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PSYCHIATRIC EMERGENCY

A. 25 years old male, presents in the emergency after a recent suicidal attempt- according
to the family he has recently lost his job, is socially withdrawn, and his appetite is
decreased and he is smoking excessively.

Q. What will be your working diagnosis?

Key:

1. Depressive disorder
2. Acute stress disorder
3. Substance abuse disorder

B. What particular area a would you to focus while assessing the patient.

Key:

Suicide risk assessment

C. Patient confide in you that he is still suicidal and has access to means. He requests you
to not share the information with the family. How will you respond.

Key:

Let the patient know that though you respect his right of confidentiality – In this
particular situation you are ethically bound to show to show the information with all
concerned.

Clinical Application of Basic Sciences

A 69 years old man presents with psychomotor retardation, tremors, low mood and
failing memory which three condition come to your mind?

1. Parkinsonism
2. Depression
3. Dementia

What are the changes in brain chemistry in old age related to illness in old age.
1. ↑Acetylcholineastrase {Dementia}
2. ↑ Cholin acetyltranserase
3. ↑Monoumie oxidase {Depression}

4.↓GABA Thalamus → Poor processing of sensory data


5.↓DOPAMINE Parkinsonism

Planning and administrative aspects

You have been asked to write the standing instructions on admission of psychiatric
patients in a long- stay mental health facility

1. What are the grounds on which you will choose to advise admission of a patient
in a high security unit?

Key:

1.
• The predictors of a high risk of threat to others and violence potential include:
• Past history of violence/aggression
• Convictions for violent crimes
• Psychopathy, Impulsivity, Borderline personality disorder
• Male gender
• Younger age
• A diagnosis of psychosis with command auditory hallucinations with accusatory
content
• Paranoid schizophrenia
• History of alcoholism and drug abuse
• An articulated plan to harm others
Research Methodology

A pharmacutical company presents to you a trial of its new antipsychotic published in a


journal. The authors claim the new antipsychotic as effective as Haloperidol. How would
you evaluate this claim?

Key:

Critically evaluate the trial for


1.whether the treatment allocation was random
2. the patients both groups were compare able in all reports
3. the sample size was adequate to show the difference
4. proper outcome measures (scales ) were used to assess the outcome in both groups
5. intention to treat analysis was done
6.compare able dosage

Ethics

A patient of paranoid schizophrenia Has shored with you that he plans to execute his
brother in law.
He has stopped you from sharing this information with anybody.

Which principle of ethics will come into play in this situation

Key: Confidentiality

How will you proceed:

Key: A breach in confidentiality is admissible on account of the potential threat to a


community member.

Inform the Police


Inform the Individual
Inform the Family

Clinical Problem Solving in Psychiatry

A 30 year old man who has 10 year History of Bipolar Disorder, and has maintained a
stable mood for one year has been brought to emergency room with a one week history
of insomnia, agitation, excessive pressured speech and paranoid persecutory delusions.
What are the possible factors which may have contributed to relapse of his illness.

Key;
Discontinuation of mood stabilizer
Acute severe stressor
Use of alcohol/ cannabis/ amphetamines
Concomitant use of antidepressant

Concomitant use of steroids

Recent Advances

Family of 65 years old man suffering from dementia consult your regarding availability
of latest drugs for dementia. What would be your reply?
Key:
Galentamaine
Rivostigmine
Donepzil

How do they act?

Key:

By decreasing the degeneration of acetylcholine by inhibiting cholinesterase inhibitors

Name any other drug which is not a cholinesterase inhibitor?

Key:

Memantine

Community Psychiatry

You have been appointed in the health ministry as an advise while planning a community
mental health services for a semi urban community of10,000 population. What are the
various aspects you would consider?

Key: Complete demographic data with details of socio economic relation, gender, age
distribution
What services/ facilities are already available.
Needs assessment with the help of elders of the community and by doing focus groups
with different groups in the community e.g. women, adolescents, workers etc.
Planning appropriate preventive and treatment facilities which are cost effective,
acceptable and accessible to the whole population.

Liaison with existing facilities e.g schools health centers where possible, arranging for
training.

Communication Skills

You are asked to deliver a talk on Destigmatization of psychiatric disorders to medical


students, what will be salient features of your talk?
Key:
Removal of myth

Removal of misconceptions
Removal of weaknesses/ deficiency in our health care.
Introduction of well integrated mental health program
Public awareness and education program
Proper training of doctors at undergraduate and postgraduate level.
Training of GPs
Involvement of Government and non Government organization.
Use of Media for education of community regarding mental health.

45 years old man getting treatment from psychiatrist for Paranoid Schizophrenia is
arrested for first degree murder.

Q-1 How will you assess whether he is fit to plead?


Q-2 What are the essential parts of Insanity defense?

Key

1-Defendant is fit to plead if he has the capacity to:

• Understand the charge and its implication.


• Can distinguish between a plea of guilty and not guilty.
• Challenge a juror to whom he might object.
• Follow the evidence in court.
• Instruct counsel on his behalf.

2- To establish a defense on the ground of insanity it must be Established that:


• Individual was suffering from a disease of the mind at the time of the crime.
• The disease caused defect of reason.
• The defect of reason robbed him of capacity to either know what he was doing or
know that it was wrong.

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