Q1. Parents bring a 24-year-old single man for showing violent and
abusive behavior, self-muttering, inappropriate social behavior breaking into
laughter one minute, and then crying incessantly for no obvious reason. They often see him gazing meaninglessly at objects and standing on one leg for
an entire day. He has been ill for over three years continuously. They have treated him with haloperidol, olanzapine, and risperidone with no response
to treatment. He has rapidly gained weight in the last few months and now weighs
110 kg. His height is 170 cm.
- What could be the most likely diagnosis?
- What could be the reasons for the poor response to treatment?
- What is the
likely pathophysiological basis of his rapid gain in weight
- What will be the
- What lab tests would you request in this case?
- In the
light of current evidence, suggest therapeutic options that you may consider.
Read the following three clinical scenarios careful carefully and respond to
- A married father who was not agreeing to his demands for getting him married, had not been sleeping well for a week, purchased ten a dozen shirts in last two
days, sold his taxi for two hundred thousand the greatest social worker of the
world who had a mission to help and believed that he never felt so well ever in
his life. He a truant thousand to help me given child.
- A 38-year-old woman presented with restlessness, overactivity interfering
behavior for the last two weeks. The psychiatrist for talk and seemed extra
happy without an obvious reason. Previously she was the past five years to treat depression that she left a year ago.
- A 20-year-old man has been experiencing repeated episodes of depressed mood
associated with disturbed biological functions and episode overactivity,
restlessness, and elation. The episodes have been occurring over the past five
years, each episode lasting for a few days. No hi, any psychoactive substance
each scenario, answer the following questions, separately.
- What is your
provisional diagnosis for each scenario?
- What is the fundamental commonality
- Identify drug treatment for each?
- Identify the case with the
worst and the one with the best prognosis, giving reasons for each.
A 50-year-old married bank officer presents for the first time with features of
acute anxiety including palpitations, excessive sweating giddiness, and
- What medical causes would you consider in the differential
- How would you manage him if after a comprehensive evaluation you
diagnose him as a case of panic disorder?
Miss X is a fourteen-year-old girl living in an orphanage. She finds it
exceedingly difficult to sleep on account of nightmares and jumps in
the chair when the doorbell rings. She complains of a persistent dull lower
abdominal pain that does not respond to any painkiller. Allow and radiological/ultrasonographic
investigations have been found normal, she has been a victim of regular
physical and sexual abuse since the age of eight.
- What is the most likely
diagnosis in this case?
- List the likely psychosocial difficulties and
psychiatric she may develop in the years to come?
- What are the various
pharmacological and non-pharmacological interventions suitable for this patient?
- What is the psychophysiology of antisocial personality disorder?
psychophysiological measures can we use in the assessment of antisocial
A 35-year-old married homemaker with 4 children is being treated for a severe
depressive episode for the last 3 months. She has shown little improvement with
the trial of two antidepressants, escitalopram venlafaxine:
- How shall you
assess this patient?
- What are the distinct steps and options for
pharmacological treatment in this case?
A 5-year-old child presents with
behavioral problems at home, which include refusal to follow parental
instruction and poor table manners. His teacher reports that he has difficulty
getting along with friends and daydreams excessively.
A 3-year-old child
is referred by the pediatrician to you for evaluation Parents who are going
through a divorce after 4 years of unhappy marriage note that the child likes
to stay by himself. The caregiver (Ayah) can communicate with the child,
though his language is delayed (can speak only one or two words) and plays with
only one toy, although he has many toys
- What is the differential diagnosis?
will be the evaluation and management steps in this case?
- How will you evaluate this child?
- What are the most likely diagnosis and the list of differential diagnoses?
- How will you manage this case?
- What is the short- and long-term prognosis in
His colleagues bring a 60-year-old man for making repeated
mathematical errors in calculations, ignoring the entries of important
financial documents, coming late to the office, and frequently spilling the tea
on his clothes. a) What will be your provisional diagnosis and differential
diagnosis? b) What specific physical and neurological and mental state signs
would you look for? c) Name four laboratory and three radiological
investigations you would consider while investigating this case?
Q.10 A relative of the patient who
admitted the patient with the diagnosis of paranoid schizophrenia wants to take
him home over the weekend. The patient is on a maintenance dose of a) Give the
leave procedure in accordance with the Mental Health Ordinance 2001 b) The
relative does not bring the patient from leaving on the agreed-upon date, how
would you proceed according to the Mental Health Ordinance 2001?
