the Patient(Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 9th Edition)


Question: Most common psychiatric illness

Mood disorders are common. In the most recent surveys, major depressive disorder has the highest lifetime prevalence (almost 17 percent) of any psychiatric disorder. Reference: Synopsis of Psychiatry, page 348.


Question: Methadone is used for opioid withdrawal because

The opioid antagonist naloxone reverses the effects of a dose of morphine or heroin within minutes. This may be life-saving in the case of a massive overdose. Naloxone administration also provokes an acute withdrawal syndrome in a dependent person who has recently taken an opioid. In the treatment of opioid addiction, a long-acting opioid (eg, methadone, buprenorphine ) is often substituted for the shoer-acting, more rewarding, opioid (eg, heroin). The signs and symptoms of withdrawal include a lot of distressing symptoms which makes the patient take the substance again. the symptoms of opiod withdrawl are remebered witha clue" ALL ORIFICES BLEED" the symptoms include rhinorrhea, lacrimation, yawning, chills, gooseflesh (piloerection), hyperventilation, hypehermia, mydriasis, muscular aches, vomiting, diarrhoea, anxiety, and hostility. the detoxification of opiod withdrawl is done by 3 methods that are listed below 1.SYMPTOMATIC DETOXIFICATION============clonidine, diazepam, dicyclomine, anti emetic, anti diarrhoeal 2.AGONIST ASOSIATED DETOXIFICATION========methadone, bupenorphine 3.ANTAGONIST ASSOSIATED DETOXIFICATION=====naltrexone STRONG OPIOID AGONISTS Morphineentanyl PAIAL AGONISTS CodeineHydrocodone MIXED OPIOID AGONIST-ANTAGONISTS BuprenorphineNalbuphine OPIOID ANTAGONISTS Naloxone


Question: A lady while driving a car meets with an accident. She was admitted in an ICU for 6 months. After being discharged she often gets up in night and feels terrified. She is a afraid to sit in a car again. The diagnosis is


Question: acrophobia is fear of

there are several named phobias that are frequently asked in entrance questions namely TYPES EXPLANATION Acro phobia Heights Agaro phobia Open places Ailuro phobia Cats Claustro phobia Closed spaces Zoo phobia Animals Myso phobia Dis and germs Xeno phobia strangers


Question: A person brings gifts for her wife next day after having fight with her. This is an example of

Undoing is a neurotic defense mechanism where an act is done to nullify a previous act.


Question: The site of lesion in korsakoff psychosis is

Wernicke-Korsakoff syndrome is associated with periventricular lesions surround the third ventricle, aqueduct, and fouh ventricle, with petechial haemorrhages in occasional acute cases and atrophy of the mammillary bodies in most chronic cases. There is frequently endothelial proliferation, demyelination, and some neuronal loss. These changes may be detected by MRI scanning. The amnestic defect is related to lesions in the dorsalmedial nuclei of the thalamus. Reference: Harrison19e pg: 1783


Question: "Attributing one's unacceptable feelings to others" is known as

(A) Projection # Attributing one's feeling to another is "Projection":# Psychological projection or projection bias is a psychological defense mechanism where a person subconsciously denies his or her own attributes, thoughts, and emotions, which are then ascribed to the outside world, usually to other people. Thus, projection involves imagining or projecting the belief that others originate those feelings.> Projection reduces anxiety by allowing the expression of the unwanted unconscious impulses or desires without letting the conscious mind recognize them.> An example of this behavior might be blaming another for self failure. The mind may avoid the discomfort of consciously admitting personal faults by keeping those feelings unconscious, and by redirecting libidinal satisfaction by attaching, or "projecting," those same faults onto another person or object.> The theory was developed by Sigmund Freud


Question: Highest insight is

Insight has six levels- level 1- complete denial of illness level 2- slight awareness of being sick and needing help, but denying it at the same time level 3- awareness of being sick but blaming it on others, on external factors, or on organic factors. level 4- awareness that illlness is causeed by something unknown in the patient. level 5- intellectual insight, admission that patient is ill and that symptoms or failure in social adjustment are caused by the patien's own peicular irrational feelings or disturbances without applying this knowledge to futue experiences. level 6- true emotional insight. Ref: Synopsis of Psychiatry, 10e, Chapter 7.1

Cognitive development and defence mechanism


Question: Catatonic features seen in schizophrenia are also seen in

Catatonia can be present in several mental disorders, most commonly seen in schizophrenia and mood disorders. The hallmark symptoms of catatonia--mutism, stuporousness, blunted affect, extreme withdrawal, negativism, and marked psychomotor retardation there are various causes for catatonia namely both catatonic and non catatonic schizophrenia, major depressive disorder (often with psychotic features medical and neurological disorders like akinetic mutism seen in frontal lobe syndromes, locked in syndrome Reference: Kaplan & Sadock's synopsis of psychiatry, 11th edition, page 360.

Symptoms and signs in psychiatry and classification


Question: Most Common delusion of Schizophrenia includes

(A) Persecution # DELUSIONS are misguided beliefs that have no basis in reality, and people with schizophrenia often suffer from delusions as a symptom of their disease. Their disorganized thinking and impaired ability to interpret new information often lead them to false perceptions. People with schizophrenia often have delusions that fit certain common categories.> Persecutory delusions are the most common type of delusions experienced by people with schizophrenia. These types of delusions are based on suspicions of being targeted by someone or something. People with these types of delusions mistakenly believe that they are being followed, harmed, poisoned or tormented. Delusions of persecution are suggestive of the paranoid type of schizophrenia.> Referential: Referential delusions are another common type of delusion reported by people with schizophrenia. People with referential delusions believe that gestures and words of others are specifically directed at them. They become convinced that they are the focus of song lyrics, books or comments made by someone on television.> Grandiose: Delusions of grandeur are based on the affected person's mistaken idea that he is someone of extreme importance. People with this type of delusions may believe they are a popular celebrity or a powerful political figure. Since they believe they are well-known or famous, it is disturbing to them when others do not recognize or acknowledge them as such.> Religious: Religious delusions center around misguided ideas about one's relationship with God. People with schizophrenia with this type of delusion may believe they have a special relationship with God or that God has given them special powers. They may profess an ability to speak directly to God or a responsibility to carry out God's plans. In some cases, these individuals may actually believe that they are God.> Somatic: Somatic delusions involve a preoccupation with one's body. These delusions commonly consist of erroneous beliefs that they are suffering from a physical condition, such as a tumor. However, the perceived source of the physical malady is usually bizarre, such as having a foreign substance in one's body.> Control: Delusions of control involve the belief that one's thoughts and actions have been taken over by some outside force. People with schizophrenia with delusions of control believe that their thoughts have been involuntarily taken from their mind. Therefore, they are convinced that the thoughts in their mind are not their own. Delusions of control may also include the belief that their bodies are being manipulated to perform certain actions.# SUBTYPES OF SCHIZOPHRENIA: With the publication of DSM-5, the APA removed all sub-classifications of schizophrenia. The five sub-classifications included in DSM-IV-TR were:> Paranoid type: Delusions or auditory hallucinations are present, but thought disorder, disorganized behavior, or affective flattening are not. Delusions are persecutory and/or grandiose, but in addition to these, other themes such as jealousy, religiosily. or somatization may also be present.> Disorganized type: Named hebephrenic schizophrenia in the ICD. Where thought disorder and flat affect are present together.> Catatonic type: The subject may be almost immobile or exhibit agitated, purposeless movement. Symptoms can include catatonic stupor and waxy flexibility.> Undifferentiated type: Psychotic symptoms are present but the criteria for paranoid, disorganized, or catatonic types have not been met.> Residual type: Where positive symptoms are present at a low intensity only.> ICD-10 defines two additional subtypes: Post-schizophrenic depression: A depressive episode arising in the aftermath of a schizophrenic illness where some low level schizophrenic symptoms may still be present. Simple schizophrenia: Insidious and progressive development of prominent negative symptoms with no history of psychotic episodes.> Latent schizophrenia, schizophrenic reaction, pseudoneurotic schizophrenia, pseudopsychopathic schizophrenia, "symptom- depleted" schizophrenia are in the Russian version of the ICD-10.


Question: Organic Mental Disease is indicated by

B i.e. Delusions Presenting Features Visual or other non-auditory hallucinationsQ Complex delusionsQ Soft neurological signsQ, confusion, disorientationQ & memory impairment Neurological signs & symptoms as seizures, sensory or motor disturbance, impairment of conciousnessQ Misidentification syndromes as capgras etc. First rank symptoms as made feelings, voices commenting etc. H/O head injury, drug or alcohol use Concurrent medical or neurological illness Ist episode, sudden onset, older age of onset. Organic Mental Disease - Organic mental disorders are of 3 types Dementia Delirium Substance & medical related condition - In subcoical dementia - complex delusions are found.Q


Question: Depot preparations are available for

Depot preparations are available for risperidone, olanzapine, haloperidol, fluphenazine There is no depot preparations for clozapine that is available as there is a lot of side effect associated with agranulatocytosis and myocarditis and hence it is not given as depot preparation. Ref.Kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 1023


Question: Generalised anxiety disorder is characterized by

GAD is characterized by free floating anxiety and negative apprehension about day today tril life events. Anxiety about specific situations are more likely to be seen in phobia. Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 407


Question: In schizophrenia, good prognostic factor is

(D) Acute onset PROGNOSTIC FACTORS IN SCHIZOPHRENIAGood Prognostic FactorsPoor Prognostic Factors* Acute or abrupt onset* Insidious onset* Onset > 35 years of age (late onset)* Onset < 20 years of age (early onset)* Presence of precipitating stressor* Absence of stressor* Good premorbid adjustment* Poor premorbid adjustment* Catatonic subtype (Paranoid subtype* Disorganized, simple, undifferentiated, has an intermediate prognosis) or chronic catatonic subtypes* Short duration (< 6 months)* Chronic course (> 2 years)* Presence of depression* Absence of depression* Predominance of positive symptoms* Predominance of negative symptoms* Family history of mood disorder* Family history of schizophrenia* First episode* Past history of schizophrenia* Pyknic (fat) physique* Asthenic (thin) physique* Female sex* Male sex* Good social support* Poor social support or unmarried* Presence of confusion, perplexity, or* Flat or blunted affect disorientation in the acute phase* Proper treatment, good treatment* Absence of proper treatment or compliance, and good response poor response to treatment to treatment* Outpatient treatment* Institutionalization (long term hospitalization)* Normal cranial CT scan* Evidence of ventricular enlargement on cranial CT scan


Question: Delusion that someone from high socioeconomic status is loving you is

Delusion is defined as a false , fixed, firm belief which is impervious to other experiences, person holds it with subjective ceainty , leads to compelling counterargument and which is outside the social , cultural and educational background. There are several types of delusions Some of the named delusions are ERATOMANIC DELUSION- De clerambault syndrome- patient has a delusion that person from a higher social class is in love with the patient. They may even STALK the person on whom they have delsuion. INFIDELITY DELUSION-OTHELLO syndrome. This is most common in ALCOHOLIC MALES. patient presents with doubt regarding infedility of the wife Delusional misidentification-CAPGRAS SYNDROME-patient with this delusion have an idea that a familiar person is replaced by an imposter Ref- Fish Psychopathology, 3e, pg 123.


