University of Dhaka

4h Professional [Link] Physiotherapy Examination

Subject: Psychiatry

1) Define and classify anxiety disorders. Write the clinical features of panic disorder.
June 2022, Aug 21, November 2021, Feb 20,Aug 20, Aug 2019 , Feb 18,Aug 18
Ans:
Anxiety disorders are a group of psychiatric disorders characterized by feelings of
fear, worry, or nervousness that are strong enough to interfere with daily activities.
They can be classified as:

a. Generalized Anxiety Disorder (GAD)

b. Panic Disorder
c. Social Anxiety Disorder (Social Phobia)
d. Specific Phobias
e. Obsessive-Compulsive Disorder (OCD)
f. Post-Traumatic Stress Disorder (PTSD)
g. Acute Stress Disorder

Clinical features of Panic Disorder:

a. Sudden and recurrent panic attacks

b. Fear of future panic attacks
c. Avoidance of places or situations associated with panic attacks
d. Physical symptoms such as heart palpitations, sweating, shaking, shortness of
breath, and dizziness
e. Persistent worry about the implications or consequences of the panic attacks
f. Significant distress or impairment in daily functioning

2) Name 4 Neuro developmental disorders. What are the clinical features of autism
spectrum disorder? June2022
Ans:
Four Neurodevelopmental Disorders are:

a. Autism Spectrum Disorder (ASD)

b. Attention Deficit Hyperactivity Disorder (ADHD)
c. Intellectual Disability (ID)
d. Developmental Coordination Disorder (DCD)

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 Clinical features of Autism Spectrum Disorder (ASD):

a. Impairments in social interaction and communication

b. Restricted and repetitive patterns of behavior, interests, or activities
c. Early onset before age 3
d. Symptoms that cause significant impairment in daily functioning
e. Difficulties with social cues, nonverbal communication, and forming
relationships
f. Repetitive behaviors or routines
g. Unusual preoccupations with specific objects or topics
h. Delayed or absent language development.

3) Write in short about psychological treatment. June2022

Ans:
Psychological treatment refers to the use of talk therapy or psychotherapy to help
individuals with mental health conditions. It involves a trained mental health
professional, such as a psychologist or psychotherapist, helping the patient to
understand and manage their thoughts, emotions, and behaviors. Common types of
psychological treatments include:
a. Cognitive Behavioral Therapy (CBT)
b. Psychodynamic Therapy
c. Interpersonal Therapy (IPT)
d. Eye Movement Desensitization and Reprocessing (EMDR)
e. Acceptance and Commitment Therapy (ACT)
f. Mindfulness-based therapies
g. Humanistic therapy
h. Group therapy
i. Exposure therapy

These treatments can be delivered in individual or group settings and may be

combined with medication for more comprehensive care. The goal is to help patients
gain insight, develop coping skills, and improve their overall mental health.

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4) A 25-year old housewife brought by family member to a psychiatric hospital with the
complaints of suspiciousness, lack of self-care, hearing of voices without any
evidence for the last seven months. Attendant also added that she did not take food
regularly and occasional became aggressive for the same duration. What is the
provisional diagnosis of the case? Write the management of the case. November-2021
Ans:
Provisional diagnosis: Schizophrenia

Management:
a. Comprehensive psychiatric evaluation
b. Antipsychotic medication (e.g. Olanzapine, Risperidone)
c. Psychotherapy (e.g. Cognitive Behavioural Therapy)
d. Regular follow-up with a mental health professional
e. Education and support for patient and family
f. Monitoring of medication compliance and side effects
g. Referral to community resources for additional support
h. Consideration of electroconvulsive therapy (ECT) in case of treatment
resistance.

