In this video 📹we are discussing previous year questions of NIMHANS exam 2019 with detailed explanations 👨🏫& some extra💡 concepts🔎.
Hello friends i am dr. anca coil consultant psychiatrist and nationwide faculty for psychiatry today in this video we will discuss nimh hands previous paper 2019 we will discuss some of the few important questions and also discuss something extra about them as these questions are seldomly asked in the paper so let us begin with the first question all of the following
Are risk factor for schizophrenia except a children born to young mothers be obstetric complication see winter birth and be cannabis use so the correct answer is option a that is children born to young mothers so let us discuss some of the important risk factors first important risk factor is the paternal age so the risk is higher in the offsprings were born to
Father’s who at the time of conceptions were older than 50 years of age that is the father’s age was more than 50 at the time of conception second important risk factor is a season of birth children are more likely who were born in winter and early spring are at a higher risk of developing schizophrenia in the later life rather than who are born in spring late
Spring and summers one of the important infections that is influenza infection is considered an important risk factor for development of schizophrenia so again a very important point next important risk factor is obstetric complications so complications occurring during pregnancy like bleeding preeclampsia abnormal fetal growth and development like premature birth
Low birth weight or congenital malformations and complications occurring during delivery like you train a tony asphyxia and emergency cesarean section all are again considered important risk factors for development of schizophrenia other important risk factors are or birth and upbringing so it is considered that it is an increased risk in urban setting so child born
In urban setting and brought up in an urban setting is at a higher risk of development of schizophrenia migration another important risk factor in fact there is an increase rate in development of schizophrenia in the second-generation who were born in the new homeland important to remember now stressful events so early childhood trauma like sexual abuse are again
Important risk factors now this is important cannabis use especially who are homozygous for comt gene that is catechol oh metal transferase now it is seen that patients who are homozygous to the valine allele are more likely to develop psychosis and indeed schizophrenia even after a single exposure to cannabis than the homozygous individuals who are homozygous
For methionine le very important cannabis use now let us discuss the next question all of the following are correctly matched side effects of antipsychotics except now antipsychotics and in fact the psychopharmacology is a very important topic to be read for an enhanced exam so let us come to the options so we have to mark which is not correct which is incorrect
So options are a clozapine and they have given the side effect its hyperprolactinemia be haloperidol the side effect dystonia see chlorpromazine side effect dry mouth and ziprasidone side effect qt see prolongation so the right answer is option a that is closed up in side effect hyperprolactinemia which is incorrect now there are two important classification of
Antipsychotics so they classified into two classes broadly first generation antipsychotics or also known as typical antipsychotics while the second class is the second generation antipsychotics or the atypical antipsychotics now important is the difference of the mechanism of action while the mechanism of action of the first generation is their d2 antagonist the
Second generation are both d2 and 5-ht two-way antagonists that is dopamine as well as serotonin antagonist now first generation are considered to be effective for the positive symptoms positive symptoms like delusions and hallucinations while the second generation are considered to be effective for both positive symptoms and negative symptoms of schizophrenia
Again important to remember the negative symptoms now there are more side effects like the extrapyramidal symptoms with first generation antipsychotics while these are less with the second generation antipsychotics similarly hyperprolactinemia is again more common with the first generation and less common with the second generation now interestingly the metabolic
Side effects like hypertension weight gain diabetes and hyperlipidemia these are all important metabolic side effect which are less with the first generation and are more with the second generation antipsychotics again important to remember now let us discuss some of the important antipsychotics and associated features of them so first are the first generation
Antipsychotics we’ll discuss few of them so first is chlorpromazine now other than the duty to antagonist it has a high alpha one blocking tendency as well as very important to remember anticholinergic side effects there may be hypersensitivity reaction associated with chlorpromazine and also can lead to cholestatic jaundice second important drug is thioridazine
Again it has a anticholinergic property as well as there are some important side effects related to the eye which we should remember with thioridazine which include bloop the pigmentation of the retina electic euler opacity and retinal degeneration also it increases the qtc interval now haloperidol again a very important first generation antipsychotic it is in fact
The most potent and in fact hence it has the highest or one of the high e ps potential other than antipsychotic using the psychotic illness it is also used sometimes useful in delirium especially for agitation in tourette’s syndrome and in huntington’s chorea these are some of the other uses of haloperidol now next are the second-generation antipsychotics again
We’ll discuss some of the few antipsychotics first is risperidone now we know that the extrapyramidal side effects are less common with second-generation but out of the second-generation risperidone has increased the risk of eps also elevation of prolactin olanzapine again has metabolic side effect in fact one of the high highest of metabolic side effect ziprasidone
