Treatment of alcohol dependence is by all except?
A. Disulfiram
B. Naltrexone
C. Flumazenil
D. Acamprosate
Correct answer : C. Flumazenil
Flumazenil is a benzodiazepine antagonist. It is not used for the treatment of alcohol dependence.
40 year old female came to the OPD with complaints of with depressed mood, insomnia, loss of appetite and lack of interest in surroundings for the past 1 year. These symptoms appeared after loss in a business deal 1 year ago. Which is correct regarding the management?
A. Selective Serotonin Reuptake Inhibitors (SSRI’s) are the most effective drugs
B. Antidepressants should be given based on the side effect profile
C. No treatment is required as it is due to loss in a business deal
D. Combination therapy with 2 or more antidepressants
Correct answer : B. Antidepressants should be given based on the side effect profile
The history is characteristic of depressive disorder. Antidepressant drugs are to be given. But there are no ideal antidepressants. The treatment should be based on the side effect profile of the drugs.
Drug used for treatment of nocturnal enuresis is?
A. Trazodone
B. Imipramine
C. Chlorpromazine
D. Sertraline
Correct answer : B. Imipramine
Treatment of nocturnal enuresis
Enuresis alarm systems are the preferred treatment for children with nocturnal enuresis.
These detect the moisture of urine when there is nocturnal enuresis.
An alarm is triggered which wakes up the child.
These systems are of 3 types – wearable alarms, wireless alarms and pad type alarms.
Alarm systems are also have the least relapse rate among the various modalities of treatment.
Motivational therapy
The child is rewarded for keeping dry at night. But punishment for bedwetting is discouraged.
There is limited evidence to support the efficacy of this approach.
Drug therapy
Pharmacological treatment for nocturnal enuresis is reserved for cases which do not respond to treatment with enuresis alarms.
Desmopressin in the preferred drug. It is given at night to reduce urine production during sleep.
Tricyclic antidepressants like imipramine can also be used. But use is limited due to side effects.
Most common cause of premature death in schizophrenia is?
A. Drug toxicity
B. Nosocomial infection
C. Homicide
D. Suicide
Correct answer : D. Suicide
Premature death in schizophrenia
Life expectancy of patients with schizophrenia is decreased by approximately 15 to 25 years. 1
Suicide is the most important cause of premature death in patients with schizophrenia.
There is a 20 fold increased risk of suicide compared to the general population.
Suicide attempts may occur without warning or expression of intent.
Cancer is the second most frequent cause of mortality in schizophrenics. 2
The rates of metabolic syndrome and cardiovascular disorders are also increased. 2
Journal references:
The paradox of premature mortality in schizophrenia: new research questions, J Psychopharmacol. 2010 November
Cancer mortality in patients with schizophrenia : A 11-year prospective cohort study, Cancer, Volume 115, Issue 15, pages 3555–3562, 1 August 2009
Which is not a cognitive dysfunction?
A. Overgeneralization
B. Thought block
C. Catastrophic thinking
D. Arbitrary inference
Correct answer : B. Thought block
Cognitive dysfunction refers to the errors in the processing of information in the thought process. Thought block is an error in the continuity of thought.
Which of the following is seen associated with alcoholic paranoia ?
A. Drowsiness
B. Delusions
C. Hallucinations
D. Impulsiveness
Correct answer : B. Delusions
Alcoholic paranoia is an alcohol induced psychotic disorder
It is characterised by delusions (mostly of persecution / jealousy / reference)
Auditory hallucinations may also be seen
All are features of autistic disorders except ?
A. Stereotypic movements
B. Impairment of social interaction
C. Visual impairment
D. Delay in speech development
Correct answer : C. Visual impairment
Autistic disorders are characterised by:
Impairement of social interaction
Disorder of communication and language (as in delayed development of speech)
Stereotypic movements
Visual impairment is not seen in autism.
Somatic passivity is seen in?
A. Depression
B. Hypomania
C. Body dysmorphic disorder
D. Paranoid Schizophrenia
Correct answer : D. Paranoid Schizophrenia
Somatic passivity is a Schneiderian first rank of Schizophrenia
An 18 year old student complains of lack of interest in studies for last 6 months. He has frequent quarrels with his parents and has frequent headaches. The most appropriate clinical approach would be to:
A. Leave him as normal adolescent problem
B. Rule out depression
C. Rule out migraine
D. Rule out an oppositional defiant disorder
Correct answer : B. Rule out depression
The given features are not something that may be considered as normal adolescent problem. Also the headache described here cannot be classified under migraine. Oppositional defiant disorder often presents at a younger age. Hence it is necessary to rule out depression.
A 25 year old female presents with 2 year history of repetitive, irresistible thoughts of contamination with dirt associated with repetitive hand washing. She reports these thoughts to be her own and distressing; but is not able to overcome them along with medications. She is most likely to benefit from which of the following therapies?
A. Exposure and response prevention
B. Systematic desensitization
C. Assertiveness training
D. Sensate focusing
Correct answer : A. Exposure and response prevention
The history is suggestive of Obsessive Compulsive Disorder. The first line of treatment is Exposure and response prevention
An 18 year old boy came to the Psychiatry OPD with a complaint of feeling changed from inside. He described himself as feeling strange as if he is different from his normal self. He was very tense and anxious yet could not point out the precise change in him. This phenomena is best called as:
A. Delusional mood
B. Depersonalization
C. Autochthonous delusion
D. Over valued idea
Correct answer : B. Depersonalization
The given history is the classical description of depersonalization.