Question: The absolute contraindication for Electro Convulsive Therapy {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: Maximum duration of time spent is in NREM stage

Young adulthood, the distribution of sleep is as follows- NREM 75% stage 1 5% stage 2 45% stage 3 12% stage 4 13% REM 25% Ref- Synopsis of psychiatry, 11e, pg 535.


Question: In Korsakoff's Psychosis, the following in not seen


Question: Intense depression & misery without any cause is

Melancholia:- Melancholia is severe depressive state with psychomotor retardation. Ref:- Kaplan & Sadock's Synopsis of Psychiatry 10th edition; Pg num:- 1892

Schizophrenia and other psychotic disorders


Question: Trichotillomania is

HABIT AND IMPULSE DISORDERS This category includes disorders such as pathological gambling, pyromania, kleptomania, trichotillomania, and intermittent explosive disorder. The disorders in this heterogeneous group are characterised by impulsive behaviour which the patient cannot resist or control. There may be a feeling of release of tension by doing the act and a feeling of guilt after the act is overTrichotillomania (compulsive hair-pulling) is characterised by noticeable hair loss caused by person's persistent and recurrent failure to resist impulses to pull out hair. There is an intense urge to pull out hair with mounting tension before the act and a sense of relief afterwards. There is no pre-existent skin lesion or inflammation, and hair pulling is not secondary to any delusion or hallucination. Ref: A sho textbook of Psychiatry.Niraj Ahuja.edition 7.Pg no:119


Question: Most common age for depression is

An almost universal observation, independent of country or culture, is the twofold greater prevalence of major depressive disorder in women than in men. The mean age of onset for major depressive disorder is about 40 years, with 50 percent of all patients having an onset between the ages of 20 and 50 years. Reference: Synopsis of Psychiatry, page 349.


Question: The following name is associated with psychodynamic theory

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: Drug of choice in Obsessive compulsive disorder is

Ans. is 'b' i.e. Fluoxetine The drug of choice for obsessive compulsive disorder is Fluoxetine.RememberThe treatment of choice for obsessive compulsive disorder is behavior therapy. (Only 50% of OCP patients show improvement with pharmacotherapy alone).


Question: Drug used for reducing sex drive in sexual offenders

Drug therapy: Antipsychotics have sometimes been used for severe or dangerous aggression associated with paraphilias. Benperidol was earlier believed to be paicularly useful but the claim has not been substantiated, and the drug is not available in the market. Antiandrogens (cyproterone acetate or medroxyprogesterone acetate) can be used in paraphilias with excessive sexual activity.


Question: Delusions of control, persecution and self reference are seen in


Question: In Profound MR, IQ is

IQ range for categoriesICD-10DSM-IVMild50-6950-55 to 70Moderate35-4935-40 to 50-55Severe20-3420-25 to 35-40ProfoundBelow 20Below 20-25Reference: Oxford Textbook of Psychiatry; 3rd edition; Chapter 18; Learning Disability


Question: Akinesia (hypoactivity) and mutism is a feature of

Akinesia + Mutism is a feature of stupor, which is seen in catatonic schizophrenia or catalepsy.
Option c : Cataplexy is sudden loss of muscle tone seen in Norcolepsy, which is not a correct answer.


Question: Most common phobia

Phobia is clinical condition where there is a fear of any stimulus because of which there is anxiety and distress and to avoid the distress there is avoidance and finally results in dysfunction MOST HERITABLE TYPE OF PHOBIA IS BLOOD INJECTION TYPE OF PHOBIA MOST COMMON TYPE OF PHOBIA IS SPECIFIC PHOBIA ONLY TYPE OF PHOBIA WHERE THERE IS HYPOTENSION AND FALLS IS BLOOD INJECTION TYPE OF PHOBIA Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 400


Question: Drugs abuse with symptoms similar like paranoid schizophrenia are seen in


Question: Flash back is seen in

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


Question: A 60 year old male comes to casuality with acute retention of urine since 12 hours. On examination there was distended bladder. His son gives a history of taking some drug by the pateint. Since 2 days as he is suffering from depression. The most likely drug is


Question: Roid rage is seen in

ANABOLIC ANDROGENIC STEROIDS Testosterone like hormones * Muscle building propey * Body builders * Normal testosterone range is 300-1000micrograms * Need to administer 10-100 times the normal to have effect kaplon and Sadock, synopsis of psychiatry, 11 th edition, pg no 686


Question: Paranoid Psychosis with cocaine is seen due to

The complications of chronic cocaine use include acute anxiety reaction, uncontrolled compulsive behaviour, psychotic episodes (with persecutory delusions, and tactile and other hallucinations), delirium and delusional disorder. Ref: Sho textbook of Psychiatry by Niraj Ahuja, 7th edition page 47.


Question: A medical student could not deliver a seminar, fearing seniors. He is aware of the irrationality of his fear. Likely diagnosis is

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

Anxiety disorders stress disorders and grief


Question: Total score in Mini Mental Status Examination is

The MMSE is a 30-point cognitive test developed in the mid-1970s to provide a bedside assessment of a broad array of cognitive function, including orientation, attention, memory, construction, and language. Kaplan & Sadock's synopsis of psychiatry, 11th edition, page 241.


Question: Tianeptine acts by


Question: Excessive sexual desire in males is known as

Disorders of Appetitive Phase (Sexual Desire Disorders)1. Hypoactive sexual desire disorder:This disorder is characterised by an absence of fantasies and desire for sexual activity which is not secondary to other sexual dysfunctions, such as premature ejaculation or dyspareunia.This disorder is many times more common in females (previously called as frigidity) and its prevalence increases with age. 2. Sexual aversion disorder and lack of sexual enjoyment disorder:In the sexual aversion disorder, there is an aversion to and avoidance of all sexual activity with a sexual paner. 3. Excessive sexual drive:Rarely, both men (Satyriasis) and women (Nymphomania) may complain of the excessive sexual drive as a problem. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 126


Question: Global cerebral dysfunction characterized by alteration in cognitive function and consciousness is known as

Delirium is the commonest organic symptom seen in clinical practice. Characterised by acute onset, clouding of consciousness, disorientation, asterixis, multifocal myoclonus, occupational delirium, tone and reflex abnormalities (Ref: A sho textbook of psychiatry, Niraj Ahuja, 7th edition, pg no.19). Alteration of consciousness is not seen in cases of anxiety, depression & dementia.


Question: Akathesia is treated by A/E

C i.e. HaloperidolAkathesia is characterised by inner restlessnessQ (feeling of discomfo & agitation) and external restlessness (compulsion to move extremities & fidgety movementsQ). It is seen in basal ganglia disorders (eg Parkinson's disease) and alongwith extrapyramidal side effects of antipsychotic drugsQ.In acute dystonia (neurolept induced), there are linguofacial bizarre muscle spasmQ (1/t grimacing, toicollis, locked jaw, chewing, puffing of cheeks) occurring within few hours or the most 1 weekQ of staing or rapidly increasing the dose of neuroleptic drug. DOC is anticholinergic, antihistaminic drugs.Anhedonia: It means not getting interest or happiness in pleasurable stimuli & nihilism (helplessness, wohlessness hopelessness). It is a feature of depression.The development of subjective symptoms of restlessness within 4 weeksQ of initiating or increasing the dose of neuroleptic with Pacing, Rocking, Fidgety movements & inability to sit or stand for atleast several minutesQ are diagnostic of neuroleptic induced acute akathisia.Haloperidol, a neurolept causes akathisia (not used in treatment)Q. Treatment of akathisia (internal & external restlessness): 1. JO Blockers (drug of choice)Q, 2. Centrally acting (antiparkinson) anticholinergics ex. trihexyphenidyl, benztropine etcQ are less effective, 3. Amantidine, Cyproheptadine & DiazepamQ are used in resistant cases only.


Question: Maximum heritability is seen in


Question: Prevalence of schizophrenia in dizygotic twins of schizophrenic patient is

Usual prevalence in general population is 0.5 to 1% and 40% in child with both parents being schizophrenic. Among dizygotic twins, it is 12% if a parent is schizophrenic Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 386

Schizophrenia and other psychotic disorders


Question: Maximum score that can be obtained in MMSE is

Mini-Mental State Examination : The MMSE is an 11-question measure developed to asses a broad array of cognitive function including orientation, attention, memory, construction, and language. Its validity and inter-rater reliability is good, takes only 5-10 minutes to administer, practical to use repeatedly and routinely. For screening, a cut-off of 24 for identifying cases of dementia has been suggested. The maximum score is 30. A score of 23 or lower is indicative of cognitive impairment. * MMSE( MINI MENTAL STATUS EXAMINATION) * MCI demtia===score less than. 24 * MILDdemntia====score less than. 20 * MODERATE demntia==score less than. 18 * SEVERE dementia====score less than 10 Reference: Page NO.1053 Chap 7.10 Psychiatric Rating Scales(Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 9th Edition)


Question: Bipolar II disorder includes


Question: "La belle indifference" is seen in

"La belle indifference" is seen in conversion disorder, where the patient has feeling of indiference towards his symptoms.
Example: If a person suddenly experiences loss of vision he is expected to get  extremely concerned about it. But patient of conversion disorder seems to be unconcerened towards his symptoms.


