Psychiatry: Medpgnotes

PSYCHIATRY
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SIGNS AND SYMPTOMS IN PSYCHIATRY 1
PSYCHIATRY
CONTENTS
SIGNS AND SYMPTOMS IN PSYCHIATRY ....................................................................................................................... 5
GENERAL FEATURES OF PSYCHIATRIC SYMPTOMS ................................................................................................... 5
DELUSION .................................................................................................................................................................. 7
ILLUSION ................................................................................................................................................................... 7
HALLUCINATION........................................................................................................................................................ 8
TESTS IN PSYCHIATRY ................................................................................................................................................ 8
SUBSTANCE RELATED DISORDERS ................................................................................................................................ 9
GENERAL FEATURES OF SUBSTANCE RELATED DISORDERS ...................................................................................... 9
AMPHETAMINE ......................................................................................................................................................... 9
COCAINE .................................................................................................................................................................... 9
CANNABIS ............................................................................................................................................................... 10
LSD .......................................................................................................................................................................... 11
ALCOHOL ................................................................................................................................................................. 11
DELIRIUM TREMENS................................................................................................................................................ 13
FETAL ALCOHOL SYNDROME .................................................................................................................................. 13
OPIOID RECEPTORS ................................................................................................................................................. 13
OPIOID DRUGS ........................................................................................................................................................ 14
OPIOID POISONING ................................................................................................................................................. 16
TREATMENT OF OPIOID POISONING....................................................................................................................... 16
NICOTINE................................................................................................................................................................. 17
CAFFEINE ................................................................................................................................................................. 17
COGNITIVE DISORDERS ............................................................................................................................................... 17
FEATURES OF COGNITIVE DISORDERS .................................................................................................................... 17
ORGANIC BRAIN SYNDROME .................................................................................................................................. 18
DELIRIUM ................................................................................................................................................................ 18
AMNESTIC DISORDERS ............................................................................................................................................ 19
DEMENTIA ............................................................................................................................................................... 19
ALZHEIMER’S DISEASE ............................................................................................................................................. 20
SCHIZOPHRENIA .......................................................................................................................................................... 21
RISK OF SCHIZOPHRENIA ......................................................................................................................................... 21
FEATURES OF SCHIZOPHRENIA ............................................................................................................................... 22
TYPES OF SCHIZOPHRENIA ...................................................................................................................................... 23
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PSYCHIATRY
MANAGEMENT OF SCHIZOPHRENIA ....................................................................................................................... 24

MOOD DISORDERS ...................................................................................................................................................... 24
DEPRESSION ............................................................................................................................................................ 24
MANIA ..................................................................................................................................................................... 26
BIPOLAR DISORDERS ............................................................................................................................................... 27
SUICIDE ................................................................................................................................................................... 27
MANAGEMENT OF MOOD DISORDERS ................................................................................................................... 27
LITHIUM .................................................................................................................................................................. 28
ANXIETY DISORDERS ................................................................................................................................................... 30
GENERAL FEATURES OF ANXIETY DISORDERS......................................................................................................... 30
GENERALISED ANXIETY DISORDERS ........................................................................................................................ 30
ANXIETY NEUROSIS ................................................................................................................................................. 30
POST TRAUMATIC STRESS DISORDER ..................................................................................................................... 30
PANIC ATTACK AND PANIC DISORDERS .................................................................................................................. 31
PHOBIA .................................................................................................................................................................... 31
OBSESSIVE COMPULSIVE DISORDER ....................................................................................................................... 32
ADJUSTMENT DISORDER ......................................................................................................................................... 33
PRE MENSTRUAL TENSION ...................................................................................................................................... 33
PSYCHOANALYSIS, EGO AND EGO DEFENCE MECHANISMS ....................................................................................... 33
PSYCHOANALYSIS .................................................................................................................................................... 33
ID, EGO AND SUPEREGO ......................................................................................................................................... 34
EGO DEFENCE MECHANISMS .................................................................................................................................. 34
RESEARCHERS IN PSYCHIATRY ................................................................................................................................ 35
LEARNING AND MANAGEMENT TECHNIQUES IN PSYCHIATRY ............................................................................... 35
PSYCHOSEXUAL STAGES OF DEVELOPMENT ........................................................................................................... 36
PERSONALITY DISORDERS ........................................................................................................................................... 36
SOMATOFORM DISORDER .......................................................................................................................................... 37
SOMATISATION DISORDER ..................................................................................................................................... 37
FIBROMYALGIA ....................................................................................................................................................... 38
HYSTERIA ................................................................................................................................................................. 38
HYPOCHONDRIASIS ................................................................................................................................................. 39
DISSOCIATIVE DISORDERS ....................................................................................................................................... 39
GENDER IDENTITY AND SEXUAL DISORDERS .............................................................................................................. 39
GENDER IDENTITY DISORDERS ................................................................................................................................ 39
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PSYCHIATRY
IMPOTENCE ............................................................................................................................................................. 40
ERECTILE DYSFUNCTION ......................................................................................................................................... 40
PREMATURE EJACULATION ..................................................................................................................................... 40
EATING DISORDERS ..................................................................................................................................................... 40
SLEEP DISORDERS........................................................................................................................................................ 41
GENERAL FEATURES OF SLEEP DISORDERS ............................................................................................................. 41
EEG .......................................................................................................................................................................... 42
REM SLEEP .............................................................................................................................................................. 43
NREM SLEEP ............................................................................................................................................................ 43
NARCOLEPSY ........................................................................................................................................................... 43
IMPULSIVE DISORDERS ............................................................................................................................................... 43
PEDIATRIC PSYCHIATRY ............................................................................................................................................... 44
GENERAL FEATURES OF PEDIATRIC PSYCHIATRY .................................................................................................... 44
ATTENTION DEFICIT HYPERACTIVE DISORDER ........................................................................................................ 44
AUTISM ................................................................................................................................................................... 45
MENTAL RETARDATION .......................................................................................................................................... 45
CONDUCT DISORDER AND SPECIFIC LEARNING DISORDER .................................................................................... 46
MANCHAUSEN SYNDROME ........................................................................................................................................ 46
TREATMENT IN PSYCHIATRY ....................................................................................................................................... 46
ANTIPSYCHOTICS ..................................................................................................................................................... 46
NEUROLEPTIC MALIGNANT SYNDROME ................................................................................................................. 49
ANTIDEPRESSANT DRUGS ....................................................................................................................................... 49
MAO INHIBITORS .................................................................................................................................................... 51
SERATONIN SYNDROME .......................................................................................................................................... 51
ANTIANXIETY DRUGS .............................................................................................................................................. 51
BENZODIAZEPINE ANTAGONIST .............................................................................................................................. 52
DRUGS ACTING ON GABA ....................................................................................................................................... 53
ELECTROCONVULSIVE THERAPY ............................................................................................................................. 53
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PSYCHIATRY
KEY TO THIS DOCUMENT
Text in normal font – Must read point.

Asked in any previous medical entrance
examinations
Text in bold font – Point from Harrison’s

text book of internal medicine 18th
edition
Text in italic font – Can be read if

you are thorough with above two.
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PSYCHIATRY
SIGNS AND SYMPTOMS IN PSYCHIATRY
GENERAL FEATURES OF PSYCHIATRIC SYMPTOMS
Word psychiatry is coined by Reil

Psychosis is coined by Ernst von
Neurosis is coined by Cullen
Father of modern psychiatry Johann Weyer
Gene associated with autistic spectral disorders and Neurexin I gene (Synaptic function)
schizophrenia
Emotion is controlled by Frontal lobe
Neurosis and Psychosis differ by Presence of Insight
Basic difference between Neurosis and Psychosis Insight
Alternating psychosis is also known as Interictal psychosis
MC Emotional disorder of Children Neurosis
Psychiatric disorders common in first born male child OCD, Tourette syndrome
Most specific of psychosis Neologism
Psychosis may be caused by Steroids, Chloroquine, INH
Psychosis Delusion and hallucination
False belief unexplained by reality shared by a number Superstition
of people
Giving long answers with great deal of Circumstantiality
tedious and unnecessary details
A 42 year old man comes to emergency Idea of reference
department with the chief complaint that
‘the men are following me’. He also
complains of hearing of voice telling him
to hurt others. He tells the examiner that
the news anchorman gives him special
messages at the state of the world every
night through the TV. Psychiatry findings
best describing the last belief of the patient
Cross sectional manifestation of emotion having both Affect
subjective and objective component
Laughs one minute and cries next minute without any Labile affect
clear stimulus
Inability to enjoy previous pleasurable activities Anhenonia
Alexithymia Inability to recognise and describe feelings
Catatonia means Increased muscle tone
Anglepoise lamp sign Sign of catatonia
Cataplexy Abrupt loss of muscle tone
Catalepsy Waxy flexibility (used to describe the
tonus in catatonia – psychological pillow)
Mannerism Old, repetitive goal directed movements
Palilalia Repetition of terminal words of own speech
Echolalia Childhood autism, Catatonic Schizophrenia, Alzheimer’s
disease
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Coprolalia Tourette syndrome

Lyme disease can lead to Tourette syndrome
Treatment of Tourette syndrome Supportive therapy
Treatment of Tourette syndrome Guanfacine
Copropraxia Obscene acts
Out of context repetition Perseveration
Persistent and inappropriate repetition of same Perseveration
thoughts
Senseless repetition Verbigeration
Thoughts in mind with rhyming rather Clang association (seen in schizophrenia)
than with meaning of thought
Making stories to fill in gaps caused by memory Confabulation
Confabulation is a disorder of Memory
Confabulation is synonymous with False memory syndrome
Processing of short term to long term memory help in Hippocampus
Deja vu is seen in Normal person, temporal lobe epilepsy, psychosis
Unfamiliarity of familial things Jamais vu
People he meets are lifeless card board figures. Depersonalisation
detached emotionless, highly unpleasant morbid
experiences
Depersonalisation is a disorder of Perception
Mutism is a recognized feature of Conversion hysteria, catatonic schizophrenia
Mutism, akinesia, awake and alert Stupor
Abulia Milder form of akinetic mutism
Inability to perform Purposeful activity in absence of Apraxia
Sensory deficit
Apraxia is a disorder of Initiating and planning movement
Synesthesia Cannabis
Reflex hallucination is a morbid variety of Synesthesia
Ganser syndrome Approximate answers, Prisoners
Gjessing syndrome Catatonic symptoms recur in phases,
changes in nitrogen balance, change in
thyroid dysfunction
Treatment of Gjessing syndrome Thyroid hormone
Bruxism if untreated Dental malocclusion, Temporomandibular joint pain
NOT true about bruxism Deworming will help
Sociopathological factor associated with mental illness Emotional stress, Frustration, Anxiety
Cognition is Thought
Loosening of association is an example of Formal thought disorder
Formal thought disorder is also associated Bipolar disorder
with
NOT a disorder of form of thought Thought block
Healthy thinking Continuity, constancy, organization
Pseudocommunity is associated with Paranoid disorders
Associated with Paranoid state L-dopa, Amphetamine, Cocaine
Detection & Treatment of Psychiatric disorders in Consultation Liaison Psychiatry
Medically Ill
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PSYCHIATRY
DELUSION
Delusion involve Disturbance of thought content

Delusion is disorder of Thought
Perceptual misconception of a real object Delusion
False belief that meets specific psychological needs Delusion
Known insane person committing murder is not Delusion
punished if it is due to act of
Delusion is NOT comprehensible, NOT reasonable
MC cause of mood congruent delusion Mania
MC cause for delusion in elderly Multiple medication use
nd
MC Type of delusion Delusion of Persecution, 2 Delusion of Jealousy
Minimum duration for delusional disorder 3 months
Delusion seen in Severe Depression & Cotard’s Nihilistic Delusion
Syndrome
Delusion of negation Colard syndrome
Delusion in Neurosyphilis Delusion of Grandiosity
Delusion of grandiosity Schizoaffective mania, Paranoid schizophrenia
Delusion of Infidelity Othello Syndrome
Delusion of jealously Othello syndrome
Infidelity and jealousy involving spouse is the thought Othello syndrome
content of
Sharing of Delusions (Folie a deux) Induced Delusional Disorder
Folie a deux is seen in Paranoid
Police is after him and would arrest him Delusion of persecution
Controlled by radiowaves by his neighbor Delusion of persecution
Delusion of persecution Schizophrenia, paranoid psychosis, maniac episode,
melancholia
Delusion that someone from high socioeconomic status De Clarambault syndrome
in loving you
Delusion of doubles Capgras syndrome
Capgras syndrome is more common in Paranoid schizophrenia
Visual hallucination of a transparent Autoscopic psychosis
phantom of his own body
Persistent delusional disorder One month, absence of hallucination, disorganised
speech and behavior
Content of thought in delusional paranomia Foul odor
NOT associated with delusion Alcoholic hallucinations
Delusion is NOT seen in Anxiety, OCD
Delusion is NOT present In Compulsive disorder
Treatment for delusion with suicidal ideas ECT
Characteristic symptom of organic psychosis Transient delusion
Characteristic symptom of induced psychotic disorder Accepting delusions of other persons
Delusion, hallucination, disturbed cognitive function Organic brain syndrome
ILLUSION
Misinterpretation with stimulus Illusion
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Phantom limb pain is an example of Illusion

Seen a rope and fears like a snake Illusion
Aberrant bizzare perception and interpretation of real Illusion
objects
HALLUCINATION
Hallucination is a disorder of Perception

