Q-1. A patient was diagnosed with schizophrenia and was started on haloperidol 5 mg. On 3rd day he presented with up-rolling of eyes. A complete neurological examination revealed on spasticity or any other abnormalities, except up-rolling of eyeballs. Visual acuity was found to be normal. What is your likely diagnosis?
b) Acute dystonia
Answer: Acute dystonia
Acute dystonia induced by drug treatment can be caused by antipsychotic, antiemetic, and antidepressant drugs.
Patients who develop abnormal positioning or muscle spasms within seven days of starting drug treatment or of a rapid increase in the dose of a drug may be diagnosed with acute, drug induced dystonia.
Treatment of drug induced acute dystonia:
Antihistamines di-phenhydramine or Promethazine
Promethazine is useful in rapidly controlling acute drug induced dystonia and easily available in most emergency department.
Q-2. Which of the following is not an objective of Mental Health Act 1987?
a) Minimal mental health care for all
b) Application of mental health knowledge in general health care
c) Promote community participation
d) Human rights for the mentally ill
Answer: Human rights for the mentally ill
Mental health act was drafted by parliament in 1987 but it came into effect in all the states and union territories of India in April 1993.
Objective of Mental Health Act 1987:
Minimal mental health care for all
Application of mental health knowledge in general health care
Promote community participation
Q-3. Which of the following is the most effective treatment modality for post traumatic stress disorder?
a) Cognitive behavioral therapy
c) Rational and emotive therapy
d) Eye movement desensitization and reprocessing
Answer: Cognitive behavioral therapy
Post-traumatic stress disorder (PTSD):
Post-traumatic stress disorder is included among the anxiety disorder in DSM-IV and is syndrome characterized by re-experiencing a traumatic event and decreased responsiveness and avoidance of current events associated with the trauma.
Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.
Cognitive behavioral therapy (Behavioral therapy of choice)
Eye movement desensitization and reprocessing
Beta blockers e.g. Propranolol
Antidepressants particularly SSRIs e.g. Sertraline and paroxetine
Carbamazepine and benzodiazepines
Alpha adrenergic blocking agent Prazosin decreases nightmares
Q-4. All are about autism except
a) 2/3 rd are mentally retarded
b) Language is impaired
c) Abnormal dermatoglyphics
d) Poor eye contact
Answer: Abnormal dermatoglyphics
Autism spectrum disorder (ASD) is a biologically based neuro-developmental disorder characterized by:
Impairment in reciprocal social and interpersonal interaction
Impairment in language and non verbal communication
Abnormal behavioral characteristics