Transcription
Yeah, good morning. So today we start with the high yield questions of psychiatry. As we all know, psychiatry is a small subject, usually asked in FMG and every exam, but it is the main subject. As I always say, if you revise psychiatry, the whole psychiatry can be revised in two to three hours, and we try to make an attempt to take up all the MCQs which we can learn in this time. So, we did this last time also, and out of that 100 questions, there were about seven questions in the last FMG. This time, we curtailed the number of questions to 50, and we see if at all we have all the FMG questions this time from this 50 only. So, past bus and these two hours, I think, should be sufficing our need to, you know, revise. It's basically a revision of psychiatry as per the best of my understanding. So, welcome you all and thank you all for joining, and now we start with psychiatry.
The first question basically is someone saying that my daughter wants to kill me. If it is not a reality, it is a delusion. We all know delusion is a fixed belief, firm belief, false belief. Picks from false belief held with undue conviction, not shared by others, and not matching with the socio-cultural background. So, it's a fixed belief, firm belief, false belief held with good morning, data. Held with undue conviction, not shared by others, and not with the socio-cultural background. Okay, well done. We'll learn magical thinking is that merely by thinking. Magical thinking is merely by thinking, action would happen. Action would merely by thinking the action would happen. That is the magical thinking. Hallucination, illusion, we know they are the disorders of perception. So, disorders of perception are the hallucination and the illusion. Illusion, we all know. Illusion, we all know. So, this is not only the revision of the 50 questions. Trust me, it is basically the, it is basically the, what do you call, the revision of all the important topics. So, it is not previous year's questions we are doing. It's previous year's topics we are revising which have been commonly asked in the examination. Illusion, we know it's a misperception of stimulus. Stimulus is there, but I misperceive it. That is what has been called as the illusion. On the other hand, hallucination is a perception without any stimulus. Nothing is there, but I am seeing something. I am hearing something. That is what has been called as the hallucination. And please mind, it is as clear as real, as three-dimensional, as live and vivid as you're all hearing me and seeing me, if at all I would not have been live with you. So, it has all the qualities of a real perception, and it is in the objective space. It is in the objective space. There is no voluntary control, and insight is absent. That is the characteristic of a hallucination, and it is a game at the cortical level. Sensory organs are not involved. Sensory organs are not. So, that is the disorders of perception. So, we have a simplest lollipopest MCQ that the hallucination is a disorder of perception, and delusion is a disorder of thought. So, it's a disorder of thought. So, for the FMG, this is the lollipopest MCQ of the FMG that the delusion is a disorder of thought, and hallucination is a disorder of perception. Okay.
Again, now a lady having two depressive episodes in the past, now has low mood, restlessness, and suddenly saying that it's the same question. So, it's basically a severe depression with psychotic symptoms. So, it's basically recurrent depression with psychotic symptoms. Okay. So, we know we will learn depression in a bit. Okay. So, we know what in English we call as depression in psychiatry has been called as the major depressive disorder. And please mind, we have to remember that in psychiatry, the mood has to be persistently, pervasively low for 14 days. And in psychiatry, we have learned, we have to remember that psychiatry diagnosis is nothing but a cluster of symptoms making a syndromeal diagnosis. So, in this case, the depression symptoms, we must appreciate that we have the major symptoms like sadness of mood, lack of interest, and lethargy. These are three major symptoms. Then we have poor attention and concentration, forgetfulness, decreased appetite, weight loss, decreased libido, decreased sleep, and classically, we have an early morning awakening. That's a symptom of depression. So, we just all you all know, we all know the depression symptoms, but I'm just enumerating them all so that we are able to remember them. Okay. Now, fifth is the crying spells, excessive guilt, I'm feeling guilty too much, pessimistic view of future, and ideas of hopelessness, helplessness, worthlessness. Nothing could help me. Suicidal idea, attempt suicide. So, that is the good morning, Dr. Va. That is the classical symptom list of depression, and we know nothing major about it. We have major depressive disorder mild. We have major depressive disorder moderate, and we have major depressive disorder severe. My only point of telling you is that nothing major about it. It's only another name for depression in psychiatry. We call it as a major. So, it is very simple, 2 + 3 for 14 days is called as the major depressive disorder mild. 2 + 4, I hope you remember the blue color and this dark color. So, any two of that blue and any three of the down black for 14 days regularly is called as the major depressive disorder mild, and any two of that, any four of that will be called as moderate depressive episode, and anything more than 2 + 3 will be 2 + 4 will be called as the anything more than 2 + 4 will be called as the it is two types, severe depression without psychotic symptoms, severe depression with psychotic symptoms. Somebody hearing voices asking him to join above, or I am having a Cotard syndrome, nihilistic delusion, I am ending, my intestines are rotten up, kidneys are damaged, brain is no there, mind is not there. It's a Cotard syndrome, or I may have a delusion of guilt. So, not just guilt, it's an undue delusion of guilt. Okay.
Now, but why should we differentiate? We see that the lady is having a recurrent depressive episode. Now, she is suspicious that somebody wants to kill him. So, it's a depression with psychotic symptoms. With the psychotic symptoms, the treatment of choice is electroconvulsive therapy. We'll appreciate that in understanding, we feel that anybody, we don't know any treatment, we give the electric shock in psychiatry, but that's not the case. In psychiatry, the electric shock has been reserved now for the severe depression with psychotic symptoms or uncontrolled aggression. So, that's we must know that electric shock is the treatment of choice for severe depression. Okay, let's come to the next question.
Now, this gentleman is having a recovered. He has fever and he has fear that he may die of tachycardia, tachypnea for the past 3 months. The most likely diagnosis is the it's a post-traumatic stress disorder. We know what is post-traumatic stress disorder. There is a stressful event. There is a stressful event, and after that event, there is a so that is a recurrence happens. So, I just write it up. So, it has been qualified as the acute stress reaction or PTSD. Just an example to appreciate that. Now, somebody has purchased a car. Well done, Dr. Sesh. Well, Dr. Visha. Somebody has purchased a car and he planned to go to the temple with the car, and while he was just outside the car, taking a prasad, there is a bomb blast, and the whole family is blown off in the air in front of his own eyes, and he's asking, where is my family? Oh, they all died in front of you. I don't remember that. So, that's why that is called dissociative amnesia. But in post-traumatic disorder, what happens is this scene is repetitively coming in front of his eyes. Repetitive, you know, the images of that event, real living experiences, illusions, flashbacks, dreams. Now, somebody experiencing these dreams, what will happen? He obviously will be in a talking state. He'll be in a numbing state. He or she will be hyperalert, and since that time, I am not able to go to the temple or I'm not able to buy a car. So, in fact, it's a triad of three things: repetition of the trauma memory, the emotional response, and the avoidance. And we say that less than one month, it has been called as acute stress reaction. More than 1 month, it has been called as the PTSD. So, less than 1 month, it has been called as the and it is the PTSD. Well done. And we had a simple understanding that treatment of choice of PTSD is behavior therapy, and drug of choice of this is the SSRI. So, psychiatry is very simple. Whenever you don't know the answer, it's simple. Treatment of choice is behavior therapy, and drug of choice is SSRI. And among the behavior therapy, the latest therapy which is coming is the CBT therapy, and the EMDR, eye movement desensitization and reprocessing. So, that's the latest technique. Commonly used is the CBT, but that's a question that treatment of choice of PTSD is EMDR.
Now, this man takes alcohol for 26 years, and he takes alcohol about one bottle per day for the last 2 years. Now, he has a tremor, hearing restlessness, hearing of voices is at times, talking irrelevantly. He's experiencing a, he's experiencing a, alcohol intoxication, alcohol hallucination, or delirium tremens. Delirium tremens is the loving MCQ of the FMG and any exam. So, let's have a look at it. But before that, first note, what is delirium? Delirium is another name for the acute confusional state. It's another name for the acute confusional state. Well done, Dr. Sophia. Well done, Dr. Uh, yeah, Sesh. No, no, no. Intoxication. Intoxication. In intoxication, the person will be sedated, but there will not be any tremors, there will not be any, you know, hearing of voices, restlessness, and he will not talk irrelevantly. In intoxication, he will just be sedated. Okay, doctors, we will, we see what is delirium? It's another name for the acute confusional state. And in this, what happens is orientation is impaired. Orientation is impaired. Person is not oriented to the time, place, and person. And there is a hallucination. It being an organic condition, it's usually visual hallucination, and classically, it's a Lilliputian hallucination. Why we have see because he has been taking. Question discussion session or the current one, it is up to you and your love. Hopefully, we'll do some half today and maybe some half tomorrow, mean on Friday morning. Okay, but let's see how, but I think we should do it deep. We should finish it off. It is not a question discussion, it is a topic revision. So, once we do it, we should be clear of delirium and delirium tremens questions across the place, and you see that we would be, when the question of delirium will come next in the time in this paper only, it'll be like a cakewalk. Let's see that. So, there is a transient, transient, and frightening delusion. Transient and frightening delusion. And there is a, and there is a reversal of sleep-wake cycle. What my pattern was, that is being reversed. So, and there is a picking behavior called as the veloculation, and that's a, there is a sundowning phenomenon, more of confusion, more of hallucination, and disorientation as the sun sets. And treatment of choice is treat the cause. So, usually delirium is because of some sepsis, some electrolyte imbalance, some infection. So, treatment is treat the cause. But till the time you treat the cause, you can give the injection haloperidol 1.5 mg IV or till the time you treat the cause, you give the injection peridol 1.5 mg IV or IV. So, that's a delirium. It's another name for the acute confusional state, and we know in delirium, there is a diffuse EEG slowing.
Now, coming to delirium tremens. So, we all know alcohol is a CNS suppressant. It appears that alcohol is a CNS stimulant, but actually, it's a CNS suppressant. Daily, I take alcohol, my CNS was calmly suppressed. Every evening, CNS was calmly suppressed. Rest. Now, one fine day, I plan to leave alcohol. I left alcohol. What will happen? CNS will become hyperactive. CNS will become hyperactive. So, we'll have a delirium plus tremors plus autonomic hyperactivity. So, there will be increased pulse, increased BP, increased respiratory rate, increased sweating, and increased brain activity. So, sometimes they say it's a EEG fastenig. EEG fastenig, you get, sir. So, that is the question they ask you that in delirium, there is a diffuse EEG slowing, but in delirium tremens, there is a EEG fastenig. And treatment of choice will be what? Treatment of choice will be treat the cause. Cause here is alcohol withdrawal. Cause here is alcohol withdrawal. So, treatment will be the offer him a quarter, half, but we can't do that in a hospital. Otherwise, in the evening, a lot of people will come to take care of your impending delirium tremens. So, we'll give something like alcohol, and we give the benzodiazepine. Give you the benzodiazepine, and we give the longest-acting benzodiazepine, that is chlordiazepoxide. So, there is a question that the drug of choice for delirium tremens is some benzodiazepine, and most likely it's a chlordiazepoxide. And if delirium tremens plus seizure plus epilepsy or alcohol withdrawal seizure, that we have the injection diazepam. If liver function test is not available, we go to lorazepam because you know these are the benzodiazepines not metabolized by the liver. So, if we don't have the liver function test, we go for either lorazepam or oxazepam. So, these are all the questions from the alcohol withdrawal, and we completed like that. Just one more, one point. The first side effect or first withdrawal side effect, first withdrawal effect to come without, first withdrawal will be the first withdrawal with the tremors. The most common side effect or most common withdrawal or the first symptom, first sign of alcohol withdrawal is tremor. Very good. Within 6 hours. Very good. So, we know delirium tremens comes within 6 to 8 hours. Hallucinations come from 6 to 8 hours. Tremors 4 to 6 hours. 6 to 8 hours. Tachycardia for 24 to 48 hours, 48 to 72 hours. So, this is what is the timeline. So, anxiety, insomnia are there, but that is how the first symptom, first sign, first withdrawal will be the delirium, sorry, the tremors. That's great.
Now, now a 50-year-old man with a three-year history of irritability, low mood, lack of interest, and general dissatisfaction with everything, and no significant disruption in sleep and appetite. He is likely to be suffering from. He is likely to be suffering from the. We have learned now that for depression, there has to be sadness of mood, crying spells, and all that, 2 + 3 for 14 days, minimum of at least seven, you know, five symptoms for 14 days. But in this condition, it's basically a three-year history, chronic history, and it's a dysthymia. We know in this, what happens is sub-syndromal depressive symptoms or so they never become syndromal. They are basically for no major depression, it is basically the. So, it is a dysthymia. It's a C for depression, there has to be 2 + 3 for 14 days. Dysthymia, as per DSM-5, it has been called as persistent depressive. It's a persistent depressive. Okay. There is also a concept of double depression, commonly as in FMG exam. Now, dysthymia is something like a depressive personality disorder. Previous time, dysthymia has been called as the sub-behavioral. So, behavioral depressive personality disorder, but in today's world, it has been called as the, you know, the, the persistent depressive. So, but it is double depression, like some friends, some people are like that, they are always having a dull mood, lethargic, always complaining, always brooding, but now what they have been. So, it's a double depression. So, it's basically the major depressive disorder on persistent depressive, or it has been called as the depression on this thing. Depression on dysthymia. So, that is the double depression, again a very popular MCQ of psychiatry. Take dots up. Let's move.
Now, a 3-month-old child with depression, what therapy should be prescribed? So, ideally, we think that we should go only for CBT, but I think we should not mind giving the antidepressant here as well. It's a postpartum depression. So, we should not mind giving the antidepressant along with the CBT. We give the cognitive behavior therapy as well as the CBT. Okay.
Now, all are the reason for cognitive impairment in the old age except the thiamine. Thiamine actually, it is responsible for the Korsakoff's psychosis. Basically, it's a misnomer. It's a recent memory loss plus confabulation. Confabulation is filling up of memory gaps. Okay. So, it's not a psychosis, it's a misnomer. It's a recent memory loss plus confabulation. So, they ask you that what is confabulation? It's also the filling up of a memory gap. You ask me what you have taken for breakfast. I tell you I have taken idli vada. Idli I have taken when I was in Chennai 4 years back, but I just filled up my memory gap from my previous information. So, that's the confabulation. But we know that dementia has been, to understand this, we learn here, the dementia has been called as the reversible and irreversible. Reversible dementia is hypothyroidism, vitamin B12 deficiency, folic acid deficiency, niacin deficiency. Vascular, irreversible are the Alzheimer's disease, Parkinson's disease, and vascular. It's a post-encephalitic, we get post-encephalitic dementia. So, that is the reversible and the irreversible causes of dementia, or what is called memory loss. Sir, now alcoholic develops delirium tremens and other symptoms. What should we give? Without answer, first is we'll give the thiamine to prevent the Korsakoff's psychosis and later the Wernicke to prevent the Wernicke's encephalopathy. And later on the. The immediate aggressive confusional variant with disorientation with ataxia with sixth nerve palsy is a Wernicke's encephalopathy. Later on the. We don't give. We give.
Sudden and transient muscle weakness while being fully conscious, triggered by laughing and crying. It's a latest trendy MCQ, latest question to understand narcolepsy. It's a hypocretin. It's a hypocretin. It's basically a narcolepsy. Narcolepsy, we know it's a pentad of the sleep attack, sleep paralysis, and cataplexy, that is sudden break in the tone of the muscles. We have hypnagogic, hypnagogic, and hypnopompic hallucinations. And we have the abnormal, abnormal intrusion, the REM will come very fast. Okay, that's narcolepsy. Okay, that's sir.
Now, next, we come on to the next question they ask you is that the most common type of hypnagogic and hypnopompic hallucination is a visual hallucination. Is a visual hallucination. Najam, crazy doctors, we'll do some questions and make the speed better next time to call you. And the treatment of choice was methylphenidate. Now the answer is modafinil. Now the answer is modafinil. Narcolepsy. I am here. Yes. Thank you. So, narcolepsy. So, now is a question which made us to believe that if we have to learn the previous year paper, we should not do previous year questions. In fact, we should do the previous year topics because first they ask you what is all the pentad of narcolepsy. So, you remember this pentad. Then they ask you, hypnagogic, hypnopompic hallucinations are seen in narcolepsy, and they say, then that most common type of hypnagogic and hypnopompic hallucination is a visual hallucination. Choice was methylphenidate. Now the answer is modafinil. And then they ask you, last one, centralize in hypothalamus. That is the beauty of this question. By one MCQ, they progress to the next level. In fact, they go to further level that it is of two types. Type two is a iatrogenic. Type one is a idiopathic one. It has an association with HLA-DR. So, it's a HLA-related illness, and in this, there is a loss of the hypocretin-producing. It's a loss of the hypocretin or orexin-producing neuron in the hypothalamus. And what is happening to this? The cataplexy has to all pentad of narcolepsy. No, all pentad of narcolepsy is present along with the along with the cataplexy. Three cataplexy. So, that's all about the narcolepsy type one, type two. Type two is usually iatrogenic, means it is postponing, post-trauma, that is a type two variety of narcolepsy.
Now, that's a question loving MCQ of the FMG. Person with depression prescribed a serotonin and noradrenaline reuptake inhibitor. Which drug is that? That is the venlafaxine. That is the venlafaxine. We know this is SSRI, and this is SNRI. This is NDR, and this is SNRI. YouTube is very late, I think, going response. Okay, antidepressant, depressant, TCA, SSRI, SNRI, NARI. Okay. Thank you. TCA is a tricyclic antidepressant. This is again a very loving MCQ of the FMG. They are interested in knowing the class of an antidepressant. Okay. So, we have TCA, we have the selective serotonin. Okay. This is the serotonin noradrenaline reuptake. NARI is noradrenaline pure alone reuptake. SNRI is noradrenergic selective serotonin augmentation. Yes. NDRI is the noradrenaline dopamine selective serotonin reuptake. So, what actually they would like you to know in FMG or in UPSC, especially the medical officer exam, the medical officer exam. So, tetracyclic is the moxapine. Eska is the imipramine. Here we have the fluoxetine. SNRI is the venlafaxine. NARI is reboxetine. SNRI is mirtazapine, and is a bupropion. Okay. It's a triptan. So, that is a classification you must remember in FMG exam. Usually, they ask about the SSRI and the mirtazapine, that is the SNRI. But this time, they ask you about the SNRI, that is venlafaxine. Okay.
Characteristic of Alzheimer's disease act on which receptor? Which receptor? The attention is from memory is from duct. Okay. No, it is choline. So, remember we give the anticholinergic drug. Sorry, we give the cholinesterase inhibitors. Drugs used for Alzheimer's disease is choline inhibitor. Cholinesterase inhibitor, and we usually give the drug donepezil. We give the donepezil. That's so in the disease, the chemical lag is the choline. The dopamine is excess in psychosis, responsible for. So, we increase the choline somehow in the patients of Alzheimer's disease. So, the chemical responsible will be the choline.
Excessive concern with physical appearance, inappropriately seductive, shallow and labile affect, being self-centered and acting dramatically is a feature of which personality? It's a histrionic personality. We take advantage of this question to learn about. So, we take our topic two, which has been called as the personality disorder. You know what is personality? Personality is a persistent. So, it is the lifestyle of an individual by way of persistent, pervasive lifestyle of an individual. Okay. Secondly, it usually forms in adolescence. And we say that no personality is good or bad, but if it causes dysfunction, it will be called as some personality, personality disorder. But it's a very good answer. I think there is a lag happening. We are at the personality disorder topic, and now we know that in psychiatry, the personality has been learned in clusters. You have cluster A, cluster B, and cluster C. Odd and eccentric is a cluster A. B is the dramatic. Anxious A, B, and C. Without in ordinary, we have the paranoid PD, schizoid PD, and we have the schizotypal personality disorder. Dramatic, attention-seeking. We have the narcissistic PD. I'm the best. Antisocial PD. See, though we have asked you a difficult question in the FMG, they usually ask you simple questions that the paranoid PD is cluster A, B, C. So, it's a cluster A. In anxious, we have the anxious avoidant PD, we have dependent PD. Okay. Really. So, we have been simple questions that the anxious avoidant personality is cluster C. The dependent PD is cluster C. Borderline PD is cluster B. So, they are the simple free marks MCQ. Okay. You get, sir.
Now, hypochondriasis in DSM-5 is called as. Hypochondriasis in DSM-5 is called as the. I think it is not reaching you on time. We are to the next question, and I could only see the personality disorder typing. I'm no problem, but that's so. We know that in DSM-5, the hypochondriasis has been called as the illness anxiety. So, we have the, we have the somatic symptom. Here we had the trauma-related disorder, somatic pain disorder, and we have the hypochondriasis. We have the body dysmorphic disorder. We have the conversion disorder. So, it has been called as the somatic symptom disorder. And hypochondriasis has been called as the illness anxiety. Let's shift it to the OCD. So, that is the DSM-5. In hypochondriasis in DSM-5, it is called as illness anxiety.
Now, identify the treatment for the antidepressant used for treatment for the tobacco dependence syndrome. Starts up. So, we have this molecule. We have learned this table. So, we know the noradrenaline and dopamine reuptake is the bupropion. Bro, we learned about the personality. So, we had this question, and the answer is the bupropion. Okay.
Now, which of the hormone used for treatment of insomnia? It's a common sense question, mostly. It's melatonin. Melatonin, we know it's a hormone released at the time of sleep. So, the same has been used for the induction of sleep in patients of insomnia.
Now, which anesthetic agent is used now for the treatment of severe depression? Now, we know ketamine has been used for the treatment of severe depression. Okay.
Now, if we see this question, this will be very easy appearing to us. Reversible dementia is caused by deficiency of. It is caused by the deficiency of. Products. So, we know vitamin B12. Very good. Thiamine. So, thiamine use has been very popular suddenly, but recently, after the death of that Hollywood actor, famous celebrity, it has been taken back. Very good. So, niacin. We just learned the topic that vitamin B12, niacin, and folic acid are used for the. Very good.
Now, five A's of negative symptoms are proposed by. So, we know that four A's are given by four A's have been given by the four A's of schizophrenia have been given by Bleuler. But the five A's of negative symptoms has been given by Nancy and Matt. Give the first rank symptom of schizophrenia. Okay. Give the term. He coined the term schizophrenia. Given the four of given the four of schizophrenia of negative symptoms. So, we know that psychosis for the first time in the world classified by Emil Kraepelin, who classified. So, he has given the term dementia praecox. It's a dementia which has come early. So, it's a lovely MCQ that the term dementia praecox has been given by Emil Kraepelin. Okay. But then, Bleuler, Eugen Bleuler, coined the terms schizophrenia, given four A's of schizophrenia, namely autism, ambivalence, affective blunting, and associational loosening. Associational loosening. We know it's a loosening of association. There is no connection between the two sentences of schizophrenia. There is my emotions are being blunted. That is called affective blunting. Ambivalence is not able to decide for and against. Autism is what we learn autism today. Okay. But now, what is the, but this is 1904. This is 1911. But nobody could find out. So, in 1960, Nancy Anderson given the divided the symptoms of schizophrenia into positive symptoms and negative symptoms. And lately, we are given on the cognitive symptoms. Positive means something extra in me. Nobody else is hearing voices. I am hearing voices. It's a hallucination, which is a positive sign. Nobody believes there is a camera here. In fact, there is a camera here. Nobody believes there is a camera here. I believe there is a camera here. Somebody wants to harm me. Somebody wants to trouble me. That's a delusion. And too much of violence is the positive symptom. Delusion, hallucination, and violence are the positive. Negative means which all of us do, but they can't do. They, means schizophrenic patients, can't do. So, we all have some motivation to live. They have a motivation and anhedonia. They do not enjoy the pleasure. Anhedonia is a pleasure. Lack of. So, motivation, anhedonia. Hideon is a pleasure. So, I can't experience the pleasure. We all socialize. They do not believe in socialization. They have asociality. We all speak language. They either do not speak at all, or they just speak five words per day. So, that's an absence of language. That's alogia. We all have the attention to focus. They have attentional deficits. We have all the emotions to display. They have the affective blunting. So, that is the five A's of the negative symptoms. Tricky MCQ. Four A's of schizophrenia were that is of schizophrenia. Question is five A's of negative symptoms of schizophrenia. Just to trouble you, I included this question because that will stimulate. That's a five, four A's of schizophrenia, and this is five A's of negative symptoms of schizophrenia. Cognitive is lack of executive functioning or memory.
Now, delirium following is the neurotransmitter decrease in the patients with delirium. Again, in delirium, that is acetylcholine.
Now, this question I have given it just to know what is enuresis. It's a passing of stool at inappropriate places. WhatsApp. Because in nocturnal enuresis is passing of urine at night. You're not in bed. By child age more than. It's a simple question that the child learned toilet training. Child learned toilet training by the age of 3 years. Toilet means where to pass stool, and for urine passing at night time, the age is 5. Now, if we just have been very, very clear, very good, Dr. Versha. So, very, very clear. Cluster C personality includes all except. Lollipop dependent, avoidant, and anancastic, or what has been called as obsessive-compulsive. It is the response. It's a narcissistic. We know it's a cluster.
Now, factors predicting poor outcome in schizophrenia are all except. Obsessive-compulsive personality disorder, cluster C, what has been called as anancastic. Yes, it is not. Maybe that sir, narcissistic is cluster B. Factors predicting the poor outcome in schizophrenia are all poor outcome. So, for you must know good outcome. So, anything good outcome is the presence of mood symptoms. Okay. See, please mind, this is the. There is a professor T.J. Crow in 1980, he classified the schizophrenia into Type I and Type II schizophrenia. This table is doubly important because if you remember this table, there is a double benefit that first is that benefit that sometimes they ask you in the medical officer exam, the Type I, Type II schizophrenia. But if you remember this, you will have another free question. We'll learn shortly. Type I is acute onset schizophrenia, usually after a precipitating event. Usually after a preceding event, predominantly we have positive symptoms, no family history, emotions are preserved, and no CT scan MRI finding, and it's a good prognosis. Type II, on the other hand, is insidious onset, gradual onset schizophrenia. As such, there is no precipitating event, predominantly we have negative symptoms. I hope now we remember what is negative. Family history is also positive. And when I tell you that emotion, negative symptoms are predominant, you know that emotions are gone. There are some accidental or incidental CT scan MRI findings, and it's a poor prognosis. So, if you remember this table, the same table applies to the good and the bad prognosis. Same table will be applied for the good and the bad prognosis. Okay. Acute onset, presence of emotional symptoms. Somebody crying, somebody depressed, insomnolence, emotion present. It's a good prognosis. Just to complete the table. Now, somebody married, female gender, late age of onset, that is answer after 45 years of age, and family history of bipolarity is a good prognosis. Acute onset with family history of bipolarity, onset after a precipitating event, predominantly positive symptoms, emotion preserved, no CT scan finding present, and somebody married, it's a good prognosis of schizophrenic personality beforehand. Somebody having a schizoid personality beforehand, and presence of the soft neurological signs. So, it's a good prognosis. It's a poor prognosis. Just had to think that having somebody having a schizoid personality beforehand and later developing schizophrenia will be a poor prognosis. And presence of these soft neurological signs indicate the poor prognosis. You get, sir. So, that's all about the good and the bad prognosis in schizophrenia.
Now, after death of wife, husband is crying, distress, not able to sleep, not going for work, not taking food, lost about 10 kg of weight, and saying to God, please take me away. I should be dead in her place. We both would have died together. That's a normal grief reaction. Okay, but we just take the advantage of this question to learn all the understanding of grief. We all know grief or bereavement is a normal emotional reaction to loss of a loved one through the process of death. And we know grief as a grief starts immediately, lasts for 1 month, at maximum for 3 months. Okay. And it has three stages: shock and denial. No, no, no. Distress. Detachment. Okay. No, no, this can't happen. This person, he person can't die. That's yesterday only we met. That's shock and denial. Distress is that I have been crying, I have been troubled up, not going to work, not taking food, and I'm distressed. That's a normal distress of grief. Detachment is that ultimately we have to detach from that. But that's all normal. What's so abnormal about it? So, that's a normal grief reaction. Now, there could be two. Now, there is something in psychiatry called as pathological grief. Either the grief is delayed, or it has been prolonged, or there is some term called as hypertrophied grief. Hypertrophied grief is no grief for more than two weeks. That's okay. That's a delayed grief. Okay. Grief lasting beyond 6 months has been called as prolonged grief, and grief more than 2 years will be called as hypertrophied grief reaction. We get at some grief more than two. Okay. So, that's the plural pathological grief. But there is something in psychiatry called as complicated grief. Complications in grief can be depression, can be psychosis. We must know that symptoms of depression till death wish in the background of death of a loved one, background death of a loved one, that's there is a lag. So, is normal grief till that time? It's a normal grief reaction. Till death wish, it is still death wish. For causing depression, calling it to be depression, it is somebody making an active suicidal attempt. Active, that indicates depression. Somebody making an active attempt of suicide, or somebody making excessively guilty about guilt. Somebody excessively guilty about the death of a loved one. It is because of all my fault that that person dies. And the anniversary reaction that indicates depression. And last is mummification. Mummies, we all know embalming the body and keeping the body after death. It's a mummification. But that is not possible nowadays. So, what is mummification? It is freezing the belongings of a loved one. Family believes it's love. Psychiatrists say it's a sign of depression in the family. Now, any delusion, any hallucination is a. So, that's a tricky MCQ, and we have seen this question that it is a. So, all symptoms are of depression, but till death wish, we say it's a normal grief reaction, which has been said as uncomplicated bereavement. We know more than 2 years of grief, it is hypertrophic grief reaction. More than 6 months is prolonged grief reaction. You get, sir. Okay.
Now, how to break bad news? That's a very, very popular. We know doctors have been beaten across the globe nowadays. So, to prevent the beating, we have a SPIKES pattern. It's a setting up of the interview, perception of client, introduction, knowledge sharing, expectation, and summarize. So, SPIKES pattern actually minimizes the, you know, the fight and the jaga in the emergency department, and when they have how to break bad news. So, it is a short form of multiple words: setting up of the interview, perception of the client. Very good, doctor, Dr. Versha, Dr. Navaraj Kumar, Dr. Sorry, but I think we might have to cut short the class, and we take up the next Friday morning 10:00 a.m. to till we finish off, cuz not possible to do one or two questions. So, that's all.
Now, catatonic signs, all of the following are catatonic signs except cataplexy. We know is a pain in narcolepsy. Symptoms are mutism. It is mutism, rigidity, despite that there is waxy flexibility. So, and you mold him like this, he can be easily molded like that, and you leave him there, he will remain like this for days and hours together. So, they maintain abnormal postures called as catalepsy, mutism, rigidity, waxy flexibility, posturing, and they have echolalia, echopraxia, echo of language, echo of movement. And we have automatic obedience. We know treatment of choice is electroconvulsive therapy, and we give the lorazepam challenge test. If we give lorazepam, sometimes the symptoms disappear. You get, sir. Yes, cataplexy, we have seen, is found in narcolepsy. So, that's all about catatonia.
So, we take up the last asked question, you know, defect in empathy, defect in the capacity to appreciate other people's feelings, especially is a core feature of. My God, empathy defect, antisocial personality. So, they have no guilt, no empathy. It's a heavy question. Very good. Very good, Dr. Navarajan, Najan Kumar. Yes. No guilt, no empathy. It's a classical feature of this social.
Now, that's a very basic question. All of the following are basic disturbances in psychosis. It's all of the above. All of the above. And in clear sense, all of them are correct. We have percent deterioration, we have hallucination, we have delusion. Question is, all are seen in psychosis except. So, question: all are seen in psychosis except where the answer is disorientation. Very good. In psychosis, there is no disorientation. Delirium differs from psychosis in. Delirium differs from psychosis in orientation. In delirium, there is disorientation. Very good. Sensorium, orientation. Very good. Ekats up.
So, we just take up this last question of IQ and wind up today's class. So, sorry, but we'll completely enjoy the remaining slides to come. So, IQ, we all know is a IQ is equal to, you know, mild is IQ is equal to mental age upon chronological age into 100. But please mind, the maximum chronological age is 16 years. After 16 years of age, divide by 16. So, when this question will be asked, we'll do 9 by 16 into 100 is equal to something like that. It's a straightforward question. Sorry. Okay. So, it's a 9 by 16 divide by two. It is 15 years. Divided by 15. So, actually, the question is 25 years old, 9 IQ. So, then the trick applies that you divide only by, we feel 9 by 25 into 100 is equal to 36, but that is wrong. In this question, we'll divide by 9 by 15 into 100 is equal to. So, IQ formula is 9 mental age by chronological age, but the maximum chronological age to be divided is 15 years of age. And we all know IQ, any IQ less than 70 is called mental retardation. In DSM-5, it has been called as intellectual disability. We know 50 to 70 is called as mild MR. 35 to 49 is moderate MR. 20 to 34 is severe MR. Less than 20 is profound MR. They are educable till 8th class. They are trainable. They are dependent and they need nursing. So, that is how the rule of IQ. Okay. Mild, moderate, severe. IQ is equal to mental age upon chronological age into 100. But and the latest question is a simple question, lollipop question is that as per DSM-5, the mentation is been called as intellectual disability. So, this will be categorized into the mild MR. Very good question is mild MR. So, well done, Dr. Versha and Dr. Navarajan, and thank you so much, you all. And we'll take up the remaining questions, but trust me, no question has ever come outside this 50 questions. Sorry, we can't do in continuation today. We will wind up and we'll take up on Friday morning 10:00 a.m. to 11:00 a.m. or maybe till we finish off. Okay. Good luck. Thank you.