False perception without external object or stimulus Hallucination
Perception occurring without external stimulus Hallucination
Hallucinogens LSD, Mescaline, phencyclidine
Features of hallucination Independent of will of observer, occurs in absence of
perceptual stimulus, sensory organs are NOT involved,
vivid sensory perception, inner subjective space
Hypnopampic hallucination Experienced while awakening
Hallucination occurring during onset of sleep Hypnogogic hallucinations
Olfactory hallucination Temporal lobe disorder
Gustatory hallucinations associated with Temporal lobe epilepsy
Organic cause of behavioral symptoms Visual hallucinations
Commonest type of organic hallucinations Visual hallucination
Visual hallucinations are seen in Alcoholism, delirium, temporal lobe epilepsy
Visual hallucinations commonly seen in Delirium
Formed visual hallucinations are seen in lesion of Temporal lobe
MC Hallucination in Non Organic Psychiatric disorders Auditory Hallucinations
Auditory hallucinations are NOT seen in Hysteria
Hallucinations are NOT seen in Anxiety
rd
3 person hallucinations 2 weeks, suspicious of his Acute psychosis
family members and had decreased sleep and appetite
TESTS IN PSYCHIATRY
MC screening test for Organic brain Disorder Bender Visual Motor Gestalt test
Signs of organic brain damage evident on Bender Gestalt test
NOT a projective test Bender Gestalt test
Rorscach test measures Personality
Rorscach inkblot test is Projective
A projective test in which pictures are Thematic appreciation test
shown to help the patient to discuss his
fantasies and fear
Test using projection Rorschach test
Halstead Reitan battery Finger oscillation, rhythm, thematic appreciation test
Halstead Reitan battery does NOT involve Constructional apraxia
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SUBSTANCE RELATED DISORDERS 9
PSYCHIATRY
SUBSTANCE RELATED DISORDERS
GENERAL FEATURES OF SUBSTANCE RELATED DISORDERS
Most widely used illicit substance in US Marijuana

Sudden onset of delusion in 35 year old with no Substance abuse
previous symptom
Drugs having abuse liability Buprenorphine, alprazolam, dextropropoxyphene
Rave drug commonly used Ecstasy
Speed ball Cocaine + opiate
Psychedelic drugs LSD, psilocybin, phencyclidine, mescaline,
harmine, bufotenin
Addictive drugs increase release of dopamine at Nucleus acumbens
Tolerance is seen is Physical dependence
NOT a factor important for substance dependence Intelligence
NOT included in definition of substance abuse Withdrawal syndrome, intolerance to drug
syndrome
NOT a criteria for substance dependence Recurrent substance related legal problems
A young man living in a metropolitan city comes with LSD
abuse to a particular drug. He says he Sees sounds and
hears colors. What substance is he taking
Narcotic and psychotropic substances act Recommends treatment or rehabilitation of drug users
and punishment of drug peddlers
Narcotic and Psychotropic drugs Act 1985
Indications for surgical intervention to Signs of toxicity from leaking drug
remove smuggled drug packets that have packets
been ingested include
AMPHETAMINE
Rave drug Amphetamine

Names for methamphetamine Meth, speed, crank, chalk, ice, glass, crystal
Activity of methamphetamine on Dopamine, Seratonin, Norepinephrine
Hepatic calcification Amphetamine
Weight gain NOT seen in Phentermine
Amphetamine NOT used in Epilepsy
Treatment of methamphetamine overdose Ammonium chloride (to acidify urine)
COCAINE
Non synthetic alkaloid compound acting similar to Cocaine

amphetamine
Cocaine Block uptake of dopamine in CNS, impairment of nerve
conduction, increased BP
Half life of cocaine 1 hour
MC Psychotic Symptom of Cocaine Paranoid Delusions
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PSYCHIATRY
Paranoid psychosis observed with cocaine overdose can Reverse tolerance

be explained by
Formication and delusion of persecution Cannabis
Tactile hallucination Cocaine overdose
Magnan symptom Tactile hallucination (Cocaine)
Haptic hallucinations Cocaine poisoning
Uncontrolled behavior & Psychotic episodes Cocaine
Black tongue Cocaine
Visual or tactile hallucinations, black staining of tongue Cocaine
and teeth
Electrolyte abnormality associated with Hyperkalemia
cocaine
A chronic alcoholic used to consume 5 bottles per day Reverse tolerance
of liquor. Recently he attains kick with 1 bottle. This is
called as
Cocaine withdrawal associated with Vivid unpleasant dreams
Yawning is a common feature of Cocaine withdrawal
Hepatotoxicity is seen in poisoning with Cocaine
Halothane is contraindicated with Cocaine
Best assay for cocaine metabolite Urine
CANNABIS
Cannabis preparation Ganja, Hashish, Charas

Extract from stems and leaves of cannabis Hashish
Active substance in hashish Tetrahydrocannabinol
Ganja is extracted from Flowering tops
Charas Resin exudates of cannabis indica
Most potent form of cannabis Charas
Hash oil is used to increase the potency of Marijuana
Fatal dose of charas 2 gram/kg body weight
Fatal dose of ganja 8 gram/kg body weight
Fatal dose of bhang 10 gram/kg body weight
NOT a form of cannabis Afeem
High density of cannabinoid receptor Cerebral cortex, basal ganglia, hippocampus
Burnt rope smell Cannabis
Run amok Cannabis
Amotivation syndrome Cannabis
Cannabis withdrawal associated with Conjunctival redness
Immediate physical affect after marijuana Conjunctival congestion, tachycardia
Cannabis is NOT associated with Suicidal tendencies
Physical dependence does NOT occur with Marijuana
Symptomatic treatment is NOT required well in Cannabis
withdrawal syndrome caused by
Withdrawal does NOT produce suicidal tendencies Cannabis
Physical dependence NOT seen in Cannabis
Medical purpose of cannabis Tics, nausea, epilepsy
Rimonabant Antagonism of cannabinoid receptor
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PSYCHIATRY
LSD
Flashback LSD
Flashback phenomenon is also associated Cannabis, Psilocybin
with
Crossover of sensory perception, sounds can be seen, LSD
colors can be heard
Morning glory is associated with LSD (clear consciousness)
Treatment is NOT required for withdrawal of LSD
Treatment for LSD abuse Talking down
ALCOHOL
Standard drink 10 – 15 gm of ethanol

Congeners Methanol, butanol, acetaldehyde, histamine, tannin, iron,
lead
Irresistible urge to drink alcohol Dipsomania
Major site of absorption of alcohol Small intestine
Metabolism of alcohol 80% by alcohol dehydrogenase, 20% by microsomal ethanol
oxidizing system
Responsible for metabolism of alcohol Alcohol dehydrogenase, Aldehyde dehydrogenase,
Microsomal ethanol oxidizing system
Ethanol is absorbed at All levels of intestinal tract
In chronic alcoholism the rate limiting component for NAD+ and NADPH
alcohol metabolism excluding enzymes are
Product formed from alcohol and NOT an intermediate Acetaldehyde
for TCA cycle
Alcohol acts in brain on GABA, NMDA
Neurotransmitter affected in dopamine GABA, glutamate, serotonin
release
Alcohol Increased MCV
Alcohol interfere with absorption in the Vitamin A, thiamine, nicotinic acid,
small intestine and decrease storage in pyridoxine, folate
liver of
Toxicity due to ethanol by Inhibiting gluconeogenesis
End product of one stage fermentation Ethanol
An alcoholic with poor judgment and decreased in 80 – 200 mg/dl
skilled motor movements. Blood alcohol level would be
Slight feeling of intoxication 0.02 g/dl
Death 0.4 g/dl
Legal intoxication 0.04 g/dl in some countries and 0.08 g/dl in some
countries
Legal limit of alcohol in India 30 gram
Legal limit for alcohol according to motor 30 mg%
vehicle act
Drunk and drive Motor vehicle act 185
Drunk and drive punishable under 510 IPC
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PSYCHIATRY
Fatal dose of absolute alcohol in adults 150 ml

Alcoholic paranoia is associated with Fixed delusions
Alcohol produces Hypoglycemia by Inhibiting Gluconeogenesis
Biochemical changes in alcoholism Hypoglycemia, Lactic acidosis, Fatty liver
Delirium and amnestic reaction Alcohol
Alcohol abuse McEwan’s Sign, Morbid Jealosy
Macewen sign Alcoholism
Alcoholic blackouts Temporary anterograde amnesia
Marchifavia bignami syndrome is Alcoholism
associated with
Alcohol intoxication is a form of Psychosis
Does NOT cause hyperpyrexia Alcohol
NOT a pathological manifestation of chronic alcoholism Piecemeal necrosis
True about alcohol dependence syndrome Tolerance, withdrawal, CAGE questionnaire, physical
dependance
Alcohol dependence best indicated by Withdrawal symptoms
Psychiatry symptoms of alcohol dependence Anxiety, suicide, depression
MC symptom of alcohol withdrawal Tremor
Characteristic of alcohol withdrawal Hallucination
Alcoholic hallucinations occur within 24 hours
NOT a feature of alcohol withdrawal Hypersomnolescence
Metabolite detected in urine in alcohol Acetaldehyde
abuse
Cavett’s test Micromethod for alcohol
Hinek Kozelka test Macromethod for alcohol
Audit questionnaire is used in Alcoholism
Cage test For diagnosing alcoholism
Widmark formula Alcohol
Best enzyme marker for chronic alcoholism Gamma glutamyl transferase
Immediate specialist assessment is NOT needed for Acute alcohol intoxication
Maintenance of substance dependence Acamprostate, disulfiram, clonidine
Alcohol dependence Acomprostate, Naltrexone, disulfiram
Disulfiram with acomprostate used for Maintenance therapy of alcohol abstinence
Drug used for mild alcohol withdrawal Benzodiazepine
Alcohol withdrawal treated with Chlordiazopoxide
Drug increases the seizure threshold in alcoholic Chlordiazepoxide
patients
Antabuse drug causes Inhibits oxidation of alcohol
Disulfiram acts by inhibiting Aldehyde dehydrogenase
Drug inhibiting Aldehyde dehydrogenase Disulfiram
For detoxification of alcohol withdrawal drug used is Disulfiram
Conversion of acetaldehyde to acetate is inhibited by Disulfiram
Disulfiram inhibits Alcohol and aldehyde dehydrogenase
Dilsufiram like reaction NOT seen in Amoxicillin
Flushing with alcohol NOT seen in Amoxicillin
NOT a side effect of disulfiram Hypertension
Uncomplicated alcohol withdrawal Diazepam
Can be given in chronic alcoholic Beclomethasone
Chronic alcoholic presented to casualty with altered Injection thiamine
sensorium. Blood sugar normal
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PSYCHIATRY
NOT used in treatment of substance dependence Flumazenil

NOT an anticraving drug for Alcohol dependence Topiramate
NOT an anticraving agent for alcohol dependence Lorazepam
Does NOT require dose reduction in cirrhosis Lorazepam
DELIRIUM TREMENS
Delirium tremens precipitated by Sudden withdrawal of alcohol, Temporary excess

alcohol, Shock after severe injury
30 year male, alcohol abuse for 15 years, fearfulness, Delirium tremens
talking to self, misrecognition, aggressive behavior,
tremulousness, seeing snakes and reptiles not visible to
others. History of drinking alcohol two days prior to
onset of present complaints
Altered consciousness, tremors, visual hallucinations Delirium tremens
Autonomic disturbances are seen in Delirium tremens
NOT a feature of delirium tremens Occulomotor nerve palsy
NOT seen in Delirium tremens Depression
NOT true about delirium tremens Severe depression
NOT true about delirium tremens Ophthalmoplegia
Drug of choice in alcohol withdrawal Chlordiazopoxide
Drug of choice in delirium tremens Chlordiazopoxide
Drug of choice for Delirium tremens Diazepam
Alcoholic 2-4 days of absentism. Treatment of delirium Diazepam
tremens
NOT used in delirium tremens Antipsychotics
FETAL ALCOHOL SYNDROME
Fetal alcohol syndrome Microcephaly, Poor coordination, Flat face

Newborn Microcephaly, ASD, epicanthal folds Fetal alcohol syndrome
Fetal alcohol syndrome is NOT characterized by Large proportionate body
OPIOID RECEPTORS
King of narcotics Opioids

Marquis test Opioid
Drug acting on mu receptors of CNS Morphine
Effect of mu receptors of opioids Miosis, Sedation
Muscle rigidity due to opioids is because of their effect Mu
on
Mu receptor responsible for Miosis
Mu receptors of opiods NOT responsible for Diuresis, bronchodilatation
Action of delta type of opioid receptors Supraspinal analgesia
Dysphoria mediated by Kappa receptor
Diuretic action of opioid due to Kappa receptor
Drug acting on kappa receptor Butorphanol
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PSYCHIATRY
Drug acting on delta receptor Etorphine

Drug acting with equal affinity of mu, kappa and delta Etorphine
receptors
Endogenous opioid receptors for endorphin & Liver
encephalin are ABSENT in
Opioids cause Hypotension
Action which does not develop tolerance to morphine Constipation
Tolerance for morphine does NOT develop for Miosis and constipation
OPIOID DRUGS
NOT a cardiac poison Opium

