MRCPsych UK contains free resources to help you with MRCPsych Paper A, B and CASC Exam Preparation.
Saturday, 30 July 2016
Morphine paradoxically prolongs neuropathic pain in rats by amplifying spinal NLRP3 inflammasome activation
Wednesday, 27 July 2016
Report- Clinico-pathological Conference on Liaison Psychiatry
The Institute of Psychiatry, Benazir Bhutto Hospital, World Health Organization Collaboration Centre, organised a Clinico-Pathological Conference (CPC), on the theme of Liaison Psychiatry, at the New Teaching Block, Rawalpindi Medical College, on the 27th of July 2016. The CPC sought to appraise the medical students, psychologists, and various physicians and surgeons in attendance, about the intricate relationship between the various disciplines of health care.
The proceedings ensued, with Dr Yousaf Raza reciting from the Holy Qur’an and welcoming the attendees on behalf of the Institute. He introduced the audience to the layout of the presentations and the theme at hand. Dr Sundus Fatima, Academic Registrar at the Institute, then took the stage to present the first case history. She gave a detailed history of a 13-year-old girl who developed psychiatric complications as part of post-encephalitic sequelae; depressive and dissociative symptoms. In addition, she also had pica. She’d had a disturbed childhood marred by inter-parental conflicts and the inability of her mother to respond to her emotional needs.
Dr Ayesha Minhas, Assistant Professor of Psychiatry and Head of the Child Psychiatry Unit at the Institute, was then called up on stage to discuss and elaborate upon the case presented by Dr Sundus. She began her presentation by alluding to the historical background of psychiatry stating that it owes its origins to the philosophy of Rene Descartes and his separation of the mind and body; originally seen by neurologists, we saw psychiatric disorders as separate entities demanding a separate speciality in the aftermath of Cartesian philosophy. She highlighted that an expanding collection of causes, from head trauma, stroke, tumor, demyelination and many others cause symptom complexes that overlap with classic psychiatric disorders. More recently, she said, neuro-inflammatory and immunological abnormalities have been documented in patients with classical psychiatric disorders. She briefly described encephalitis as an acute inflammation of the brain caused by viruses. Occasionally, she said, it may present with psychiatric manifestations. She then elaborated upon depression and dissociation with particular emphasis on their interrelation. She spoke about the dissociation as the process by which we move thought, feelings, and information out of awareness as a human defence mechanism. Depression, she said, triggers dissociative coping, and dissociative coping allows depression to gain momentum. Dissociation and depression exacerbate each other! She also shed light on pica; persistent ingestion of nonnutritive substances for at least 1 month at an age for which this behaviour is developmentally inappropriate. She spoke about how pica might result from a specific nutrient deficiency and also of its relationship to OCD. She concluded by discussing the management of the case, specifically highlighting the importance of maintaining a liaison with the physicians for a follow-up on her encephalitis. They discussed the need for antidepressants in the case with family therapy. In the end, Dr Ayesha alluded to the possibility of a merger between neurology and psychiatry with the advances in neuroscience.
Dr Ayesha Nasir presented the next case, a first-year trainee at the Institute. She spoke about a patient who suffered a head injury and presented to the ER with vomiting and abdominal pain a day later. Surgery, medicine, ophthalmology, psychiatry, gynaecology saw her and finally passed away in the medical ICU. The physicians and surgeons initially thought her overturned hands and feet to be a case of conversion disorder. However, her deranged vitals and labs showed serious physical problems.
Dr. Asad Nizami, Assistant Professor of Psychiatry at the Institute, then took up the discussion of the case. He too began his presentation with a detour to the history of psychiatric illnesses. He alluded to the French neurologist Jean-Martin Charcot and his description of conversion symptoms. Dr Nizami alluded to the fact that usually a patient presenting in the ER with behavioural symptoms is assumed to be suffering from a psychiatric ailment without consideration that there are multiple organic problems that might present with behavioural issues. He went to detail conversion disorder as a presentation of neurological or medical symptoms that can’t be traced to a neurological or medical aetiology. He enlisted various sensory and motor symptoms for conversion. He highlighted the importance of identifying a psychological cause for a definitive diagnosis. Dr Nizami alluded to a study that showed how patients diagnosed with conversion disorder followed for a 9-year period was diagnosed with organic disease. Another study showed that 11.5 % of patients diagnosed with conversion disorder actually had neurological disorders and a systematic review showed a decline in the mean rate of misdiagnosis from the 1950s to the present day.