5) What are the somatic symptoms and related disorders? Discuss the Clinical features
of conversion disorder. June 2022, November-2021,Feb 2019,
Ans:
Somatic symptoms and related disorders:

Somatic symptoms and related disorders are a group of mental disorders in which
psychological stress is expressed through physical symptoms such as pain, weakness,
and sensory loss. Some examples of these disorders include:

a. Somatic symptom disorder

b. Illness anxiety disorder
c. Conversion disorder (also known as functional neurological symptom
disorder)

Clinical features of Conversion Disorder:

a. Unexplained motor or sensory symptoms (e.g. weakness, paralysis, blindness,

deafness)
b. Symptoms not fully consistent with recognized neurological conditions
c. Psychological stress or conflict preceding onset of symptoms
d. Absence of organic pathology to explain symptoms
e. Symptoms causing significant distress and impairing daily functioning
f. Symptoms not intentionally produced or feigned (malingering)

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6) Define personality. Classify personality disorders. Describe the management of
borderline personality disorder. November-2021, Feb 20,Feb 2019, August 2019, Feb
2018 , Aug 18
Ans:
Personality: Personality refers to a set of enduring traits, behaviors, and patterns of
thought and emotion that make an individual unique and distinguishable from others.

Classification of Personality Disorders: Personality disorders are classified into three

clusters based on common characteristics and symptoms. They are:

a. Cluster A (odd or eccentric): Paranoid, Schizoid, Schizotypal

b. Cluster B (dramatic, emotional, or erratic): Borderline, Narcissistic, Histrionic,
Antisocial
c. Cluster C (anxious or fearful): Avoidant, Dependent, Obsessive-compulsive.

Management of Borderline Personality Disorder:

a. Psychotherapy: Dialectical behavior therapy (DBT) is the most researched and

effective form of psychotherapy for BPD.
b. Medication: Antidepressants, mood stabilizers, and atypical antipsychotics
may be prescribed to manage co-occurring symptoms such as depression,
anxiety, and impulsive behavior.
c. Hospitalization: In severe cases, hospitalization may be necessary for
stabilization and management of suicidal ideation and behavior.
d. Family involvement: Family members can play a supportive role in the
treatment and management of BPD.
e. Self-help and support groups: Patients with BPD can benefit from support
groups and other resources that promote coping skills and provide a sense of
community.

It is important to note that treatment for BPD is long-term and requires a collaborative
and individualized approach involving the patient, family, and mental health
professionals.

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7) Classify child psychiatric disorders? Write the presentation and management of
autism spectrum disorder. November-2021,Feb 2020, Feb 2017, Feb 2019 ,Aug 2019
Ans:
Classification of Child Psychiatric Disorders:

a. Attention Deficit/Hyperactivity Disorder (ADHD)

b. Anxiety Disorders
c. Mood Disorders
d. Disruptive Behavior Disorders
e. Developmental Disorders (including Autism Spectrum Disorder)

Autism Spectrum Disorder (ASD): Presentation: Impairments in social interaction and

communication, as well as repetitive behaviors and limited interests.

Management:

a. Early identification and intervention

b. Behavior and communication therapies
c. Medications (e.g. antidepressants, antipsychotics)
d. Family support and education
e. Special education services
f. Collaboration with multidisciplinary team (e.g. psychologist, speech therapist,
occupational therapist)

8) A 45-year old businessman came to a psychiatrist with the complaints of sadness, loss
of interest in his daily all activities, poor sleep, cannot concentrate in his work,
occasional suicidal thought for the last one month. His symptoms started after great
loss in his business. What is the provisional diagnosis of this man? Write the
management According to your diagnosis.
Ans:
Provisional diagnosis: Major Depressive Disorder.
Management:
a. Medication: Antidepressants such as selective serotonin reuptake inhibitors
(SSRIs) may be prescribed.
b. Psychotherapy: Cognitive behavioral therapy (CBT) or Interpersonal therapy
(IPT) may be useful.
c. Lifestyle changes: Encourage regular exercise, healthy diet, and sufficient
sleep.
d. Monitoring: Regular follow-up appointments to monitor symptoms and adjust
treatment as needed.
e. Safety: Assess for suicide risk and provide a safety plan if necessary.
f. Referral: Consider referral to a specialist if symptoms persist or worsen.

