2014 april Flashcards
A 30 year old housewife being managed for bipolar affective disorder has been stable using lithium using Lithium for past 03 years. She has presented to your clinic along with her husband to seek information regarding risks of continuing lithium use during pregnancy as she wishes to conceive again.
a) What informational care would you like to give to this patient, keeping view the adverse effects of lithium use during pregnancy?
b) what investigations would you like to carry out if patient decides to continue use of lithium during pregnancy?
c) What alternative management plan would you suggest in light of current international guidelines?
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23 years old female, masters in psychology, comes to your office with history of repeated washing of hands and thoughts of contamination for the past three months. She had a similar episode two year back which got better with deep breathing and progressive muscular relaxation. For the past three months she has been trying these methods but her condition has worsened. She is in distress and has stopped pursuing her Ph.D. in clinical psychology for the fear of contamination of her clothes if she sits somewhere else other than her own chair which she washes 13 times daily.
a) How would you respond to her queries regarding:
The most likely diagnosis
The neuro-biological basis of her illness
b) Draw the algorithm for treatment of her illness keeping in view the recent guidelines.
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A twenty five year old convict on terrorism charges, is brought to you assessment. His lawyer has taken a plea that he is a psychiatric patie and therefore should be pardoned. He has produced an EEG of the patie when he was 12 years old showing abnormal slow waves in tempo leads. The convict is known to have skinned his victims, tortured the before killing them, and would cut their nose, and store it in a bag as ‘souvenir’ of his victims. There is history of taking a fall while ‘one-wheeling on his bike, five years ago. When approached the convict has no remorse or feeling of guilt about his actions,
a) What is the differential diagnosis and the most likely diagnosis?
b) List the psychometric, and biological investigations that you would require, and the likely finding in each, in light of the most likely diagnosis that you have made.
c) What is the management plan that you will draw in light of international guidelines in this patient?
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A 21 year old college student came to psychiatrist with her mother wit complaints that she had awakened from sleep two days earlier with total numbness and paralysis in both legs. She said she was feeling “OK” but incapable of caring for herself and had summoned her mother front city to come and take care of her. For the past 2 years she had shared as apartment with her friend who moved out on the day preceding the onset her symptoms “after a fight”. On examination, patient was tense and in distress. No neurological deficit was found.
a) What is the most likely diagnosis and differential diagnosis?
b) How would you manage this patient?
c) Write 6-8 lines on how you would explain this disorder and its nature to patient’s mother.
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Cognitive Behavior Therapy has established its role in the treatment depressive disorders. In light of current evidence on the use of CBT psychosis in general and schizophrenia in particular, respond to following queries:
a) List three ways in which CBT employed in treatment of psychosis
different from the one used in treatment of depression?
b) List and briefly analyse the role of three evidence based psycho social interventions that can be used in the management of patients with schizophrenia..
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A 40-year-cld man comes to the emergency room with symptoms Tachycardia, diaphoresis, mydriasis, and hyperthermia. He also sho muscle twitching and clonus. His medications include a Protease Inhib and fluoxetine 20 mg daily which was started 1 week ago.
a) What is the most likely diagnosis?
b) What is the most likely pathophysiology of this disease process?
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Treatment adherence among psychiatric patients is an area of small concern in mental health.-a) in light the current evidence on the subject, what is the extent of problem Support your answer with at least two studies on the subject b) Identify eight factors that reduce treatment adherence among psychiatric patients.
c) List four steps interventions that you may put in place in y department of mental health to improve treatment adherence. Supple the choice of your interventions with at least two studies on the subject
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A 19 year old female is brought to the OPD on account of persist to eat adequately. For the past one year she is on a diet plan as she she is fat. Her mother is worried because she looks very thin, has hist
frequent headaches and episodes of fainting. Recently aches and episodes of fainting. Recently there have been three proposals for her marriage but were declined on ac examination she is 5 feet and 7 inches tall and has a weight of 40 kg. She has a low mood. occasional episodes of weeping and feelings of inadequacy, about herself.
a) What is the most likely diagnosis?
b) What metabolic, endocrinological and hematological abnormalities would be present in this case?
c) Calculate her BMI?
d) How would you manage her in light of current guidelines?