Question: Agoraphobia is

(A) Fear of open spaces PHOBIC DISORDERSFear of Situation or ObjectsPhobias* Dread of Open spaceAgoraphobia* Dread of VehiclesAmaxophobia* Dread of FloodsAntlophobia* Dread of ConfinementClaustrophobia* Dread of Being locked inClithrophobia* Dread of DogsCynophobia* Dread of Sexual intercourse or STDCypridcphobia* Dread of DrinkingDipsophobia* Dread of Surgical operationErgasiophobia* Dread of MarriageGamophobia* Dread of FoodGatophobia* Dread of WritingGraphophobia* Dread of WomenGynephobia* Dread of SunHeliophobia* Dread of SteelingKleptophobia* Dread of SpeakingLalophobia* Dread of RabiesLyssophobia* Dread of PregnancyMaieusiophobia* Dread of CorpseNecrophobia* Dread of OdoursOsmophobia* Dread of EatingSitophobia* Dread of TuberculosisPhthisiophobia* Dread of ChokingPnigophobia* Dread of FirePyrophobia* Dread of ColdPsychrophobia* Dread of DevilSatanophobia* Dread of DeathThanatophobia* Dread of Being Buried aliveTaphephobia* Dread of GodTheophobia* Dread of StrangersXenophobia> Agoraphobia is an anxiety disorder which primarily consists of the fear of certain settings that may present unexpected challenges or demands.> These could include parking lots, shopping malls or restaurants.


Question: A 50 year old guy presented with 25 years of married life, having 5 years of established doubt on his wife's fidelity, despite proof to the contrary, and his other aspects of life are normal. The probable diagnosis is

(C) Delusional disorder # DELUSIONAL DISORDER is an uncommon psychiatric condition in which the patients present with delusions, but with no accompanying prominent hallucinations, thought disorder, mood disorder, or significant flattening of affect.> There are seven types of Delutional disorders: Erotomanic type (erotomania): delusion that another person, often a prominent figure, is in love with the individual. The individual may breach the law as he/she tries to obsessively make contact with the desired person. Grandiose type: delusion of inflated worth, power, knowledge, identity or believes himself/herself to be a famous person, claiming the actual person is an impostor or an impersonator. Jealous type: delusion that the individual's sexual partner is unfaithful when it is untrue. The patient may follow the partner, check text messages, emails, phone calls etc. in an attempt to find "evidence" of the infidelity. Persecutory type: This delusion is a common subtype. It includes the belief that the person (or someone to whom the person is close) is being malevolently treated in some way. The patient may believe that he/she has been drugged, spied-on, harassed and so on and may seek "justice" by making police reports, taking court action or even acting violently. Somatic type: delusions that the person has some physical defect or general medical condition Mixed type: delusions with characteristics of more than one of the above types but with no one theme predominating. Unspecified type: delusions that cannot be clearly determined or characterized in any of the categories in the specific types.


Question: The most common form of dissociation hysteria is

Dissociative Amnesia This is the commonest clinical type of dissociative disorder. Occurring mostly in adolescent and young adults (females more than males, except in war), it is characterised by a sudden inability to recall impoant personal information (amnesia), paicularly concerning stressful or traumatic life events. The amnesia cannot be explained by everyday forgetfulness and there is no evidence of an underlying medical illness. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 100


Question: Maximum benefit from ECT is seen in

Lucio Bini and Ugo Cerletti *introduced ECT in 1938 for the treatment of psychiatric illness Indications for the Use of Electroconvulsive Therapy (ECT) Diagnostic Indications Clinical indications Major a)Major depression, both unipolar and bipolarb)Psychotic depression in paicularMania, including mixed episodesc)Schizophrenia with acute exacerbation d)Catatonic subtype paicularly Schizoaffective disorder Primary use Rapid definitive response required Risks of alternative treatments outweigh benefitsPast h/o poor response to drugs/good response to ECTPatient preference Other Secondary use a)Parkinson's disease b)Neuroleptic malignant disorder Failure to respond to pharmacotherapy in the current episodeIntolerance of pharmacotherapy in the current episodeRapid definitive response necessitated by deterioration of the patient's condition this is one of the repeated questions in psychiatry you always have to carefully read all the choices if the choice has depression with suicidal ideas , that is the answer if depression with suicidalideas is not given in the choice , then search for catatonia if catatonia is also not in the choice then go for treatment resistant schizophrenia and mania in PGI queestion paper where there are multiple answers for a single question, you can select all these choices namely depression with suicidal ideas catatonia treatment resistant mania and schizophrenia Ref: P.3290 chap. 31.34a Electroconvulsive Therapy


Question: In Alzheimer disease patients, the major effect on neurotransmitter systems of tacrine, donepezil, rivastigmine, and galantamine is to

Low levels of Ach are associated with the symptoms of Alzheimer disease. Tacrine, donepezil, rivastigmine, and galantamine are acetylcholinesterase inhibitors (i.e., they block the breakdown of Ach, increasing its availability). These agents can thus be effective in slowing down the progression of the illness. They do not restore the function the patient has already lost.


Question: Blunting of affect is seen in

Ans. a (Schizophrenia). (Ref. Harrison, Medicine, 15th ed., 2554; Psychiatry by Niraj Ahuja, 5th ed., 55)EUGEN BLEULER'S FUNDAMENTAL SYMPTOMS OF SCHIZOPHRENIA (4 A'S)# Ambivalence (marked inability to decide for or against)# Autism (withdrawal into self)# Affect blunting (disturbance of affect)# Association disturbances (loosening of association, thought disorder)


Question: Defence mechanism in OCD

Three defense mechanisms are common in OCD- Isolation, Undoing & Reaction formation Isolation: Unconsciously isolate and disown their own thoughts, experiencing as forign thoughts. Undoing: unconsciously cancel out an unacceptable desire or act by performing another act. Reaction formation: suppress an unacceptable desire by taking on a lifestyle that expresses the opposite desire.

Cognitive development and defence mechanism


Question: "Rationalization" is seen in

Rationalization is a neurotic defense mechanism where an individual gives rational explanation to justify his own unacceptable behavior, seen in substance abuse disorder.
Ex: A chronic alcoholic blames his family environment as a cause of his alcoholism.


Question: Type of schizophrenia with mental retardation is

froph's schizophrenia: This is a syndrome of 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 systematized. therefore, behavioural disturbances are much more prominent than delusions and hallucinations Schizophrenia DSM-5 DSM-5 has deleted all subtypes Delusion hallucinations disorganized speech grossly disorganized or catatonic behaviour negative symptoms Duration >1month (active phase of illness) Impairment in work, interpersonal, self-care during the period of illness All these should be present for >6 months which includes ICD-10 requires a duration of-of month subtypes Paranoid presence of one or more delusions and frequent auditory hallucinations. Most common*. Good prognosis *if treated. Age of onset middle age Disorganized (Hebephrenic) thought disorder, disorganized behaviour and flat or inappropriate affect. Delusions and hallucinations, if present, are poorly systematized. They have Poor premorbid function*, an insidious onset during adolescence*, a continuous course*, and a poor prognosis* Catatonic* common in low SES. >2 of following symptoms: Immobility (stupor or catalepsy*) excessive purposeless motor activity negativism peculiar movements(posturing,stereotypy,mannerisms,grimacing); echolalia*- or echopraxia* Undifferentiated diagnosis is through the exclusion of the other subtypes. Includes those who meet criteria for schizophrenia but cannot be placed into any subtypes Residual* Have met the criteria for schizophrenia before, have negative symptoms, residual symptoms, but no longer have psychotic symptoms the catalepsy*-a person maintains the body position(even painful) into which they are placed. echolalia*-repetition of words ; echopraxia*- repetition of movements Reference: P.61 Textbook of Psychiatry , Neeraj Ahuaja


Question: Not a feature of dementia is

A i.e. Loss of Sensorium- Memory impairment (ex. forgetfulness) is typically an early & prominent feature in dementia.- No matter how severe the disorientation seems (d/t memory impairment),However, patients show no impairment in their level of consciousness.- Lability of emotions, sloppy grooming, uninhibited remarks, silly jokes or a dull, apathetic or vacuous facial expression & manner suggest dementia especially when coupled with memory impairment.


Question: Antipsychotic drug with least extrapyramidal effects is


Question: According to Sigmund Freud, primary process thinking is

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. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no.206

Cognitive development and defence mechanism


Question: More common in binge eating compared to bulimia nervosa is

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.144


Question: Bruxism is

Bruxism (teeth-grinding): The patient has an involuntary and forceful grinding of teeth during sleep. Though the bed paner repos loud sounds produced by grinding of teeth and destruction of the tooth enamel is obvious, the patient remains completely unaware of the episode(s). Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 140


Question: Characteristic feature of subcoical dementia is

A i.e. Memory loss Aphasia, Agnosia, Dyslexia are characteristic features of coical dementia. So we are only left with memory loss for sub coical dementia.


Question: "Mellanby effect" is seen with

Mellanby effect: Intoxicating effect of alcohol are greater at a given BAC (blood alcohol concentration) when blood alcohol level is increasing than for the same BAC when blood alcohol level is falling.