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9) Write the presentation and management of ADHD. November-2021, Aug 19,
Ans:
Presentation: Attention-deficit/hyperactivity disorder (ADHD) is a
neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity,
and impulsivity. Symptoms typically present in childhood and can continue into
adulthood.

Management:

a. Medication: Stimulant medications such as methylphenidate and

amphetamines may be prescribed.
b. Psychotherapy: Behavioral therapy, such as parent training and skill-building,
can be beneficial.
c. Lifestyle changes: Encourage regular exercise and a healthy diet.
d. Education and support: Provide resources and support for the individual and
their family.
e. Monitoring: Regular follow-up appointments to monitor symptoms and
medication side effects.
f. Collaboration: Work with teachers and other healthcare providers to ensure a
comprehensive approach to treatment.
g. Comorbidities: Evaluate and treat any coexisting mental health conditions.

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10) Define obsession and compulsion. Write the presentation and management of
obsessive-compulsive disorders. June2022
Ans:
Obsession: An obsession is an intrusive and persistent thought, image, or urge that is
experienced as distressing, time-consuming, or impairing to daily life.

Compulsion: A compulsion is a repetitive behavior or mental act that an individual

feels driven to perform in response to an obsession or according to rigid rules. These
behaviors are performed to reduce anxiety, prevent harm, or to ensure a specific
outcome.

Presentation: Obsessive-compulsive disorder (OCD) is a mental health disorder

characterized by recurring obsessions and compulsions. Symptoms can range from
mild to severe and can interfere with daily life.

Management:

a. Medication: Antidepressants such as selective serotonin reuptake inhibitors

(SSRIs) may be prescribed.
b. Psychotherapy: Cognitive behavioral therapy (CBT) with a focus on exposure
and response prevention (ERP) can be effective.
c. Lifestyle changes: Encourage regular exercise and a healthy diet.
d. Monitoring: Regular follow-up appointments to monitor symptoms and
medication side effects.
e. Support: Provide support and education to the individual and their family.
f. Collaboration: Work with other healthcare providers to ensure a
comprehensive approach to treatment.
g. Comorbidities: Evaluate and treat any coexisting mental health conditions.

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11) Enlist the major and minor mental disorders. What is Mood Disorder?
Ans:

Major mental disorders:

a. Schizophrenia
b. Bipolar Disorder
c. Major Depression
d. Obsessive-Compulsive Disorder
e. Panic Disorder
f. Post-Traumatic Stress Disorder
g. Borderline Personality Disorder

Minor mental disorders:

a. Generalized Anxiety Disorder

b. Social Phobia
c. Specific Phobias
d. Attention Deficit Hyperactivity Disorder
e. Dysthymia
f. Substance Use Disorders

Mood Disorder: A Mood Disorder is a type of mental illness in which the patient
experiences a persistent change in mood and related symptoms that impact daily life,
including:

a. Major Depressive Disorder (MDD)

b. Bipolar Disorder
c. Cyclothymic Disorder
d. Dysthymic Disorder.

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12) Discuss in short about clinical features and management of obsessive Compulsive
disorder. November-2021,Feb 2017, Aug 2018, June 2022,
Ans:

Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by

unwanted and intrusive thoughts (obsessions) that lead to repetitive behaviors
(compulsions) aimed at reducing anxiety caused by the obsessions.

Clinical Features:

a. Recurrent, persistent and intrusive thoughts, images, or impulses (obsessions).

b. Repetitive behaviors or mental acts (compulsions) performed to alleviate
anxiety caused by the obsessions.
c. The compulsions consume a significant amount of time and interfere with
daily activities.

Management:

a. Psychotherapy: Cognitive-behavioral therapy (CBT) and exposure and

response prevention (ERP) have been shown to be effective in treating OCD.
b. Medications: Antidepressant medication, specifically Selective Serotonin
Reuptake Inhibitors (SSRIs), have been shown to be effective in reducing
OCD symptoms.
c. Combination of therapy and medication is often recommended for better
treatment outcomes.
d. Self-help strategies, such as mindfulness and stress management, can also be
useful in managing symptoms.