Opium is a derivative of Papaver somniferum
Alkaloids present in morphine Codeine, thebaine, papaverine
Opioids differ from opiates in that they are Synthetic derivatives
Site of action of opioid Dorsal horn
Action of opiates on Locus cereleus
Action of opiates Miosis
Epidural opioids Functions of intestine affected, Can cause itching, Cause
respiratory depression, Act on dorsal horn substantia
gelatinosa
Opioid peptide Endorphin, leu 5 enkephalin, met encephalin
Action of beta endorphin Mainly inhibitory
Opioid induced seizures Children are most susceptible
MC used drug for Spinal ANALGESIA Morphine
Naturally occurring opioid Morphine
Least protein bound Morphine
Most potent derivative of morphine Oxymorphine
Action of Morphine Direct cardiac depression, releases ADH, depresses
respiration partly
Decreased vascular resistance is seen with Morphine
MC cause of Late Medullary Paralysis Morphine
Undesirable side effect of Morphine Increased pressure in biliary tract, constipation, nausea,
dysphoria
NOT a route of morphine Sublingual, Inhalational
NOT a route of administration of morphine Subarachnoid
Dezocine More potent and faster acting than morphine, Similar
duration of action, Partial agonist antagonist action,
Does NOT increase histamine release
MC abused Opioid Heroin
Smack Heroin
Semi synthetic opioid Heroin
NOT an adulterant of heroin Charcoal
Necrotic overdosage induced pulmonary edema Heroin
Treatment of heroin dependence Buprenorphine, clonidine, lofexidine
NOT used to treat heroin dependence Disulfiram
Chemical name of Heroin Diacetylmorphine
Pethidine compared to morphine Does not suppress cough
Pethidine is pharmacologically different from Morphine Constipation
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PSYCHIATRY
in causing
Drug contraindicated in renal failure Pethidine
Opioid that should NOT be used with MAO inhibitors Pethidine
Least addictive potential Codeine
NOT an opioid agonist Ketamine
Opioid agonist-antagonist compounds Buprenorphine, Nalbuphine, Pentazocine, Nalmefene
Pentazocine Decreased vomiting and constipation compared to
morphine, risk of addiction is less than that of
morphine, agonist antagonist
Minimum Respiratory depression Pentazocine
Contraindicated in Porphyria, Minimal Medullary Pentazocine
Depression
Tramadol Opioid analgesic
Buprenorphine Partial agonist at mu agonist
Buprenorphine 25 times more potent than morphine
Bell Shaped Dose Response Curve, Most Potent Buprenorphine
Morphine
Ceiling effect Buprenorphine
Alternate to methadone for treatment of opioid Buprenorphine
dependence
Butarphonol Opioid agonist antagonist
Alvimopen Peripheral mu antagonist
Fedotozine Kappa receptor antagonist
100 times more potent than morphine Fentanyl
MC used Lipophilic drug for Spinal ANALGESIA Fentanyl
Muscle Spasm Fentanyl
Remifentanyl Short half life, More potent than alfentanyl
Remifentanil Useful for short painful procedures, Metabolized by
plasma esterases, Equipotent as fentanyl
Constant Context Sensitive Half Time Remifentanil
Shortest acting intravenous analgesic Remifentanil
Shortest elimination half life Remifentanil
Opioid NOT given intrathecally Remifentanil
Best induction agent for outpatient anaesthesia Alfentanyl
Does NOT cause Respiratory Depression Alfentanyl
Maximum Late Medullary Paralysis Alfentanyl, Buprenorphine
Common side effect seen with alfentanyl Chest wall rigidity
More potent opioid Sulfentanyl
Highly protein bound Sulfentanyl
Opioid having maximum plasma protein binding Sulfentanil
capacity
Opioid with long t 1/2 and high oral parenteral activity Methadone
ratio
NOT true about methadone Its main indication is pain
Long term maintenance in opioid addiction Methadone
Least sedative narcotic Papaverine
Opioid drug given by transdermal route Fentanyl
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PSYCHIATRY
OPIOID POISONING
Sudden respiratory distress, bilateral basal crepitations Narcotic overdose

suggestive of pulmonary edema. alveolar wedge
pressure is normal
A patient has piloerection, mydriasis, Opioid abstinence
increased blood pressure and abdominal
cramps
Patient presented to emergency Mepiridine overdose
department with respiratory depression,
constricted pupil, stuporous and suffered
grand mal seizure
Pin point pupil suggests poisoning with Opioids
Type of respiration in opioid poisoning Slow
Acute opioid withdrawal characterised by Rhinorrhoea, piloerection, insomnia
Diarrhoea, rhinorrhoa, sweating, lacrimation Heroin withdrawal
Opium addict, given up opium for 2 days, withdrawal Rhinorrhoea
symptom
Symptom of opioid withdrawal Lacrimation
Opioid withdrawal associated with Yawning
Terms used for opioid withdrawal Cold turkey, kicking the habit
Raw flesh like smell during autopsy Opium
Chasing the dragon phenomena is Opioid
associated with
NOT a feature of opioid withdrawal Miosis, constipation, Polyuria
TREATMENT OF OPIOID POISONING
Opioid receptor antagonists Naloxone used for opioid induced constipation,

naltrexone may be used for alcohol dependence,
Nalmifene has a longer life than Naloxone
Treatment of Opium poisoning Stomach wash, Purgative, Naloxone
Opioid Overdose Naloxone
Best antagonist for morphine Naloxone
Naloxone is an antidote for Pethidine, Pentazocine, Diphenoxylate
Naloxone is contraindicated in neonatal resuscitation if Methadone
mother is on
Naloxone does NOT reverses completely Sedation
Adverse effects of naloxone Hypertension, Pulmonary edema, Ventricular
dysrrhythmia
NOT an adverse effect of naloxone Seizure
nd rd
Treatment of Opioid withdrawal Symptoms Methadone, 2 – Buprenorphine, 3 –
Clonidine/Cefexidine
Opioid Detoxification All the above + Naltrexone
Rapid opiate detoxification Naltrexone + alpha 2 agonist
Opioid Relapse Naltrexone
Naltrexone used in opioid dependence to Prevent relapse
Naltrexone Opioid antagonist, Used to treat opioid dependence
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COGNITIVE DISORDERS 17
PSYCHIATRY
and alcohol dependence

Naltrexone does NOT block Craving for opioids
NOT true about naltrexone Parenterally administered
Nalmefene LONGER acting than naloxone
Does NOT possess even slightest agonist action Nalmefene
NOT a pure opioid antagonist Nalorphine
NOT used in opioid dependence Disulfiram
NICOTINE
Pipes, cigars accumulate in Oral mucosa (alkaline pH)

Cigarettes accumulate in Lung (acidic pH)
Most serious component of cigarette smoke Tar
predisposing to cancer
Effects of smoking Decreased HDL, Increased hematocrit, Increased heart
rate and increased catecholamine, Increased
carboxyhemoglobin
Smoking induce Cytochrome P450
Nicotine withdrawal is associated with Bradycardia, Depression, Headache, Anxiety
Fagerstrom test for Nicotine dependence
Symptom NOT associated with Nicotine withdrawal
More effective in smoking cessation Bupropion
Drugs used for smoking cessation Bupropion, varneciline, clonidine
Most acute effect of smoking cessation Shift of oxyhemoglobin curve to right
NOT a form of smoking cessation Tablets
Smoke free society is initiated in Norway
CAFFEINE
Caffeine Trimethylxanthine
Caffeinism occurs if ingestion of caffeine is 500 mg/day
above
Caffeine withdrawal is associated with Headache, depression, anxiety
NOT a feature of caffeine withdrawal Mania
COGNITIVE DISORDERS
FEATURES OF COGNITIVE DISORDERS
As per WHO, percentage of aggregate 10%

point prevalence of neuropsychiatric
illness in the world
Probabilistic learning is from Past experiences
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PSYCHIATRY
Implicit learning is Procedural skill acquirement

Explicit memory is Remembering past events with consciousness
1 week before incidence recall Recent memory
Memory in past few hours Recent memory
Ability to form a concept and generalize it Abstract thinking
Out of sight mind is Sensorimotor stage
Cognitive disorder Dementia, delirium
Cognitive dysfunction Catastrophic thinking, arbitrary inference,
overgeneralistion
Patient undergone cardiac bye pass surgery, forgetting Cognitive dysfunction
things, NOT able to recall names
NOT a cognitive dysfunction Thought block
NOT seen in organic psychosis Normal common knowledge
Mini mental status is 30 point programme to evaluate cognitive function
NOT a cognitive behavior change technique Consolidation
Nootropic drug Piracetam
Types of Psychoanalytic Psychotherapy Cognitive therapy, Psychoanalysis, Insight therapy
Cognitive remediation used in Improving memory
ORGANIC BRAIN SYNDROME
Visual hallucination without auditory hallucination Organic brain damage

Delusion, hallucination, disturbed cognitive function Organic brain syndrome
Disorientation is commonly seen with Organic brain damage
Disturbed orientation Organic mental disorder
Organic mental disease is indicated by Delusion
Suggestive of organic cause of behavioral symptoms Prominent visual hallucinations
Behavioral problem suggesting organic brain lesion Visual hallucination
Disorientation for time Korsakoff’s psychosis, dementia, delirium
DELIRIUM
Commonest symptom postoperatively Delirium

Highest risk of delirium ICU patients
Agent causing delirium Dhatura
Delirium is associated with Dhatura, lead, opioid, cannabis
Delirium is mostly seen in Tertiary care services
Sun downing Delirium
Delirium is associated with Hyponatremia, Hypokalemia, Meningitis
Illusion with altered sensorium Delirium
Slow waves in EEG activity Delirium
Features of delirium Attention deficit, autonomic instability, altered sleep
wake pattern, hallucination
Visual hallucinations, illusions, fugue, disorientation Delirium
Semiconsciousness, altered sensorium, visual Delirium
hallucinations, fragmented delusion
Lilliputian hallucination is associated with Delirium
Delirium Decreased attention
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PSYCHIATRY
Delusion in delirium Transient

Delirium is associated with Disorientation
Delirium and schizophrenia differentiated by Complete consciousness
NOT a feature of delirium Loss of memory
NOT a feature of Delirium Hyperactivity
AMNESTIC DISORDERS
45 year male, alcohol dependence, confusion, Wernicke encephalopathy

nystagmus, ataxia, 6th nerve weakness
Wernicke’s disease Global Confusion, Ophthalmoplegia, Ataxia
Wenicke’s encephalopathy Residual palsy in 50% of patients, extraocular palsy
disappears in hour
NOT involved in Wernicke’s Encephalopathy Hippocampus
Treatment of Wernicke’s Encephalopathy Thiamine
Vitamin required in increased Carbohydrate diet Vitamin B1
Confabulation typically seen in Alcoholism
Korsakoff’s psychosis Severe anterograde and mild retrograde memory
Korsakoff’s syndrome Confabulation
Korsakoff’s psychosis is diagnosed by Impairment of long term memory
Features of Korsakoff’s psychosis Reversible, Lack of insight, Loss of intellectual functions
but preservation of memory, Loss of recent memory
Site of lesion in korsakoff’s psychosis Mamillary body
NOT involved in Wernicke’s korsakoff’s syndrome Periventricular grey matter
NOT a feature of Wernicke Korsakoff Psychosis Normal pupillary response, Normal sensorium
NOT seen in korsakoff psychosis Suicidal tendencies
NOT seen in korsakoff’s psychosis Loss of remote memory
NOT a feature of Korsakoff’s syndrome Defective motor skill
NOT normal in korsakoff’s psychosis Learning
Anterograde amnesia Head injury
Anterograde commonly seen after Post traumatic head injury
Psychogenic amnesia characterized by Patchy impairment of personal memories
DEMENTIA
Psychiatric disorder common in India above 60 Dementia

MC cause of dementia in adult Alzheimer’s disease
Cause of reversible dementia Hypothyroidism, subacute combined degeneration
Reversible cause of dementia Toxic, post encephalitis
Treatable cause of dementia Hypothyroidism, SDH, Hydrocephalus
Dementia NOT seen in Schizophrenia
Dementia NOT seen in Ganser syndrome
Dementia Irreversible, hallucination are NOT common, nootropics
has limited role
Most helpful in differentiating dementia Grasp reflex
from severe depression
Irreversible dementia Alzheimer’s disease
Cortical dementia Simple delusion
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PSYCHIATRY
Subcortical dementia Complex delusion

Characteristic feature of subcortical dementia Memory loss
Sub cortical dementia NOT seen in Alzheimer’s disease
Does NOT cause subcortical dementia Alzheimer disease
Biological amnesia Pre senile dementia
Vascular dementia is characterized by Disorientation, memory deficit, emotional liability,
personality disorientation
Frontotemporal dementia Pick’s disease, Non fluent aphasia, semantic dementia
Frontotemporal dementia is associated with Progranulin protein
Localized regional cerebral atrophy Frontotemporal dementia
Frontotemporal dementia Loss of insight
NOT true about dementia Delirium is present
Dementia with lewy body Posterior parietal involvement
Pick’s body in pick’s disease Tau Protein
NOT true about dementia Clouding of consciousness
NOT a feature of dementia Loss of sensorium
NOT a feature of cortical dementia Multiple sclerosis
Mini mental scale 10 Dementia
MMSE test is also known as Folstein
Rivastigmine, Donepezil used in management of Dementia
ALZHEIMER’S DISEASE
MC Mental Disorder causing death Alzheimer’s and Other Dementia

Chromosomal anomaly associated with Alzheimer Trisomy 21
disease
Protein involved in Alzheimer disease Apo E gene
Protein affected in Alzheimer’s disease β-amyloid
NOT a predisposition to Alzheimer’s disease Smoking
Biochemical etiology of Alzheimer disease relates to Acetylcholine
Neurotransmitter NOT associated with Alzheimer Dopamine
disease
Alzheimer's disease Temporal & Parietal
Alzheimer’s disease begins in Transentorhinal region
Involved in alzheimer’s disease Cortical atrophy of temporoparietal cortex
Nucleus involved in alzheimer’s disease Basal nucleus of Meyernet
Area of brain resistant to Alzheimer’s disease Lateral geniculate body
Propagnosia , loss of memory, 3rd person hallucinations Alzheimer disease
in 70 year old man, 1 month increased deep tendon
reflexes, mini mental examination score 20/30
Extensor plantar features and myoclonus Late features
in Alzheimer diseases are
Feature of Alzheimer disease Recent memory loss
Features of Alzheimer disease Neurofibrillary tangles, senile plaques, amyloid
angiopathy
Cerebral amyloid angiopathy Confined to particular lobe
Neurofibrillary tangles and senile plaques Alzheimer’s disease
Senile degenerative plaques Alzheimer’s disease
Hirano bodies Alzheimer disease
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SCHIZOPHRENIA 21
PSYCHIATRY
Senile plaque in Alzheimer’s disease Ubiquitin

stained with
Neurofibrillary tangles contain Aluminium
Number of neurofibrillary tangle associated with Severity of dementia
Number of senile neural plaques correlates with Age
Presence of tau protein suggest Neurodegeneration
NOT a feature of Alzheimer disease Lewy body
NOT true about Alzheimer’s disease Extracellular lesions can occur in absence of
intracellular inclusions to make pathological diagnosis
of Alzheimer’s disease
NOT a feature of Alzheimer’s disease Cerebellar atrophy, cerebral infarcts
NOT seen in Alzheimer’s disease Acalculia
Alzheimer’s disease is related to Small vessel disease
Donepezil and Rivastigmine used in management of Alzheimer’s disease
Drug used in Alzheimer disease Rivastigmine
Anticholinergic drug used in Alzheimer disease Rivastigmine
Drug used in Alzheimer disease having adverse effect Tacrine
on Liver
Huperzine A is used in treatment of Alzheimer disease
Antihelminth used in management of Metrifonate
Alzheimer disease
Secretase inhibitors used in management Taranflurbil, semagacestat
of Alzheimer disease
Which if combined with rivastigmine decreases its Tricyclic antidepressants
efficacy
NOT used for Alzheimer disease Quinagolide
NOT used in Alzheimer disease Ropinirole
SCHIZOPHRENIA
RISK OF SCHIZOPHRENIA
General Population 1%
Nephew/Niece 2.5%
Half siblings 3.5%
Non twin sibling of Schizophrenic 8%
Dizygotic twin of Schizophrenic 12%
Child with One parent Schizophrenic 12%
Sibling of Schizophrenic with one parent 15%
Schizophrenic
Child with Both parents Schizophrenic 40%
Monozygotic twin of Schizophrenic 47%
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SCHIZOPHRENIA 22
PSYCHIATRY
FEATURES OF SCHIZOPHRENIA
Incidence of suicide 8-10 per 10 lakh population