Question: extinction 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: Most common cause of suicide is

Depression is the most common cause of suicide Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 604-607


Question: Wernicke&;s encephalopathy in alcohol consumption can be treated with

Alcohol-Induced Amnestic Disorder: (1) Wernicke's encephalopathy, Confabulation, Ataxia, Ophthalmoplegia (gaze palsy, lateral orbital palsy)horizontal nystagmus tends to reverse rapidly with thiamine supplementation. it can be remebered with a mnemonic GOA G====Global confusion O====ophthalmoplegia A====Ataxia (2) Korsakoff's syndrome (permanent in 50 to 70%): anterograde, retrograde amnesia and potential impairment in visuospatial, abstract, and other types of learning. .They respond to 50 to 100 mg of oral thiamine a day, usually administered for many months. Both are due to thiamine deficiency, causing neuropathological lesions symmetrically in mammillary bodies, thalamus, hypothalamus, midbrain, pons, medulla, fornix, and cerebellum. Reference: P.1279 11.2 Alcohol-Related DisordersKaplan & Sadock's Comprehensive Textbook of Psychiatry, 9th Ed


Question: Normal therapeutic level of Lithium level is

Blood Lithium Levels (in treatment of bipolar disorder)* Therapeutic levels = 0.6-1.2 mEq/L (For the treatment of acute mania)* Prophylactic levels = 0.6-1.0 mEq/L (For relapse prevention in bipolar disorder)* Toxic lithium levels > 2.0 mEq/L Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no.190


Question: Agoraphobia commonly occurs with

(C) Panic attacks # Agoraphobia is an anxiety disorder characterized by anxiety in situations where the sufferer perceives certain environments as dangerous or uncomfortable, often due to the environment's vast openness or crowdedness.> These situations include wide-open spaces, as well as uncontrollable social situations such as the possibility of being met in shopping malls, airports and on bridges.> Agoraphobia is defined within the DSM-IV TR as a subset of panic disorder, involving the fear of incurring a panic attack in those environments. In the DSM-5, however, agoraphobia is classified as being separate from panic disorder.> The sufferer may go to great lengths to avoid those situations, in severe cases becoming unable to leave their home or safe haven.


Question: Ambivalence is most commonly seen in

SCHIZOPHRENIA:- Eugen Bleuler coined the term "Schizophrenia. which replaced dementia praecox in scientific literature. Bleuler proposed four symptoms which he called as fundamental (or primary) symptoms of schizophrenia. These symptoms are also known as 4 A's of Bleuler. They include: A. Autistic thinking and behavior (Autism): Excessive fantasy thinking which is irrational and withdrawn behavior. B. Ambivalence: Marked inability to take decisions. C. Affect disturbances: Disturbances of emotions such as inappropriate affect. D. Association disturbances: Disturbances of association of thoughts such as formal thought disorders. Ref:- Psychiatry by Sandeep Govil, pg num:- 80

Schizophrenia and other psychotic disorders


Question: A patient on t/t for psychiatric disorder takes overdose of a drug, develops bradycardia, hypotension, decreased sweating and salivation. The likely drug is


Question: Somnambulism is seen in

Most of the NREM phase disorders occur in NREM 3, except Somnoliquy & Bruxism which are seen in NREM 2.


Question: Delusions of persecution, grandiosity and infidelity are features of

i.e. (Paranoid schizophrenia): (2721-H 17th)PARANOID SCHIZOPHRENIACharacterized by1. Delusion of persecution2. Delusion of reference3. Delusion of grandeur (or grandiosity)4. Delusion of infidelity (or Jealousy)5. Schneider's first rank symptoms6. The delusions are usually well-systematized7. The personality deterioration is much less than in other types of schizophrenias8. Patients may be apprehensive (due to delusions & hallucination)SCHIZOPHRENIACATATONICClinical presentation is dominated by profound changes in motor activity, negativism and echolalia or echopraxiaPARANOIDProminent preoccupation with a specific delusional systemDISORGANIZEDDisorganized speech and behavior are accompanied by a superficial or silly affectRESIDUALNegative symptomatology exists in the absence of delusions, hallucination or motor disorders


Question: Black patch delirium is seen in

Delirium can develop after cataract surgery in ilder patient who wear eye patches.Delirium caused by this sensory deprivation is called as "Black patch" delirium.


Question: Agoraphobia is associated with

(D) Panic disorders # AGORAPHOBIA is characterized by anxiety in situations like environment's vast openness or crowdedness.> These situations include wide-open spaces, as well as uncontrollable social situations such as the possibility of being met in shopping malls, airports and on bridges.> It is most commonly associated with panic disorders and standardized tools, such as Panic and Agoraphobia Scale, can be used to measure the severity of agoraphobia and panic attacks and monitor treatment.> Exposure treatment can provide lasting relief to the majority of patients with agoraphobia. Systematic desensitization may also be used. Medications like selective serotonin reuptake inhibitor (SSRI). Benzodiazepines, MAO inhibitors and tricyclic antidepressants are also sometimes prescribed for treatment of agoraphobia.> Antidepressants should be used in conjunction with exposure as a form of self-help or with cognitive behaviour therapy.


Question: CAGE test is used for diagnosis of

CAGE Questionnaire The CAGE questionnaire basically consists of four questions: i. Have you ever had to Cut down on alcohol (amount)? ii. Have you ever been Annoyed by people's criticism of alcoholism? iii. Have you ever felt Guilty about drinking? iv. Have you ever needed an Eye-opener drink (early morning drink)? A score of 2 or more identifies problem drinkers. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 39


Question: Cingulotomy is used to treat

Cingulotomy and Capsulotomy are the psychosurgical techniques that can be used in the treatment of OCD.


Question: Treatment of seasonal affective disorder

Seasonal affective disorder is mood disorder with seasonal pattern treated with Bright light therapy.


Question: Anxious,shy, avoidant symptoms come under cluster

Patients with cluster C personality disorders have shy and anxiety features. This cluster contains 3 personality disorders namely Avoidant Dependent Obsessive-compulsive Ref. Kaplan and sadock synopsis of psychiatry, page 742


Question: Rapid cycling Bipolar disorder is characterized by

(A) More than 4 episodes per year # RAPID CYCLING MOOD DISORDER has an earlier age of onset (third decade) than recurrent depressive (unipolar) disorder. Unipolar depression, on the other hand, is common in two age groups: late third decade and fifth to sixth decades.> An average manic episode lasts for 3-4 months and a depressive episode lasts from 4-6 months. Unipolar depression usually lasts longer than bipolar depression.> With rapid institution of treatment, the major symptoms of mania are controlled within weeks and of depression within 6-8 weeks.> Nearly 40% of depressive with episodic course improve in 3 months, 60% in 6 months and 80% improve with in a period of one year. 15-20% of patients develop a chronic course of illness, which may last for two or more years. Chronic depression is usually characterized by less intense depression, hypochondriacal symptoms, presence of comorbid disorders (like dysthymic disorder, alcohol dependence, personality disorders and medical disorders), presence of ongoing stressors and unfavorable early environment.> As the age advances, the intervals between two episodes shorten and, the duration of the episodes and their frequency tends to increase. Although not all patients have relapses, it has been estimated that up to 75% of patients have a second episode within 5 years.> Some patients with bipolar mood disorder have more than 4 episodes per year; they are known as rapid cyclers.> About 70-80% of all rapid cyclers are women.> When phases of mania and depression alternate very rapidly (e.g. in matter of hours or days), the condition is known as ultra-rapid cycling.> Some of the factors associated with rapid cycling include the use of antidepressants (especially tricyclic antidepressants), low thyroxin levels, female gender, bipolar II pattern of illness, and the presence of neurological disease.> There is an increased mortality in patients with mood disorders by almost two times the general population. The most important cause of death is suicide, the life-time risk of which is 10-15 times higher in depression. Patients with depression also have higher mortality rates from cardiovascular diseases and co-morbid alcohol and drug use disorders. Patients with depression also exhibit a variety of disturbances in immune function.


Question: NOT a side effect of Lithium

(A) Leucopenia # RENAL: The renal side-effects occur in 10-50% of all patients on maintenance lithium therapy. Polyuria, polydipsia. Tubular changes. Nephrogenic diabetes insipidus. Nephrotic syndrome.> Gastrointestinal: These side-effects are nausea, vomiting, diarrhea, metallic taste and abdominal pain.> Dermatological: These include acneiform eruptions, papular eruptions and exacerbation of psoriasis.


Question: General Adaptation Syndrome {GAS} is seen in

Hans Selye developed a model of stress that he called as General Adoptation Syndrome (GAS). It consisted of three phases- 1. Alarm reaction, 2. Stage of resistance, 3. Stage of exhaustion. Ref: Synopsis of Psychiatry, 11e, pg 477

Cognitive development and defence mechanism


Question: Therapeutic exposure is a form of

Main line of management for phobias is psychological management The main management is exposure which can be done in several ways which is explained below SYSTEMATIC DESENSITIZATION JOSEPH WOLPE Joseph Wolpe gave the concept of systematic desensitization This is a treatment used in phobia In phobia there is a conditioned fear response to aversive neutral stimulus and avoidance of that response leads to phobia Whenever there is a fear response there is stimulation of sympathetic system In that case stimulation of parasympathetic system by relaxation there is reduction in anxiety First step is to make a step ladder which are arranged based on the severity Then is go step by step and along with doing applied relaxation Slowly the the sympathetic system is reduced The patient will be able to approach stimulus without anxiety Ref.Kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 398


Question: Most commonly abused opioid is

Heroine-brown sugar /diacetylmorphine is the most commonly abused opioid opiods works on mu, kappa and delta receptor. there is a new recpetor that is introduced that is called as orphanin receptor opiod withdrawl is a distressing experience for the patient that makes the patient to take the sunstance again the main clue for opiod withdrawl isALL ORIFICES BLEED there is lacrimation, sweating, vomiting, rhinorrhea, diarrhoea, muscle cramps and stomach ache the piloerection that occurs in opiod withdrawl is called as COLD TURKEY the tratment of opiod withdrawl can be doneby several means SUPPOIVE CARE: clonidine+benzodiazepines+dicyclomine+anti emetic+anti diarrhoeal AGONIST ASSOSIATED DETOXIFICATION: methadone and bupenorphine ANTAGONIST ASSOSIATED DETOXIFICATION: naltrexone Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 338


Question: "Chasing the dragon" is a slang used with

"Chasing the dragon" refers to inhalation of vapours of Heroin (opioid) placed on a heated aluminium foil.