13) Write the clinical features of mania February 2018.

Ans:
Mania is a state of elevated or irritable mood, increased energy and activity levels,
and decreased need for sleep, often accompanied by other symptoms, that occurs in
Bipolar Disorder.
Clinical Features of Mania:
a. Elevated or irritable mood
b. Increased energy and activity levels
c. Decreased need for sleep
d. Racing thoughts and excessive talking
e. Grandiose thinking
f. Impulsive or reckless behavior
g. Distractibility
h. Aggression or agitation
i. Risky or dangerous behavior
j. Delusions or hallucinations (in severe cases)

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14) What are the types of major mental illness Feb 20
Ans:
Here are some of the most common types of major mental illness:
a. Depression
b. Bipolar disorder
c. Schizophrenia
d. Anxiety disorders (e.g. panic disorder, OCD)
e. Eating disorders (e.g. anorexia, bulimia)
f. Personality disorders (e.g. borderline personality disorder)
g. Psychotic disorders
h. Substance abuse disorders.

15) Write the clinical features of manic episode. June2022

Ans:
Manic episode is a period of elevated or irritable mood, increased energy, decreased
need for sleep, grandiosity, and decreased inhibitions. The following are some of the
common clinical features of manic episode:
a. Abnormally elevated, expansive, or irritable mood
b. Increased energy, activity, and restlessness
c. Grandiose thinking or delusions
d. Racing thoughts and speech
e. Decreased need for sleep
f. Impulsive or reckless behavior
g. Aggressiveness or agitation
h. Substance abuse
i. Hypersexuality
j. Poor judgment and insight.

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16) Enlist the clinical features of bipolar mood disorder. August 2019,Feb 18, Feb 20,
June 22
Ans:

Bipolar disorder, also known as manic-depressive illness, is a mental disorder

characterized by periods of mania and depression. The following are some of the
common clinical features of bipolar disorder:

Mania:

a. Abnormally elevated, expansive, or irritable mood

b. Increased energy, activity, and restlessness
c. Grandiose thinking or delusions
d. Racing thoughts and speech
e. Decreased need for sleep
f. Impulsive or reckless behavior
g. Aggressiveness or agitation
h. Substance abuse
i. Hypersexuality
j. Poor judgment and insight.

Depression:

a. Persistent sadness, anxiety, or "empty" mood

b. Loss of interest or pleasure in activities
c. Decreased energy, fatigue
d. Insomnia or hypersomnia
e. Feelings of worthlessness or guilt
f. Difficulty concentrating
g. Recurrent thoughts of death or suicide.

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17) What is stress? Describe the clinical feature of post traumatic stress disorder + Write
the clinical features and management of acute stress disorder. August 2019,Feb 2020,
Feb 2019, Aug 2019, Feb 2018, Aug 2018, Feb 2017,
Ans:

Stress is the physiological and psychological response to events that are perceived as
challenging or threatening. It is a normal part of life and can be beneficial in small
doses, but chronic stress can have negative effects on mental and physical health.

Post-Traumatic Stress Disorder (PTSD) is a type of anxiety disorder that can develop
after exposure to a traumatic event, such as combat, natural disasters, sexual assault,
or other life-threatening experiences. The following are some of the common clinical
features of PTSD:

a. Re-experiencing the traumatic event through flashbacks, nightmares, or

intrusive thoughts
b. Avoidance of stimuli associated with the trauma
c. Negative alterations in mood and cognition
d. Increased arousal and reactivity
e. Persistent symptoms that last for more than one month.

Management of PTSD may include psychotherapy, such as cognitive-behavioral

therapy and exposure therapy, as well as medications, such as antidepressants.

Acute Stress Disorder (ASD) is a similar condition that can develop within a month of
exposure to a traumatic event. The following are some of the common clinical
features of ASD:

a. Re-experiencing the traumatic event through flashbacks or intrusive thoughts

b. Avoidance of stimuli associated with the trauma
c. Increased arousal and reactivity
d. Difficulty sleeping
e. Negative alterations in mood and cognition.