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A 33 years old truck driver reported to the hospital with history of fever, body aches and weakness. Detailed history reveals that he had been using alcohol and cannabis for the past 12 weeks. He further disclosed that he had been having frequent sexual contacts with female commercial sex workers. He never used condom while having sexual intercourse and has been treated 4 times in the past for yellowish discharge from the urethra. On investigations he is found to be HIV positive.a) What are the psychological reactions that the patient is likely to experience after he learns about the diagnosis?
b) Enumerate the neuro-psychiatric sequel that you will warn him against.
c) What treatment options would you suggest to him?
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A couple in their early forties, married for the past 15 years present to you in the clinic. The husband has recently developed inability to reach an erection.
a) What diagnosis comes to your mind?
b) Enlist 4 specific tests you would recommend for the condition.
c) Enlist 5 treatment options for it.
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Mr. X is a 28 years old male admitted in psychiatry ward. He presents with the complaints of eating insects, wearing bangles, having stitched skin of his forearms, believing that this could strengthen him. He occasionally wears female dresses. These complaints began 8 years back after he had has a severe accident while driving in which he remained unconscious for half a day. There is no previous history of any psychiatric illness.
a) What is the differential diagnosis and the most likely diagnosis?
b) What are the points in the favor of your first differential diagnosis?
c) How would you manage this case?
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A 7 year old boy is brought by his mother with complaints by his teacher that he is very restless. He cannot sit at one place for long periods keep on roaming in the class, disturbing other children and teacher Com ner does not seem to listen to teacher and fails to follow his schoolwork. He wants to play with other children but they refuse it because he cannot wait for his turn and leaves play abruptly. He is not bothered his safety and gets injured frequently He talks excessively, interferes when elders are speaking, and is frequently beaten by father because he not learn and keeps on making the same mistakes repeated. His gives history of normal birth and developmental milestones with development. She says that he is an intelligent boy, socially in normally with sibs and shows no stereotyped pattern of inter behavior. a) What is your diagnosis according to ICD-10? b) Name the common comorbid conditions known to exist with the disorder. c) How would you manage this child as regards psychological pharmacological interventions?
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A 67 year old male patient is brought to psychiatric OPD with complaints of insidious onset of forgetfulness, visual hallucinations, frequent falls and variations in attention and alertness. On physical examination, patient is found to have tremors, rigidity and difficulty initiating movements. a) What is your provisional diagnosis and differential diagnosis? b) What specific data would you collect to substantiate your provisional diagnosis? c) Name five investigations you would like to request in this case. d) How will you proceed with non pharmacological and pharmacological management according to recent international guidelines?
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A 65 year old married, retired dentist presents with complaints of feeling low. He has-experienced a series of professional. difficulties over the years including a prosecution for fraudulent billing. The mental state examination shows depressed mood. However, the patient has no vegetative signs and no history of mental illness. He had difficulty finding the physician’s office and instead wandered away. He had problem in recent memory and calculation and could not remember where his daughter lived? He walks with an unsteady gait and his family noticed that he passed faeces in clothes twice. A) What is the most likely diagnosis? What specific investigations would you request for to confirm your diagnosis? What are the specific changes that you expect to see in these tests? What is the specific treatment for this disorder
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A 37 years old male is brought to your office by his younger sister for assessment. She requests you to assess him and issue a certificate mentioning that he is suffering from mental retardation. She wants to resent that certificate in the court so that she can become the guardian of his property as he is unable to take care of it. Recently half of his property was sold by his elder brother after obtaining his signatures fraudulently. After assessment you find out that he actually suffers from the said problem as mentioned by his sister. Keeping in view the above Will you issue such a certificate to her? Justify your response. How will you address the issue keeping in view the Mental Health Act 2001 and how will you explain the issue of ownership of the property?
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