Author: Neelam Maurya

Compilation Of Psychiatric Disorders In Pediatric Patients

COMPILATION OF PSYCHIATRIC DISORDERS IN PEDIATRIC PATIENTS


COMPILATION OF PSYCHIATRIC DISORDERS IN PEDIATRIC PATIENTS

  • Important psychiatric disorders in pediatric patients include,
    • Conduct disorder.
    • Oppositional defiant disorder.
    • Specific disorders of scholastic skills – Learning disorders.

Conduct disorder:

  • Associated with unsatisfactory family relationships & failure at school.
  • Later stages lead to antisocial personality disorder (dissocial personality disorder).

Features:

Characterized by –

  • Repetitive & persistent pattern of disregard for rights of others.
  • Aggressiveness & dissocial behavior (excessive fighting or bullying).
  • Cruelty to animals/people.
  • Severe destruction of property (fire setting).
  • Stealing.
  • Truancy from school.
  • Repeated lying.
  • Frequent running from school & home.
  • Defiance of authority figures.
  • Disobedience pattern.

Oppositional defiant disorder:

  • Less severe than conduct disorder.

Features: 

  • Characterized by persistently negativistic & defiant behavior (frequent arguing with adults, refusal to comply with adults).
  • Frequent loss of temper (deliberately annoying adults).
  • Note: No serious violations (theft, fire setting, destruction, etc.) – Unlike conduct disorder.

Management:

  • Conduct & oppositional defiant disorder –
    • Family intervention & behavioral therapy.
    • Low dose antipsychotics effective in some.

Learning disorders:

  • Also referred as Specific developmental disorders of cholastic skills”.

Features: 

  • Characterized by significant impairment in one or more of scholastic skills which are out of proportion to intellectual functioning of child.
  • Eg: Significant difficulty in reading while having normal writing & arithmetic skills with normal IQ.

Subtypes: 

  • Specific reading disorder (Dyslexia).
  • Disorder of written expression (specific spelling disorder).
  • Specific disorder of arithmetic skills.
  • Mixed disorders of scholastic skills (reading, writing & arithmetics).

Other features:

  • Inattention.
  • Hyperactivity.
  • Emotional disturbances.

Exam Important

  • Repetitive & persistent pattern of disregard for rights of others is seen in conduct disorder.
  • Aggressiveness & dissocial behavior (excessive fighting or bullying) and repeated lying is feature of conduct disorder.
  • Dyslexia is specific reading disorder.
  • Learning disorders are developmental disorders are characterized by significant impairment in one or more of the scholastic skills which are out of proportion to intellectual functioning of child.
Don’t Forget to Solve all the previous Year Question asked on COMPILATION OF PSYCHIATRIC DISORDERS IN PEDIATRIC PATIENTS

Module Below Start Quiz

Mental Retardation

MENTAL RETARDATION

Q. 1

X-linked disease leading to mental retardation is :

 A

Myotonic dystrophy

 B

Fragile-X syndrome

 C

Tuberous sclerosis

 D

Phenylketonuria

Q. 1

X-linked disease leading to mental retardation is :

 A

Myotonic dystrophy

 B

Fragile-X syndrome

 C

Tuberous sclerosis

 D

Phenylketonuria

Ans. B

Explanation:

B i.e. Fragile – x – Syndrome


Q. 2

Which is MC genetic cause of mental retardation –

 A

Tuberous sclerosis

 B

Cri-du-chat syndrome

 C

Fragile-x-syndrome

 D

Angel’s syndrome

Q. 2

Which is MC genetic cause of mental retardation –

 A

Tuberous sclerosis

 B

Cri-du-chat syndrome

 C

Fragile-x-syndrome

 D

Angel’s syndrome

Ans. C

Explanation:

Ans. is ‘c’ i.e., Fragile-X-syndrome

o Down’s syndrome is the most common genetic cause of mental retardation, and fragile-X is second to Down’s.

Also know

o Most common inherited cause of mental retardation is fragile-X-syndrome (because down’s syndrome is congenital cause but not inherited).