Management of ASD may include cognitive-behavioral therapy, medication, and

other stress management techniques, such as relaxation and mindfulness. In most
cases, symptoms of ASD resolve within one month, but some individuals may go on
to develop PTSD.

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18) A 30-year-old house wife came to the psychiatric outpatient department with
complaints of sadness, loss of interest in daily activities, fearfulness, stare looking,
sleep disturbance, Occasional crying spell for the last 3 weeks. What is the
provisional diagnosis of the case? Write the management of this case. August 2019
Ans:

Provisional diagnosis: Major Depressive Disorder (MDD)

Management:

a. Psychotherapy: Cognitive-behavioral therapy (CBT) or interpersonal therapy

(IPT)
b. Antidepressant medication: Selective serotonin reuptake inhibitors (SSRIs)
c. Lifestyle changes: Regular exercise, a balanced diet, and sufficient sleep
d. Support from family and friends
e. Close monitoring of symptoms and adjustments to treatment plan as needed
f. Referral to a specialist if symptoms persist or worsen.

19) A 45 year old man brought to a psychiatric hospital with aggressive and violent
behavior with dirty and torn dress and told that his wife is trying to kill him by mixing
poison in the food. He also complaints of hearing of voices in absence of people. His
symptoms started gradually for the last one year. What is the provisional diagnosis of
the case? Write the management of this case. August 2019
Ans:

Provisional diagnosis: Paranoid Schizophrenia

Management:

a. Psychotherapy: Cognitive-behavioral therapy (CBT) or family therapy

b. Antipsychotic medication: Second-generation antipsychotics (SGAs)
c. Social skills training
d. Rehabilitation and support for daily living
e. Close monitoring of symptoms and adjustments to treatment plan as needed
f. Referral to a specialist if symptoms persist or worsen.
g. Hospitalization in a psychiatric hospital if necessary for aggressive or violent
behavior.

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20) Define dementia and depression. Write the differences between dementia and
depression in tabulated form. August 2019, Feb 19
Ans:
Dementia: Dementia is a progressive decline in cognitive function, including
memory, reasoning, and communication abilities. It is usually associated with aging
but can occur in younger individuals as well.

Depression: Depression is a common mental health disorder characterized by

persistent feelings of sadness, hopelessness, and loss of interest in activities that were
once enjoyable. It can be triggered by a life event, or it may have no apparent cause.

Differences between Dementia and Depression:

Dementia Depression
Progressive decline in cognitive Persistent feelings of sadness, hopelessness,
function and loss of interest in activities
Can be triggered by a life event or have no
Usually associated with aging
apparent cause
Impairment in memory, reasoning, and Can cause physical symptoms such as
communication abilities fatigue and changes in appetite or sleep
Changes in behavior and personality
May involve changes in thoughts and beliefs
can occur
Treatment may include psychotherapy,
Treatment often focuses on managing
antidepressant medication, and lifestyle
symptoms and slowing progression
changes

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21) Define delirium and dementia. Write the differences between delirium and dementia
February 2017, Feb 18, Feb 19, June 22
Ans:
Delirium: A sudden and severe change in mental function that can occur as a result of
an illness or medical condition. It is characterized by confusion, disorientation, and
changes in behavior and mood.

Dementia: A progressive decline in mental ability, including memory loss and

difficulties with language, reasoning, and daily activities, caused by physical changes
in the brain.

Delirium Dementia
A sudden and severe change in mental
A progressive decline in mental ability
function
Develops rapidly over hours to days Progresses over months to years
Can be reversed if the underlying cause is
Not reversible, degenerative condition
treated
Typically age-related brain changes,
Can be caused by a wide range of factors
genetics, and lifestyle factors
Confusion, disorientation, changes in Primarily affects memory and thinking
perception and behavior abilities
22) What is somatization? Write the clinical features of conversion disorder. August 2019
Ans:
Somatization is a mental health condition characterized by physical symptoms that
cannot be explained by a medical condition or injury.