Prof. Fareed A. Minhas, Head of the Institute & Professor of Psychiatry, then took the stage and presented his paper published in the British Journal of Psychiatry on the development of psychiatric services in Pakistan. The study was a longitudinal descriptive survey presented to the consultation-liaison psychiatry service provided by the Institute of Psychiatry they evaluated to teaching hospitals in Rawalpindi during the first two years of its functioning. He described how the liaison registers are meticulously maintained and all cases seen by on-call trainees are discussed in detail in every morning meeting. He raised the concern that of the three teaching hospitals associated with RMC, only BBH had a psychiatric service and 96 % of the referrals were from the BBH Emergency; how are the psychiatric patients presenting to the other two hospitals being dealt with, he asked. The second highest referral rate, after the emergency, was from the medical unit. This illustrates, he said, the importance of the people working in those departments to have an experience in psychiatry and be cognisant of its nuts and bolts to efficiently identify psychiatric illnesses from organic illnesses. He also highlighted an alarming fact that we may ignore a lot of the medical and surgical problems in those departments if a presumptive suggestion of a psychiatric illness is made by the attendants or the patient. He appreciated the efforts of CPSP in mandating neurology and medicine trainees to rotate for three months in psychiatry and proposed that paediatric trainees do the same in child psychiatry seconding Prof. Rai Asghar’s suggestion, which he gave at an earlier symposium. Similarly, he said, the rotations of psychiatric trainees in the medicine and neurology department are equally important. Prof. Minhas closed the session with a vote of gratitude to all those in attendance.
This CPC provided the audience with an excellent overview of liaison psychiatry in Pakistan. The case histories presented provided the pragmatic challenges in the field. In the end, the most important message delivered was to build bridges between specialities by understanding the other more for the benefit of the patients.
Report prepared by Dr Yousaf Raza, Post-Graduate Resident at the Institute of Psychiatry.
Friday, 22 July 2016
Most Common Cause of Excessive Daytime Sleepiness
Most Common Cause of Excessive Daytime Sleepiness
Alcoholics may have impaired performance on cognitive tasks:
Alcoholics may have impaired performance on cognitive tasks especially (name the cognitive domain) ?
Parents with Low intelligence has higher risk of abusing their child:
True or false
Afshan Malik; True,,,,it also depends on families background and culture...families with upper class can also abuse their children...
Mehdi Intisar; False it more relay on environmental circumstances
Abbas Sepah; True but a few of them has proved to be very caring if social support is present otherwise your statement is True
Ok yes it true. Please note that risk factor is just a risk factor. It does CAUSE ANYTHING. it increases the chance, just that
Tuesday, 19 July 2016
Incidence of down syndrome decreased:
Why has the incidence of down syndrome decreased ?
Temperament, people with down syndrome:
What kind of temperament do people with down syndrome have ?
Learning disability in down syndrome:
Learning disability in down syndrome is
- Mild to moderate
- Moderate to severe
- Severe to profound
Fastest growth of IQ of down syndrome:
Fastest growth of IQ of down syndrome occur at the age of
a) First six months
b) 6 months to 1 year
c) 1 to 2 years
Inflammation on Contrast enhanced CT:
Inflammation on Contrast enhanced CT appears
MRI pulses create images similar to CT:
Which MRI pulses create images similar to CT
Difference between Flight of ideas & Pressure of thoughts:
What is the difference between flight of ideas and pressure of thoughts.
Sunday, 17 July 2016
Safe antipsychotics in Epilepsy Mnemonic
- S-> sulpiride
- A-> amisulpiride
- T-> trifluperazine
- H-> haloperidol
Friday, 15 July 2016
Most common themes of obsessions Mneomonic
- R Religion
- O Orderliness
- S Sex
- I Illness
- D Dirt and contamination
- A Aggression
Thursday, 14 July 2016
Models of breaking Bad news
- SAD NEWS
- ABCDE PEWTER
- Kays Model
Most commonly used drugs for Tardive Dyskinesia Mnemonic
- Gingko Biloba
- Vitamine E
Wednesday, 13 July 2016
>> Diagnostic and Statistical Manual of Mental Disorders, 5th Edition.