One of the following usually differentiates hysterical symptoms from hypochondriacal symptoms:
A. Symptoms do not normally reflect understandable physiological or pathological mechanism
B. Physcial symptoms are prominent which are not explained by organic factors
C. Personality traits are significant
D. Symptoms run a chronic course
Correct answer : A. Symptoms do not normally reflect understandable physiological or pathological mechanism
Hysteria (Conversion disroder) is a condition in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation.
Hypochondria is a belief that physical symptoms are signs of a serious illness, even when there is no medical evidence to support the presence of an illness.
Perseveration is:
A. Persistent and inappropriate repetition of the same thoughts
B. When a patient feels very distressed about it
C. Characteristic of schizophrenia
D. Characteristic of obsessive compulsive disorder (OCD)
Correct answer : A. Persistent and inappropriate repetition of the same thoughts
Perseveration is seen in schizophrenia.
Rivastigmine and Donepezil are drugs used predominantly in the management of:
A. Depression
B. Dissociation
C. Delusions
D. Dementia
Correct answer : D. Dementia
Rivastigmine and Donepezil are cholinergic stimulators. They are used in the treatment of Alzheimer’s disease – the most common cause of dementia.
Bright light treatment has been found to be most effective in treatment of:
A. Anorexia nervosa
B. Seasonal affective disorder
C. Schizophrenia
D. Obsessive compulsive disorder
Correct answer : B. Seasonal affective disorder
Seasonal affective disorder refers to episodes of depression that occur every year during autumn or winter. Symptoms improve in spring and summer.
Mutism and akinesis in a person, who appears awake and even alert, is best described as:
A. Twilight state
B. Oneiroid state
C. Stupor
D. Delirium
Correct answer : C. Stupor
Intense nihilism, somatization and agitation in old age are the hallmark symptoms of:
A. Involutional melancholia
B. Atypical depression
C. Somatized depression
D. Depressive stupor
Correct answer :A. Involutional melancholia
All of the following are associated with better prognosis in schizophrenia, except:
A. Late onset
B. Married
C. Negative symptoms
D. Acute onset
Correct answer :C. Negative symptoms
Loosening of association is an example of:
A. Formal thought disorder
B. Schneiderian first rank symptoms
C. Perseveration
D. Concrete thinking
Correct answer :A. Formal thought disorder
5-HIAA is a metabolite of:
a) Serotonin
b) Dopamine
c) Epinephrine
d) Histamine
Correct answer : a) Serotonin
5-HIAA is a metabolite of Serotonin.
A middle aged person reported to Psychiatric OPD with the complaints of the fear of leaving home, fear of travelling alone and fear of being in a crowd. He develops marked anxiety with palpitations and swelling if he is in these situations. He often avoids public transport to go to his place of work. The most likely diagnosis is:
a) Generalised anxiety disorder
b) Schizophrenia
c) Personality disorder
d) Agoraphobia
Correct answer :
d) Agoraphobia
A patient with acute psychosis, who is on haloperidol 20 mg/day for last 2 days, has an episode characterized by tongue protrusion, oculogyric crisis, stiffness and abnormal posture of limbs and trunk without loss of consciousness for last 20 minutes before presenting to casualty. This improved within a few minutes after
administration of diphenhydramine HCl. The most likely diagnosis is:
a) Acute dystonia
b) Akathisia
c) Tardive dyskinesia
d) Neuroleptic malignant syndrome
Correct answer :
a) Acute dystonia
A 30 year old man who was recently started on haloperidol 30 mg/day developed hyperpyrexia, muscle rigidity, akinesia, mutism, sweating, tachycardia and increased blood pressure. The investigations showed increased WBC count, increased creatinine phophokinase. These is no history of any other drug intake or any signs of
infection. The most likely diagnosis is:
a) Drug overdose
b) Neuroleptic malignant syndrome
c) Drug induced Parkinsonism
d) Tardive dyskinesia
Correct answer : b) Neuroleptic malignant syndrome
The following is not an atypical antipsychotic
a) Thioridazine
b) Clozapine
c) Olanzapine
d) Resperidone
Correct answer : a) Thioridazine
The drug which is used for long term maintenance in opioid addiction :
a) Naloxone
b) Nalorphine
c) Butarphenol
d) Methadone
Correct answer : d) Methadone
Most common substance abuse in India is :
a) Tobacco
b) Cannabis
c) Alcohol
d) Heroin
Correct answer : a) Tobacco
Explanation:
Most common substance abuse in India – Tobacco (see statistics below)
Most common substance abuse in the world – ?? Probably tobacco (According to WHO statistics, there is an estimated 1.1 billion tobacco users in the world – corresponds to 1/3 of people above 15 years of age)
Most common illicit substance abuse in India – Cannabis (see statistics below)
Most common illicit substance abuse in the world – Cannabis (see statistics below)
National Household Survey of Drug and Alcohol Abuse in India – Estimated users: (2001)
Tobacco – 162 million
Alcohol – 62 million
Cannabis – 9 million
Opiates – 2.5 lakh
Cannabis is by far the most widely cultivated, trafficked and abused illicit drug. About 147 million people, 2.5% of the world population, consume cannabis (annual prevalence) compared with 0.2% consuming cocaine and 0.2% consuming opiates.
References :
Substance use disorder, Manual for physicians – published by National Drug Dependance Treatment Centre, AIIMS
Naltrexone is used in opioid addiction because
a) To treat withdrawl symptoms
b) To treat overdose of opioids
c) Prevent relapse
d) Has addiction potential
Correct answer : c) Prevent relapse
The drug of choice for obsessive compulsive disorder
a) lmpiramine
b) Fluoxetine
c) Chlorpromazine
d) Benzodiazepine
Correct answer : b) Fluoxetine
Delusion is a disorder of:
A. Thought
B. Perception
C. Insight
D. Cognition
Correct answer : Thought