11. A 56-year-old man is getting
medication for diabetes mellitus, ischemic heart disease, and hypertension. He
is currently admitted to the intensive care unit by a medical specialist on
account of chronic renal failure. The nurse on duty tells the doctor that the
old man gets irritable, talks irrelevantly, does not recognize anybody around
and fears his caregivers and family members. These symptoms usually become
worse at night. a) What is the most likely diagnosis in this case? b) What are
the major causes of such a presentation? c) How will you manage this case?
12. A 52-year-old lady is referred by a general physician with the complaint of abnormal movements around the mouth and
some abnormal hand movements. The patient was treated by a psychiatrist 02
years back but never revisited the psychiatrist and continued the treatment on
During a TV interview, they stated that patients with schizophrenia
are more likely to be violent than the general population. How would you
respond to inform the general population and compare it with patients with other
mental illnesses focusing on the predictors of violence?
- What differential diagnosis would you consider?
- What treatment options are
Q13: A 35-year-old male patient, suffering
from bipolar affective disorder, is on lithium carbonate for the last 10
years. He was stable till 6 months ago but since then has increased frequency
and severity of episodes despite good compliance and consistent maintenance of
lithium blood levels.
- What do you think maybe the mechanism for this unresponsiveness
- How would you manage this unresponsiveness to lithium?
- Lithium is relatively less effective, with an efficacy rate of around 30
percent in which six conditions?
15 A recent trial on the effectiveness of
typical versus atypical antipsychotics included that there is no difference
between the two groups Critically evaluate this statement in the light of
recent advances, naming few studies with similar results and findings.
16 A young lady of 28 came to psychiatric
OPD with an irresistible urge to over at followed by feelings of guilt and
self-induced vomiting. She also uses laxatives to compensate for overeating.
She wants to know if this is a normal pattern of behavior or an illness?
you will respond to her?
- What do you think is the most likely diagnosis?
- Outline management steps for this patient according to the NICE 2004
A chain smoker for the last 25 years has recently been diagnosed with
severe ischemic heart disease. His physician advises him to quit smoking, but
he is convinced that smoking has nothing to do with his health. His wife
believes that he is dependent on cigarettes and it is difficult for him to
quit. Respond to the following queries made by her
- What are the
psychophysiological effects of nicotine?
- How would you manage nicotine
dependence in this case?
- Is this a psychiatric disorder? If yes, what is it
called in ICD-10 and what are the diagnostic guidelines?
Q.18 A 20-year-old male from Waziristan is
brought to the Psychiatric Intensive Care Unit for an urgent psychiatric
consultation after being arrested by agencies. He attempted to blow himself
with a bomb and made a physical assault on a quad at a check post. He remains abusive and threatens to kill all "enemies of Islam, wears when approached and thinks that he will blow himself up with a bomb to
attain access to 'heaven and other bounties" promised to him by his
- Keeping in mind the risk factors for violent and suicidal behavior
and the sociocultural context of the individual, list ten questions that you
will ask from the individual and the representatives of agencies to establish
the abnormality/psychiatric disorder in the individual.
- If the individual
does not fulfill any criteria of a formal mental illness, how would you respond
to a query by a media representative asking if the individual is mentally ill
Q.19 Mrs. X is a 26-year-old known patient
of bipolar affective disorder type 1 She is being treated with Valproic Acid
and lithium carbonate. She now plans to conceive. She seeks your advice on the
relative advantages and disadvantages of conceiving and using lithium during
pregnancy. How would you respond to the following queries of the patient?
- What are the risks if I stop all treatment during pregnancy?
advice will you give? Illustrate your response with references from literature?
- What risks do I run if I continue to use lithium during pregnancy?
impact can lithium have if I will breastfeed my baby?
Q.20 A34-year-old operating room assistant
has been referred to you by a physician to whom he reported 9th time in the
last three months with a fear that he has developed AIDS, requesting to examine
him and re-testing him for AIDS. He reveals that his roommate in the mess
recently revealed himself to have homosexual relationships with multiple
partners. The client himself never had a homosexual contact nor carries a
factor for AIDS. He has anankastic-traits. He remains worried about his health
however has no depression or disturbed biological functions. a) What will be
the differential diagnosis in this case? What is the most likely diagnosis?
Justify. b) How would you manage this case?