1 A 30 yrs old female complains of feeling low for last two months with inability to enjoy previously enjoyable activities. This symptoms is known as

a. Apathy

b. Amotivation

c. Anhedonia

d. Avolition

Ans c) Anhedonia

· Loss of interest in, and withdrawal from, all regular and pleasurable activities.

· Associated with depression

· clinician must document that the patient has actually given up previously enjoyed pastimes.

· The inability of the person with depressive disorder to experience normal emotions (commonly observed among young depressed patients) differs from the schizophrenic patient's flat affect in that the loss of emotions is itself experienced as painful

· William Shakespeare in Hamlet's disgust: €œHow weary, stale, flat, and unprofitable seem to me all the uses of the world€

Apathy

· Dulled emotional tone associated with detachment or indifference;

· observed in certain types of schizophrenia and depression.

Negative symptoms in schizophrenia: affective flattening, alogia, anhedonia, avolition, and attention

2. Events occurring in past one week is

a. Working memory

b. Recent memory

c. Long term memory

d. Delayed memory

Ans b) Recent memory

— Working memory model (Baddeley & Hitch, 1974)

— Subdivides memory into three main types.

— Sensory memory

— Brief (lasting no longer than a quarter of a second)

— Results from a visual, auditory, or other sensory event.

— Working memory

— Two main components

— Short-term or immediate memory

o Lasts for several seconds.

o Can be extended to several minutes if rehearsing or concentrating on particular information.

o Typically represented in meaningful chunks such as words or numbers.

— Central executive

— Four main components: (1) a central executive that keeps track of and gathers information; (2) a visual system called the visuospatial scratchpad, which holds visual representations of objects; (3) a phonologic "system" that holds verbal information; and (4) an episodic buffer that is capable of binding together information from different modalities into a coherent trace.

— long-term memory

— Encodes information in robust form and can last for decades.

— Delayed memory: memory for information presented in the last few minutes.

— Recent memory : knowledge accumulated in the last few days or weeks.

— Remote memory : knowledge accumulated over several years.

3. A 20 yrs old female presented with complaints of nausea, vomiting and severe pain in legs. Her physical examination and lab investigations are normal. Most appropriate diagnosis for this patient would be

a. Generalized anxiety disorder (GAD)

b. Somatization disorder

c. Somatoform pain disorder

d. Conversion disorder

Ans b) Somatization disorder

Somatization disorder

o an illness of multiple somatic complaints

o in multiple organ systems

o occurs over a period of several years

o results in significant impairment or treatment seeking, or both.

o 5-to-1 female-to-male ratio

o lifetime prevalence among women in general population - 1 or 2 percent.

o inversely related to social position and occurs most often among patients who have little education and low incomes.

o usually begins during a person's teenage years.

o Prognosis: Poor to fair

Diagnosis	Clinical Presentation	Diagnostic Features	Demographic and Epidemiological Features	Management Strategy	Prognosis
Somatization disorder	Polysymptomatic Recurrent and chronic Sickly by history	Review of systems profusely positive Multiple clinical contacts Polysurgical	Young age Female predominance 20 to 1 Familial pattern 5%–10% incidence in primary care populations	Therapeutic alliance Regular appointments Crisis intervention	Poor to fair
Conversion disorder	Monosymptomatic Mostly acute Simulates disease	Simulation incompatible with known physiological mechanisms or anatomy	Highly prevalent Female predominance Young age Rural and low social class Little-educated and psychologically unsophisticated	Suggestion and persuasion Multiple techniques	Excellent except in chronic conversion disorder
Pain disorder	Pain syndrome simulated	Female predominance 2 to 1 Older: 4th or 5th decade Familial pattern Up to 40% of pain populations	Simulation or intensity incompatible with known physiological mechanisms or anatomy	Therapeutic alliance Redefine goals of treatment Antidepressant medications	Guarded, variable
Hypochondriasis	Disease concern or preoccupation	Previous physical disease Middle or old age Male-female ratio equal	Disease conviction amplifies symptoms Obsessional	Document symptoms Psychosocial review Psychotherapeutic	Fair to good Waxes and wanes

4. Lithium toxicity can be seen in all of the following conditions except

a. When lithium is given above the therapeutic range

b. When lithium is given in the therapeutic range

c. When lithium is given with NSAIDs

d. When lithium is given with Fluoxetine

Ans d) When lithium is given with Fluoxetine

· Lithium intoxication is primarily a neurotoxicity that can lead to death or permanent neurological damage (often cerebellar).