- Multiple vocal and motor tics
- Starting before the age of 18 and
- Persisting for a duration of at least one year
- We have excluded other causes of tics.
Maudsley Prescribing Guidelines (13th Edition)
They recommend alpha-2 agonists such as Clonidine or Guanfacine as the first-line pharmacological treatment for Tics and Tourette Syndrome
American Family Physicians and Canadian Guidelines
Antipsychotics possess a variety of serious adverse effects (Pringsheim et al., 2012) and even though the evidence base for them is strong, we use them in cases not responding to alpha-2 agonists.
- Taylor, D. (2018). The Maudsley Prescribing Guidelines. The Maudsley Prescribing Guidelines.
- Kenney, C., Kuo, S.-H., & Jimenez-Shahed, J. (2008). Tourette’s syndrome. American Family Physician, 77(5), 651–658. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18350763
- Pringsheim, T., Doja, A., Gorman, D., McKinlay, D., Day, L., Billinghurst, L., … Sandor, P. (2012). Canadian Guidelines for the Evidence-Based Treatment of Tic Disorders: Pharmacotherapy. The Canadian Journal of Psychiatry, 57(3), 133–143.
Cognitive Deficits in Multiple Sclerosis
- Mostly the impairments are seen later in the course.
- The impairments are mild and progress slowly.
- Well-practiced verbal skills are often preserved.
Features of schizoid personality, Mnemonic
- D detached
- A aloof
- I introspective
- L lacking enjoyment
- E emotionally cold
Clinical features of complex partial sezires, Mnemonic
"Pardon DJ Hell, you are Producing GAS that is AFFECting All the Fearful TEDS, CoSTing them MaDness"
- Distorted perceptions, Deja Vu
- Jamais Vu
- Grimacing and other body movements
- Stereotyped behaviors
- Fear and anxiety
- Euphoric or ecstatic states
Autonomic and visceral
- Epigastric aura
- Other bodily Sensations
- Speech disturbances
- Thought disturbances
- Memory disturbances
- Depersonalization, derealization
Skills taught in Dialectical Behavior therapy, Mnemonic
- Anger control
- Interpersonal skills
- Ways of tolerating Distress
Elements of Dialectical Behavior Therapy, Mnemonic
- Dialectical ways of thinking
- Cognitive and behavioral techniques
Abnormal beleifs that cause stigma, Mnemonic
These abnormal beleifs of the people form the basis of psychiatric stigma: DUFIT
- These people are Dangerous
- They are Unpredictable
- They Feel different from the rest of us
- They are Incurable
- Psychiatric patients can't be Talked to or related to
Tuesday, 12 July 2016
What is the difference between negative reinforcement and punishment?
2) Negative reinforcement involves removal of unpleasant stimulus while punishment is presentation of an unpleasant stimulus.
Better imaging study for the assement of change in behavior
Sarmad Mushtaq Ct withcontrast
Immo Mani With contrast
Valeed Ahmed Yess with contrast,,, inflammation and tumors etc can create change in behavior that can be better viewed by contrast enhanced CT, contrast agents can not enter the BB barrier except in arease of inflamation where the barrier is damages ir tumor where it is not formed,,,so the contrast enters there very well, making the area distinct due to more absroption of radiation
What are the main uses of small group psychotherapy ?
- To modify interpersonal problems
- To to encourage adjustment to the effects of physical or mental illness
- As a form of supportive treatment
Group therapy versues individual therapy; which one is superior?
Monday, 11 July 2016
Stressors impact on health & well-being
According to richard lazarus, what kind of stressors are having most impact on health and well being ?
Social Readjustment Scale:
On social readjustment scale, the most stressful event is ?
a) Death of spouse
b) Death of child
c) Death of parent
d) Death of sibling
Isha Mughal: All
Kira Awan: I think it varies from situation to situation... in case of children... its death of parents..in case of couple... its death of spouse...in my case its marriage !!!
Components and Principles of management of schizophrenia Mnemonic
What are the components and principles of management of schizophrenia ?
Answer: MENOMONIC -> CONFIATE
- CBT, cognitive remediation, clozapine, crisis resolution teams.