Is associated with prolonged qtc interval vipro clozapine now this is a very interesting molecule now it has common side effects like say a lorry in fact this is one of the most common side effects of clozapine it has weight gaining tendency in fact out of all the second generation it has the maximum weight gaining tendency or maximum metabolic side effect again a
Very important side effect include constipation now clozapine is used only for so clozapine is the drug which is reserved for treatment-resistant schizophrenia so it is mostly used for treatment-resistant schizophrenia because of the serious side effects which are seizures agranulocytosis and myocarditis which you can remember from the mnemonic sam so these are
Important serious side-effects which may be in fact lead to death so one should be very careful while using clozapine another important name one should remember is keen very important as in the in the nineteen seventies close of pean was banned because of the death do you do a grande low psychosis in the patient but it was reintroduced after the study conducted
By kane at all who also gave the criterias for treatment-resistant schizophrenia so very important name to remember with clozapine now the third question choose the incorrect combination out of the following so they have given clusters of personality disorder and specific personality disorder efficient a cluster a paranoid personality disorder b option cluster
B borderline personality disorder c cluster c histrionic personality disorder and d cluster c anxious personality disorders so we have to choose the incorrect combination so the right answer is option c that is cluster c and histrionic personality disorder because we know histrionic personality disorder is a personality disorder of cluster b now let us discuss
The personality disorders and the clusters so dsm has divided personality disorders into three important clusters cluster a cluster b and cluster c now important personality disorders in the cluster a are paranoid personality disorder schizoid and schizotypal important to remember that schizotypal personality disorders are among the disorders personality disorder
Which have one of the highest risk of development of schizophrenia very important cluster b personality disorders include antisocial personality disorders borderline personality disorder histrionic personality disorder x’ and narcissistic personality disorder while cluster c personality disorders include avoidant anxious personality disorder dependent personality
Disorder and obsessive-compulsive personality disorder now each of them have characteristic traits so the group characteristic of cluster a is that they’re odd or eccentric cluster b have a common trait of that the patient appears to be dramatic emotional or behave in a erratic manner while cluster c are anxious or fearful these are important group characteristic
Of each of these cluster now let us discuss the next important again a very important topic suicide which has been many times as in the exams now which of the following is not a high risk factor of suicide so the options are a previous suicide attempt option b substance use option c chronic illness and option d young age so the right answer is option d that is
Each language it is not a high risk factor for suicide now let us discuss this is again very important what are the high risk factors now first we’ll discuss the demographic factors so age more than 45 years is considered to be a high risk factor male gender in comparison to female again are considered to have a high risk because it is considered that males may use
More lethal methods for suicide now again des vosges separated or widowed people are at a higher risk person who is unemployed or who has poor relationships are also at a higher risk of suicide now in the health related factors person having chronic illness like some chronic pain tumour person with substance use no person with certain psychiatric illnesses like
Depression psychosis or severe personality disorder are also at a higher risk now this is very important hopelessness person having negative views about the future if person has hopelessness again it is an important risk factor in fact one of the important of the all risk factors now among the suicidal activities person who has frequent or intense or prolonged
Suicidal ideation one should be very careful at there is a higher risk of suicide now multiple attempts of suicide again is a very very important risk factor and in fact we’ll discuss two of the important risk factors so person who is planning order he has already planned the way to suicide again is an important risk factor someone using lethal methods like for
Example gunshot is again at a higher risk factor a suicidal note present is again an important risk factor now if a switch is the most important risk factor so out of all these some one of the most important risk factor is a previous suicide attempt and one of the second-most important risk factors is presence of hopelessness very very two important risk factors
Also just to tell that the current rate of suicide in india so the current rate of suicide in india according to the latest data of the national crime research bureau and crb is ten point six per lakh population so this is the important rate suicide rate also the most common method again these questions may be asked so most common method of suicide is again in
India most common is hanging followed by poisoning so again two important points to remember very very important points so these were the important topics and we shall wish you all the best for the exam if you want to join us on facebook you can join our group psychiatry by dr. on keep going also you can like and subscribe a youtube channel doctor uncle boyle md
Psychiatry thank you and all the very best
Transcribed from video
NIMHANS Previous Questions 2019 | INICET | New Questions | Detailed Explanation | Dr. Ankit Goel By Dr. Ankit Goel M.D. Psychiatry