Clinical features of Conversion Disorder (a type of somatoform disorder) include:

a. Unexplained motor or sensory symptoms (such as paralysis, blindness, or loss
of sensation)
b. Symptoms not consistent with recognized neurological or medical conditions
c. Significant distress or impairment in social, occupational, or other important
areas of functioning
d. Psychogenic (or "functional") origin of symptoms suggested by the medical
history, physical examination, and laboratory tests.

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23) What is epilepsy? Describe the differences between epilepsy and conversion disorder.
February 2018, August 2018
Ans:
Epilepsy is a neurological condition characterized by recurrent seizures (i.e. episodes
of temporary disturbance in the normal electrical activity of the brain that cause
changes in behavior, consciousness, or movement).

The differences between epilepsy and conversion disorder:

Epilepsy Conversion Disorder

A neurological condition
A type of somatoform disorder characterized by
characterized by recurrent
physical symptoms without a medical explanation
seizures
Caused by abnormal electrical Believed to be caused by psychological or
activity in the brain emotional factors
Symptoms include physical symptoms such as
Symptoms include seizures
paralysis, blindness, or loss of sensation
Diagnosed through medical history, physical
Diagnosed through medical
examination, and exclusion of other medical
history, EEG, and MRI
conditions

24) A 40 years old business man came to you-with crying spell, sadness, loss of interest in
daily all activates and occasional thinking of suicide for the last one month. What is
the provisional diagnosis of the case? Write the management of the case. August 2018
Ans:

The provisional diagnosis of this case could be Major Depressive Disorder.

Management of Major Depressive Disorder typically involves a combination of

psychotherapy and medication.

a. Psychotherapy: Cognitive Behavioral Therapy (CBT) or Interpersonal

Therapy (IPT) can help the individual identify and change negative thought
patterns and behaviors.
b. Medication: Antidepressant medication such as selective serotonin reuptake
inhibitors (SSRIs) may be prescribed to alleviate symptoms of depression.
c. Lifestyle changes: Encouraging the individual to engage in physical activity,
maintain a healthy diet, and get adequate sleep can help improve symptoms.
d. Monitoring and follow-up: Regular monitoring and follow-up with a mental
health professional is important to assess the effectiveness of treatment and
make any necessary adjustments.
e. Suicidal ideation: If the individual is expressing thoughts of suicide, it is
important to take this seriously and take appropriate action to ensure their
safety, such as hospitalization or referral to a crisis center.

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25) Define Schizophrenia. Write the DSM-V diagnostic criteria of Schizophrenia. Feb 19,
August 2018, Feb 17,
Ans:

Schizophrenia is a chronic and severe mental disorder that affects a person's thoughts,
feelings, and behaviors. It is characterized by symptoms such as delusions,
hallucinations, disordered thinking, and decreased motivation and emotional
expression.

DSM-V diagnostic criteria for Schizophrenia:

A. Two (or more) of the following symptoms must be present for at least one month
in the absence of any mood disturbance:

a. Delusions
b. Hallucinations
c. Disorganized speech (e.g., frequent derailment or incoherence)
d. Grossly disorganized or catatonic behavior
e. Negative symptoms (i.e. diminished emotional expression or avolition)

B. For a significant portion of the time since the onset of the disturbance, one or more
major areas of functioning, such as work, interpersonal relations, or self-care, are
markedly below the level achieved prior to the onset.

C. Continuous signs of the disturbance persist for at least six months. This six-month
period must include at least one month of symptoms that meet Criterion A (active-
symptomatic phase) and may include periods of prodromal or residual symptoms.

D. Schizophrenia is not due to another medical condition, substance abuse, or

medication-induced.

E. If there is a history of Autistic Disorder or another Pervasive Developmental

Disorder, the additional diagnosis of Schizophrenia is made only if prominent
delusions or hallucinations are also present for at least a month in the absence of any
mood disturbance.

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26) What is psychosis? Write the clinical features and management of schizophrenia.
February 2017
Ans:

Psychosis is a mental health condition characterized by a loss of contact with reality,

typically involving delusions and hallucinations.