Life time risk of schizophrenia 1%
Incidence of schizophrenia in India 1-5%
Dopamine hypothesis is implicated in Schizophrenia
etiology of
Schizophrenia is common in Adolescents
Maximum heritability Schizophrenia
Percentage of monozygotic twins in schizophrenia 50%
Genetics of schizophrenia Reduced expression of genes encoding Glutamic acid
decarboxylase – GAD 1 (synthesize GABA) in prefrontal
cortex, Neuregulin 1 (member of EGF family)
Dementia precox coined by Kraeplin
Bleuler’s 4 A of Schizophrenia Autism (Abstract thinking), Ambivalence, Association
Lack, Affect Blunted
Schizophrenia is a Functional psychosis
Impaired insight is seen in Schizophrenia
Ambivalence Schizophrenia
Late onset schizophrenia after 45 years of age
Schneider First Rank Symptoms Auditory hallucinations, Thought Insertion, Thought
withdrawal, Thought broadcasting, Made feeling, Made
actions, Somatic Passivity, Delusional Perception
First order symptoms of schizophrenia Running commentary of one’s thoughts, primary
delusion, somatic passivity
First rank symptom Voice commenting on action
NOT a first rank symptom of Schizophrenia Perplexity, Echolalia
NOT a first rank symptom Depersonalization
People affected in Schizophrenia More Intelligent
Schizophrenia commonly occurs in Adolescents, low socioeconomic factors
Schizophrenia associated with Asthenic personality
Somatic passivity Paranoid schizophrenia
Primary disturbance in schizophrenia Formal thought disorder
Schizophrenia Altered affect, Incongruity of emotion, Neologism
Pathognomic of schizophrenia Auditory hallucination giving running commentary
Schizophrenia Thought broadcasting, third person hallucination,
makes violence
Loss of insight Schizophrenia
Features of schizophrenia rather than organic psychosis Third person hallucination, split personality, systemized
delusion
Psychosis, negativism, fluctuating consciousness is seen Schizophrenia
in
Von Gogh Syndrome Self Mutilation in Schizophrenia
MC hallucination in Schizophrenia Auditory
Delusions are characteristically seen in Schizophrenia
Delusion of Influence Schizophrenia
Paranoid schizophrenia presents with Persecutory or Grandiose delusion
Schizophrenia like symptoms Amphetamine
First symptom to go off on treatment of schizophrenia Auditory hallucination
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SCHIZOPHRENIA 23
PSYCHIATRY
Auditory and Visual hallucination with clear sensorium Schizophrenia

MC cause of premature death in schizophrenia Suicide
NOT true about hallucinations in Almost always continuous
schizophrenia
NOT a characteristic of schizophrenia Intermittent mood changes, altered sensorium, elation
False about schizophrenia Sustained mood changes
Biochemical feature in schizophrenia Increased dopamine and increased seratonin
Neurotransmitter involved in both positive and negative Dopamine
symptoms of schizophrenia
Positive symptoms of schizophrenia Conceptional disorganization, delusions or
hallucinations
Negative symptoms of schizophrenia Loss of function, anhedonia, decreased
emotional expression, impaired
concentration, diminished social
engagement
Poor prognostic features in schizophrenia Insidious onset, onset less than 20 years of
age, disorganized, chronic course, absence
of depression, predominance of negative
symptoms, family history, past history,
asthenic, male, poor social support,
unmarried, flat or blunted affect,
institutionalization, evidence of
ventricular enlargement on CT scan
Poor prognostic factor in schizophrenia Past history of schizophrenia, Gradual onset
Bad prognostic feature of schizophrenia Negative history, late onset of disease
Bad prognostic feature of schizophrenia Negative symptoms
Good prognostic feature of schizophrenia Affective symptoms
Good Prognostic feature in Schizophrenia Acute onset, Affective disorder, High intelligence,
Obvious precipitating factor, Atypical symptoms
TYPES OF SCHIZOPHRENIA
Catatonia is commonly seen in Schizophrenia

Waxy flexibility, rigidity, negativism, grimacing, Catatonic schizophrenia
mannerism
Catatonic schizophrenia is associated with Motor symptoms
Psychomotor symptoms in Schizophrenia Catatonic
Stupor, waxy flexibility, Posturing Catatonic Schizophrenia
Late onset good prognosis Catatonic
Best prognosis Catatonic schizophrenia
Catatonic features of schizophrenia also seen in Severe depression, conversion disorder
Schizophrenia with late onset and poor prognosis Catatonic schizophrenia
NOT a feature of catatonic schizophrenia Flight of ideas, gegelhalten
NOT a feature of catatonia Catalepsy
NOT a feature of catatonia Cataplexy, increased deep tendon reflex
NOT a feature of catatonia Grandiosity
MC type of Schizophrenia Paranoid
Defect of conation is typically seen in Paranoid schizophrenia
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MOOD DISORDERS 24
PSYCHIATRY
Delusion of persecution, control and self reference Paranoid schizophrenia

NOT true about paranoid schizophrenia Rapid deterioration of personality
Disorganized schizophrenia is also called as Heberphrenic schizophrenia
Early onset, poor prognosis Heberphernic
Grossly disorganized, severe personality deterioration Heberphrenic
and worst prognosis
Day rocking, muttering softly to self, Disorganized schizophrenia
looking at reflection in a small mirror,
needs help in dressing and showering,
giggles and laughs for no apparent reason
Type schizophrenia with worst prognosis Simple schizophrenia
Simple Schizophrenia Social withdrawal
Schizophrenia with worst prognosis Undifferentiated
Visual hallucinations without Auditory hallucination Chronic schizophrenia
Schizophrenia occurring in persons with Propf schizophrenia
IQ less than 70
Type I schizophrenia Responds well to treatment
Type II schizophrenia NOT characterized by Disorganized behavior
MANAGEMENT OF SCHIZOPHRENIA
Neuropathological findings in Schizophrenia Enlargement of lateral ventricles of cerebral hemispheres,

Reduction in cortical thickness
Homovanilic acid in blood is associated Schizophrenia
with
Drugs used in schizophrenia Trifluphenazine, fluphenazine, chlorpromazine,
clozapine, olanzapine, risperidone, haloperidol
Treatment of negative symptoms in schizophrenia Clozapine
Drug of choice for Refractory Schizophrenia Clozapine
Schizophrenic is getting chlorpromazine, his auditory Clozapine
hallucinations are not controlled
Recently approved drug for Schizophrenia Praliperidone (Metabolite of Risperidone)
Paliperidone D2 and 5HT2A antagonist, used for
treatment of schizophrenia, can cause
neuroleptic malignant syndrome
NOT a treatment of schizophrenia Pemoline
MOOD DISORDERS
DEPRESSION
Incidence of Suicide 8 -10 per lakhs Population

Chance of identical twins associated with 50%
major depression
MC age group of Major Depression Middle aged Females
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MOOD DISORDERS 25
PSYCHIATRY
Maximum loss of DALY occurs in which psychiatric Depression

condition
Psychological disorder commonly associated with Depression
myxedema
MC type of post pubertal psychosis Depression
MC side effect of antihypertensive medication Depression
Hypothyroidism is associated with features of Depression
Parkinsonism commonly presents with Depression
Common cause of mood congruent delusion Depression
Brief depressive disorder Depressive episode lasting for atleast 2
days but less than 2 weeks
MC Mental Disorder causing DALY loss Unipolar Depression
MC Psychiatric disorder in India/World Major Depression
Depression is commonly associated with Pancreas
cancer of
Psychiatric disorder associated with Depression
chronic hepatitis C infection and may
complicate with interferon alpha therapy
Features of depression Insomnia, weight loss, loss of self esteem
Early morning awakening is associated Depression
with
Major Psychosis Endogenous depression
Depression is a Mood disorder
Depression (DSM-IV) 2 weeks
Major depression Minimum duration 2 weeks, shows REM latency
Major depression Abnormally diminished activity in prefrontal cortex,
monoaminergic system disturbances, genetic
predisposition is present
Most important feature of major Alteration in affect
depression
Double depression Major depression on neurotic depression
In depression, there is deficiency of Seratonin
Otto veraguth sign Depression
Depression is associated with Adrenocortical insufficiency, pancreatic
carcinoma, hyperparathyroidism
Depression is associated with Increased CRH, Increased adrenal size
Nihilistic delusions seen in Endogenous depression, double depression
Learnt helplessness resemble Depression
Nihilistic ideas Cotard syndrome, Depression
Delusions of Nihilism and early morning insomnia Major depression
Nihilistic delusion, Pseudodementia Depression
Delusion seen in depression Guilt, Poverty, Nihilistic delusion
Risk factors for suicidal tendency in depression Written or verbal communication of suicidal intent,
early stage of depression, recovering stage of
depression
Suicidal tendencies most common with Depression
Depression in elderly is typically Suicidial tendencies
associated with
Slowed Thought Depression
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MOOD DISORDERS 26
PSYCHIATRY
Neurotic depression characterized by Weight gain, Hypersomnia, Ruinous appetite

Essential feature for diagnosis of depression Anhedonia
25 year old woman, intense depressed mood for 6 Anhedonia
months and inability to enjoy previous pleasurable
activities
NOT seen in endogenous depression Third person hallucination
NOT a feature of depression Normal ability to think or concentrate
Neurofinding in Major Depression Decreased blood flow and metabolism of Prefrontal
Cortex (Especially Left)
Treatment of choice in Depression CBT
Neurotic depression is also known as Dysthymia
Neurotic depression is associated with Anxiety
Dysthymia Chronic mild depression
Dysthymia 2 years
3 years history of depression Dysthymia
NOT true about dysthymia Delusions
Intense nihilism, somatization and agitation in old age Involutional melancholia
Depression with Marked Psychomotor Retardation Melancholic
New plant extract tried for treatment of St. John’s wort
depression
A 35 year old man with major depression, Increase the dose to sertaline
he was started on sertaline 25 mg/d. After
one week dose is increased to 50 mg/d.
Patient remains depressed and does not
respond to sertaline
A patient with depression is prescribed Continue fluoxetine with same dose
with fluoxetine. He is followed after 2 (should wait for 4 – 6 weeks)
weeks. He showed no improvement. Next
line of management
FDA approved treatment for refractory Combination of fluoxetine with olanzapine
depression
Adjuvant treatment of depression Levothyroxine
MANIA
Mania is a Bipolar disorder

Stage of mania Stage 1 – euphoria, stage 2 – elation, stage 3
– escalation, stage 4 - ecstasy
Mania a potu Pathological intoxication
Mania is a disorder of Mood
Criteria to diagnose mania duration 1 week
Pressure of Thought Mania
Increase in goal directed activity Mania
Basic defect in Mania Mood elation
Mania Elevated mood, delusion of grandiosity, distractibility
Increased alcohol consumption, sexual indulgence, Mania
irritability, lack of sleep
Acute mania with mood disturbance Cyclothymic disorder
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MOOD DISORDERS 27
PSYCHIATRY
Neurotransmitter increased in mania Noradrenaline

NOT seen in mania Clouding of consciousness, disorientation
BIPOLAR DISORDERS
Increased sodium retention in body is Depression and mania

associated with
Type of inheritance proved by molecular X linked
genetics in bipolar syndrome
Maniac depressive psychosis Equal incidence in male and female (only
in bipolar disorder), younger age of onset
in women, predisposition of aggressive
women with masculin, diagnosis is reliable
across geographical area
Chromosome associated with bipolar disease Chromosome 18 and chromosome 13
MDP Patient remits completely in between attack
Period of normalcy in between two psychotic disorders Maniac depressive psychosis
is a feature of
BPAD include Recurrent maniac episodes, depressive episode with
hypomanic episodes, maniac and depressive episodes
BPAD does NOT include Recurrent depressive disorders
Recurrent depressive disorder means Unipolar depressive disorder
Type II bipolar disorder Major depression and hypomania
Rapid cyclers 4 or more episodes of either depression/mania in a year
Mood disorder seen in Schizoid state
NOT BPAD Recurrent depressive episodes, maniac episodes and
dysthymia
NOT included in diagnosis of bipolar disorder Depression
Poor prognosis in mood disorders Double depression, chronic ongoing stress,
co morbid personality disorder
Proven efficacy in bipolar syndrome Lamotrigine
SUICIDE
Suicidal risk in common in Childhood depression, Endogenous depression,

depression in involution
MC mental disorder as a cause of suicide Depression
Suicidal tendencies are most common in Depression, Schizophrenia, substance abuse
Suicidal attempts are more common in Severe depression, Bipolar disorder, Old age
Neurotransmitter associated with suicidal tendencies Serotonin
Increased suicidal tendency is associated with alteration Serotonin
in brain levels of
MANAGEMENT OF MOOD DISORDERS
Drug of choice for prophylaxis of mania Lithium
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MOOD DISORDERS 28
PSYCHIATRY
Drugs more effective during episodes of Olanzapine and benzodiazepines

hypomania
Treatment of euphoric mania Lithium
Dysphoric / True mixed mania Divalproex
Drug NOT used in Acute mania Clonidine
Neurotransmitters involved in depression Serotonin, norepinephrine
Antidepressant treatment based on Side effect profile of drug
Exercise relive depression by Raising endorphin level
Cognitive therapy is used for Depression
Drug of choice of depression in old person Fluoxetine
Drug of choice in elderly with depression and Coronary Fluoxetine
artery disease
Newer MAO inhibitors are useful in the treatment of Depression
NOT a serotonin norepinephrine reuptake inhibitors Paroxetine, Escitalopram
Treatment of Choice for Depression in Pregnancy and TCA
Lactation
Used to elevate mood Deep brain stimulation
Repetitive transcranial magnetic stimulation is Depressive disorder
approved for
Treatment of Choice for Depression with suicidal ECT
tendencies/delusional features
Treatment of choice for depression with suicidal Electroconvulsive therapy
tendencies
Mood stabilizers Lithium, Carbamazepine, Valproate
Maintenance of maniac depressive psychosis Carbamazepine, divalproex
Drug of choice for rapid cycling MDP Valproate
Prevention of Relapse in Bipolar Disorder Lithium
Which is not used for the treatment for Bipolar Benzodiazepines
disorders
Prophylaxis of BPD Lithium, olanzapine, lamotrigine
Prophylaxis of Bipolar Disorder Lithium
Drug used for prophylactic maniac depressive psychosis Lithium carbonate
NOT given for prophylaxis of BPD Carbamazepine, valporate
NOT used in Prophylaxis of Maniac depressive Psychosis Haloperidol
LITHIUM
Mechanism of action of lithium Affects Na+ K+ ATPase and accumulates

intracellularly, inhibits adenyl cyclase
and decrease cAMP intracellularly,
inhibit catecholamine release at synapse
Half life of lithium 24 hours
80% of lithium excreted in PCT
Thiazide + Lithium Lithium toxicity aggravated
Haloperidol should NOT be used with Lithium
Antipsychotic drug contraindicated in first trimester of Lithium
pregnancy
Antihypertensive contraindicated in patient on lithium Diuretics
therapy in order to prevent toxicity
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MOOD DISORDERS 29
PSYCHIATRY
Decreases renal lithium clearance Diuretics