Q. 3

An IQ between 50 & 70 would be classified as what kind mental retardation –

 A

Mild

 B

Moderate

 C

Severe

 D

Borderline

Q. 3

An IQ between 50 & 70 would be classified as what kind mental retardation –

 A

Mild

 B

Moderate

 C

Severe

 D

Borderline

Ans. A

Explanation:

Ans. is ‘a’ i.e., Mild 

Quiz In Between


Q. 4

IQ in moderate mental retardation –

 A

90-70

 B

70-50

 C

50-35

 D

35-20

Q. 4

IQ in moderate mental retardation –

 A

90-70

 B

70-50

 C

50-35

 D

35-20

Ans. C

Explanation:

Ans. is ‘C’ i.e., 50-35 


Q. 5

Most common type of mental retardation –

 A

Mild

 B

Moderate

 C

Severe

 D

Profound

Q. 5

Most common type of mental retardation –

 A

Mild

 B

Moderate

 C

Severe

 D

Profound

Ans. A

Explanation:

Ans. is ‘a’ i.e., Mild 


Q. 6

Mental retardation is defined if IQ is below ‑

 A

90

 B

80

 C

70

 D

60

Q. 6

Mental retardation is defined if IQ is below ‑

 A

90

 B

80

 C

70

 D

60

Ans. C

Explanation:

Ans. is `c’ i.e., 70 

o A child with IQ . 70  is called mentally retarded.

Quiz In Between


Q. 7

IQ – 40 level of mental retardation:        

NEET 13

 A

Mild

 B

Moderate

 C

Severe

 D

Profound

Q. 7

IQ – 40 level of mental retardation:        

NEET 13

 A

Mild

 B

Moderate

 C

Severe

 D

Profound

Ans. B

Explanation:

Ans. Moderate


Q. 8

Severe mental retardation is:        

NEET 13

 A

50-70

 B

35-50

 C

20-35

 D

< 20

Q. 8

Severe mental retardation is:        

NEET 13

 A

50-70

 B

35-50

 C

20-35

 D

< 20

Ans. C

Explanation:

Ans. 20-35


Q. 9

IQ in mild mental retardation is

 A

50-70

 B

35-49

 C

20-34

 D

< 20

Q. 9

IQ in mild mental retardation is

 A

50-70

 B

35-49

 C

20-34

 D

< 20

Ans. A

Explanation:

Ans. is ‘a’ i.e., 50-70

Quiz In Between


Q. 10

Most common type of mental retardation ‑

 A

Mild

 B

Moderate

 C

Severe

 D

Profound

Q. 10

Most common type of mental retardation ‑

 A

Mild

 B

Moderate

 C

Severe

 D

Profound

Ans. A

Explanation:

Ans. is ‘a’ i.e., Mild


Q. 11

IQ of 15 is which grade of mental retardation ‑

 A

Mild

 B

Moderate

 C

Borderline

 D

Profound

Q. 11

IQ of 15 is which grade of mental retardation ‑

 A

Mild

 B

Moderate

 C

Borderline

 D

Profound

Ans. D

Explanation:

Ans. is.’d’  i.e., Profound

   Category                                        IQ

Normal intelligence > 90
Borderline intelligence 70 – 89

Mental retardation

Mild MR

Moderate MR

Severe MR

Profound MR

50 – 69

35 – 49

20-34

0-19


Q. 12

Education criteria for mental retardation is ‑

 A

Mild

 B

Moderate

 C

Severe

 D

Profound

Q. 12

Education criteria for mental retardation is ‑

 A

Mild

 B

Moderate

 C

Severe

 D

Profound

Ans. A

Explanation:

Ans. is ‘a’ i.e., Mild 

Quiz In Between



Mental Retardation

MENTAL RETARDATION


MENTAL RETARDATION

Introduction:

  • Condition characterized by incomplete development of intellectual functions & adaptive skills (skills for successful Iife).
  • Intelligence is measured by Intelligence Quotient (IQ).

Calculation method:

  • IQ = Mental age/Chronological age x 100 
    • Maximum denominator – 15 (even for elderly assessment).
  • IQ less than 70 – Considered as “mental retardation”.

Category & their IQ:

  • Normal – 90-109
  • Borderline – 70-89
  • Mild mental retardation – 50-69
  • Moderate mental retardation – 35-49
  • Severe mental retardation – 20-34
  • Profound mental retardation – <20.
  • Level of functioning varies with severity of mental retardation.

Causes: 

  • Down syndrome & fragile-X syndrome – Most common chromosomal cause.

Features:

  • Behavioral problems in mental retardation – Have maladaptive behavior (aggression, self injurious behaviors, hyperactivity, etc).

Management:

  • Modified by behavioral therapy techniques – Contingency management.
    • Desired behaviors rewarded & undesired behaviors punished.

