Psychiatry — High-Yield Topics
Must-Know Conditions
- schizophrenia
- delusional-disorder
- acute-and-transient-psychotic-disorder
- schizoaffective-disorder
- morbid-jealousy
- mania
- psychotic-depression
- substance-induced-psychosis
- organic-psychosis
- dementia
- delirium
- depression
Common Viva Topics
- Schizophrenia: Schneider’s First Rank Symptoms, Clinical Phases (Prodromal cardinal feature: unexplained functional decline), “Rule of Thirds” for prognosis.
- Indicators of poor prognosis: Male sex, insidious onset, younger age, negative symptoms, high Expressed Emotion.
- Genetic Risk: Identical twin (45-48%), Child of 2 affected parents (46%), Sibling (9%).
- Pharmacological Management:
- Stepwise approach: 1st-line atypical → maintenance → clozapine for resistance
- Why atypicals over typicals? (EPS profile)
- Depot indications and precautions
- Clozapine: Definition of treatment resistance, starting dose 12.5 mg, slow titration, target trough ≥200 µg/L, FBC monitoring (weekly ×18 wk then 4-wkly), side effects (agranulocytosis 0.8%, myocarditis, seizures, sialorrhea, constipation).
- Management: Calgary Depression Scale to distinguish depression from negative symptoms.
Common OSCE Stations
- Risk Assessment: Evaluating suicide (5-10% lifetime risk) and aggression risk in a psychotic patient.
- Counselling: Explaining the need for long-term medication (at least 3 years after 1st episode); monitoring for Clozapine.
Frequently Tested MCQ Areas
- ⚠️ First-line treatment for catatonic schizophrenia is ECT.
- ⚠️ Depot antipsychotics are not used in acute episodes.
- ⚠️ ICD-10 duration for schizophrenia is 1 month (vs 6 months for DSM-5).
- ⚠️ Simple Schizophrenia requires a one-year duration for diagnosis.
- ⚠️ Mortality in schizophrenia is 3x general population; life expectancy reduced by 15-20 years (CV disease + suicide).
- ⚠️ Rapid neuroleptization (loading doses) is not recommended; use benzodiazepines for sedation.
Key Comparisons
Weak Areas / Needs Review
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