Question: Capgras syndrome is

o Delusion that a familiar person is replaced by an imposter This is more common in Alzeimers demetia and organic conditions. ref.kaplon and sadock, synopsis of psychiatry, 11 th edition, pg No.333

Schizophrenia and other psychotic disorders


Question: Increase in suicidal behaviour is due to

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. This finding has been replicated many times and in different diagnostic groups.CSF, neurochemical, and receptor studies suppo the hypothesis that reduced central serotonin is associated with suicide. Reference: Synopsis of Psychiatry, page 766, 767.


Question: Drug of choice for prophylaxis of Mania is

B i.e. Lithium Condition Drug of choice Acute mania Prophylaxis of bipolar disorder Lithium (Li)Q LiQ Rapid cyclers ValproateQ or Li & L-T3 > Carbamazepine


Question: Excessive sexual desire in female

Ans. a- Nymphomania Nymphomania is an excessive sexual desire in females where she enjoys having multiple sexual paners or desires excessive sexual activity.Satyriasis is an excessive sexual desire in males where they enjoy having multiple sexual paners or desire excessive sexual activity.Types of Sexual perversionsThese are persistently indulged sexual acts in which complete satisfaction is sought and obtained without sexual intercourse.a) Sadism :Sexual gratification is obtained or increased from acts of physical cruelty or infliction of pain on one's paner.It is seen more commonly in men. To obtain sexual gratification, the sadist may bite, beat, whip, produce cuts on the victim, etc.b) Lust murder :In extremes of sadism, murder serves as a stimulus for the sexual act and becomes the equivalent of coitus, the act is accompanied by erection, ejaculation, and orgasm.c) Necrophagia : (Necros =corpse; phagia = to eat) :This is an extreme degree of sadism in which the person after mutilating the body, sucks or licks the wounds, bites the skin, drinks blood, and eats the flesh of his victim to derive sexual pleasure.d) Masochism :Sexual gratification is obtained or increased by the suffering of pain.Masochists get pleasure from being beaten, abused, toured, humiliated, enslaved, degraded, or dominated by their sexual paner.e) Necrophilia :In this condition, there is a desire for sexual intercourse with dead bodies.It is said to have a sadomasochistic foundation and that decomposition, foul smell, and coldness act as stimulants.f) Fetishism :A fetish is an abnormal stimulus or object of sexual desire.Fetishism means the use of such objects of sexual gratification leading to orgasm. For example underclothing, brassiere, petticoat, stocking, shoes, etc.g) Transvestism = Eonism:A transvestite (trans = opposite, vista = clothing) is a person whose whole personality is dominated by the desire of being identified with the opposite sex.


Question: Most common symptom of alcohol withdrawal is

Features of alcohol withdrawal include tremor of the hands (shakes); agitation and anxiety; autonomic nervous system overactivity including an increase in pulse, respiratory rate, sweating, and body temperature; and insomnia. These symptoms usually begin within 5-10 h of decreasing ethanol intake, peak on day 2 or 3, and improve by day 4 or 5, although mild levels of these problems may persist for 4-6 months as a protracted abstinence syndrome.Harrison 19epg 2727


Question: A patient was on treatment with trifluperazine for some time. He presents with complaint of hypehermia, lethargy and sweating. Needed investigations are

D i.e. Hemogram, CPK & Renal Function Test

Hemogram, Electrolyte level and creatinine


Question: Antipsychotic drug with prolonged action


Question: Rivastigmine and Donepezil are drugs used predominantly in the management of

In dementia, specific drug treatment such as cholinesterase inhibitors (e.g. donepezil, rivastigmine, galantamine) in moderate Alzheimer&;s disease, or memantine (NMDA antagonist) in moderate to severe Alzheimer's disease, can be helpful. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 26


Question: Life span of Sigmund Freud was

1856-39 and he passed most of his life in Austria

1859-36 and he passed most of his life in Austria

1859-36 and he passed most of his life in Grmany

1859-36 and he passed most of his life in France


Question: Antipsychotic drug associated with raised QT interval

Anti-psychotic Drugs that prolong the QT interval and in some have been associated with torsades de pointes Clozapine-Anti-psychotic / Schizophrenia Felbamate-Anti-convulsant / Seizure Fosphenytoin-Anti-convulsant / Seizure Lithium-Anti-mania / bipolar disorder Quetiapine-Anti-psychotic / Schizophrenia Risperidone-Anti-psychotic / Schizophrenia Ziprasidone-Anti-psychotic / Schizophrenia

Schizophrenia Spectrum and Other Psychotic Disorders


Question: ECT is useful in


Question: Oedipus complex has been described 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: Widmark Formula is used for

C i.e. Alcohol The neuropathological lesion of wernicke - Karsakoff syndrome are symmetrical & paraventricular, involving the mammillary bodyQ, the thalamus, hypothalmus, mid brain, pons, medulla, fornix & cerebellum. Mc Ewan's sign & morbid jealousy is seen in alcohol abuse, and Widmark formula is used to determine the quantity of alcohol taken by person.


Question: Drug effect mimicking ''Schizophrenia' includes

(C) Phencyclidine # PHENCYCLIDINE is an NMDA receptor antagonist also acts as a D2 receptor partial agonist. It induces symptoms that mimic schizophrenia. Amphetamines trigger the release of dopamine and excessive dopamine function is believed to be responsible for many symptoms of schizophrenia.> Cannabis use is also suspected to contribute to the hyperdopaminergic state that is characteristic of schizophrenia.> Drugs such as ketamine, Phencyclidine (PCP), and Lysergic acid diethylamide (LSD) have been used to mimic schizophrenia for research purposes.> Alcohol abuse via a kindling mechanism can occasionally cause the development of a chronic substance induced psychotic disorder, i.e. schizophrenia.


Question: 25 years old gentleman has repeated thoughts that he has not locked his car door properly and frequently checks it while driving. He also repeatedly checks locks in his house. Diagnosis is

Obsessive compulsive disorder (OCD) and obsessive compulsive personality disorders a(OCPD)two different types of disorders OCD is classified under anxiety disorders whereas OCPD is classified under personality disorder Patients with OCD have recurrent, irresistible, irrelevant and intrusive thoughts that are EGO DYSTONIC. They will present with repeated doubts wheather they have locked the door and vehicles, repeated contamination thoughts and does acts to counter this obsessions. These acts are called as compulsions. OCPD , a type of cluster C personality which is characterized by Preoccupied with rules Perfectionism that interferes with task completion Inflexibility Devoted to work Stubbornness EGO SYNTONICITY IS THE CHARACTERISTIC FEUTURE Key note. OCD= EGO DYSTONIC OCPD= EGO SYNTONIC Ref. Kaplan and sadock synopsis of psychiatry, 11e, Pg.756.


Question: A patient was brought with coarse tremors, arousal, sweating, irritability and tachycardia. History of daily alcohol intake is present. The diagnosis is

Coarse tremors / tremulousness is the most common symptom seen after alcohol withdrawl. Arousal, sweating, irritability and tachy cardia are the other sympthoms seen after 6-8 hours of alcohol withdrawl.


Question: Bad prognostic indicator of Schizophrenia is

B i.e. Family history of schizophreniaPrognostic Factors: Predictors of Course & Outcome in SchizophreniaFactorsGood outcome(i.e. Better prognosis)Poor Outcome(Poorer prognosis)OnsetAge at onset (clinical)Onset type of SchizophreniaAcute (abrupt)QAbout 20-25Late onset Schizophrenia (>45 yr)QInsidiousQBelow (Early (childhood) onsetSchizophreniaQRate of progression (clinical)Episode of schizophreniaLength of episode prior to assessment (i.e.Course)RapidFirstSho (months or less; <6months)SlowPast history of schizophreniapresentChronic (years; > 2years)Sex & PhysiqueFemaleQ, Fatty (pyknic)QMale, Thin (asthenic)QFamily history of mental illnessAffective (mood disorder)(2SchizophreniaPrenatal adverse events & other adversesocial factorsGene polymorphism eg COMT (catechol-0-methyl-transferase), NMDA2A,NRG1 (neuregulin), DTNBP1 (dysbindin),G72, DAAO (D-aminoacid oxidase),RGS4, PRODH (Proline dehydrogenase)Genetic factors absent(none)Genetic factorsPresentPrecipitating factor (stressor)PresentAbsentInitial Clinical SymptomsMood disorder symptoms(especially depression)Q,Withdrawn/negative symptoms(eg flat or blunt affect, povey of predominance of positivesymptoms, catatonia, paranoia,schizoaffective symptoms, atypicalsymptoms, confusion(disorientation/perplexity)thought, apathy, asociality);obsessive-compulsive symptoms,autistic behaviorSchizophrenia-subtypeCatatonia subtype (paranoid hasintermediate prognosis), type 1non-deficit typeDisorganized, simple,undifferentiated, chronic catatonic,type II deficit typeCT/MRI (Head)Normal morphologyDilated (enlarged) ventricle, brainatroph y(2Neurological signs & symptoms; H/Operinatal trauma; assaultiveness, substanceabuse, cannabis use, many relapses & noremission in 3 yearsAbsentPresentPremorbid scocial, sexual, and workGood (eg married), resident ofPoor (eg single, divorced;(occupational) historiesdeveloped country, middle or highwidowed); underdeveloped socioeconomic statusnation, low S-E status, irregularoccupational recordEarly treatment with medication, long termPresentAbsent (i.e. absence of properdrug maintenance, response to medication treatment or poor response toinitially; out door treatment treatment or required long termhospitalization)