Exam Important

  • Calculation for IQ = Mental age/Chronological age x 100.
  • IQ less than 70 is considered as “mental retardation”.
  • Down syndrome & fragile-X syndrome are the most common chromosomal cause of mental retardation.
  • Behavioral problems in mental retardation are managed by behavioral therapy techniques like contingency management.
Don’t Forget to Solve all the previous Year Question asked on MENTAL RETARDATION

Module Below Start Quiz

Electroconvulsive Therapy (Ect)

ELECTROCONVULSIVE THERAPY (ECT)

Q. 1

The only definite contraindication to ECT is:

 A Brain tumour
 B Glaucoma
 C Aortic aneurysm
 D Myocardial disease 
Q. 1

The only definite contraindication to ECT is:

 A Brain tumour
 B Glaucoma
 C Aortic aneurysm
 D Myocardial disease 
Ans. A

Explanation:

Brain tumour


Q. 2

ECT is contraindicated in:

 A Intracranial SOL
 B Pregnancy
 C Cardiac disease
 D Psychosis
Q. 2

ECT is contraindicated in:

 A Intracranial SOL
 B Pregnancy
 C Cardiac disease
 D Psychosis
Ans. A

Explanation:

Intracranial SOL 


Q. 3

Which of the following is NOT true about electroconvulsive therapy (ECT)?

 A

Mainly used for the treatment of major depressive disorder

 B

No absolute contraindications to the use of ECT

 C

Should not be used in pregnancy

 D

Pheochromocytoma is a relative contraindication

Q. 3

Which of the following is NOT true about electroconvulsive therapy (ECT)?

 A

Mainly used for the treatment of major depressive disorder

 B

No absolute contraindications to the use of ECT

 C

Should not be used in pregnancy

 D

Pheochromocytoma is a relative contraindication

Ans. C

Explanation:

Between 80% and 90% of all ECT treatments are performed for the treatment of major depressive disorder.

There are no absolute contraindications to the use of ECT. With appropriate preparation, ECT can be used effectively and safely in both pregnant and elderly patients. Pheochromocytoma is a relative contraindication for ECT.

Ref: Loosen P.T., Shelton R.C. (2008). Chapter 18. Mood Disorders. In M.H. Ebert, P.T. Loosen, B. Nurcombe, J.F. Leckman (Eds), CURRENT Diagnosis & Treatment: Psychiatry, 2e.

Quiz In Between


Q. 4

Indications for ECT are :

 A

Paranoid schizophrenia

 B

Depression with suicidal tendency

 C

Neurotic depression

 D

All

Q. 4

Indications for ECT are :

 A

Paranoid schizophrenia

 B

Depression with suicidal tendency

 C

Neurotic depression

 D

All

Ans. B

Explanation:

B i.e. Depression with sucidal tendency


Q. 5

ECT is indicated in

 A

Neurotic Depression

 B

Auditory hallucination

 C

Schizophrenia

 D

Delusional Depression

Q. 5

ECT is indicated in

 A

Neurotic Depression

 B

Auditory hallucination

 C

Schizophrenia

 D

Delusional Depression

Ans. D

Explanation:

D i.e. Delusional Depression


Q. 6

ECT is useful in

 A

Mania (Acute)

 B

Chronic Schizophrenia

 C

Acute Depression

 D

Pannic Disorder

Q. 6

ECT is useful in

 A

Mania (Acute)

 B

Chronic Schizophrenia

 C

Acute Depression

 D

Pannic Disorder

Ans. C

Explanation:

C i.e. Acute depression

Quiz In Between


Q. 7

ECT is not useful in treatment of

 A

Chronic Schizophrenia

 B

Catatonic Schizophrenia

 C

Endogenous depression

 D

Acute psychosis

Q. 7

ECT is not useful in treatment of

 A

Chronic Schizophrenia

 B

Catatonic Schizophrenia

 C

Endogenous depression

 D

Acute psychosis

Ans. A

Explanation:

A i.e. Chronic schizophrenia


Q. 8

ECT in depressive phase ofMDP is useful because it:

 A

Produces recurrence

 B

Reduces recurrence

 C

Shortens duration

 D

Increases drug effects

Q. 8

ECT in depressive phase ofMDP is useful because it:

 A

Produces recurrence

 B

Reduces recurrence

 C

Shortens duration

 D

Increases drug effects

Ans. C

Explanation:

C i.e. Shortens durations


Q. 9

ECT is most useful in:

 A

Mania

 B

Depression

 C

OCD

 D

Schizophrenia

Q. 9

ECT is most useful in:

 A

Mania

 B

Depression

 C

OCD

 D

Schizophrenia

Ans. B

Explanation:

B i.e. Depression

Quiz In Between


Q. 10

Indications of ECT is /are :

 A

Psychotic depression

 B

Catatonic schizophrenia

 C

Cyclothymia

 D

A & B

Q. 10

Indications of ECT is /are :

 A

Psychotic depression

 B

Catatonic schizophrenia

 C

Cyclothymia

 D

A & B

Ans. D

Explanation:

A, B i.e. Psychotic depression, Catatonic schizophrenia


Q. 11

Absolute contraindication to ECT is

 A

Glucoma

 B

Brain Tumor

 C

Aortic Aneurism

 D

MI

Q. 11

Absolute contraindication to ECT is

 A

Glucoma

 B

Brain Tumor

 C

Aortic Aneurism

 D

MI

Ans. B

Explanation:

B i.e. Brain tumor


Q. 12

ECT is absolutely contraindicated in

 A

Pregnancy

 B

Very ill patient

 C

Raised Intracranial Tension

 D

Severe heart disease

Q. 12

ECT is absolutely contraindicated in

 A

Pregnancy

 B

Very ill patient

 C

Raised Intracranial Tension

 D

Severe heart disease

Ans. C

Explanation:

C i.e. Raised Intracranial tension

Quiz In Between


Q. 13

ECT causes

 A

Antegrade amnesia

 B

Retrograde amnesia

 C

Both

 D

None

Q. 13

ECT causes

 A

Antegrade amnesia

 B

Retrograde amnesia

 C

Both

 D

None

Ans. C

Explanation:

C i.e. Both


Q. 14

Most common complication of ECT is

 A

Antegrade Amnesia

 B

Retrograde Amnesia

 C

Physociasis

 D

Depression

Q. 14

Most common complication of ECT is

 A

Antegrade Amnesia

 B

Retrograde Amnesia

 C

Physociasis

 D

Depression

Ans. B

Explanation:

B i.e. Retrograde amnesia


Q. 15

Memory disturbance of ECT recovers in

 A

Few days to few weeks

 B

Few weeks to few months

 C

Few months to few year

 D

Permanent

Q. 15

Memory disturbance of ECT recovers in

 A

Few days to few weeks

 B

Few weeks to few months

 C

Few months to few year

 D

Permanent

Ans. B

Explanation:

B i.e. Few weeks to few months 

Quiz In Between


Q. 16

What is contraindication for ECT ‑

 A

Arrthmia

 B

Epilepsy

 C

HIV

 D

Cerebral aneurysm

Q. 16

What is contraindication for ECT ‑

 A

Arrthmia

 B

Epilepsy

 C

HIV

 D

Cerebral aneurysm

Ans. D

Explanation:

Ans. is ‘d’ i.e., Cerebral aneurysm

Contraindications of ECT

  • Absolute : – Increased intracranial tension.cerebrovascular response to ECT include marked increased in cerebral blood flow and blood flow velocity. Cerebral oxygen consumption increases as well. The rapid increase in systemic blood pressure may transiently overwhelm cerebral autoregulation and may result in increased in intracranial pressure. Therefore, the use of ECT is prohibited in patients with known space occupying lesion (brain tumor) or head injury, cerebral (intracranial) aneurysm.
  • Relative : – Recent myocardial infarction, severe hypertension, cerebrovascular accident, severe pulmonary disease, Retinal detachment, Pheochromocytoma.

Q. 17

ECT is contraindicated in –

 A

Very ill patients

 B

Raised ICT

 C

Heart disease

 D

Pregnancy

Q. 17

ECT is contraindicated in –

 A

Very ill patients

 B

Raised ICT

 C

Heart disease

 D

Pregnancy

Ans. B

Explanation:

Ans. is ‘b’ i.e., Raised ICT


Q. 18

Indications for ECT are all except ‑

 A

Severe depression with suicidal risk

 B

Catatonic schizophrenia

 C

Severe psychosis

 D

Sever manic attack

Q. 18

Indications for ECT are all except ‑

 A

Severe depression with suicidal risk

 B

Catatonic schizophrenia

 C

Severe psychosis

 D

Sever manic attack

Ans. D

Explanation:

Ans. is ‘d’ i.e., Sever manic attack

Indications of ECT

  • Severe depression with suicial risk or with psychotic features or with stupor.
  • Some types of schizophrenia (catatonic or paranoid)
  • Schizophrenic or depressive stupor
  • Severe catatonia with stupor
  • Severe psychoses (schizophrenia or mania) with risk of suicide or homicide or physical assault.

Quiz In Between



Electroconvulsive Therapy (Ect)

ELECTROCONVULSIVE THERAPY (ECT)


ELECTROCONVULSIVE THERAPY (ECT)

Introduction:

  • A type of convulsive therapies used for psychiatric disorders treatment.
  • Usage of electricity as an agent inducing convulsions – Referred as “electroconvulsive therapy.”

Types:

A. Direct ECT:

  • Anesthetic agents & muscle relaxants not used.
  • Generalized convulsions produced result in fractures or teeth dislocations.
  • Higher incidence of side effects – Rarely used now.

B. Modified ECT (Indirect ECT):

  • Anesthetic agents & muscle relaxants are administered before ECT.
  • Muscles relaxed → risk of bone fractures &other injures from motor activity during seizures minimized.

Technique:

  • Based on electrode placement – Bilateral ECT & Unilteral ECT.

