AMC MADE EASY (PSYCHIATRY CLASS)

BY - DR. TAHREEM
AMC CAT Adult Adult Women’s
Child Mental Population
MCQ Health Health Health TOTAL
Health Health Health
BLUEPRINT (Medicine) (Surgery) (Obs/(Gyn)
ITEM
30 % 20 % 12.5 % 12.5 % 12.5 % 12.5 % 150 Qs
TOTALS

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 Anxiety Disorders
 Fear : Known, external, definite threat

 Anxiety : Alerting signal, which makes one take an action, it is unknown, internal and vague threat

 Features of anxiety : Sweating, tremors, restlessness, tachycardia, mydriasis, increased urinary

frequency, diarrhoea, hyperreflexia and cold clammy skin
 Panic attack : An acute attack of intense anxiety, with a feeling of impending doom ,
palpitations, choking sensations, chest pain, dizziness, depersonalization, derealization,
fear of having a heart attack, dying or going mad.

Symptoms peak within 10 mins and subside within few mins Rx : Reassurance
DDx : Hyperthyroidism, Pheochromocytoma & Hypoglycaemia
 Panic Disorder
 Recurrent panic attacks with at least 1 month of persistent worry about :

Having another attack or complication of attack

Significant behavioural changes related to attacks
Not associated with Substance abuse / Psychiatric disorder

Rx : SSRIs / Venlafaxine

Agoraphobia
 Fear of places from which escape might be difficult

Specific Phobia
 Strong, persistent & irrational fear of an object or a situation.
Out of proportion to the apparent stimulus.
 Specific phobia ( continued )
 Rx : Systematic desensitization

 Cynophobia : Fear of dogs

 Rx : 1st relaxation techniques ( Deep Breathing )
2nd Systemic Desensitisation
 Think about dog
Look at the photo of dog
Look at the dog while detained > then look while it is undetained > then while it is approaching
Let the dog get close to you
Pat the dog >>> Hold the dog >> Play with the dog
Social anxiety disorder :
 Experienced in anxiety provoking social situations ( Eg : Canteens, Restaurants, Staff Meetings )
Fear of embarrassment
Rx : Same as other phobic disorders / Beta Blocker before social events
Generalised Anxiety Disorder
 Free floating anxiety / Excessive worries
 Restlessness or feeling edgy
 Being easily fatigued
 Difficulty in concentration
 Irritability
 Muscle tension
 Sleep Disturbances

At least 3 symptoms for minimum 6 months, both physiologic and psychologic symptoms of anxiety are
present.
Rx : SSRIs / CBT
Obsessive Compulsive Disorder
 Obsessions : Recurrent, intrusive thoughts images or impulses, which cause anxiety.
Pt considers them as a product of their own mind.
 Compulsion : Repetitive behaviours/mental acts performed in response to obsessions
Reduce anxiety temporarily.
 Ego dystonic (Not acceptable to self and wants to be treated DDx : OCPD – Ego Syntonic)

 Etio : Seratonergic Dysregulation

 Duration criteria - Two weeks

 Rx : Pharmacotherapy (SSRIs / Clomipramine)

Psychotherapy (Relaxation training / Exposure and response prevention / Desensitization)
 Post Traumatic Stress Disorder
 Severe anxiety symptoms following a life threatening injury to self or others.
Eg:- Stressors : Trauma such as earthquake/ floods, wars, murder, rape, serious accidents etc
 Symptoms :

Reexperiencing of traumatic events ( Flash backs/ Nightmares )

Avoidance of stimuli associated with trauma
Increased arousal ; Hypervigilance, Insomina, Exxagerated startle response.
Anxiety, Depression, Impulsivity & emotional lability are common.
Survivors Guilt
Symptoms must last for at least 1 month to diagnose it as PTSD
Symptoms lasting for < 1 month ( but > 2 days) & within 1 month of stressor– Acute Stress Disorder
 Rx : SSRIs
CBT
 Adjustment Disorder :
 Anxiety symptoms / Depression in response to an identifiable psychological stressor.

 Stressor : Relationship issues (Breakup), changes of job, migration, death of loved one.

 Social or occupational functioning is impaired

 The symptoms are in excess of the normal expected reaction to the stressor.

 Occurs within 3 months of response to the stressor and lasts for <6 months after removal of the stressor

Rx :
 1. Pharmacological (Antidepressants, antianxiety drugs)

 2. Psychotherapy (Supportive psychotherapy)

 Somatoform disorders
 Physical symptoms with no medical explanation
 Symptoms are severe enough to interfere with ones ability to function in social or occupational activities

Somatic symptoms disorders :

 One or more somatic symptoms affecting many organ systems over several years
GI – nausea / vomiting / pain abdomen
CVS – palpitations / sob / chest pain
CNS – amnesia / dizziness / difficulty walking, talking
Pain – headaches , diffuse neck / backache, arthralgia
 Excessive thoughts, feelings or behaviours related to symptoms
 Associated with impaired social, occupational and family functioning
 Rx : Psychotherapy by a single supportive doctor
Conversion Disorder
 Pt presents with symptoms suggestive of neurological deficit but, no cause can be found on investigations.

 Commonly associated with other comorbid psychiatry disorders ( personality disorders )

 Mutism, Blindness, paralysis are m/c symptoms

 Pseudo seizures , gait disturbances, weakness, paralysis, tics, jerks etc

 La belle indifference : Lack of concern about impairment

 Rx : Psychotherapy

Hypochondriasis
 Preoccupation with fear of having or an idea that one has a serious physical illness

 Investigations = normal / fear persists despite reassurance.

 This belief affects patients level of functioning

 Symptoms must occur > 6 months

 Rx : Psychotherapy
 Factitious disorder
 Wilful production of symptoms to get medical attention ( hospitalisation ) & take sick role.
 Usually they are related to medical field.
 Symptoms can be imposed on self or others (Munchausen by proxy).
 Becomes angry when confronted .

Malingering
 Wilful production of symptoms for an obvious gain (financial incentive, avoiding legal case, tough job)

 Not a psychiatric disorder.

 Preoccupied more with reward rather than Rx.
 Discrepancy in complaints and objective findings
 Lack of co-operation by patients during evaluation and treatment.
 Body Dysmorphic Disorder
 Preoccupation with an imagined defect/slight anomaly in physical appearance

 Most common concerns are facial flaws

 Repetitive behaviour (E.g. mirror checking) or mental acts (Comparing self with others)

 House bound

 Avoid social situations

 Rx : Psychotherapy / Pharmacotherapy ( SSRIs )

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