Anti hypertensive NOT to be used in patient on Lithium Diuretics
Diuretic decrease renal lithium clearance Hydrochlorthiazide
Dose of lithium should be decreased in Thiazides
patients taking
NOT a part of treatment of lithium toxicity Using an antagonist
NOT true about lithium Na+ is specific antidote for lithium intoxication
Not true about lithium Non individual variation in rate of excretion
Lithium is best used in MDP bipolar
Lithium is used in treatment of Major depression, Vascular headache, Neutropenia
Acute mania managed by Lithium
Lithium is most useful in Prophylaxis of Mania
Lithium is used in Endogenous depression, Recurrent mania,
Schizoaffective Psychosis, Paranoid Psychosis
Lithium is used in treatment of Cluster headache
NOT an indication of lithium Generalized anxiety disorder
Lithium stopped before surgery 48 hours
Lithium levels should be measured after 12 hours
Serum level of drug is monitored when patient is on Lithium
Lithium monitoring done because of Low therapeutic index
Pre treatment evaluation of lithium therapy Serum creatinine
Narrow therapeutic index Lithium
Therapeutic level of Lithium in acute mania 0.6 – 1.2 mg/dl
Drug causing congenital valvular heart disease Lithium
MC Side Effect of Lithium Tremor
Lithium Leucocytosis, Polyuria/Polydipsia, Hand tremor, Muscle
weakness, Confusion, Nausea, vomiting, diarrhea
Long term use of lithium leads to Hypothyroidism
MC cardiac anomaly associated with use of Lithium in I Ebstein anomaly of Tricuspid valve
trimester of Pregnancy
Abnormality to check lithium is given to a pregnant Cardiac anomaly
female
Lithium use in pregnancy may result in Fetal cardiac malformation
Coarse tremors, dysarthria and ataxia are side effects of Lithium
Lithium toxicity Increased by decreased sodium levels
Lithium Cause benign and reversible depression of wave on
ECG
Increases thirst and cause dilute diuresis Lithium
Lithium cause Hypercalcemia
Drug of choice for lithium induced diabetes mellitus Amiloride
Tremors of lithium toxicity is treated with Propanolol
Mineral to be given adequately in a Iodine
patient taking lithium
Drug increasing lithium levels if Ibuprofen
prescribed with lithium
NOT an adverse effect of lithium Hyperthyroidism
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ANXIETY DISORDERS 30
PSYCHIATRY
ANXIETY DISORDERS
GENERAL FEATURES OF ANXIETY DISORDERS
Most prevalent psychiatric disorder in Anxiety disorders

generalized community
Unpleasant emotional state for which cause is either Anxiety
not readily identified or perceived to be uncontrollable
or unavoidable
Neurotransmitters associated with Increased noradrenaline, decreased GABA
anxiety and decreased serotonin
NOT a manifestation of anxiety Papillary constriction
NOT a symptom of anxiety Somatic and Psychological
Behavioral therapy is indicated in Phobia, OCD
Akathesia Motor restlessness
Treatment of performance anxiety Beta blockers before the event
GENERALISED ANXIETY DISORDERS
GAD – Short term treatment Benzodiazepines

GAD – Long term treatment SNRI
Generalized Anxiety Disorder 6 months
Generalized anxiety disorder Mydriasis
Generalized adaptation syndrome is seen in Stressful syndrome
GAS refers to Path of stress ANS when we are aroused by stressful
situation
Generalized anxiety disorder Excessive anxiety about multiple events in
conjunction with three or more of the
following symptoms for a period of 6
months : impaired sleep, poor
concentration, easy fatigability,
irritability, muscle tension or restlesness
Drugs used in generalized anxiety disorders Alprazolam, Paroxetine, Venlafaxine, Gabapentin,
buspirone
ANXIETY NEUROSIS
Profound mood disturbance Anxiety neurosis

Anxiety neurosis Excessive sweating, Palpitations, Tremor
Delusions are NOT seen in Anxiety neurosis
POST TRAUMATIC STRESS DISORDER
MC mental disorder after war zone Post traumatic stress disorder
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PSYCHIATRY
Post traumatic stress syndrome is due to Major life threatening events

Post traumatic stress syndrome Females, recall of events and avoidance of similar
experiences, disturbed sleep
Criteria for PTSD 1 month
Flash back phenomenon Post traumatic stress disorder
Post traumatic stress disorder is associated with Excess norepinephrine release
Excessive release of norepinephrine from Post traumatic stress disorder
local cereleus in response to stress and
increased noradrenergic activity at
projection site in hippocampus and
amygdale
Treatment of Post Traumatic stress Disorder SSRI
NOT a feature of post traumatic stress disorder Numbing, does NOT occur after 6 months, anxiolytic is
the treatment of choice, occurs in intellectual
NOT a clinical feature of Post traumatic stress disorder Hallucinations
Grief Normal response to loss of a loved person
Abnormal grief reaction Delayed or absent grief
PANIC ATTACK AND PANIC DISORDERS
Panicogenic agents Intravenous infusion of sodium lactate, Yohimbine, CCK 4,

CO2
Acute Panic Attack 10 minutes – 1 hour
Part of brain affected in panic disorder Locus cereleus
MRI feature of panic disorder Atrophy of right temporal lobe
PET feature of panic disorder Vasoconstriction
st
Panic disorder -1 line Benzodiazepines
Drug of choice Panic disorder SSRI
Drug of choice in Panic disorders Imipramine
Treatment of Choice for Panic disorder Cognitive Behavioral therapy
Neurotransmitters associated with panic disorders Seratonin, GABA, CCK, dopamine, pentagastrin
Panic disorder does NOT involve Glutamate
Sudden palpitation, sensation of impending doom Panic attack
Most appropriate treatment of panic attack Short term benzodiazepine, SSRI, CBT
Differential diagnosis of panic disorder Myocardial infarction, pheochromocytoma, mitral valve
prolapse, carcinoid syndrome
NOT included in psychosis Panic attack
Lack of insight is NOT a feature of Panic attack
PHOBIA
Systematic desensitization is used for Phobia

Treatment of choice for Phobia Behavioral therapy
Fear of travelling in crowded places Agoraphobia
Agoraphobia is a fear of Open Place, crowded place
MC Phobia encountered in Clinical practice Agoraphobia
NOT a feature of agoraphobia Visual hallucinations
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PSYCHIATRY
Fear of closed places Claustrophobia

Fear of height Acrophobia
Fear of darkness Nyctophobia
Fear of dust Myrophobia
Algephobia Fear of pain
Most specific feature of social phobia Blushing or shaking
Drug of choice for Social Phobia SSRI
Commonest phobia Social phobia
Treatment of Choice for Phobia Cognitive Behavioral therapy
Phobia Neurosis
Phobia typically seen at age of 8 years Thanatophobia
Thanatophobia Fear of death
Social phobia Irrational fear of activities
Definitive treatment of all type of phobia Behavioural therapy
Agoraphobia treated with Systematic desensitization, psychodynamic therapy,
exposure therapy, relaxation therapy, behavioral
therapy
Therapeutic exposure is a form of Behavioral therapy
Drug of choice for agoraphobia Clonazepam
Phobia is Neurosis
50 year male, uncomfortable In using lift being in Exposure
crowded places. treatment
Flooding is used for treatment of Phobia
OBSESSIVE COMPULSIVE DISORDER
Lifetime prevalence of OCD 2.5%

OCD may be a sequel of Group A beta hemolytic streptococcal
pharyngitis
In OCD Anxiety is produced, if not allowed to act
Obsessive Compulsive disorders include Sense of Guilt, Patient is aware of helplessness, Anxiety
relieved by an act
Disturbance of affect is NOT seen in Obsessions
Repeated occurrence of unwelcome thoughts followed Obsessive Compulsive disorder
by irresistible desire to do the act
A taxi driver is chronically consumed by Compulsion secondary to an obsession
fears of having accidentally run over a
pedestrian. Although he tries to convince
himself that his worries are silly, his
anxiety consumes to mount until he drives
back to the scene of ‘accident’ and proves
to himself that nobody lies hurt in the
street.
Neurotransmitter involved in OCD Serotonin
Secondary Depression OCD
Suicidal tendency is NOT commonly seen with Obsessive disorder
Defense mechanism adopted in OCD Isolation
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PSYCHOANALYSIS, EGO AND EGO DEFENCE MECHANISMS 33
PSYCHIATRY
Treatment of OCD Exposure and response prevention

OCD Ego alien, patient tries to resist against, insight is
present
Delusion is NOT ego alien
NOT a feature of OCD Indecisiveness
Drug of choice for OCD Fluoxetine
Tricyclic antidepressant used in the treatment of OCD Clomipramine
MC Type of OCD Washers
ECT is NOT used in Obsessive Compulsive disorder
Abnormal thought possession Obsessive compulsive disorder
OCD Ego dystonic, ego alien
OCD Repetitiveness, irresistibility, unpleasantness, conscious
about the disorder
Defense mechanism against OCD Denial
Differentiate obsessional idea from delusion Ideas is regarded as senseless by patient
Transmitter mainly involved in OCD Serotonin
OCD patient likely to develop Secondary depression
Treatment of choice for OCD Combination of behaviour and drug therapy
Psychosurgery of choice in intractable OCD Cingulotomy
NOT used for OCD Diazepam, MAO inhibitor
Best CBT technique for OCD Response prevention
Habituation and though stop tried for OCD
ADJUSTMENT DISORDER
Adjustment disorder Significant symptoms in response to an

identifiable psychosocial stressor,
symptoms develops within 3 months of
onset of stressor, limitations in functioning
Adjustment disorder Development of depressed mood anxiety related
symptoms of mild to moderate grade in response to an
identifiable stress within 3 months
Adjustment disorder Absented himself from work
PRE MENSTRUAL TENSION
NOT a differential diagnosis of pre menstrual tension Chronic fatigue syndrome
PSYCHOANALYSIS, EGO AND EGO DEFENCE MECHANISMS
PSYCHOANALYSIS
Father of Psychoanalysis Sigmund Freud

Pinel is famous for Psychoanalysis
Fundamental technique used in psychoanalysis Free association
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PSYCHIATRY
Theory of psychoanalysis development was given by Freud

Sigmund Freud’s primary process of thinking is Illogical and primitive
Important work of ‘The ego and Anna Freud
mechanism of defense’
A 70 year old woman has had three face Integrity Vs despair
lifts and never leaves house without make
up. She forbids her grandchildren to
address her as grandmother. According to
Erickson, which state of development is
she having difficulty mastering?
Psychodynamic model of disease explains Unconscious conflict
psychopathologic cause of all mental illness to be
NOT true about psychoanalysis Unguided communication has no meaning
ID, EGO AND SUPEREGO
‘id’ was coined by Freud

Executive organ of id Ego
Part of mind working on reality principle Ego
Concept of superego Freud
Superego Contains ego ideal
EGO DEFENCE MECHANISMS
Important defense mechanism Repression

Excludes painful stimulus from awareness Repression
Mature defense mechanisms Suppression, sublimation, anticipation,
humor, altruism
Mature defense mechanism Anticipation, Altruism
Mature defense mechanism Suppression, Anticipation
Mature defense Mechanism Sublimation
Psychological defense mechanism Displacement
Neurotic defense mechanism Repression
Preparing mentally for facing an unacceptable situation Reaction formation
Alcoholic after rehabilitation, works full Altruism
time as a full time volunteer for a non-
profit organization assisting patient with
liver cirrhosis
Blaming others Projection
Chronic alcoholic blames family environment as a cause Rationalization
of his alcoholism
Excludes painful stimuli from awareness Rationalization
Reluctant child forced to bring sugar from a shop spills Passive aggression
half of it on the way.
Displacement reaction is characteristically seen in Phobia
Defense mechanism seen in drug addicts Denial
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PSYCHIATRY
Undoing is typically seen in OCD

NOT a defense mechanism Obsession, Transference, derailment
RESEARCHERS IN PSYCHIATRY
Abolished practice of forcible restraints chaining Philippe Pinel (France)

mentally ill person
Moral treatment of mentally ill patient first stressed by Pinel
Cognitive Therapy of Depression Aarnon Beck
Topic commonly focused in cognitive Faulty ideas and belief
therapy
Psychodynamic theory Freud
Cocaine in psychiatry Freud
Free association Freud
Life span of Freud 1856-1939 ,Austria
Interpretation of dreams by Freud 1900
Ambivalence coined by Eugen bleuler
Schizophrenia is coined by Eugen Bleuler
Split thought in schizophrenia Eugen bleuler
Eight stage classification of human life Erikson
Therapeutic community Maxwell
Catatonia was coined by Kalbaum karl
Ross classified five stages of Death
LEARNING AND MANAGEMENT TECHNIQUES IN PSYCHIATRY
Psychological model that attempts to Health belief model

explain and predict health behaviors on
focusing attitudes and beliefs of
individuals
Chronic smoker developed chronic cough ready to stop Contemplation and sickness suceptibility
but he thinks it will make him irritable, stage of
behavioral change
When information memorized afterwards is interfered Proactive inhibition
by information learnt earlier, it is called
Stage of intuitive thought appearance in Jean Piaget Preoperational stage
scheme
Piaget’s psychoanalytic theory is used to assess Cognitive development
Reinforcement is used in Conditional learning
Pavlov’s experiment is an example of Classical conditioning
Mechanism behind classical conditioning Collateral nerve growth
Behavior therapy to change maladaptive behavior using Operant conditioning
response as reinforcer uses the principle of
Boy is NOT taking vegetables, mother gives chocolates Operant conditioning
with vegetables. This is
Operant conditioning where paradigm pain stimulation Punishment
given to a child for decreasing a certain undesired
behavior can be classified as
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PERSONALITY DISORDERS 36
PSYCHIATRY
Many of our bad activities in day to day life can be Negative conditioning
removed by
Psychodynamic theory of mental illness is based on Unconscious internal conflict
Counter transference Doctor’s feeling towards patient
NOT a method of learning in psychiatry Catharsis
Behavior therapy is useful in Phobia, OCD, Personality disorder, Panic attack, Anxiety
Cognitive behavior therapy deals with Maladaptive assumptions, Emotional consciousness of
automatic thoughts
NOT a part of cognitive behavior therapy Consolidation
NOT done in behavior therapy to increase a behavior Punishment
Patient of contamination phobia was asked by the Modelling
therapist to touch everything he touches
Systemic desensitization therapy used for Phobia
Treatment of obsessive compulsive disorder Exposure and response prevention
Reviving and bringing a psychiatric patient to normal Abreaction
consciousness
Features of seasonal affective disorder More common in women, anergy, fatigue,
weight gain, hypersomnia, episodic
carbohydrate craving, disease prevalence
increases with distance from equator,
improvement may occur by altering
exposure to light
Treatment of Choice for Seasonal Affective Disorder Phototherapy
Stimulation of nerve leading to elevated mood Vagus > Olfactory
PSYCHOSEXUAL STAGES OF DEVELOPMENT
Oedipus complex Freud

Oedipus complex seen in Boys, 3-5 years
In psychoanalytic terms, OCD is fixed at Anal stage
PERSONALITY DISORDERS
Components of personality Adjustment, Agreeableness, Sociability, Openness

NOT included in personality trait Problem solving
Cluster B Dramatic, irrational, erratic, acting out, emotional
Groups vulnerable for Suicide Widows, Positive family history, Aggressive behavior
Type A personality is susceptible for Coronary heart disease
Type A personality NOT characterized by Mood fluctuations
Type D personality has risk of Coronary heart disease
High sense of self esteem unable to take criticism Narcisstic personality
Multiple personality is seen in Identity disorder
Personality disorder Onset at early childhood and adolescence, matures
around adulthood, NOT associated to social norms,
pervasive and maladaptive behavior
Repeated self inflicted injuries Borderline personality
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SOMATOFORM DISORDER 37
PSYCHIATRY
Pervasive pattern of instability of interpersonal Borderline personality disorder

relationship self image affects, marked impulsivity that
begin at early adulthood
Female, slashed wrists, attempted suicide Border line personality disorder
Oddities of speech, mannerism, clothing, magical Schizoid personality
thinking, excessive preoccupation with fantasy,
emotional coldness
Emotional coldness and indifferent to Schizoid
praise and criticism
Inappropriate sensitivity, self importance, suspicioness Paranoid personality
Drug abuse Antisocial personality
Fole a deux Dependent personality
Anankastic personality Rigidity and stubbornness
Treatment of personality disorder Antipsychotics drugs are used, SSRI used in treatment,
behavior therapy
Treatment of personality disorder Dialectical behavior therapy
Psychotherapy for personality disorders is They often see their problem as a result of
so difficult because others
NOT a personality disorder classified as schizophrenia in Schizotype
ICD
Irresistible desire to do certain thing Impulse
SOMATOFORM DISORDER
SOMATISATION DISORDER
Individual have recurrent multiple Somatoform disorder

somatic complaints that cannot be
explained medically is known as
20 year female with complaints of nausea vomiting and Somatoform pain disorder
pain in legs. Physical examination and lab examinations
are normal
NOT a specific somatoform disorder Somatisation disorder
NOT a somatoform disorder Obsessive compulsive disorder
NOT a feature of somatization disorder Professional patients, maintain sick role
Seizure during sleep Epilepsy
Briquet syndrome Factitious disorder
Chronic fatigue syndrome Predisposed by childhood trauma, physical inactivity. At
least 6 months is required for diagnosis. Not relieved by rest
Cut off for severe fatigue in chronic >18
fatigue syndrome
Management of chronic fatigue syndrome Cognitive behavioral therapy
Management of chronic fatigue syndrome Cognitive behavioral therapy, Graded exercise therapy
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SOMATOFORM DISORDER 38
PSYCHIATRY
FIBROMYALGIA
Fibromyalgia Associated with stress

Breakaway pattern of weakness is seen in Fibromyalgia
Fibromyalgia SPECT studies have reduced blood flow to thalamus
Milnacipran Inhibits norepinephrine and serotonin
uptake, used for major depression and
fibromyalgia
HYSTERIA
Separation of any aspect of normal Dissociation

subjective experience from conscious
awareness as a result of psychological
distress
Consciousness, memory, identity and Dissociation
perception disruption defines
Defense mechanism in hysteria Dissociation
Maintaining sick role Factitious disorder
Scars on abdomen, maintain sick role and seek Factitious disorder
attention from nurse
Example for dissociation and conversion reaction Hysteria
Dissociation conversion disorder previously described Hysteria
as
Fixation of hysteria Phallic
MC presentation of hysterical pain Abdominal pain
Conversion disorder Conversion disorder is made only after
history of stressor, complaint of bodily
problems of motor type like
pseudoparalysis, pseudoseizure,
pseudoaphonia or sensory type like
pseudoblindness not explained by organic
problem
Dissociative fugue occurs in Hysteria
MC form of Dissociative hysteria Amnesia
Conversion reaction Secondary gain ,relation with stress
Characteristic field defect of hysteria Tubular vision
Field of vision in hysteria Spiral
La belle indifference is seen in Conversion reaction
La belle indifference Disregard for symptoms despite apparent
severity
Hysteria is characterized by Indifference to suffering
Hysterical neurosis is characterized by Dramatic and irregular gait
Epileptic fit and hysterical fit differentiated by Incontinence of Urine
Differentiate hysterical symptom from hypochondriacal Symptoms do NOT reflect understandable physiological
symptom or pathological mechanism
Malingering differentiated from disease by Uncooperative, Hostile toward medical profession,
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GENDER IDENTITY AND SEXUAL DISORDERS 39
PSYCHIATRY
Complaints characteristic of.

Difference between malingering and hysteria Conscious motive in malingering
Psychosomatic illness can be differentiated from Autonomic disturbance
hysteria by
Uncommon hysterical symptom Palpitation
Uncommon hysterical symptom Vomiting
NOT a feature of hysteria Autonomic symptoms
NOT seen in hysterical somatization Positive physical sign
Hysterical abdominal pain is NOT associated with Night Pains
NOT true about conversion disorder Late age onset
Treatment of choice in Hysterical Aphonia Free association
Psychotherapy is most useful in Hysteria
Hysteria in an intelligent educated person Psychoanalysis
responds best to
Behavior therapy NOT useful in Hysteria
HYPOCHONDRIASIS
Preoccupied with feeling of illness Hypochondriasis

Hypochondriasis 6 months
Definition of hypochondriasis Preoccupation with a serious illness despite medical
testing and reassurance to the contrary
DISSOCIATIVE DISORDERS
MC Type of Dissociative disorder Dissociative amnesia

MC Type of Dissociative amnesia Circumscribed
Young female presented with halos, abdominal pain, Dissociative disorder
amnesia
Person missing from home, found wandering Dissociative fugue
purposefully, well groomed and denies of having any
amnesia
Disorder in which an individual may Psychogenic fugue
manifest a personality that is opposite to
his normal personality
Seen in dissociative disorder Fugue, amnesia, multiple personality
NOT a dissociative disorder Psychogenic deafness
GENDER IDENTITY AND SEXUAL DISORDERS
GENDER IDENTITY DISORDERS
Irresistible sexual desire in male Satyriasis

Homosexual person feels, he is imposed by a female Gender identity disorder
body and persistent discomfort with his sex
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EATING DISORDERS 40
PSYCHIATRY
Wearing clothes of opposite sex for temporary Dual role transvestism

enjoyment
Transvestic fetishism Affected individuals are aroused when
dressed as woman
Trans sexualism means Persistent sense of discomfort regarding one’s
anatomical sex
Chromosomal defect is NOT a feature of Concealed sex
Bremelanotide used for Erectile dysfunction
IMPOTENCE
Impotence is expressed as Inability to perform sexual act

Impotence is commonly caused by Beta blockers
Impotence quad hoc Impotent to particular woman
Essential ingredient of Master and Johnson’s treatment Avoidance of demand for performance
of Impotence
Impotence Sensate Focus
ERECTILE DYSFUNCTION
Erectile dysfunction Sildenafil citrate

Pharmacological action of sildenafil is PDE 5
associated with
Toxic effects of sildenafil is associated with PDE 6
55 year old diabetic patient, impotence with failure to Vacuum constriction device
get erection after papaverine intracavernous injection.
Colour doppler shows no abnormality of arteries but
shows mild venous run off. treatment of choice
Used in erectile dysfunction Apomorphine, alprostadil, PGE1 analogues
Drug used for erectile dysfunction when Alprostadil
PDE 5 inhibitors are not effective
Apomorphine is Emetic
NOT used in treatment of erectile dysfunction Phenylephrine
Sympathomimetic drugs NOT used in therapy of Erectile dysfunction
PREMATURE EJACULATION
Treatment of Premature Ejaculation Squeeze technique

Dhat syndrome Fear of losing semen
EATING DISORDERS
Female athlete triad Eating disorders, amenorrhea and

decreased bone mineral density
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SLEEP DISORDERS 41
PSYCHIATRY
Anorexia is caused by Denervation of stomach, increased Leptin, Increased

CCK in Brain
Anorexia can be differentiated from bulimia by Peculiar pattern of food handling
Good outcome in anorexia nervosa is Age of onset
associated with
NOT a common feature of anorexia nervosa Binge eating
NOT a feature of anorexia nervosa Amenorrhea is rare
NOT true about anorexia Decreased appetite
Drug of choice in anorexia nervosa Imipramine
Treatment of choice for anorexia nervosa Nutritional supplement
Excessive eating followed by purging by use of laxatives Bulimia nervosa
Prognosis of Bulimia Bad
Features of Bulimia nervosa Caries, Metabolic alkalosis, Parotitis, Intermittent
dieting, Repeated vomiting, Use of Cathatic and
diuretics
Most appropriate drug for treatment of Bulimia nervosa Fluoxetine
NOT seen in bulimia Menorrhagia
SLEEP DISORDERS
GENERAL FEATURES OF SLEEP DISORDERS
Circadian rhythm Suprachiasmatic nucleus

Key regulators of sleep in Hypothalamus
What will happen to sleep wake cycle if all Will be prolonged greater than 24 hours cycle length
environmental external cues are removed
REM sleep Paradoxical sleep
Main difference between REM sleep and wakefulness Decreased muscle tone
Paradoxical sleep Low amplitude, mixed frequency waves
Noctural penile tumnescence occurs in REM sleep
Night mare REM sleep
Night mares 3-6 years
EEG changes in Paradoxical sleep predominantly Mixed frequency
NOT a feature of paradoxical sleep EEG shows decreased activity
NOT a feature of REM sleep Bruxism
Night terrors occur during NREM sleep
Frequency of sleep spindles in Light Sleep 10 – 14 / second
K complex, sleep spindles Stage II
Slow waves is seen in NREM sleep stage IV
Phenomena closely associated with slow wave sleep Sleep walking
Drug of choice for night terrors Diazepam
Clinical definition of enuresis Beyond 4 years for daytime and beyond 6 years for
night time
Which is NOT correct about Nocturnal Enuresis in Imipramine is given
Children less than 4 years
Antidepressant used in nocturnal enuresis Imipramine, trimipramine
Relapse rate for nocturnal enuresis lowest with Bell alarm systems
In insomnia patient sleep most accurately recorded by Actigraph
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SLEEP DISORDERS 42
PSYCHIATRY
Remelteon Acts on both MT1 and MT2, metabolized by CYP 450,

approved for insomnia, no addiction potential
OSAS twice fold risk factor with Male sex
Criteria for diagnosis of sleep apnea is 30 seconds apnea for more than 10 times
known as
Presentation of obstructive sleep apnea Day time somnolence, noturia, respiratory
insufficiency
The sonorous sound in sleep apnea also known as Stridor hacking
Muller maneuver for Obstructive sleep apnea syndrome
50 year old obese smoker, alcoholic with snoring and Weight reduction and diet modification
hypertension, apneic attack of 5 per hour during sleep.
Apart from cessation of smoking, management
FDA approved indication for use of modafinil as an Obstructive sleep apnea
adjunct
Laser uvulopalatopharyngeal plasty for Snoring
EEG
Most important in sleep regulation Serotonin

EEG curves also known as Berger’s rhythm
Brain finger printing Used by EEG on lead
EEG is useful in evaluation of Intermittent Explosive disorder
EEG Bilaterally symmetrical
Normal adult human EEG Will not show high frequency waves during stage 3,
Shows alpha rhythm when a person is awake but
inattentive
EEG is normal in Locked in state
Pseudocoma is seen in Locked in state
Alpha coma EEG waves of 12 Hz, diffuse cortical damage, bad
prognosis
Frequency of A waves in EEG 8-12 seconds
Usual voltage of alpha rhythm 50 mv
Alpha rhythm REM sleep
Closed eyes and wandering mind Alpha waves in ECG
EEG pattern over occipital lobe when patient closed his Alpha wave
eyes
Beta waveforms in EEG Awake or alert state
EEG recorded from surface of scalp during REM sleep Beta
Frequency of beta waves in EEG 13 – 30
Delta waves of EEG over frontal region Metabolic encephalopathy
EEG of metabolic encephalopathy Generalized slowing
Slow wave sleep associated with Delta activity
Delta waves are found in Deep sleep
Waves seen Stage IV NREM Delta
Frequency of delta wave Less than 4 Hz
A person has which change in EEG in changing from Beta to delta
awake to unconscious
Highest frequency in EEG Gamma wave
EEG waves in hippocampus Theta
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IMPULSIVE DISORDERS 43
PSYCHIATRY
Symmetric high voltage triphasic slow wave Hepatic encephalopathy

Burst suppression in EEG Anoxic encephalopathy, HIE, phenobarbitol
administration to lower ICP in traumatic brain injury,
Severe hypothermia
Produce decreased EEG Hypothermia
EEG slowing during induction of anesthesia is due to Hypothermia
REM SLEEP
Autonomic hyperactivity and maximum REM sleep

dreams associated with
REM sleep is associated with Sexual arousal
Duration of nocturnal tumnescence About 100 times per night
During REM sleep, blood flow increased in Anterior cingulate cortex, pons, amygdala
NREM SLEEP
Slow wave sleep predominant in first one NREM stage III and IV
third of night sleep is a phase of
Nocturnal enuresis Stage IV of REM sleep
Treatment of choice for night terror Clonazepam
NARCOLEPSY
Narcolepsy is a disorder of REM sleep

Most important part of brain involved in narcolepsy Hypothalamus
Cataplexy is seen in Narcolepsy
Cataplexy means Sudden loss of tone
MC feature of narcolepsy Sleep attack
Most pathognomic of narcolepsy Cataplexy
Narcolepsy Sudden sleep, cataplexy, second decade
Associated with Narcolepsy Obesity, Lymphocytosis, Sexual impotence
NOT seen in narcolepsy Snoring
Typical polysomnography finding in Shortened REM latency, REM intrusion
narcolepsy during inappropriate period
Modafinil is approved for treatment of Obstructive sleep apnea syndrome, shift worker
syndrome, Narcolepsy
Drug approved for narcolepsy Gamma hydroxyl butyric acid
IMPULSIVE DISORDERS
Impulsive action Pyromania, Kleptomania, Trichtillomania

Oniomania is a disorder of Compulsive buying
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PEDIATRIC PSYCHIATRY 44
PSYCHIATRY
Kleptomania Irresistible desire to steal things

NOT a compulsive habit forming disorder Nymphomania
Defense mechanism in nymphomania Compensation
PEDIATRIC PSYCHIATRY
GENERAL FEATURES OF PEDIATRIC PSYCHIATRY
School child is most apt to have fears about Death or injury

Abstract thinking observed at 3 years
Behavior of adolescent is best described by Paradoxical
A homosexual stage in early adolescence Considered to be normal phenomenon
Common adjustment mechanism in children Projection
MC emotional disorder of children Neurosis
Common cause of enuresis in children Psychologic stress
10 year child is always restless inattentive to study and Its a serious illness require medical treatment
always wants to play outside. Parents are extremely
distressed.
Girl, headache while studying. Vision normal. NOT Self worth
further evaluated
Average IQ in Wechsler intelligence scale scoring 90
A girl aged 20 yrs complains of headache while Family history of headache, self expectations, her
studying. Her vision is found to be normal. Things interest in studies
considered
Juvenile offenders are below the age of 18 years
Boys who are over 16 years of age, Brostal
difficult to be handled in a certified school
or have misbehaved there are sent to
ATTENTION DEFICIT HYPERACTIVE DISORDER
Attention Deficit Hyperactive Disorder Male preponderance

11 year boy unable to concentrate, hardly ever in his Attention deficit hyperactive disorder
seat, roams around the hall
Hyperkinetic child Low IQ, Low attention deficit
ADHD in childhood can lead to Antisocial behavior, alcoholism, intellectual changes
Feature of ADHD Learning disability
NOT an essential feature of ADHD Mental retardation
NOT seen in hyperkinetic child Left to right disorientation
Hyperkinetic children does NOT show Hallucination
Methylphenidate is drug of choice for ADHD
nd
Attention Deficit Hyperactive Disorder Methylphenidate, 2 - Dextroamphetamine
Drugs used for treatment of ADHD Antidepressants, Amphetamines, Alpha agonists
Drug used to treat ADHD and narcolepsy Pemoline
Commonest side effect of methylphenidate Tics
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PEDIATRIC PSYCHIATRY 45
PSYCHIATRY
(Ritalin)
10 year child always restless, inattentive to study, want Behavioral therapy
to play outside. Next
AUTISM
Enzyme deficiency associated with autism Adenylsuccinate lyase

Autism is Pervasive Developmental disorder
Onset of autism is before 3 years of age
A girl with normal milestones spend time by seeing her Autism
own hand, do not interact with others
Delayed speech, poor concentration, difficulty in Autism
communication
6 year child birth asphyxia, does not communicate well, Autistic disorder
does not mix with people
Autism Incoordinate social interaction, defective reciprocal
interaction,
Infantile autism is characterized by Impaired neurobehavioral development, socioeconomic
hazard
Autism Biological causation, pervasive social and language
communication problem
NOT a feature of autism Visual impairment
NOT an characteristic of autism Onset after 8 years of age
Neuroanatomic abnormalities in Autism are found in Limbic system
2 year old child girl, wringing stereotype movements, Rett’s syndrome
poor social skills and deceleration of head growth after
6 months
Mostly confined to females Rett syndrome
NOT seen in Rett syndrome Macrocephaly
Asperger syndrome Developmental delay
MENTAL RETARDATION
Number of mentally retarded persons in INDIA 10 – 15 millions

MC Type of Mental Retardation Mild Mental Retardation
Mental retardation is NOT seen in Albinism
Inborn error of metabolism a/w Mental Retardation Homocystinuria
Mental retardation, Large testis, Large teeth Fragile X syndrome
Nucleotide repeat sequence in Fragile X syndrome CGG
Shermann pradox is associated with Fragile X syndrome
NOT a feature of fragile X syndrome Large nose
NOT associated with increased risk of malignancy Fragile X syndrome
A 4 year baby having large face, large jaw, large ear, Fragile X syndrome
macroorchidism
Management of choice for severe mental retardation Serial stimulation
Eligibility for disability benefit as per National trust act Mental retardation
Preventable cause of mental retardation Hypothyroidism
16 year old, mental age 9. IQ Mild mental retardation
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MANCHAUSEN SYNDROME 46
PSYCHIATRY
Disability Act 1995 Blindness, Low vision, Leprosy, Hearing impairment,

Locomotor disability, Mental retardation, Mental illness
Percentage of disability for certification 40%
nd
MC cause of Mental retardation Down’s Syndrome, 2 Fragile X Syndrome
MC cause of Mental retardation Birth Asphyxia
IQ in mental age equal to chronological age 100
Imbecile IQ 25-49, capacity 3-7 years of age, impaired self care
Male child of 15 years, with mental age of 9 years, IQ of 60
According to disability act,7th disability Mental illness
X linked disease leading to mental retardation Fragile X syndrome
Lack of development in children may be due to Deafness, mental subnormality
Conditions associated with mental retardation Trisomy 21, Fragile X syndrome, Homocystinemia,
Phenylketonuria, Tuberous sclerosis
IQ in Mild mental retardation 50 – 70
IQ of 50-70 Mild mental retardation
IQ means Capability of the child to perform intellectual tasks in
relation to children of same age
Mental retardation is NOT seen in Hypopituitarism
Preventable cause of mental retardation Cretinism
Mental retardation if IQ is below 70
Presenile dementia, if IQ is below 60
Moderate Mental Retardation 35-49 %
CONDUCT DISORDER AND SPECIFIC LEARNING DISORDER
Conduct disorder of child manifests with Disregard for right of others, doesn’t care for authority,
backward in study, steal things
14 year boy, difficulty in expressing himself in writing Specific learning disorder
frequent spelling mistakes. but mathematical ability and
social adjustment appropriate for age
Best therapy suited to teach life skill to a mentally Contingency
challenged child
Poor scholastic performance is NOT associated with PICA
MANCHAUSEN SYNDROME
Pseudologia fantastica Manchausen syndrome

Munchausen syndrome is a Factituous disorder
TREATMENT IN PSYCHIATRY
ANTIPSYCHOTICS
Common side effect of chronic use of phenothiazines Tardive dyskinesia
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TREATMENT IN PSYCHIATRY 47
PSYCHIATRY
5-HIAA may be false negative if patient is taking Phenothiazines

NOT a phenothiazine Haloperidol
Phenothiazines have Antiemetic action
Side effect of phenothiazines Opisthotonus
Priapism is associated with Phenothiazines
Least extrapyramidal side effects among options Thioridazine
Maximum hypotensive side effect Thioridazine
Galactorrhea caused by Phenothiazines
Most potent antipsychotic Haloperidol, fluphenazine
Distinct side effect of haloperidol Akathisia
Antipsychotic drug induced parkinsonism treated by Anticholinergics
Major difference between typical and atypical Former cause tardive dyskinesia
antipsychotics
Antipsychotic used as antidepressant Ziprasidone, flupenthixol
Antipsychotics can NOT cause Seizures
Potency of antipsychotics is based on Extrapyramidal symptoms
Antipsychotic drug with Selective D2 agonism Aripriprazole, Bifeprunox
Side effect of Antipsychotics Akathisia
Least Hypotensive Antipsychotic Molindone
Antipsychotic least likely to cause weight Molindone
gain
Blood levels of Neuroleptic are useful to check Toxicity
Galactorrhoea and amenorrhoea are side effects of Tuberoinfundibular dopamine pathway
antipsychotics due to involvement of
Antipsychotic with least extrapyramidal effects Risperidone, Thioridazine
Antipsychotic with prolonged action Fluphenazine
Available as depot preparation Haloperidol, risperdone, olanzapine, imipramine,
fluphenazine
Haloperidol toxicity is associated with Long QT
Metabolic syndrome commonly associated with Antipsychotics
Dry mouth in antipsychotics due to Muscarinic blockade
Depression is NOT a side effect of Flupenthixol
Maximum hypotension Thioridazine, Clozapine
Brown vision is a side effect of Thioridazine
Which of the following drug is available as depot Fluphenazine
preparation?
Seratonin dopamine antagonist Zotepine, sertindole
Carbamazeine is NOT used for Schizophrenia
Risperidone increases risk of Extrapyramidal symptoms
Risperidone acts of D2, 5HT2
NOT an atypical psychotic Loxapine
Antipsychotic with longest elimination half life Aripriprazole
NOT associated with increase in prolactin Quetiapine
Pimozide belongs to Diphenyl butryl piperidine
Dopamine agonist Bromocriptine
Bromocriptine Synthetic derivative, Has alpha blocking action,
Decreases GI motility, Acts on both D1 and D2 receptor
Bromocriptine Causes hypotension
Bromocriptine Dopamine receptor agonist
Bromocriptine NOT useful in Endogenous depression
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PSYCHIATRY
Long acting dopamine agonist Cabergoline

Long acting dopamine agonist Pramipexole
Dopamine agonist given in once a day dosage Pergolide
Highly sedating potential Quetiapine
Side effects of quetiapine Weight gain, constipation, blurring of
vision, somnolescence
Drug of choice in intractable hiccups Chlorpromazine
Most suitable drug in Psychosis Chlorpromazine
Least Potent antipsychotic Chlorpromazine
NOT a common side effect of chlorpromazine Osteoporosis
NOT a side effect of chlorpromazine Euphoria
Akathisia is commonly associated with Haloperidol
Akathisia is best treated with Proponolol
In drug induced parkinsonism, benzhexol has a role in Akathisia
Akathisia is treated by Trihexyphenidyl, haloperidol, promethazine
Irresistible urge to move about inner restlessness Akathisia
Akathisia is a Motor disorder
Common side effect of Haloperidol Akathisia
NOT true about tardive dyskinesia Antimuscarinic drug reduces its severity
Pacing, inability to sit at one place after haloperidol Propanolol
treatment
Extrapyramidal symptoms seen with Anti psychotics
Extrapyramidal symptoms best treated with Procyclidine
Antipsychotics Acute dystonia(7 days), Tardive dyskinesia(3 months),
Akathisia, Neuroleptic Malignant Syndrome
Tongue protrusion, oculogyric crisis, stiffness, abnormal Acute dystonia
posture of trunks and limbs. 2 days after haloperidol
Extrapyramidal symptoms within 2 days after Acute dystonia
administration of antipsychotics
Early sign of tardive dyskinesia Vermiform movement of tongue
Treatment of acute dystonia as a result of Procyclidine intravenously
metoclopramide
Feature of Akathisia is Restlesness
Oculogyric crisis is produced by Triflupherazine, Perchlorperazine, Perphenazine
Side effect of Chlorpromazine for which anticholinergic Oculogyric crisis
is used
Drugs used in Haloperidol induced dystonia Diazepam, Benztropine, Trihexyphenidyl
Drug of choice in phenothiazine induced dystonia Benztropine
Extrapyramidal symptoms common with Metoclopramide, phenothiazines, reserpine
Drug given for metoclopramide induced dystonic Promethazine
reaction
Long acting atypical antipsychotic Risperidone
Atypical antipsychotic agent Clozapine, Resperidone, aripripazole, olanzapine
Highest potential to cause metabolic syndrome Clozapine
Clozapine Used in schizophrenia, precipitate seizures, may cause
agranulocytosis
Clozapine Action more on D4 than D2, seizure, sialorrhoea,
agranulocytosis, should be discontinued if EBC count
less than 3000/mm3,should not be given with
carbamazepine
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PSYCHIATRY
Relative Contraindication for Clozapine Seizure disorder