Bilateral ECT: 

  • Most commonly used.
  • Involves electrodes placed on both sides of skull (bifronto-temporal electrode placement).

MOA:

  • Induction of bilateral generalized seizure via ECTs.
  • By down regulation of postslnaptic beta-adrenergic receptors.
  • Changes in growth factors & molecular mechanisms (increased brain derived neurotrophic factor, BDNF)
  • Neurogenesis (hippocampus).

Indications:

Depression (Major depressiue disorder): 

  • Both major depressive disorder & bipolar disorder.
  • Mainly for depression with suicide risk (Acute suicidal patients).
  • Depression with stupor.
  • Depression with psychotic symptoms (psychotic depression or delusional depression).

Manic episode:

  • Acute mania – Not 1st line treatment.
  • Only for intolerant/unresponsive to pharmacotherapy.
  • Severe maniac patients with suicide risk.

Schizophrenia:

  • Catatonic schizophrenia – 1st line treatment.
  • Note: Not effective in chronic schizophrenia.

Other indications:

  • Intractable seizures.
  • Neuroleptic malignant syndrome.
  • Delirium.
  • On-off phenomenon of Parkinson’s disease

Adverse effects:

Memory disturbances:

  • Most common side effect.
  • Retrograde amnesia more common.
  • Mild & recovery within 1-6 months after treatment.

Other side effects:

  • Delirium
  • Headache
  • Muscle aches
  • Fractures (very rare with modified ECT)
  • Nausea
  • Vomiting.

Contraindications:

  • No absolute contraindications.

Relative contraindication:

  • Raised intracranial tension (space occupying lesion in CNS).
  • Recent myocardial infarction
  • Severe hypertension
  • Cerebrovascular disease
  • Severe pulmonary disease
  • Retinal detachment

Note: Pregnancy not a contraindication.

Exam Important

  • Generalized convulsions produced during direct ECT result in fractures or teeth dislocations.
  • ECT is used for major depressiue disorder, catatonic schizophrenia, intractable seizures, neuroleptic malignant syndrome, delirium & on-off phenomenon of Parkinson’s disease.
  • ECT not effective in chronic schizophrenia.
  • Memory disturbances most commonly retrograde amnesia occur as side effect to ECT.
  • There are no absolute contraindications to ECT.
  • Raised intracranial tension (space occupying lesion in CNS) is a relative contraindication to ECT.
Don’t Forget to Solve all the previous Year Question asked on ELECTROCONVULSIVE THERAPY (ECT)

Module Below Start Quiz

Psychotherapy

PSYCHOTHERAPY

Q. 1

Patient of contamination phobia was asked by therapist to follow behind and touch everything he touches in patients house Therapist kept talking quietly & calmly all the time. And the patient was asked to repeat the procedure twice daily. The procedure is

 A

Flooding

 B

Modelling

 C

Positive reinforcement

 D

Aversion therapy

Q. 1

Patient of contamination phobia was asked by therapist to follow behind and touch everything he touches in patients house Therapist kept talking quietly & calmly all the time. And the patient was asked to repeat the procedure twice daily. The procedure is

 A

Flooding

 B

Modelling

 C

Positive reinforcement

 D

Aversion therapy

Ans. B

Explanation:

B i.e. Modelling


Q. 2

All of the following are done in behavior therapy to increase a behavior except:

 A

Punishment

 B

Operant conditioning

 C

Negative reinforcement

 D

Reward

Q. 2

All of the following are done in behavior therapy to increase a behavior except:

 A

Punishment

 B

Operant conditioning

 C

Negative reinforcement

 D

Reward

Ans. A

Explanation:

A i.e. Punishment 

Punishment & frustrative-non reward lead to decrease in resultant behavior, whereas both positive & negative reinforcements increases (reinforces) the frequency of a particular response.

Operant conditioning describes how consequences of a behavior lead to an increase or decrease in that behavior. Behavior is increased when it is followed by reward (Positive reinforcement) or removal of unpleasant stimulus (negative reinforcement) and reduced by taking away a positive stimulus (frustrative-non reward) or adding a negative stimulus (punishment).


Q. 3

Agoraphobia treated with

 A

Systemic desensitization

 B

Psychodynamic therapy

 C

Exposure therapy

 D

All

Q. 3

Agoraphobia treated with

 A

Systemic desensitization

 B

Psychodynamic therapy

 C

Exposure therapy

 D

All

Ans. D

Explanation:

A i.e. Systemic desensitization; B i.e. Psychodynamic therapy; C i.e. Exposure therapy


Q. 4

A 22 years old male comes to your office with complains of frequenting checking of doors even when they are locked. He is distressed about this fact. He is subsequently diagnosed to have obsessive compulsive disorder. Consider the following statements:

  1. Repression and reaction formation are the defense mechanisms involved
  2. SSRIs are the drug of choice
  3. Risperidone may be used in SSRI resistant cases to augment the response
  4. Systemic desensitization is the psychotherapy of choice

Which of the above are correct statements?