Question: Opiate withdrawl is treated with


Question: Most common mental disorder as a cause of suicide

Suicide is a model of psychiatric emergencies and is also the commonest cause of death among the psychiatric patient&;s psychiatric disorders are a major cause of suicide, for example, depression(1major depression 2depression secondary to a serious physical illness 3reactive depression), alcoholism and drug dependence and schizophrenia (Ref: a sho textbook of psychiatry, Niraj Ahuja, 7th edition, pg no.222)


Question: Waxy flexibility and stereotype verbal and behavioural signs are seen in

Ans. c (Catatonic schizophrenia). (Ref. Psychiatry by Niraj Ahuja, 5th ed., 60, 254)Schizophrenia: Symptoms must be present at least 6 monthsSchizophreniform Disorder: > 1 month but < 6 months.FEATURES OF CATATONIC SCHIZOPHRENIA# Bizarre posturing# Rigidity# Echolalia, echopraxia# Mutism# Waxy flexibility# Ambitendancy (no goal directed actions)# Stupor# Negativism (motiveless resistance to all commands and doing opposite)# Other signs (mannerisms, stereotype verbal and behavioural automatic obedience, verbigeration)TYPES OF SCHIZOPHRENIA ***Schizophrenia Paranoid Type# MC Type of Schizophrenia# Older patients (Onset is in their late twenties or thirties)Best prognosis# Presenting Symptoms: Preoccupation with delusions and/or hallucinations, usually involving grandeur or persecution.Schizophrenia Disorganized Type# Presenting Symptoms: Disorganized speech and behavior. Flat or inappropriate affect. Marked regression to primitive disinhibited behavior (Bizarre Behavior). Severe thought disorder. Poor contact with reality# Risk Factors: These patients tend to be younger than 25Worst prognosis.Schizophrenia Catatonic Type# Presenting Symptoms: Psychomotor Disturbances, ranging from severe retardation to excitation. Extreme negativism. Peculiarities of voluntary movements. Mutism is very common.# Complications: Medical care may be necessary because of exhaustion, malnutrition, self- inflicted injury, or hyperpyrexia.Schizophrenia Residual Type# Presenting Symptoms: Absence of positive symptoms (delusions, hallucinations, disorganized speech/behavior & catatonic behavior).# Patients tend to have negative symptoms (Social Withdrawal, Flat Affect, Occupational Dysfunction).Schizophrenia Undifferentiated Type# Presenting Symptoms: Meet criteria for schizophrenia.# Do not meet criteria for other schizophrenia types.


Question: The Psychological disorder most commonly associated with myxedema


Question:
Dissociative disorders are
(A)Multiple person
(B)Fugue
(C)Hypochondriasis
(D)Obsession
(E)Borderline personality'disorder

Dissociative Disorders Types Dissociative fugue Multiple persona
I -' disorder Dissociative amnesia Trance & possession disorder Ganser’ssyndrome (found in prison inmates) Characterized by Onset is sudden,
disturbance is temporary & recovery' is often abrupt Disturbance in the normally integrated functions of conciuosness,
identity & memory Often, there is precipitating stress before the onset.
There is clear temporal relation b/w stressor & the onset of illness Secondary gain is present Physical examination & investigation is normal


Question: Transference resolved by

(D) Psychodynamic psychotherapy # Transference: Patient's feelings, behavior and relationship with the therapist.> Transference is a phenomenon in psychoanalysis characterized by unconscious redirection of feelings from one person to another.> Transference was first described by Sigmund Freud, who acknowledged its importance for psychoanalysis for better understanding of the patient's feelings.> Focus in psychodynamic psychotherapy is, in large part, the therapist and patient recognizing the transference relationship and exploring the relationship's meaning.> Since the transference between patient and therapist happens on an unconscious level, psychodynamic therapists who are largely concerned with a patient's unconscious material use the transference to reveal unresolved conflicts patients have with childhood figures.


Question: Most common type of schizophrenia


Question: "Amotivational syndrome" is caused by

Ans. a (Cannabis) (Ref-Kaplan & Sadock's Synopsis of Psychiatry, Xth/ Chapter 12.5, Pg 420).MARUUANA/AND/CANNABIS# Marijuana is the most commonly used illegal drug in the United States.# Acute intoxication from marijuana and cannabis compounds is related to both the dose of Tetrahydrocanabinol (THC) and the route of administration.# THC is absorbed more rapidly from marijuana smoking than from orally ingested cannabis compounds.# Acute marijuana intoxication usually consists of a subjective perception of relaxation and mild euphoria resembling mild to moderate alcohol intoxication.# This condition is usually accompanied by some impairment in thinking, concentration, and perceptual and psychomotor function. Higher doses of cannabis may produce behavioral effects analogous to severe alcohol intoxication. THC causes a specific "amotivational syndrome."# Often it can be difficult to recognize the signs of marijuana use because most of the signs take place while the individual is under the influence. Marijuana users may show following signs: Rapid, loud talking and bursts of laughter in early stages of intoxication, Sleepy or stuporous in the later stages, Inflammation in whites of eyes; pupils unlikely to be dilated, Odor similar to burnt rope on clothing, Weight gain or loss., etc# Chronic marijuana use has also been reported to increase the risk of psychotic symptoms in individuals with a past history of schizophrenia.Signs and Symptoms of Intoxication and WithdrawalDrugIntoxicationWithdrawalOpioidsCNS depression, nausea, vomiting, constipation, pupillary constriction, seizures, respiratory depression (life-threatening in overdose). Naloxone/naltrexone will block opioid receptors and reverse effects (beware of antagonist clearing before opioid, particularly with long-acting opioids such as methadone).Anxiety, insomnia, anorexia, diaphoresis, dilated pupils, fever, rhinorrhea, piloerection, nausea, stomach cramps, diarrhea, yawning.Extremely uncomfortable, but rarely lifethreatening.AmphetaminesPsychomotor agitation, impaired judgement, tachycardia, pupillary dilation, hypertension, paranoia, angina, hallucination, sudden death.Treat with haloperidol for severe agitation and symptom-targeted medications.Post-use "crash" with hypersomnolence, depression, malaise, severe craving, suicidality.Phencyclidine hydrochloride (PCP)Belligerence, psychosis, violence, impulsiveness, psychomotor agitation, fever, tachycardia, vertical/ horizontal nystagmus, ataxia, delirium. Give benzodiazepines for severe symptoms; otherwise reassure.Recurrence of intoxication symptoms due to reabsorption in the GI tract; sudden onset of severe, random violence.LSDMarked anxiety or depression, delusions visual hallucinations, flashbacks, pupillary dilation. Give benzodiazepines or traditional antipsychotics for severe symptoms. MarijuanaEuphoria, slowed sense of time, impaired judgement, social withdrawal, appetite, dry moth, conjunctival injection, hallucinations, anxiety, paranoia, amotivational syndrome. BarbituratesLow safety margin, respiratory depression.Anxiety, seizures, delirium, lifethreatening cardiovascular collapse.BenzodiazepinesInteractions with alocohol, amnesia, ataxia, somnolence, mild respiratory depression.Rebound anxiety, seizures, tremor, insomnia, hypertension, tachycardia.


Question: Schizophrenia with the worst prognosis

Hebephrenic schizophrenia Key Symptoms: Disorganized speech, behavior (often silly/ shallow) and flat or inappropriate affect Order of prognosis from good to bad in Schizophrenia: Catatonic > Paranoid > Undifferentiated > Hebephrenic > Simple Reference: Oxford Handbook of psychiatry; 3rd edition; Chapter 6; Schizophrenia and related psychoses

Schizophrenia and other psychotic disorders


Question: Tourette is a disorder of

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


Question: Most common side effect after ECT


Question: The eight stage classification of human life is proposed by


Question: Pseuddogia Fantastica is seen in

Patients with "Factitious disorder or Munchausen syndrome" distart the history and there will be discrepancy between history, examination and reports which is termed as "Pseudologia Fantastica".


Question: Alexithymia is

Alexithymia is inability or difficulty in describing or being aware of one's emotions or moods; elaboration of fantasies associated with depression, substance abuse, and posttraumatic stress disorder (PTSD). Reference:Kaplan & Sadock's Comprehensive textbook of Psychiatry Tenth edition, Volume 3 Pg.4559

Inability to recognize and describe feelings

Symptoms and signs in psychiatry and classification


Question: behavioural therapy 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: Pimvanserin is used in the treatment of

Pimvanserin is a 5HT2A blocker used to treat delusions and hallucinations in Parkinson's disease associated psychosis.


Question: Depression is seen ina) Hyperthyroidismb) Hypoglycemiac) Adrenal disorderd) Pheochromocytoma

Endocrinological disorders causing major depression are :-

Thyroid :- Hypothyroidism, Hyperthyroidism
Adrenal :- Cushing's disease, Addison's disease
Parathyroid :- Hyperparathyroidism, hypoparathyroidism
Pituitary :- Hypopituitarism, Acromegaly, Hyperprolactinemia


Question: Delusion is disorder of

Ans. a (Thought). (Ref. Short, Textbook of Psychiatry by Niraj Ahuja, 5th/86)# Delusion is a disorder of belief.# Delusion is false unshakable belief, which is not keeping with patient's socio-cultural & educational background.# These are of 2 types:- Primary- Secondary# Primary delusions (Autochthonous delusions)- Arise de-novo & cannot be explained on the basis of other's experiences or perceptions.- Also known as autochthonous delusions, they are characteristic of schizophrenia & are seen in its early stages.# Secondary delusions- These are commonest delusions seen in clinical practice & are not diagnostic of schizophrenia.- They are seen in other psychoses too.- These can be explained as arising from other abnormal experiences.