- Outreach teams
- Needs assessment
- Family intervention
- Integrated treatment for comorbid substance abuse
- Therapeutic realtionship
- Early intervention
Antipsychotic Groups, Mnemonic
- Butyrphenonoes, benzisoxazole
- Substituted benzamides
- Diabenzothiazepines, diabenzodiazepines
- fLOxetine has the LOngest half life among all SSRIs
- Hunting 4 CAGs. The gene for Huntington lies on chromosome 4p and codes for the protein huntingtin and mutations causes CAG repetitions (36+)
- AntOn syndrome occurs in Occipital lobe syndrome
- T-tWo. Areas with Water appear brighter on T2 weighted MRI images e.g. CSF, tumors, inflammation.
- HypnaGogic hallucinations occur when you are GOing to sleep.
- CatalePSY is associated with the PSYchiatric disorder rather than narcolePSY which is unfortunately associated with cataplexy.
- LEFT hippocampal damage causes VERBAL memory deficits, the SPEECH area (Broca's area) also lies on the LEFT usually. So now, right hippocampal damage causes non verbal memory loss.
- PRAder WILLI patients are WILLING to PREY for food. (Insatiable appetite leading to obesity).
- Type I error or alpha error is what drug companies tend to commit. Drug does not work but they report it works. That is to reject the null hypothesis when in fact it is true. For example a companies null hypothesis was that paroxetine does not work for children and adolescents and they rejected it. Later on it was found that it does more harm than good. So they had wrongly commited the type 1 or alpha error.
- Sleep Spindles Seen in Second Stage of Sleep.
Mnemonic for the Adult Traits Associated with Freud's Oral Phase of Development
- Pessimism, passivity
Components of Personality Mnemonic
These can help to asses premorbid personality the menomonic is CARLUP
- Character traits
- Attitudes and standards
- Leisure activities
- Ultimatel concern
- Prevailing mood and emotional tone
Sunday, 10 July 2016
Terror Management Theory:
Every human is aware of the inevitable nature of death; yet people don't feel as terrified of death as expected even at old age. What mechanism reduces this terror ?
"One theory that explains this is terror management theory"
According to this theory, it is the culture that prevents this fear. People either keep themselves unaware of this reality or those who are aware of it most of the time ; they would be pursuing their cultural goals. In this way they would also be increasing their self esteem. These two (high self esteem, and cultural world view being defended, reduce the fear or anxiety of the inevitability of death.
For example, Muslims would become more religious in old age and that would also elevate their self esteem and give a purpose to their lives so their death related anxiety would reduce . I think, if i am not wrong, there is a Hadith related to this as well, that we should remind ourselves about death every now and then "remind often the destroyers of pleasures"death [sunan at Tirmhdi]. wherever you are, death will find you, even if you are in towers built-up strong and high" Quran [4:78] (someone correct me). Which according to this theory would make people more religious (if they are).
Thursday, 7 July 2016
Principal features of a therapeutic community Mnemonic
- Directness and honestly, decisions are shared.
- Shared activities
- Mutual help
Component of Working Memory that acts as a bridge between short term and long term memory
- Visuospatial sketchpad
- Phonological loop
- Central executive
- Episodic buffer
The answer is D, episodic buffer.
Long-term Consequences of Maternal Deprivation Mnemonic
Long-term Consequences of Maternal Deprivation Mnemonic
- Psychopathy (affectionless)
- Aggression (increased)
- Intelligence (being low)
- Depression, delinquency
Tuesday, 5 July 2016
Explicit consent is
Oral and written
Consent by a diabetic patient who appears incompetent
A 55-year old woman with diabetes is diagnosed to have gangrene on both feet. She was brought to the hospital. She told the doctor the she is feeling fine and she has no medical problems. Can she give consent for the amputation of both legs?
Anam Najam no
Hajira Mehboob No she needs psychological treatment...
Hospitalizing autism patient who is not resisting
You are working in the UK as a consultant psychiatrist. A 20 year old Patient is suffering from autism. You think he should be admitted to autism treatment center. Guardians are not willing to hospitalize him although the patient himself is not actively refusing to be hospitalized. What is the most appropriate step to take ?
Admit him to the hospital
Treat on out patient basis
Refer to best interests assessor
An adult patient who was suffering from autism was admitted to bounwood hospital because he by himself was not resisting to be admitted although his carers were not willing for this. This case indicated a “gap” in the law i.e. Failure to protect an individual’s liberty if he can not resist.
Deprivation of liberty safeguards
Bournewood case lead to deprivation of liberty safeguards act in 2007, according to which such patients will be asses by a ‘best interests assessor’ before such action is taken to make sure it is in the best interest of the patient. The act itself is complicated.
Down's Syndrome Original Name
Down syndrome was originally known as ?
Exception to the rule of consent to treatment
Which of the following cannot be considered as an exception to direct informed consent?
B. Detention under mental health act
C. Emergencies where full information cannot be given
D. Incompetent patient
E. Passively compliant patient
Valeed Ahmed The answer is E, passive compliance is not an exception, rather an implied consent is.
The situations in which explicit consent is not required are :
Implied consent given
Necessity (harm likely, competency doubted)
What is Waiver
A competent adult patient who is suffering from malignant cancer does not want to know about his prognosis. What is this known as ?
Valeed Ahmed This is known as waiver in legal terms.
Consent for pregnancy by adolescent
A 15-year old girl recently becomes pregnant. She went to a doctor for abortion. She told the doctor not to tell her parents about this pregnancy. What is the nest appropriate step in management ?
Inform the parents for the consent
Do not inform the parents and deal with abortion per local laws
Obtain a court order for the abortion
Deny abortion and don't inform the patient
A Vignette for Discussion
Psychotherapy session is ending abruptly
pllz give your ideas
Read the following case scenario carefully
Khalid came to Mr. Jamil, a counselor working in a local hospital, with the presenting complaints of having anger, difficulty in maintaining relationships, feeling of being alone and lack of interest in daily activities. Khalid also reported himself to be restricting in his social activities since the death of his wife. Counselor developed a management plan for Kahlid for six sessions in which he used different behavioral and cognitive techniques. On the sixth session (the last session) with Khalid the counselor told him that today he will terminate the counseling however he can come for the follow up sessions. But Khalid told the counselor that still he does not find himself able enough to quit counseling sessions. However counselor was of the view that six sessions were more than enough to get out of his problem and now he should practice what he had learned during the course of counseling. Now answer the following questions about the above mentioned case scenario.
1. What flaws or lack of counseling skills you can identify in the current scenario and its
2. What suggestions you can give to the counselor for dealing with the client
Types of learning theories in this case
unconditioned response- shouting and beating
conditioned stimulus -school bag
conditioned response- abdominal pain.,,,, If we want to prevent this behaviour then
operant learning -with reward
( give chocolate or his favourite lunch etc)
Pathological jealousy; a symptom or syndrome ?
Pathological jealousy is a paranoid symptom or syndrome ?
Inam Ul Haque Masood I believe it is a syndrome as it is a constellation of symptoms which gives uniqueness to the syndrome
Abbas Sepah The other name is Othello's syndrome, so it's a syndrome
Valeed Ahmed Yeah othello s :D, Have heard this name dozens of times. ok it is a syndrome as there is a group of systematized symptoms consitent with the central theme of the delusion and not just the delusion
Mentally ill patient needs medical treatment
An adult patient is severely depressed refuses get treated for HCV infection. How should this patient be dealt with ?
First treat depression and then for HCV
Treat for HCV and depression without consent
Obtain a court order to treat for both
Anam Najam First treat depression and then for HCV
Waleed Ahmed When a mentally ill patient refuses consent to medical treatment, the steps are
Step 1 treat the psychiatric condition
If psychiatric condition can not be treated, consider legal action e.g. Court order or consent from relative
Mechanism of Dementia in Downs Syndrome
Which of the following is responsible for dementia seen in adults with Down’s syndrome?A. Loss of genetic material in chromosome 21
B. Extra genetic material in chromosome 21
C. Genetic material lost from chromosome 14
D. Loss of genetic material corresponding to presenilin -1
E. Loss of genetic material corresponding to Apoe4
Ok extra genetic material is the correct answer. The gene that codes for b amyloid is located on chromosome 21. Since down syndrome is due to trisomy 21 so there is increased amount of genetic material that production of its product proteins. Product protein of the APP gene located on chromosome 21 is beta amyloid that is central to the aetiology of alzheimers
Sensory stimulation therapies for dementia
- White noise
- Aroma therapy
- Music therapy, Massage
- Bright light therapy
You are about to check a patients Blood pressure. As you Reach the bedside and open your BP apparatus, the patient extends her arm to let you check her BP although you have not asked for a consent yet. What is the best next step
Take verbal consent
Check her BP without asking
ICD-11 Criteria for Gambling Disorder (6C50)
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