 A

a & b

 B

b & c

 C

b, c & d

 D

a, b, c & d

Q. 4

A 22 years old male comes to your office with complains of frequenting checking of doors even when they are locked. He is distressed about this fact. He is subsequently diagnosed to have obsessive compulsive disorder. Consider the following statements:

  1. Repression and reaction formation are the defense mechanisms involved
  2. SSRIs are the drug of choice
  3. Risperidone may be used in SSRI resistant cases to augment the response
  4. Systemic desensitization is the psychotherapy of choice

Which of the above are correct statements?

 A

a & b

 B

b & c

 C

b, c & d

 D

a, b, c & d

Ans. B

Explanation:

Ans: B. b & c

(Ref Kaplan & Sadock 11/e p406).

  • Frequent checking of door locks – Suggestive of OCD.

Psychological defensive mechanisms:

  • 3 major mechanisms determine form & quality of obsessive-compulsive symptoms & character traits:
  • Isolation, undoing & reaction formation.

Repression:

  • Primary mechanism.
  • Not involved in OCD.

Treatment for OCD:

  • DOC – SSRI (Fluoxetine,fluvoxamine, paroxetine, sertraline, citalopram).
  • Psychotherapy of choice:
  • Exposure & response prevention rather than systemic desensitization.

Behavior Therapy:

  • Effective as pharmacotherapies in OCD.
  • Treatment of choice for OCD.
  • Conducted in both outpatient & inpatient settings.
  • Patients must be truly committed to improvement.

Principal behavioral approaches:

  • Exposure & response prevention.

Other methods:

  • Desensitization, thought stopping, flooding, implosion therapy & aversive conditioning

Quiz In Between



Psychotherapy

PSYCHOTHERAPY


PSYCHOTHERAPY

  • Treatment of psychiatric disorders by using psychological methods.
  • Most important method – Behavior therapy.

Behavior therapy:

  • Psychological treatment where patient’s maladaptive behaviors changed to improve quality of life.
  • “Behavior therapy” is generic term – Used to describe a variety of specific techniques intended to remove maladaptive behaviors. 

Techniques of behavior therapy: 

  • Systematic desensitization.
  • Therapeutic graded exposure or in vivo exposure (or exposure & response prevention)
  • Flooding (Implosion).
  • Modeling (Participant modeling).
  • Assertiveness training.
  • Social skills training.
  • Aversive conditioning (Aversion therapy).

Systemic desensitization:

  • Based on “reciprocal inhibition” principle.
  • According to this principle, f anxiety-provoking stimulus provided while a person is in relaxed state, the anxiety gets inhibited.
  • Used in treatment of phobias, obsessive-compulsive disorders & certain sexual disorders.

Therapeutic graded exposure or in vivo exposure (or exposure & response prevention):

  • Similar to systematic desensitization except that no relaxation techniques used & real-life situations used.
  • Used in phobias & obsessive-compulsive disorder.

Flooding (Implosion):

  • Patient made to confront feared situation directly, without any hierarchy (as in systematic desensitisation or graded exposure & no relaxation exercises used).

Modeling (Participant modeling):

  • Therapist himself makes contact with phobic stimulus & demonstrates patient.
  • Patient learns by imitation & observation.

Assertiveness training:

  • Person is taught to be assertive (asking for his rights & refusing unjust demands of others).

Social skills training:

  • Involves imparting skills required for dealing with others & living a social life.
  • Used in schizophrenia.

Aversive conditioning (Aversion therapy):

  • Clinical use of classical conditioning principle.
    • An association created between unwanted behavior & painful stimuli —> unwanted behavior ceases.
  • Now rarely used due to ethical considerations.
  • Used for unwanted behaviors treatment (paraphilias).

Indications for behavior therapy:

  • Primarily in anxiety disorders treatment (like phobia, panic disorders).
  • Also used in depression, dissociative disorders, eating disorders, sexual disorders, personality disorders, substance used disorders & schizophrenia.