· Factors associated with toxicity

o excessive intake (accidental or deliberate)

o reduced excretion (kidney disease, low-sodium diet, drug interaction)

o reduced volume of distribution (dehydration)

o individual sensitivity (the elderly and the organically impaired).

· There is no magic serum lithium concentration below which intoxication never occurs and above which it is inevitable.

· Fluoxetine: Occasional reports of a serotonin-like syndrome with potent serotonin reuptake inhibitors.

· NSAIDs: May reduce renal lithium clearance and increase serum concentration; toxicity reported (exception is aspirin)

5. All of the following are the features of Narcolepsy except

a. Sudden onset of sleep attacks

b. Presence of catalepsy

c. Short duration of episode

d. Present in second decade

Ans b) Presence of catalepsy

Narcolepsy

· abnormality of the sleep mechanisms; specifically, REM-inhibiting mechanisms

· most frequently begins in adolescence or young adulthood, generally before the age of 30

· Symptoms

o most common symptom is sleep attacks

o cataplexy(a sudden loss of muscle tone, such as jaw drop, head drop, weakness of the knees, or paralysis of all skeletal muscles with collapse)

o hypnagogic or hypnopompic hallucinations

o sleep paralysis (uncommon)

· Diagnosis

o Clinical

o Investigational

§ nighttime polysomnographic recording : characteristic sleep-onset REM period

§ HLA-DR2 is found in 90 to 100 percent of patients

§ Recent study:deficient in the neurotransmitter hypocretin

· Treatment

o No cure exists for narcolepsy, but symptom management is possible

o Modafinil œ₁-adrenergic receptor agonist, has been approved by the US Food and Drug Administration (FDA) to reduce the number of sleep attacks and to improve psychomotor performance in narcolepsy.

o tricyclic drugs or SSRIs to reduce cataplexy.

6. All of the following are cardinal sign of pervasive developmental disorder except

a. Abnormality in reciprocal social interaction

b. Abnormality in communication

c. Repetitive and stereotyped behavior

d. Intellectual subnormality

Ans d) Intellectual subnormality

· More than two thirds of children with autistic disorder have mental retardation, although it is not required for the diagnosis.

· DSM-IV-TR includes five pervasive developmental disorders: autistic disorder, Rett's disorder, childhood disintegrative disorder, Asperger's disorder, and pervasive developmental disorder not otherwise specified.

· characterized by impaired reciprocal social interactions, aberrant language development, and restricted behavioral repertoire.

· typically emerge in young children before the age of 3 years

Feature	Autistic Disorder	Asperger's Syndrome	Rett's Syndrome	Childhood Disintegrative Disorder	Pervasive Developmental Disorder Not Otherwise Specified
Age at recognition (mos)	0–36	Usually >36	5–30	>24	Variable
Sex ratio	Male > Female	Male >> Female	Female (?Male)	Male > Female	Male > Female
Loss of skills	Variable	Usually not	Marked	Marked	Usually not
Social skills	Very poor	Poor	Varies with age	Very poor	Variable
Communication skills	Usually poor	Fair	Very poor	Very poor	Fair to good
Circumscribed interests	Variable (mechanical)	Marked (facts)	NA	NA	Variable
Family history—similar problems	Sometimes	Frequent	Not usually	No	Unknown
Seizure disorder	Common	Uncommon	Frequent	Common	Uncommon
Head growth decelerates	No	No	Yes	No	No
IQ range	Severe MR to normal	Mild MR to normal	Severe MR	Severe MR	Severe MR to normal
Outcome	Poor to fair	Fair to good	Very poor	Very poor	Fair to good

