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 individual's BMI?  What lab tests would you request in this case?  In the light of current evidence, suggest therapeutic options that you may consider. 2 Read the following three clinical scenarios careful carefully and respond...

General Advice for Written Papers (MRCPsych Paper A and B) We need preparation for the written exams, and we would suggest you think about starting your revision at least three months before each one. Although it’s difficult to balance examination revision with a full-time job, it is possible with wonderful organisation and discipline. Furthermore, many people have other responsibilities, such as children, which makes it much more difficult to fit in. It may have been years since you took your medical school examinations, and getting back into the swing of things can take some time. One technique is to start with half a day on weekends or a couple of evenings each week, then escalate the time as the examination approaches. There will be times when you can’t do any revision, for example, during weeks of night shifts. Although individuals strive to cram as much studying as possible into the weeks leading up to the test, it is equally crucial to relax and enjoy yourself. Rather than makin...

CASC is an OSCE-style clinical exam made up of 16 stations in total. There is one circuit of eight stations in the morning and one circuit of eight stations in the afternoon. They have scrapped previously linked stations.  Any clinical topic can come up, and only the most impractical scenarios are off-limits. Commonly tested stations include: Brief history-taking e.g. psychosis, depression Collateral history e.g. in dementia Risk assessment following self-harm information-giving e.g. ECT, medication, psychological therapies Discuss management plans with consultants and other members of staff, e.g. nursing students and ward managers. Physical examination e.g., EPSEs, cardiovascular, neurological The CASC tests knowledge and communications skills such as history taking, explanation & advice, breaking bad news, and managing challenging consultations. When you first look into the CASC exam, the pass rate may not fill you with optimism about passing it. However, having a rough ...

A 40 years old man attends your outpatient carrying his CT scan brain which is suggestive of space-occupying lesions in the parietal lobe. a) What clinical signs would you look for while examining this patient? b) How would you elicit those signs?

Single-photon Emission Tomography SPET Principle uses single-photon (gamma-ray) emitting isotopes given IV or inhaled the resolution is lower than PET Uses SPET can give information about: regional cerebral blood flow ligand binding Clinical uses include: Alzheimer’s disease When the symptomatology (e.g. hallucinations, epilepsy) occurs when the patient is not near a scanner; we can give a suitable ligand at the material time and the patient scanned afterward Schizophrenia reduced rCBF in frontal regions—‘hypofrontality’ Affective disorders as that in schizophrenia, with reversal after antidepressant therapy Alzheimer’s disease decreased rCBF in posterior parietal and temporal regions Xenon inhalation Shows the failure of activation of frontal lobes in schizophrenics performing the Wisconsin Card Sorting Test