PSYCHIATRY

SCHIZOPHRENIA (3)

TOPIC
FINDINGS

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hallucination (2nd, 3rd person and running

commentary),
visual hallucination,
persecutory delusion,
thought insertion,
Identify premorbid personality?

aggressive behaviour
delusions of thought inference and delusion of
control
Schneider first rank
suicidal attempt.
negative symptoms - social withdrawal and
reduced speech.
Other symptoms - manic symptoms, mdd, or anxiety
symptoms
compliance to meds?
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QUESTIONS

Looseness of association, poor abstract, partial

insight

Etiology - Dopamine hypothesis

type of schizophrenia (paranoid? Or phase? Or
Resistant?) side effect of risperidone, clozapine?
kind of auditory hallucination common in
schizophrenia
type of persecutory delusion?
Ix -FBC if clozapine (agranulocytosis)
Investigation before started the medications
Mx other than biological? - psycotherapy
IM depot antipsy- clopixol, fluanzol, modecate
Prognosis factor
MENTARI Selayang
Acute management of aggressive
Extrapyramidal symptoms.
a person can see the music and voices what do
you call it? receptive hallucinations
condition people will have more visual then
auditory hallucinations? Substance abuse

GENERALIZED ANXIETY DISORDER

TOPIC

FINDINGS

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excessive worry & insomnia since 1& 1/2 years

ago
insomnia (difficulty initiating & maintain sleep)
stressor (father passed away)
BE SKIM :Blank mind difficulty concentrating,
Easy fatigability, Sleep disturbance, Keyed up
on edge or restless feeling, Irritability, Muscle
tension.
Identify premorbid personality?

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QUESTIONS

Diagnosis

Blood investigation (TFT)

Physiological changes causing to develop these

symptoms? What pathway? Sympathetic

Zolpidem pharmacology, s/e and dependency

and tolerance.

Manage - escitalopram & alprazolam (pathway

of drugs)
Non- pharmacological tx - relaxation technique,

breathing technique, CBT, graded exposure,

family therapy

medical illness regards to her sleep OSA

suddenly fall asleep in middle of talking?

Narcolepsy
other medical illness (hypertension hint)

Phaeochromocytoma.
Specific valvular heart condition that presented
with anxiety feature.
they asked ALL about anxiety disorder types.
IMPORTANT
ISSUES:
Notes:

MAJOR DEPRESSIVE DISORDER (5)

TOPIC
FINDINGS

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INSTRUCTIONS
(specific PE)

sleep deprivation and LOA for 2 months.

Stressor/precipitating (wife having affair,
parents always quarrel)
With psychosis (AH) or without
Suicidal risk (SAD PERSON)
SIGECAPS - S leep changes: increase during day or decreased sleep at night I
nterest (loss): of interest in activities that used to interest them G uilt (worthless):
depressed elderly tend to devalue themselves E nergy (lack): common presenting
symptom (fatigue) C ognition/C oncentration: reduced cognition &/or difficulty
concentrating A ppetite (wt. loss); usually declined, occasionally increased P
sychomotor: agitation (anxiety) or retardations (lethargic) S uicide/death preocp.
Detailed history of symptoms sleep (time, duration,), LOA (amount,duration)
Anhedonia
Rule out anxiety, manic symptoms. (Grandiosity or inflated self-esteem Sleep
decreased need for Talkative pressure of speech Pleasure will engage in high-risk
and irrational activities for pleasure, such as sex, spending, drugs, etc. Activity
goal directed, and psychomotor agitation increased Ideas flights of Distractibility)
Identify premorbid personality?

(cognitive): short term memory impaired,

knowledge low (could be because short term
memory loss), insight good

QUESTIONS

Criteria to dx mdd?

Management

Type of bipolar and what are they?

Suicide risk

Prognosis

Why do you say depressive episode, not MDD.

How to treat patient medically : -Name 5 SSRI.
BZD MOA and which ion channel involved. -Nonpharmacological management.

If pt good function with long depression what you call it

dysthymia
other ix you want to do to exclude medicall illness Hypothyroid.
stops medication when she wants to pregnant? Why?
impaired her socially and occupationally?
Mx biopsychosocial: (kena tahu each medication) a. SSRI
sertraline b. SNRI c. CBT d. Marital therapy (address stressor) .
perceptual disturbances depressed - mood congruent psychosis

IMPORTANT
ISSUES:
Notes:

stilnox = escitazolapram

OBSESSIVE-COMPULSIVE DISORDER (2)

TOPIC
FINDINGS

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change in behaviour 3 years ago in which she

became obsessed w cleanliness. Detailed
history..
anxiety sx like feeling anxious, palpitation,
excessive sweating whenever she had the
obsession.
Functioning level impairment.
obsessional themes like doubt and checking.
interpersonal relationship

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INSTRUCTIONS
(specific PE)

QUESTIONS

IMPORTANT
ISSUES:

Notes:

prov diagnosis
Define obsesion and the main themes.
medication first line
ix
why dvlp ocd?
Cbt, response prevention?
can obsession happen in normal people? how
different from ocd?
how to say the compulsive behabvior are
abnormal compared to normal individual.
ocd pt can have suicidal thought? How?
Family history - OC personality?
Predisposing factor. This patient Type1
personality and financial and family problem.

