Spotting the Study Design We can work the type of study by looking at three issues: Assigning exposures Will you “assign” exposures?  If you assign exposure—which might be an intervention, like an antidepressant, a placebo, or a therapy, for example—you are doing an experimental (intervention before observation) study.  Observational (no intervention involved)  Experimental designs  Will there be a control group? Controlled study. Will there be an active comparator or placebo?  Some trials use an active comparator, and we call it active comparator trial. if you want to you a placebo, your study design is a placebo-control trial.  will the allocation be random?   yes > randomised no > non-randomised/quasi-experimental    Will the allocation be swapped from time to time? Yes -> cross-over, No ->  parallel Who will know about the allocation of the treatment?           Everyone -> open-label          All except patients > single-blinded          Neither patients nor asse

A young lady of twenty-eight, came to the psychiatric outpatient department with an irresistible urge to overeat 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 behaviour or an illness?   How will you respond to her?  What is the likely diagnosis?  Outline management steps for this patient according to the NICE stepped-care approach.     It is likely you are suffering from an eating disorder, in which people repeatedly experience an irresistible urge to eat an enormous amount of food in a brief time. The associated feelings of guilt and efforts to counteract the resultant We would like to carry out a detailed assessment to confirm the diagnosis. But that you are cannot control the episodes implies that the behaviour may not be normal.   Diagnosis  Bulimia nervosa   If there was evidence of BMI being lower than 17.5, or recent severe weight loss, we would diagnose anorexia ner

Causes of Poor Response to Treatment in Patients with Schizophrenia There can be several reasons for poor response to treatment in schizophrenia and may be related to illness, patient and their environment, treatment or clinician. Patients started on treatment at a relatively later stage in the course of their illness and/or patients having slow onset schizophrenia respond poorly to treatment. Likewise, disorganised/hebephrenic schizophrenia carries a poor prognosis. Poor compliance, subtherapeutic doses and (sometimes) plasma concentrations may also be reasons for inadequate response, just as comorbid substance or alcohol abuse is. Patients who use medications periodically, upon worsening, become less likely to respond to treatment.  Related to the Illness Slow onset schizophrenia  Hebephrenic subtype Predominantly negative symptoms Related to the Patients and their Environment Comorbid substance/alcohol use Poor compliance with treatment High-expressed emotions (positive

Clock Drawing Test: A Neuropsychological Assessment Tool Introduction The Clock Drawing Test (CDT) is a simple and quick neuropsychological assessment tool that can help identify cognitive impairments in patients with conditions such as dementia, stroke, and brain injury. The test has been used for over 50 years as a quick and easy way to assess various aspects of cognitive function, including visuospatial ability, executive function, and language skills. How does the CDT work? The test is conducted by asking the patient to draw a simple clock face on a blank piece of paper and place the numbers in the correct order. The patient is then asked to place the hands on the clock to indicate a specific time, such as 10 after 11. The clock drawing can be scored based on specific criteria, including the presence of numbers and the placement of the hands. What does the CDT measure? The CDT is used to assess several aspects of cognitive function, including visuospatial ability, executive functio

Somatic Symptom (Somatization) Disorder Vignette The medical team requested you to see a 31-year-old woman in a medical ward who has been an in-patient for 2 weeks undergoing investigations for constant pain in her upper abdomen for the last 2 months. We initially thought this to be gastric or duodenal, but endoscopy was negative. Recently, it has been informed by her husband that she has presented to several hospitals over the past 2 years complaining about a wide variety of symptoms and different pains for which they had identified no physical cause despite multiple investigations. In addition, she is concerned about her physical symptoms but does not consider them as a warning sign of any serious underlying disease. After a detailed discussion about the case, the medical team has a psychiatric opinion.  What is the most likely diagnosis? Enlist the differential diagnosis in this case.  What information in history supports the most likely diagnosis? How will you manage this patient?