Exam Important

  • Most important method in psychotherapy is behavior therapy.
  • Techniques used in behavious therapy includes Systematic desensitization, therapeutic graded exposure or in vivo exposure (or exposure & response prevention), flooding (Implosion), modeling (participant modeling), assertiveness training, social skills training & aversive conditioning (aversion therapy).
  • Systemic desensitization is based on “reciprocal inhibition” principle.
  • Systemic desensitization used in treatment of phobias, obsessive-compulsive disorders & certain sexual disorders.
  • Therapeutic graded exposure is also referred as in-vivo exposure/exposure & response prevention.
  • Exposure & response prevention is used in phobia treatment.
  • Aversive conditioning is used for unwanted behaviors treatment (paraphilias).
Don’t Forget to Solve all the previous Year Question asked on PSYCHOTHERAPY

Module Below Start Quiz

Death & Dying

DEATH & DYING

Q. 1

An 82 year old woman, whose husband passed away 6 weeks ago after a long illness, is admitted to the hospital for worsening of her cardiac problems. During the hospital stay, a psychiatrist is invited to consult at the request of her daughters. The daughters think their mother is depressed, because she is tearful, often talks about her dead husband, and states that she had heard his voice several times. She blames herself for not having gone with him on his last visit to his sister, and she starts crying. She has never seen a psychiatrist before and has been “strong” all her life. Which of the following is the most likely diagnosis?

 A

Depression secondary to general medical condition

 B

Dysthymia

 C

Grief reaction

 D

Major depressive disorder

Q. 1

An 82 year old woman, whose husband passed away 6 weeks ago after a long illness, is admitted to the hospital for worsening of her cardiac problems. During the hospital stay, a psychiatrist is invited to consult at the request of her daughters. The daughters think their mother is depressed, because she is tearful, often talks about her dead husband, and states that she had heard his voice several times. She blames herself for not having gone with him on his last visit to his sister, and she starts crying. She has never seen a psychiatrist before and has been “strong” all her life. Which of the following is the most likely diagnosis?

 A

Depression secondary to general medical condition

 B

Dysthymia

 C

Grief reaction

 D

Major depressive disorder

Ans. C

Explanation:

A normal or uncomplicated grief reaction after the loss of a beloved person may resemble depression in some ways (e.g., changes in sleep or appetite, sadness, withdrawal).
However, as the loss becomes remote, the grief-stricken person is able to re- experience joy.
Self-blame is focused on what was not done in relation to the deceased person.
Illusions or hallucinations of the deceased person are common. The uncomplicated grief reaction can last several months, or longer, depending on the relationship to the deceased.
 
Depression secondary to a general medical condition  can be seen in association with cardiopulmonary disease, among other disorders; however, since the symptoms are related to the precipitating event, one would have to wait till the normal grief is resolved and then reassess the presence of symptoms of depression.
 
The main diagnostic criterion of dysthymia involves milder symptoms of depression occurring every day for at least 2 years.
 
Major depressive disorder can be precipitated by the loss of a beloved person, but it has a distinct quality even though some symptoms are the same. Suicidal ideation, guilt related to the person alone and not to the deceased person, and feelings of worthlessness are common. Significant functional impairment is typical.
 
Ref: Ropper A.H., Samuels M.A. (2009). Chapter 24. Fatigue, Asthenia, Anxiety, and Depressive Reactions. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor’s Principles of Neurology, 9e.

Q. 2

A man coming from mountain whose wife died 6 months prior says that his wife appeared to him and asked him to join her. The diagnosis is

 A

Normal grief

 B

Grief psychosis

 C

Berevement reaction

 D

Supernatural phenomenon

Q. 2

A man coming from mountain whose wife died 6 months prior says that his wife appeared to him and asked him to join her. The diagnosis is

 A

Normal grief

 B

Grief psychosis

 C

Berevement reaction

 D

Supernatural phenomenon

Ans. B

Explanation:

B i.e. Grief psychosis 

  • Bereavement, Grief or Mourning is a psychological reaction of those who survive a significant loss. Differences between normal & abnormal grief:

Identifying with deceased person such as taking on certain admired traits or treasuring certain possessions is normal; believing that one is the deceased person or is dying of exactly what the deceased person died of (if infact this is untrue) is not normal.

Hearing the fleeting, transient voice of a deceased person may be normal; persistent, intrusive, complex auditory hallucinations are not normalQ.

Denial of certain aspects of the death is normal; denial that includes the belief that the dead person is still alive is not normal.

Grief

  • Is a normal response of an individual to the loss of a loved object which presents with:

– Various physical & mental symptoms like sighing, crying, chocking, breathing difficulty, weakness etc. – Preoccupation with memory of deceased

– Sense of presence of deceased & misinterpretation of voices & faces of others as that of lost. – Seeing person in dreams & fleeting hallucinations.

Abnormal Grief Exaggeration of one or more normal symptoms of griefQ

– Duration > 6 months.Q 

 

Pathological/Morbid Grief

Complicated Grief

1

Associated with psychotic or

neurotic illness

•     Chronic Grief

•     Delayed Grief

•     Inhibited Grief =

•     Anniversary Reaction

=

Duration > 6 monthsQ

Onset after 2 weeks of lost (death)

Denial of loss

Grief reaction on death anniversary

       
  • Over idealization of deceased.

