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Psychiatry Class 3 (AMC Made Easy)

The document provides an overview of various anxiety disorders and somatoform disorders. It discusses the features, diagnostic criteria and treatment options for conditions like panic disorder, social anxiety disorder, generalized anxiety disorder, obsessive compulsive disorder, post-traumatic stress disorder, adjustment disorder, somatic symptom disorder, conversion disorder, hypochondriasis, factitious disorder, malingering and body dysmorphic disorder.

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Arslan Ashraf Chajra
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41 views

Psychiatry Class 3 (AMC Made Easy)

The document provides an overview of various anxiety disorders and somatoform disorders. It discusses the features, diagnostic criteria and treatment options for conditions like panic disorder, social anxiety disorder, generalized anxiety disorder, obsessive compulsive disorder, post-traumatic stress disorder, adjustment disorder, somatic symptom disorder, conversion disorder, hypochondriasis, factitious disorder, malingering and body dysmorphic disorder.

Uploaded by

Arslan Ashraf Chajra
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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AMC MADE EASY (PSYCHIATRY CLASS)

BY - DR. TAHREEM
AMC CAT Adult Adult Women’s
Child Mental Population
MCQ Health Health Health TOTAL
Health Health Health
BLUEPRINT (Medicine) (Surgery) (Obs/(Gyn)
ITEM
30 % 20 % 12.5 % 12.5 % 12.5 % 12.5 % 150 Qs
TOTALS

https://chat.whatsapp.com/Goz6VDQjOJB2hm3y5tIUnK (Whatsapp Group)

https://t.me/AmcMadeEasy (Telegram Group)


https://www.facebook.com/groups/683087893263486 (Facebook Group)
Anxiety Disorders
 Fear : Known, external, definite threat

 Anxiety : Alerting signal, which makes one take an action, it is unknown, internal and vague threat

 Features of anxiety : Sweating, tremors, restlessness, tachycardia, mydriasis, increased urinary


frequency, diarrhoea, hyperreflexia and cold clammy skin
 Panic attack : An acute attack of intense anxiety, with a feeling of impending doom ,
palpitations, choking sensations, chest pain, dizziness, depersonalization, derealization,
fear of having a heart attack, dying or going mad.

Symptoms peak within 10 mins and subside within few mins Rx : Reassurance
DDx : Hyperthyroidism, Pheochromocytoma & Hypoglycaemia
Panic Disorder
 Recurrent panic attacks with at least 1 month of persistent worry about :

Having another attack or complication of attack


Significant behavioural changes related to attacks
Not associated with Substance abuse / Psychiatric disorder

Rx : SSRIs / Venlafaxine

Agoraphobia
 Fear of places from which escape might be difficult

Specific Phobia
 Strong, persistent & irrational fear of an object or a situation.
Out of proportion to the apparent stimulus.
 Specific phobia ( continued )
 Rx : Systematic desensitization

 Cynophobia : Fear of dogs


 Rx : 1st relaxation techniques ( Deep Breathing )
2nd Systemic Desensitisation
 Think about dog
Look at the photo of dog
Look at the dog while detained > then look while it is undetained > then while it is approaching
Let the dog get close to you
Pat the dog >>> Hold the dog >> Play with the dog
Social anxiety disorder :
 Experienced in anxiety provoking social situations ( Eg : Canteens, Restaurants, Staff Meetings )
Fear of embarrassment
Rx : Same as other phobic disorders / Beta Blocker before social events
Generalised Anxiety Disorder
 Free floating anxiety / Excessive worries
 Restlessness or feeling edgy
 Being easily fatigued
 Difficulty in concentration
 Irritability
 Muscle tension
 Sleep Disturbances

At least 3 symptoms for minimum 6 months, both physiologic and psychologic symptoms of anxiety are
present.
Rx : SSRIs / CBT
Obsessive Compulsive Disorder
 Obsessions : Recurrent, intrusive thoughts images or impulses, which cause anxiety.
Pt considers them as a product of their own mind.
 Compulsion : Repetitive behaviours/mental acts performed in response to obsessions
Reduce anxiety temporarily.
 Ego dystonic (Not acceptable to self and wants to be treated DDx : OCPD – Ego Syntonic)