7. As per WHO classification Schizophrenia is classified under chapter

a. F 10-19

b. F 20-29

c. F 30-39

d. F 40-49

Ans b) F 20-29

F10 to F19: Mental and behavioral disorders due to psychoactivc substance use

F20 to F29: Schizophrenia and schizotypal and delusional disorders

F30 to F39: Mood (affective) disorders

F40 to F48: Neurotic stress-related and somatoform disorders

8. All of the following statement are true about ECT except

a. Bilateral ECT is more efficacies than Unilateral ECT

b. Brief pulse machine is more efficacious than sine wave machine for ECT

c. Modified ECT is more efficacious than direct ECT

d. Contraindicated in Recent Myocardial infarction

Ans d). Contraindicated in Recent Myocardial infarction

· There are no systemic illnesses that preclude the administration of ECT when the treatment is clearly warranted, although some conditions call for special care.

· Among them are

o severe hypertension

o uncontrolled cardiac arrhythmia

o bleeding tendencies

o recent myocardial infarction

o cerebrovascular lesion, and increased intracranial pressure or brain lesion.

· The case literature provides ample suggestions for the appropriate treatment with ECT of patients with these conditions

· Bilateral/ unilateral ECT

o Historically, most practitioners have used bifrontotemporal electrode placement because of its reliability in producing efficacy and its ease of use.

o The relatively better cognitive side effect profile of right unilateral ECT should encourage wider use now that the efficacy of this electrode placement can be ensured with adequate dosing strategies.

· Brief pulse/Sine wave

o The slow rise of sine wave results in accommodation and increases in the threshold for neuronal firing.

o This observation has led to a preference for brief pulse waveforms, which instantly achieve peak intensity (on the order of microseconds), over the relatively slower-rising sine waveform, which typically reaches peak intensity in several milliseconds.

· Modified/ Direct

o

9. Electra complex is seen in

a. Males 3-5 years

b. Females 3-5 years

c. Male 5-12 years

d. Females 5-12 years

Ans b) Females 3-5 years:

· The girl develops penis envy (discontent with female genitalia following a fantasy that they result from loss of penis). This is theorized by Freud to lead to a wish to receive the penis and to bear a child. Resolution occurs by identification with the mother. This phase has been called as Electra complex.

· Seen in phallic phase.

Males 3-5 years: Castration anxiety; Oedipus complex.

5-12 years: Latency phase

· Oedipus and electra complex resolves at beginning of this stage

· Relative sexual quiescence

· Superego is formed

10. All of the following statement are true about Venlafexine except

a. It can increase blood pressure

b. It can cause discontinuation syndrome

c. It causes sweating

d. It is not metabolized and excreted unchanged in urine

Ans d). It is not metabolized and excreted unchanged in urine

· metabolized by hepatic cytochrome P450 (CYP) 2D6

· Sweating is more common with venlafaxine than the SSRIs (and frequently treated with terazosin).

· can cause an increase in blood pressure (BP) in some persons. Diastolic hypertension was seen more often in patients treated with doses of venlafaxine greater than 300 mg per day.

· Abrupt discontinuation of venlafaxine use can produce a discontinuation syndrome consisting of dizziness, anxiety, nausea, somnolence, paresthesias, and insomnia. Therefore, venlafaxine use should be tapered gradually over 2 to 4 weeks.

11. All of the following statements are true about Asperger’s disorder except

a. Qualitative impairment in social interaction is seen

b. Stereotyped pattern of behaviour is seen

c. Significant delay in language functions is seen

d. Cognitive development is normal

e. Ans c) Significant delay in language functions is seen

· Unlike autistic disorder, in Asperger's disorder no significant delays occur in language, cognitive development, or age-appropriate self-help skills.