Question: Most accurate treatment for erectile dysfunction is

Sildenafil citrate has been used for the treatment of erectile dysfunction. Rapidly absorbed after oral administration, the maximum plasma concentration is reached in 30-120 minutes. It is metabolised in liver (mainly by cytochrome P450 3A4) and is conveed to an active metabolite. Sildenafil has a terminal half-life of about 4 hours. It is highly bound to plasma proteins and is not dialyzable. It is a competitive and selective inhibitor of cGMP (cyclic guanosine monophosphate)-specific PDE-5 (phosphodiesterase type 5). It prevents the rate of breakdown of cGMP causing enhanced relaxation of cavernosal smooth muscle, increase in aerial flow into corpus cavernosa, compression of subtunical veins, and hence penile erection. The typical dose is 50 mg (25-100 mg), 1 hour before sexual activity. The maximum recommended dosing frequency is once a day. The adverse effects include a transient and mild headache, flushing, dyspepsia, and nasal congestion. Caution needs to be exercised in patients with known history of hypersensitivity, Other similar drugs include tadalafil and vardenafil. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 132


Question: Normal Lithium therapeutic level is


Question: Reversible cause of dementia is

Dementia Types:- The dementia can be divided in to reversible and irreversible dementias. It is extremely impoant to do detailed work up of a patient of dementia as around 15% of cases are reversible. The reversible causes of dementia are:- A. Neurosurgical conditions (subdural hematoma, normal pressure hydrocephalus, intracranial tumors, intracranial abscess). B. Infectious causes (meningitis, encephalitis, neurosyphilis, lyme disease). C. Metabolic causes (vitamin B12 or folate deficiency, niacin deficiency, hypo and hypehyroidism, hypo and hyperparathyroidism D. Others (drugs and toxins, alcohol abuse, autoimmune). Ref:- Psychiatry by Sandeep Govil; pg num:- 35


Question: A distinguishing feature of psychotic disorders is

psychosis is a type of illness where the patient does not have touch with reality and beleives in fantacy. it is charecterstically mentioned that these patients does not have insight. insight is defined has patient not having any understanding about their illness this lack of touch with reality and accepting the fantacy usually presents as delusions and hallucinations. suspisousness is considered to be at the idea level which even normal people can have and that cannot be considered as a distinguishing feuture for the diagnosis of psychosis Suspiciousness may be seen in delusional/paranoid psychotic disorders as well as a paranoid personality disorder, whereas impaired reality testing is the hallmark of psychotic experience. obsessions and compulsions are pa of neurotic illness and it is not a feuture of psychosis severe depression can present even without psychosis and hence it is not a distinguishing feuture for psychosis Reference: Oxford Textbook of Psychiatry; 3rd edition


Question: Fixation is a concept related to

Fixation is concept introduced by Sigmund Freud, he explains this in his each stage of Psychosexual stages of development. Ref: Synopsis of Psychiatry, 11e, pg 157.

Cognitive development and defence mechanism


Question: significance of punishment in behaviour management 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: Term 'Catatonia' was used by

Contributor: Kahlbaum, Karl (1828-1899) Coined the Term: Catatonia, Symptom complex, Cyclothymia Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no.244

Cognitive development and defence mechanism


Question: shared psychotic disorder

* Shared psychotic disorder o Induced psychotic disorder o Falret o Patient who has a psychotic symptom passes the delusion to a new person o The new person is dependent on the person harboring the psychotic symptoms o The new person may be intellectually impaired or have subnormal intelligence o Treatment of choice is the SEPERATION of the patient from the person who is inducing the delusion o Low dose antipsychotics may help Ref.Kaplon and Sadock, Synopsis of Psychiatry, 11 th edition, Pg.no.333

Schizophrenia and other psychotic disorders


Question: A 25 years old male c/o recurrent abdominal pain but biochemical assays and ultrasound abdomen is normal. He also complains of constant headaches. He suddenly complains of loss of vision of bilateral eyes. Ophthalmologist finds nothing on examination. Symptoms are most probably due to

Ans. D. Factitious disorderFactitious disorderIt is also known as Hospital addiction, hospital hoboes, or Professional patient.The term Munchausen syndrome is used for those patients who repeatedly simulate or fake diseases (intentionally) for the sole purpose of obtaining medical attention. There is no other recognizable motive (in contrast to malingering).The typical presentation of Munchausen syndrome is characterized by a restless journey from doctor to doctor and hospital to hospital, an ever-changing list of complaints and symptoms.The patient tries to maintain the sick role to obtain medical attention. There may be evidence of earlier treatment usually surgical procedure, for example, multiple surgical scars (gridiron abdomen).

Posterior inferior cerebellar aery infarct


Question: Global cerebral dysfunction characterised by alteration in cognitive function and consciousness is known as

Ans. c (Delirium) (Ref. Kaplan & Sadock's Synopsis of Psychiatry, 10th ed., p. 325. Table 10.2-5)Global cerebral dysfunction characterised by alteration in cognitive function and consciousness is known as delirium.# Delirium is Characterized by disorganized thinking, hallucinations (often visual), illusions, misperceptions, disturbance in sleep- wake cycle, cognitive dysfunction.# Usually 2deg to other illness (e.g., CNS disease, infection, trauma, substance abuse/withdrawal, metabolic/electrolyte disturbances, hemorrhage, urinary/fecal retention).# Most common presentation of altered mental status in inpatient setting. Abnormal EEG.# Treatment:Identify and address underlying cause. Optimize brain condition (02, hydration,# pain, etc). Antipsychotics (mainly haloperidol).Delirum versus DementiaCharacteristicsDeliriumDementiaHistoryAcute, identifiable dateChronic, cannot be datedOnsetRapidInsidiousDurationDays to weeksMonths to yearsCourseFluctuatingChronically progressiveLevel of consciousnessFluctuatingNormalOrientationImpaired periodicallyDisorientation to personMemoryRecent memory markedly impairedRemote memories seen as recentPerceptionVisual hallucinationsHallucinations less commonSleepDisrupted sleep-wake cycleLess sleep disruptionReversibilityReversibleMostly irreversiblePhysiologic changesProminentMinimalAttention spanVery shortNot reduced PsychosisA distorted perception of reality (psychosis) characterized by delusions, hallucinations, and/ or disorganized thinking. Psychosis can occur in patients with medical illness, psychiatric illness, or both.HallucinationsPerceptions in the absence of external stimuli (e.g., seeing a light that is not actually present).DelusionsUnique, false beliefs about oneself or others that persist despite the facts (e.g., thinking aliens are communicating with you)Somatoform disordersSomatization disorder# Set of eight more symptoms (four pain, two gastrointestinal, one sexual, one pseudoneurologic)# Onset before age 30# Symptoms usually occur over period of years# More common in women than in men (20 to 1)Conversion disorder# One or more symtoms# Altering of physical functioning, suggesting physical disorder# Usually skeletal, muscular, sensory, or some peripheral non-autonomic system, e.g., paralysis of the hand, loss of sight# Loss of functioning is real and unfeigned# Loss for la belle indifferenceHypochondriasis# Unrealistic interpretation of physical sign as abnormal# Preoccupation with illness or fear of illness when none present# Preoccupation persists in spite of reassurance# At least 6 months duration# Treat by simple palliative care and fostering relationshipSomatoform pain disorder# Severe, prolonged pain with no cause found# Pain disrupts day-to-day life# Look for secondary gainBody dysmorphic disorder# Preoccupation with unrealistic negative evaluation of personal attractiveness# Sees self as ugly or horrific when normal in appearance# Preoccupation disrupts day-to-day life# May seek multipe plastic surgeries or other extreme interventions


Question: Drug that is mostly used to decrease the suicidal tendencies in Manic Bipolar Disorder

(B) Lithium # With Lithium treatment, patients have been shown to present a decreased risk of suicide (especially when treated with Lithium) and a reduction of frequency and severity of their episodes, which in turn moves them toward a stable life and reduces the time they spend ill.> In order to maintain their state of balance, therapy is often continued indefinitely, as around 50% of the patients who dis- continue it relapse quickly and experience either full-blown episodes or sub-syndromal symptoms that bring significant functional impairments.> There is a high rate of suicide among people with untreated bipolar disorder, and studies show that lithium treatment significantly reduces this risk.> Conversely, patients who discontinue lithium treatment are 20 times as likely to commit suicide during the first 6 months following discontinuation.


Question: A man taking 20 cigarettes per day, staed coughing, his family suggested quitting cigarettes. He is ready to quit but thinks that quitting will make him irritable, the best health planning model followed is aEUR'

Precontemplation and preparation Five stages of change have been conceptualized for a variety of problem behaviours The five stages of change are: ?- Precontemplation- Contemplation- Preparation- Action- MaintenancePrecontemplationIt is the stage at which there is no intention to change behaviour in the forseeable future. Many individuals in this stage are unaware or underaware of their problems.ContemplationIt is the stage in which people are aware that a problem exists and are seriously thinking about overcoming it but, have not yet made a commitment to take an action.PreparationIt is a stage that combines intention and behavioural criteria.Individuals in this stage are intending to take action in the next month and have unsuccessfully taken action in the past yearActionIt is the stage in which individuals modify their behaviour experiences or environment in order to overcome their problems.Action involves the most ove behavioural changes and require considerable commitment of time and energy.MaintenanceIt is the stage in which people work to prevent relapse and consolidate the gains attained during action.For addictive behaviour this stage extends from six months to indeterminate period past the initial action.