Quiz In Between



Death & Dying

DEATH & DYING


DEATH & DYING

  • Is a series of responses in an iindividual after informing about his impending death.
  • 3 stages of death and dying were proposed by Elizabeth Kubler-Ross.

Stage 1 – Denial and shock:

  • Characterized by refusal to accept diagnosis & reaction of shock.
  • Stage 2: Anger.
  • Stage 3: Bargaining.
  • Stage 4: Depression.
  • Stage 5: Acceptance.

Grief, bereavement & mourning:

Bereavement:

  • State of being deprived of someone due to death.

Grief:

  • Is psychological feeling precipitated by death of a loved one.

Mourning:

  • Process by which grief is resolved.
  • Involves societal practices like funerals, burial & memorial services.

Exam Important

  • 3 stages of death and dying were proposed by Elizabeth Kubler-Ross.
Don’t Forget to Solve all the previous Year Question asked on DEATH & DYING

Module Below Start Quiz

Adjustment Disorder

ADJUSTMENT DISORDER

Q. 1

Miss B, a 27 year old nurse had extracurricular interest in trekking and painting. She broke up relationship with her boy friend. Two months later she lost interest in her hobbies and was convinced that she would not be able to work again. She thought life was not worth living and has consumed 60 tablets of phenobarbitone to end her life. She is most likely suffering from:

 A

Adjustment disorder

 B

Conversion disorder

 C

Depressive disorder

 D

Post-traumatic stress disorder (PTSD)

Q. 1

Miss B, a 27 year old nurse had extracurricular interest in trekking and painting. She broke up relationship with her boy friend. Two months later she lost interest in her hobbies and was convinced that she would not be able to work again. She thought life was not worth living and has consumed 60 tablets of phenobarbitone to end her life. She is most likely suffering from:

 A

Adjustment disorder

 B

Conversion disorder

 C

Depressive disorder

 D

Post-traumatic stress disorder (PTSD)

Ans. A

Explanation:

Adjustment disorder is a reaction to an identifiable psychosocial stressor, that leads to maladaptive reactions including impairment in occupational functioning and symptoms that are in excess of normal and expected reaction to this stressor.

Symptoms of adjustment disorder with depressed mood includes tearfulness and feelings of hopelessness.

Symptoms develop in response to an identifiable stressor within 3 months.

Ref: Principles and Practice of Geriatric Psychiatry Edited By Mohammed T. Abou-Saleh, 3rd Edition, Page 70 ; Clinical Guide to The Diagnosis and Treatment of Mental Disorders By Michael B. First, 2nd Edition, Page 395 ; Counseling for Post Traumatic Stress Disorder By Michael J Scott, 3rd Edition, Page 8


Q. 2

A 45 year old father presents with sleep deprivation, lethargy headache, and low mood two months after knowing that his son is suffering from leukemia. He interacts reasonably well with others, but has absented himself from work. Which of the following is the most probable diagnosis?

 A

Depression

 B

Adjustment disorder

 C

Somatisation disorder

 D

Psychogenic headache

Q. 2

A 45 year old father presents with sleep deprivation, lethargy headache, and low mood two months after knowing that his son is suffering from leukemia. He interacts reasonably well with others, but has absented himself from work. Which of the following is the most probable diagnosis?

 A

Depression

 B

Adjustment disorder

 C

Somatisation disorder

 D

Psychogenic headache

Ans. B

Explanation:

The patient in question has an identifiable stress in the form of his son suffering from leukemia.
After this identifiable stress this patient developed symptoms of lethargy, low moods, headache, sleep deprivation, and started missing work. Since the symptoms appeared within 3 months of the onset of stressor, a diagnosis of adjustment disorder is most likely.
 
DSM IV Diagnostic criteria for adjustment disorder includes:
Development of emotional or behavioral symptoms in response to an identifiable stressor occurring within 3 months of onset of the stressor.

 

These symptoms are clinically significant as evidenced by the following:

  • Marked distress that is in excess of what would be expected from exposure to the stressor
  • Significant impairment in social or occupational functioning
  • Stress related disturbance does not meet the criteria for another specific Axis I disorder and is not  merely an exacerbation of a pre existing Axis I or Axis II disorder
  • The symptoms does not represent bereavement
  • Once the stressor has terminated, the symptoms do not persist for more than additional 6months
It is said to be acute when the disturbance last for less than 6months and chronic if disturbance last for more than 6 months.
 
Ref: Psycho-Oncology By Jimmie C. Holland, 2nd Edition, Page 304; Lippincott’s Primary Care Psychiatry By Robert M. McCarron

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