Increased risk of agranulocytosis Clozapine
NOT a side effect of clozapine Weight loss
Antipsychotic with Least Extrapyramidal side effect Clozapines
Major side effect of clozapine Agranulocytosis
Atypical antipsychotic Clozapine
Levosulpride D2, D3, D4 antagonist
Appetite NOT decreased by Olanzapine
NEUROLEPTIC MALIGNANT SYNDROME
Hyperthermia, Muscle rigidity, change in consciousness, Neuroleptic malignant hyperthermia

increased creatine phosphokinase activity
Increased heat production in malignant hyperthermia is Increased muscle metabolism by excess of calcium ions
due to
Neuroleptic malignant syndrome is associated with Lead pipe rigidity
Drugs associated with neuroleptic Metoclopramide, phenothiazine,
malignant syndrome haloperidol
NOT a feature of Neuroleptic malignant syndrome Hypothermia
Does NOT cause neuroleptic malignant syndrome Amantidine
Does NOT cause neuroleptic malignant syndrome Domperidone
Investigations needed for neuroleptic malignant Hemogram, CPK, renal function test
syndrome
Malignant neuroleptic syndrome is treated with Dantrolene
ANTIDEPRESSANT DRUGS
Tricyclic antidepressants Blocks 5HT or NE uptake, Sedation, Anticholinergic

action
ECG change associated with overdose of QRS widening
tricyclic antidepressants
TCA cause anticholinergic action by Muscarinic receptor
Dry mouth during antidepressant therapy is caused by Muscarinic acetylcholine receptors
blockade of
NOT an action of TCA Anti MAO I action
TCA adversely interact with Tranylcypromine
TCA contraindicated in Glaucoma
NOT a clinical indication of TCA Uncontrolled seizure
Tricyclic antidepressant causing tardive Amoxapine
dyskinesia
Imipramine is mainly used as Transquilizer
Imipramine is used in endogenous Depression
Displace imipramine from protein binding sites Aspirin, propanolol, glibenclamide
Imipramine should NOT be used with Nikethamide (nikethamide is a stimulant)
Antidepressant used in nocturnal enuresis Imipramine
Cause of urinary retention in amitryptyline Anticholinergic
Psychiatric drug overdose cause bradycardia, Amitryptyline
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PSYCHIATRY
hypotension, decreased sweating and salivation

Side effect of amitryptyline Urinary retention
Drug NOT used in spasticity Amitryptyline
NOT a side effect of amitryptyline Weight loss
Tricyclic antidepressant poisoning Myoclonic jerks, seizures, tachycardia, metabolic
acidosis
Amitryptyline poisoning Sodium bicarbonate infusion, gastric lavage, diazepam
for seizure control
Should NOT be done amitryptyline poisoning Atropine as antidote
HIAA is a metabolite of Serotonin
SSRI Citalopram, Fluoxetine, Seratline, Fluoxamine
NOT a serotonin norepinephrine reuptake inhibitor Tianeptin
NOT an SSRI Amoxapine
NOT a selective serotonin reuptake inhibitor Desipramine
NOT a SSRI Dusulpein
SSRI are less effective than TCA in Chronic pain of neuropathic origin
management of
Side effect of SSRI Nausea, diarrhea, weight gain, sexual dysfunction,
Common side effect of SSRI Loose stools, anxiety
NOT a side effect of SSRI Urinary retention
Treatment of antidepressant induced diarrhea Famotidine
Treatment of antidepressant induced sexual dysfunction Bethanechol, Cyproheptadine, Bupropion, Amantadine
(Given befor sex)
Minimal discontinuation syndrome/ Fluoxetine
On sudden stoppage of what antidepressant drug does
NOT cause any side effect/ Longest half life
Drug of choice for depression in old Fluoxetine
patients
Least addictive Fluoxetine
SSRI Fluoxetine
Least anticholinergic side effects Fluoxetine
Antidepressant safely used in children Fluoxetine
Fluoxetine Non sedating, newer, NO abuse liability,
Mode of action of fluoxetine Inhibiton axonal uptake of 5HT
Newer antidepressant with nausea as troublesome side Fluoxetine
effect
Main difference between Fluoxetine and Imipramine Less side effects
Side effects of fluoxetine Sweating, urinary retention, diarrhea
Common side effect of fluoxetine Anxiety
Side effect of fluoxetine Loose stools
Side effect of paroxetine Erectile dysfunction, Decreased libido
NOT a side effect of paroxetine Premature ejaculation, Constipation
Antidepressant without anticholinergic effects Fluvoxamine
Antidepressant used as antipsychotic Amoxapine
Antidepressant found to be associated with tardive Amoxapine
dyskinesia and neuroleptic
Antidepressant causing Priapism Trazodone
Tianeptine acts by Seratonin uptake enhancer
Antidepressant increasing 5HT uptake Tianeptine
Non selective serotonin reuptake inhibitor Venlafaxine
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PSYCHIATRY
Venlafaxine is used in treatment of Depression

Desvenlafaxime SNRI, can cause priapism, glaucoma,
hyperlipidemia
MC side effect of desvenlafaxine Nausea
Dopamine and noradrenaline reuptake inhibitor Bupropion
New anti depressant that has no effect on 5HT receptor Reboxetine
Anti depressant having no specific inhibitory effect of P450 Escitalopram
system
Anti depressant with least cardiovascular Mianserin
side effects
NOT an antidepressant Pimozide
MAO INHIBITORS
May cause hypertensive crisis in patient on MAO Tyramine

therapy
MAO inhibitors should NOT be used with Pethidine
Food NOT given with MAO inhibitors Cheese, Beer, Fish
Phenelzine, non selective MAO inhibitor Propanolol
has interaction with
Moclobemide MAO inhibitor
MAO B inhibitor Deprenil
MAO – B inhibitors Pramipexole, Ropinirole
NOT a MAO inhibitor Maprotiline
Selegiline MAO B inhibitor, Does NOT cause cheese reaction, May
be used in on off phenomenon
Selegiline is an active inhibitor of MAO B
Selective inhibitor of monoamine oxidase B Selegiline
Tranylcypromine dangerous interaction with Amitrypline
Patient on antidepressant therapy developed sudden Tranylcypromine
hypertension on consuming cheese
MAO induced hypertensive crisis is Phenotolamine
reversed with
SERATONIN SYNDROME
Results in serotonin syndrome when combined with TCA, SSRI

MAO inhibitors
Serotonin syndrome is precipitated by Pentazocine, Buspirone, Mepiridine
Serotonin syndrome Tremor, agitation, cardiovascular collapse, predictable
NOT idiosyncratic, SSRI and MAO inhibitors cause it,
hypertension, hyperthermia, hyperreflexia
Feature of serotonin syndrome Myoclonus
Treatment of serotonin syndrome Cyproheptadine
ANTIANXIETY DRUGS
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PSYCHIATRY
Mandraux Hypnotic with antihistaminic

Benzodiazepines Diazepam causes lesser respiratory depression than
midazolam, Nitrazepam is metabolized in liver
Benzodiazepines Have active metabolites, decreased nocturnal gastric
secretion, extensively metabolized by CYP3,act at GABA
a receptors
Benzodiazepines Increase the frequency of opening chloride ion channels
that are coupled to GABA (A) receptors
Benzodiazepines Hypnotic, anxiolytic, amnestic
Drug acting through alpha subunit of GABA Benzodiazepine
Benzodiazepine and sedatives comparison If taken in higher doses less toxic than other sedatives
Benzodiazepine NOT used in elderly and those with liver Diazepam
disease
Diazepam acts on Ascending reticular activating system
Diazepam Oil based, contains propylene glycol which
is a venous irritant
Causes amnesia for longest duration Lorazepam
NOT metabolized by liver Oxazepam
Shortest acting benzodiazepine Midazolam
Inverse agonist of benzodiazepine receptor Betacarboline
Non benzodiazepine anxiolytic Buspirone
Buspirone Anxiolytic
Buspirone Anti anxiety agent, Slow and prolonged action,
Rifampicin causes decreased plasma levels of Buspirone
Anxiolytic action with least sedation Buspirone
Newer Non sedative Non hypnotic anxiolytic Buspirone
Does NOT bind to GABA receptor chloride channel Buspirone
Buspirone as compared to benzodiazepines Does NOT interfere with GABA nergic transmission
Sedation of buspirone Low
Buspirone Non benzodiazepine, used to induce sleep, anti-anxiety,
delayed onset of action
Barbiturates are derivatives of Urea
Drug commonly used in treatment of insomnia due to Mepobramate
anxiety
Beta blockers are indicated in Anxiety
Used in anxiety SSRI, clonazepam, buspirone
Anxiolytic with antidepressant action Alprazolam
NOT an adverse effect of benzodiazepines Tinnitus
BENZODIAZEPINE ANTAGONIST
Flumazenil Specific antagonist of BZD, given intravenously, acts on

GABA A receptor
Benzodiazepine antagonist Flumazenil
Duration of action of Flumazenil 30 or 40
NOT true about flumazenil Acts on same site on GABA channel where
benzodiazepines bind
NOT true about flumazenil It may be used in barbiturate poisoning
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PSYCHIATRY
DRUGS ACTING ON GABA
Ligand gated intrinsic ion channel GABA-A receptor

GABA-A receptor Ligand gated ion channel, receptor with
intrinsic ion channel, present on neuronal
membrane in CNS
Receptors with intrinsic ion channel GABA-A, NMDA, nicotinic cholinergic,
5HT-3
Agent binds to GABA receptor chloride channel complex Zolpidem
Baclofen acts on GABA-B receptor
Directly blocks chloride pore Picrotoxin
Does NOT act via GABA-A receptors Promethazine
ELECTROCONVULSIVE THERAPY
Foremost indication of ECT Depression with suicidal attempts, Catatonic

schizophrenia
Atropine is given before electroconvulsive Prevention of aspiration
therapy for
ECT is associated with Downregulation of beta adrenergic
receptor
Adequate motor seizure duration should 20 seconds
be
ECT in depressive phase of MDP is useful because it Shortens duration
ECT is the treatment of choice in Psychotic depression, Delusional depression, acute
depression
ECT is NOT useful in treatment of Chronic schizophrenia
Disadvantage of Modified ECT Necessity of an anesthetist
ECT is contraindicated in Increased ICT, Brain tumor, Pregnancy
Contraindication for ECT Retinal detachment
Volts required by ECT >80 mVolts
Increases on ECT Brain derived neurotrophic factor
Intraocular pressure after ECT Decreases
Best marker for ECT Brain derived growth factor
MC complication of ECT Amnesia
Memory disturbance in ECT recovers in Few weeks to few months
MC Side Effect of Direct ECT Fracture T4-T8 Spine
MC Side Effect of Modified ECT Retrograde Amnesia
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PSYCHIATRY

MANAGEMENT OF SCHIZOPHRENIA ....................................................................................................................... 24

KEY TO THIS DOCUMENT

Text in normal font – Must read point.

Text in bold font – Point from Harrison’s

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SIGNS AND SYMPTOMS IN PSYCHIATRY

GENERAL FEATURES OF PSYCHIATRIC SYMPTOMS

Word psychiatry is coined by Reil

Coprolalia Tourette syndrome

Delusion involve Disturbance of thought content

Misinterpretation with stimulus Illusion

Phantom limb pain is an example of Illusion

Hallucination is a disorder of Perception

SUBSTANCE RELATED DISORDERS

GENERAL FEATURES OF SUBSTANCE RELATED DISORDERS

Most widely used illicit substance in US Marijuana

Rave drug Amphetamine

Non synthetic alkaloid compound acting similar to Cocaine

Paranoid psychosis observed with cocaine overdose can Reverse tolerance

Cannabis preparation Ganja, Hashish, Charas

Standard drink 10 – 15 gm of ethanol

Fatal dose of absolute alcohol in adults 150 ml

NOT used in treatment of substance dependence Flumazenil

Delirium tremens precipitated by Sudden withdrawal of alcohol, Temporary excess

FETAL ALCOHOL SYNDROME

Fetal alcohol syndrome Microcephaly, Poor coordination, Flat face

King of narcotics Opioids

Drug acting on delta receptor Etorphine

NOT a cardiac poison Opium

Sudden respiratory distress, bilateral basal crepitations Narcotic overdose

TREATMENT OF OPIOID POISONING

Opioid receptor antagonists Naloxone used for opioid induced constipation,

and alcohol dependence

Pipes, cigars accumulate in Oral mucosa (alkaline pH)

FEATURES OF COGNITIVE DISORDERS

As per WHO, percentage of aggregate 10%

Implicit learning is Procedural skill acquirement

ORGANIC BRAIN SYNDROME

Visual hallucination without auditory hallucination Organic brain damage

Commonest symptom postoperatively Delirium

Delusion in delirium Transient

45 year male, alcohol dependence, confusion, Wernicke encephalopathy

Psychiatric disorder common in India above 60 Dementia

Subcortical dementia Complex delusion

MC Mental Disorder causing death Alzheimer’s and Other Dementia

Senile plaque in Alzheimer’s disease Ubiquitin

Incidence of suicide 8-10 per 10 lakh population

Auditory and Visual hallucination with clear sensorium Schizophrenia

Catatonia is commonly seen in Schizophrenia

Delusion of persecution, control and self reference Paranoid schizophrenia

Neuropathological findings in Schizophrenia Enlargement of lateral ventricles of cerebral hemispheres,

Incidence of Suicide 8 -10 per lakhs Population

Maximum loss of DALY occurs in which psychiatric Depression

Neurotic depression characterized by Weight gain, Hypersomnia, Ruinous appetite

Mania is a Bipolar disorder

Neurotransmitter increased in mania Noradrenaline

Increased sodium retention in body is Depression and mania

Suicidal risk in common in Childhood depression, Endogenous depression,

MANAGEMENT OF MOOD DISORDERS

Drug of choice for prophylaxis of mania Lithium

Drugs more effective during episodes of Olanzapine and benzodiazepines

Mechanism of action of lithium Affects Na+ K+ ATPase and accumulates