Question: Quod Hanc means

This is a very interesting concept When males comes with impotence the history has to be obtained from the patient to rule out wheather it is organic or psychogenic erectile dysfunction Ceain points in history helps us to confirm that we are dealing with a case of psychogenic impotence The history is mainly * Early morning erection * Erection when not needed * Erection during masturbation * Erection when having sexual relationship with other paners now when coming back to the question there are ceain people who can maintain erectio only with ceain paners but could not maintain erection with other paners called as impotence quoad hunc another question that asked under this heading is Madonna- putana complex * given by Freud * These men can maintain erection with women whom they consider as degraded Ref.Kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 584


Question: Wernicke&;s encephalopathy is due to deficiency of

The commonest cause of the organic amnestic syndrome is chronic alcohol dependence. It is also called as Wernicke-korasakoff syndrome. Wernicke&;s encephalopathy is the acute phase of delirium proceeding to the organic amnestic syndrome, while korasakoff&;s syndrome is the chronic phase of the amnestic syndrome. (Ref: a sho textbook of psychiatry, Niraj Ahuja,7th edition, pg no. 27)


Question: Obsessive Compulsive Neurosis is likely to progress into

C i.e. Secondary depression In OCN failure to control ego-alien impulse leads to development of depression, as the patient is unable to control the behaviour about which he knows that it is irrational & absurd.


Question: Ability to form a concept and generalize is known as

Thinking characterised by the ability to grasp the essentials of a whole, to break a whole into its pas, and to discern common propeies. To think symbolically. Ref: Synopsis of Psychiatry, 11e, pg 1407.

Cognitive development and defence mechanism


Question: Mental retardation is diagnosed if. (Intelligence quotient) is less than


Question: Perseveration is

(B) Repetition of word or a phrase > "Perseveration refers to a tendency to present with a point or theme, even after it has been dealt with exhaustively or the listener has tried to change the subject."> Perseveration is seen in schizophrenia3 but is not characteristic of this disorder.> It also seen in autistic disorders and few other psychosis. It is chracterised by repeatition of thoughts, speech or brief behavioural sequences without a sense of incompletion and not as a preventive or a corrective measure. This implies clearly that it is carried out without any purpose.

Inability to change the mental set in spite of a new stimulus

Persistence of uncomfortable posture for long periods


Question: Sleep pattern seen in mania is

A person in mania is hyperactive so that he has decreased need for sleep.


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

An obsession is defined as an idea, impulse or image which intrudes into the conscious awareness repeatedly, patient tries to resist against it but is unable to . an obsession is usually associated with compulsion and a compulsion is defined as a form of behaviour which usually follows obsessions,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: 18 years old male hears voices discussing him in 3rd person has

Voices discussing the person in 3rd person (third person hallucination) is characteristic of schizophrenia.


Question: A 24 year old female working in a office thinks his boss is secretly in love with her. Even though he denies the facts, she feels he is hiding it from her. This disorder is suggestive of

Declerembault syndrome also called as Erotomania is where a female usually of lower socioeconomic status believes that  a high profile male is secretly in love with her.

Cotard syndrome : Delusion of Nihilism.
Othello syndrome : Delusion of Infidelity.
Capgrass syndrome : Delusion of Doubles.


Question: Ataxia abasia is seen in

Conversion Disorder Conversion disorder is characterised by the following clinical features: 1. Presence of symptoms or deficits affecting motor or sensory function, suggesting a medical or neurological disorder. 2. Sudden onset. 3. Development of symptoms usually in the presence of a significant psychosocial stressor(s). 4. A clear temporal relationship between stressor and development or exacerbation of symptoms. 5. The patient does not intentionally produce the symptoms. 6. There is usually a ' secondary gain' (though not required by ICD-10 for diagnosis). 7. Detailed physical examination and investigations do not reveal any abnormality that can explain the symptoms adequately. 8. The symptom may have a 'symbolic' relationship with the stressor/conflict. Dissociative Motor Disorders: The motor disturbance usually involves either paralysis or abnormal movements. The 'paralysis' may be a monoplegia, paraplegia or quadriplegia. The abnormal movements can range from tremors, choreiform movements and gait disturbances, to convulsive movements. These movements either occur or increase when attention is directed towards them and may disappear when the patient is watched unobserved. These movements do not fit the 'typical' clinical picture of the abnormal involuntary movement disorders. The gait disturbance (ataxia abasia) is usually characterised by a wide-based, jerky, staggering, dramatic and irregular gait with exaggerated body movements. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 99


Question: Disruption or disorganization of biological rhythm is observed in

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


Question: T.J.Crow

Type I
Type II

Positive Symptoms
Negative Symptoms

CT and MRI normal
CT and MRI shows enlarged ventricles

Good Prognosis
Bad Prognosis

Divided Schizophrenia into 2 subtypes , Type I & Type II


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

Ans. is 'a' i.e., Type A personality Types of personalitiesA. Type A personality: - Type 'A' individuals are impatient, time-conscious, highly competitive, ambitious, hostile, and aggressive. They have difficulty in relaxing and are concerned about their status. Type A individuals are often highly achieving workaholics, who do multitask, drive themselves with deadlines and are unhappy about the smallest of delay. Type 'A behavior is expressed in three major symptoms:-i) Time urgency and impatience (Time pressure)ii) Free floating hostilityiii) CompetitivenessB. Type B personality: - Type B individuals are opposite of Type A. They are relaxed and easy going and have no sense of urgency. They do not get stressed (in contrast to Type A' individuals).C. Type C personality:- A type C personality is designated to individuals who appear to be Cancer prone and someone higher risk for developing cancer (e.g. breast cancer). They tend to be introverted, respectful, eager to please, and compliant.D. Type D personality:- This type of individual have increased level of anxiety, irritation and depressed mood. Type D personality is associated with increased risk of cardiovascular problems, e.g. recurrent MI or sudden cardiac death. People with type D personalities seem to have more highly activated immune system and more inflammation, which could mean more damage to blood vessels in the heart and throughout the body.


Question: Physical dependence is not seen with

C i.e. Cannabis Physical dependence and withdrawl symptoms are absent in LSD and mild in cannabinoids (cannabis), amphetaminesQ, ectasy, psychedelics, cigarettes and caffeine. So symptomatic treatment is not required in withdrawl of LSD (1st) > cannabis (2nd answer)Q. Drug Physical dependence Psychic dependence Physical withdrawl problems Psychic withdraw( problems Opioids Severe Severe Strong Strong Alcohol Moderate Moderate Strong Moderate Barbiturates Moderate Moderate Strong Moderate Amphetamines Moderate Moderate Mild Mild Benzodiazepine Mild Mild Moderate Moderate Crack / Cocaine + (Probable) Moderate Moderate Severe Nicotine(cigarettes) Mild Moderate Mild Strong Caffeine Mild Moderate Mild Mild Phencyclidine + (Probable) Mild Mild None Ectasy - - Mild None Cannabinoids (Cannabis, marihuana) + (Probable / little) Moderate Mild Mild LSD (Lysergic acid diethylamide) Nonedeg Mild - * Amphetamine & cocaine are non addictive, or cause psychological but not physical dependence, but critics claim this of limited meaning now


Question: A 23 year old engineering student is brought by his family to he hospital with history of gradual onset of suspiciousness, muttering and smiling without clear reason, decreased socialization, violent outbursts, and lack of interest in studies for 8 months. Mental status examination revealed a blunt affect, thought broadcast, a relatively preserved cognition, impaired judgment and insight. He is most likely to be suffering from

C i.e. SchizophreniaNon bizarre delusionsQ (i.e. involving situations that occur in real life such as being followed, infected, loved at distance or deceived by spouse or having disease or being persecuted) of atleast one month duration.Criteria A for schizophrenia has never been met.Apa from delusional area, the personality, behaviour & functioning is not markedly impaired (almost normal).Mood disturbance (if occur) are brief in duration as compared to delusional periods.


Question: Severe mental retardation is

Mental retardation level IQ range Mild 50-69 Moderate 35-49 Severe 20-34 Profound < 20 (Ref: A sho textbook of psychiatry, Niraj Ahuja,7th edition, pg no 156)


Question: Ribot's law deals with

Ans.C. Retrograde amnesiaRibot's Law states that during incidents of retrograde amnesia recent memories are more likely to be lost than more remote memories.Retrograde amnesia often follows a principle known as Ribot law


Question: In individuals 2 to 18 years old, the Stanford Binet Scale is most useful for evaluating

The Stanford-Binet Scale is useful for evaluating general intellectual ability in individuals 2 to 18 years old. Cerebral dominance, perceptuomotor performance, memory, and presence or absence of dyslexia are evaluated in adults using neuropsychological tests such as the Halstead-Reitan and Luria-Nebraska test batteries.


Question: Elation is controlled by

Elation (moderate elevation of mood): A feeling of confidence and enjoyment, along with an increased psychomotor activity. Elation is classically seen in mania. Reference: A sho textbook of psychiatry by Ahuja, page 70. Emotion derives from basic drives, such as feeding, sex, reproduction, pleasure, pain, fear, and aggression, which all animals share. The neuroanatomical basis for these drives appears to be centered in the limbic system. Reference: Synopsis of Psychiatry, page 13.

Symptoms and signs in psychiatry and classification


Question: Difference between neurosis and psychosis is


Question: Twisting and protrusion of tongue, chewing of lips is seen in

Tardive dyskinesia is usually seen late after use of typical antipsychotics in which lip smacking, chewing, twisting and protrusion on tongue .pt. is advised to take atypical antipsychotics Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg: 410-412

Schizophrenia and other psychotic disorders


Question: Most common presentation of obsessive compulsive disorder in adult is

Most common OCD is about contamination followed by pathological doubt.


Question: Most common genetic cause of mental retardation is

Most common cause of mental retardation is Down syndrome followed by Fragile X syndrome.


Question: Flash backs are seen with

A i.e. LSD Spontaneous recurrence of LSDQ, or sometimes cannabis use experience even during a withdrawl state is known as Flash back LSD intoxication causes bad tripsQ ie acute panic reaction in which the individual experiences a loss of control over his self.


Question: Paradoxical suicide is

"Paradoxical suicide": Antidepressants to patients cures the motor symptoms first followed by mood, hence the patient after initiation of antidepressants become active enough and may commit suicide.

Suicide seen in caretakers of depression

Suicide seen in children of depressed individuals

Suicide seen in parents of depressed individuals

Suicide seen after initiation of treatment


Question: Stages of death was given by