BIPOLAR (3)
TOPIC
FINDINGS

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manic symptoms DIGFAST (present with

manic episode)

low mood prior to admission. (present with

depressive episode)

ask about melancholic feature anhedonia

and Lack of mood reactivity.
good family support?

functioning social, occupational?

Elicit predisposing Precipitating Perpetuating Protective
factors,.
Elicit sexual history Mania(hypersexuality)

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INSTRUCTIONS
(specific PE)

QUESTIONS

how ask for delusion (grandiouse)

what good prognostic criteri in this pt -good

compliance good insight
whats poor prognostic
medication for remision .lithium. common?
sodium valproate.
downside lithium? narrow therapeutic index.

what drug causing depression? Alcohol, How?

ECT side effects cycles
If ECT was administered during depression
phase, can patient develop manic phase post
ECT? (Yes
investigation you want to do if patient came for
the first time? (TFT to rule of hypothyroid and
urine for drug test) 12. Other investigation to
know the well being of the patient? (FBC, LFT,
RP, RBS, LIPID profile since patient has HPT so
assess CVS risk factor)
Why patient develop manic symptoms? (If we
give antidepressant without mood stabilizer in
Bipolar patient, he can has mood swings. Vice
versa)
Midazolam. Tell me the MOA of the drug.
increase GABA
medical condition we cannot give
benzodiazepine MG, COPD, OSA. (disease that
cause respiratory depression).
Mood stabilizer Lithium, Sodium valproate,
Lamotrigine and carbamazepine.
Patient has bipolar, and his wife doesn't. So
what is the percentage of having child with
bipolar? (Tak tahu, sila cari)
If both has bipolar? (Child has >50% chance
getting bipolar.
can we combine Lithium together with sodium
valproate? and what is the purpose of
combining the drug?
risk of suicide worthlessness n hopelessness
what is the difference between worthlessness n
hopelessness?
difference in pt who had depression in young age and old
age? older they
tend to presented with pseudodementia.
5 ssri in Malaysia- setealine fluoxamine fluvoxatine
acetalopram
ssri safe for pt that have many comorbids acetalopram.
anti depressent that can cause sedation

IMPORTANT
ISSUES:

side effct of ssri -

Notes:

DYSTHMIA (2)
TOPIC
FINDINGS

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INSTRUCTIONS
(specific PE)

feeling low mood for the past two years

stressor (husband was having an affair.)
feeling worthlessness and loss of interest in her hobbies
loss of apetite and loss of weight
symptom panic attack sbb dia risau fikir pasal keadaan dia which was shortness of
breath, palpiattion and feeling abt to die.
no hyperthyroid sx, no hypothyroid sx.

QUESTIONS

IMPORTANT
ISSUES:

depression spectrum (mdd,

schizoooooaffective,bipolar, DYSTHYMIa)
escitalopram) cause her to feel sleepy - what
other ssri that is non drowsy.?
side effects of ssri
what sort of CBT that is beneficial?

Notes:

persistent depressive dis

TOPIC
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depressed nearly every day with insomnia due

to his parents always quarrel
melancholic ft
paranoid delusion(sepatutnye for pdd xde
psychosis sx).
suicidal ideation b4 but never try to make an
attempt

INSTRUCTIONS
(specific PE)

QUESTIONS

IMPORTANT
ISSUES:

Notes:

How many relapses he had

How he describe his parents.
What is it in the history that suggestive of
schizoprenia besides +ve sx
What is your ddx
How would u mx this pt
What is the se of escitalopram

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INSTRUCTIONS
(specific PE)

QUESTIONS

IMPORTANT
ISSUES:

Notes:

TOPIC
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INSTRUCTIONS
(specific PE)

QUESTIONS

IMPORTANT
ISSUES:

Notes:

panic disorder
TOPIC
FINDINGS

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panic disorder symptoms (palpitation,

sweatings, tremor,dizzy).

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INSTRUCTIONS
(specific PE)

QUESTIONS

IMPORTANT
ISSUES:

Notes:

TOPIC

medical condition induced depression

FINDINGS

H
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case of left hemiplegic stroke 2 years ago

depressed because he unable to function as no
longer work and unable to do his usual exercise
routine
loss of appetite
suicidal ideation
poor concentration
detailed history regarding medical illness

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INSTRUCTIONS
(specific PE)

QUESTIONS

IMPORTANT
ISSUES:

Notes: