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MRCPsych - General Adult Psychiatry: Q’s And A’s
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MRCPsych - General Adult Psychiatry: Q’s And A’s
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MRCPsych - General Adult Psychiatry: Q’s And A’sThe prevalence of catatonic phenomenon among patients with schizophrenia
is estimated to be around Right Ans - 5-10%
Mannerisms are the most common
catatonic phenomenon in schizophrenia, followed by stereotypies, stupor,
negativism, automatism and echopraxia in order of frequency.
About 10-15% of patients with catatonia meet the
criteria for schizophrenia.
catatonic symptoms are more prevalent in the developing nations than in the
West.
Immobility and mutism are the most commonly observed catatonic symptoms
among depressed patients.
Somatic syndrome is defined by a set of vegetative or biological features of
depression.
The ICD-10 criteria for somatic syndrome of depression require at least four
symptoms from
a list of eight. Right Ans - (1) marked loss of interest or pleasure;
(2) loss of emotional reactions;
(3) early-morning awakening (2 hours before normal waking time);
(4) diurnal worsening of
mood;
(5) objective evidence of marked psychomotor retardation or agitation;
(6) marked loss
of appetite;
(7) loss of libido and
(8) 5% or more of body weight lost unintentionally in the past month.
Seasonal affective disorder Right Ans - Familial risks of affective disorders
in SAD are similar to those found in non-seasonal depressive illnesses.
Typical depressive symptoms of SAD respond better to bright-light therapy
whereas atypical symptoms respond to phototherapy at all intensities.
,In phototherapy retinal light exposure is important; skin absorption is not
sufficient to modify circadian rhythms or depressive symptoms.
Early-morning phototherapy is superior but leads to more side-effects, such
as easy startle, gastrointestinal intolerance and headaches.
Conventional antidepressants have also been reported to have a therapeutic
effect in SAD.
The 1-year prevalence of dysthymia is estimated to be around: Right Ans -
Dysthymia has a 1-year prevalence of 1-3%. The lifetime prevalence according
to the National Comorbidity Survey 1994 is 6%.
Dysthymia has a high comorbidity with other
psychiatric disorders, particularly major depression. In one series, only about
25-30% of cases were observed to occur over a lifetime in the absence of
other psychiatric disorders. The
comorbidity of personality disorders seems to be very high (60-80%). Early-
onset dysthymia is
defined as having onset before age 21.
The most powerful predictors of recurrence of depressive episodes: Right
Ans - -the presence of residual symptoms after apparent recovery (increases
risk of recurrence nearly 3fold)
-history of previous episodes of depression (doubles risk)
Other possible risk predictors for recurrence include somatic syndrome,
reversed
vegetative signs, early age of onset, and family history of mood disorders.
Recurrence risk is
higher in bipolar than in unipolar mood disorders.
The proportion of patients who develop a depressive episode and then go on
to develop an episode of mania within 10 years is approximately: Right Ans
- 1 in 10
If the illness begins at a younger age, the switch
, happens earlier. This rate increases if severely depressed hospitalized
patients are considered.
It is known that the majority of bipolar patients,
particularly women, begin with depressive episodes. Among hospitalized
depressed patients
followed up for nearly a decade, 1% a year converted to bipolar I and 0.5% a
year converted to bipolar II.
Factors associated with a change of polarity from unipolar to bipolar were
younger age, male sex, family history of bipolarity, antidepressant-induced
hypomania, hypersomnic and retarded phenomenology, psychotic depression,
and a postpartum episode.
The mean age at which the switch occurs is
32 years.
The average number of previous episodes in those who switch varies between
two and four.
normal mourning vs depression. Right Ans - Parkes described features that
may distinguish normal mourning from depression. Normal
mourning is characterized by pangs of grief, angry pining, and anxiety when
reminded of the loss, brief hallucinations, somatic symptoms, and
identification-related behaviours.
The presence of psychomotor retardation, generalized guilt and suicidal
thoughts after the first month suggest development of depression.
Clinging behaviour and inordinate pining may be early signs of prolonged
grief as described by Parkes.
Specifiers Right Ans - Specifiers are extensions to a diagnosis that further
clarify the course, severity, or special features of the diagnosis.
Used in DSM, not ICD
longitudinal course of bipolar disorder? Right Ans - mania generally lasts
for a shorter time than depression.
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