 Etio : Seratonergic Dysregulation

 Duration criteria - Two weeks

 Rx : Pharmacotherapy (SSRIs / Clomipramine)


Psychotherapy (Relaxation training / Exposure and response prevention / Desensitization)
Post Traumatic Stress Disorder
 Severe anxiety symptoms following a life threatening injury to self or others.
Eg:- Stressors : Trauma such as earthquake/ floods, wars, murder, rape, serious accidents etc
 Symptoms :

Reexperiencing of traumatic events ( Flash backs/ Nightmares )


Avoidance of stimuli associated with trauma
Increased arousal ; Hypervigilance, Insomina, Exxagerated startle response.
Anxiety, Depression, Impulsivity & emotional lability are common.
Survivors Guilt
Symptoms must last for at least 1 month to diagnose it as PTSD
Symptoms lasting for < 1 month ( but > 2 days) & within 1 month of stressor– Acute Stress Disorder
 Rx : SSRIs
CBT
Adjustment Disorder :
 Anxiety symptoms / Depression in response to an identifiable psychological stressor.

 Stressor : Relationship issues (Breakup), changes of job, migration, death of loved one.

 Social or occupational functioning is impaired

 The symptoms are in excess of the normal expected reaction to the stressor.

 Occurs within 3 months of response to the stressor and lasts for <6 months after removal of the stressor

Rx :
 1. Pharmacological (Antidepressants, antianxiety drugs)

 2. Psychotherapy (Supportive psychotherapy)


Somatoform disorders
 Physical symptoms with no medical explanation
 Symptoms are severe enough to interfere with ones ability to function in social or occupational activities

Somatic symptoms disorders :


 One or more somatic symptoms affecting many organ systems over several years
GI – nausea / vomiting / pain abdomen
CVS – palpitations / sob / chest pain
CNS – amnesia / dizziness / difficulty walking, talking
Pain – headaches , diffuse neck / backache, arthralgia
 Excessive thoughts, feelings or behaviours related to symptoms
 Associated with impaired social, occupational and family functioning
 Rx : Psychotherapy by a single supportive doctor
Conversion Disorder
 Pt presents with symptoms suggestive of neurological deficit but, no cause can be found on investigations.

 Commonly associated with other comorbid psychiatry disorders ( personality disorders )

 Mutism, Blindness, paralysis are m/c symptoms

 Pseudo seizures , gait disturbances, weakness, paralysis, tics, jerks etc

 La belle indifference : Lack of concern about impairment

 Rx : Psychotherapy

Hypochondriasis
 Preoccupation with fear of having or an idea that one has a serious physical illness

 Investigations = normal / fear persists despite reassurance.

 This belief affects patients level of functioning

 Symptoms must occur > 6 months

 Rx : Psychotherapy
Factitious disorder
 Wilful production of symptoms to get medical attention ( hospitalisation ) & take sick role.
 Usually they are related to medical field.
 Symptoms can be imposed on self or others (Munchausen by proxy).
 Becomes angry when confronted .

Malingering
 Wilful production of symptoms for an obvious gain (financial incentive, avoiding legal case, tough job)

 Not a psychiatric disorder.


 Preoccupied more with reward rather than Rx.
 Discrepancy in complaints and objective findings
 Lack of co-operation by patients during evaluation and treatment.
Body Dysmorphic Disorder
 Preoccupation with an imagined defect/slight anomaly in physical appearance

 Most common concerns are facial flaws

 Repetitive behaviour (E.g. mirror checking) or mental acts (Comparing self with others)

 House bound

 Avoid social situations

 Rx : Psychotherapy / Pharmacotherapy ( SSRIs )


For more info regarding classes and resource materials, feel free to join our groups

 https://chat.whatsapp.com/Goz6VDQjOJB2hm3y5tIUnK (Whatsapp Group)

 https://t.me/AmcMadeEasy (Telegram Group)

 https://www.facebook.com/groups/683087893263486 (Facebook Group)

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