Clinical features of schizophrenia include:

a. Delusions: False beliefs that persist despite evidence to the contrary.

b. Hallucinations: Sensory experiences that occur without external stimuli, such
as hearing voices.
c. Disorganized speech: Difficulty in organizing thoughts and communicating
effectively.
d. Abnormal motor behavior: Repetitive and/or purposeless movements.
e. Negative symptoms: Flat affect, lack of motivation, and social withdrawal.

Management of schizophrenia may involve:

a. Medication: Antipsychotic drugs are the first line of treatment for

schizophrenia, aimed at reducing symptoms such as delusions and
hallucinations.
b. Psychotherapy: Cognitive-behavioral therapy and family therapy can help
individuals with schizophrenia manage their symptoms and improve their
social and interpersonal functioning.
c. Vocational rehabilitation: Assistance in finding and maintaining employment,
increasing independence and quality of life.
d. Self-help groups: Offer support, information, and a sense of community to
individuals with schizophrenia and their families.
e. Hospitalization: In severe cases, hospitalization may be necessary to manage
acute symptoms and provide stability and safety.

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27) A 10 year old boy brought by his parent with the complaints hyper activity and
impulsivity in all situations difficult to concentration in studying, difficult to give
attention in school difficult to follow instructions and fails to finish school work for
the last four years. What is the provisional diagnosis of the case? Give the
management plan of the case. August 2018
Ans:
Provisional Diagnosis: Attention Deficit Hyperactivity Disorder (ADHD)

Management plan:
a. Comprehensive evaluation by a pediatrician or a child and adolescent
psychiatrist.
b. Diagnosis confirmed through standardized rating scales, behavioral
observation and clinical interview with the child, parents and teacher.
c. Behavioral and educational interventions like parent training, classroom
accommodations and individualized support.
d. If needed, pharmacotherapy with medications like methylphenidate,
atomoxetine etc. under close medical supervision.
e. Regular follow up and monitoring of treatment response.
f. Referral to a psychologist for psychotherapy and counseling to address
emotional and social difficulties related to ADHD.
g. Collaboration with school for academic support and modifications.

28) A 14-year student presented with sudden weakness of her right hand that she can't
write properly and occasional fall from standing with lockjaw that she can't open her
mouth, eyes close tightly when tried to open eyes and she was conscious. Her
symptoms started when she was returned home after appearing an examination. All
investigations revealed no abnormality. What is the provisional diagnosis of the case?
Write the management of the case. February 2017
Ans:
Provisional Diagnosis: Psychogenic Non-Epileptic Seizures (PNES)
Management Plan:
a. Referral to a neurologist or a epilepsy specialist for further evaluation.
b. Video EEG monitoring to confirm the diagnosis.
c. Psychological evaluation by a psychologist or a psychiatrist to rule out any
underlying psychological or emotional factors.
d. Cognitive behavioral therapy (CBT) and/or psychotherapy to address the
psychological causes and manage the symptoms.
e. Patient and family education regarding the condition and its management.
f. Avoidance of triggering factors like stress, anxiety and fatigue.
g. Regular follow-up to monitor the response to treatment.
h. Consideration of medication for coexisting psychiatric or neurological
conditions.

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29) A 40-year house wife presented with feeling of sadness, loss of interest in daily all
activities, sleep disturbance, occasional suicidal thinking and loss of body weight for
the last one month. What is the provisional diagnosis of the case? Write the
management of the case. February 2017
Ans:

Provisional Diagnosis: Major Depressive Disorder (MDD)

Management Plan:

a. Comprehensive evaluation by a mental health professional to confirm the

diagnosis.
b. Patient education regarding the illness and its treatment options.
c. Psychological interventions like Cognitive Behavioral Therapy (CBT) and/or
Interpersonal Therapy (IPT).
d. Antidepressant medication as prescribed by a physician after considering the
patient's medical history, medication interactions and potential side effects.
e. Regular follow-up and monitoring of the treatment response and side effects.
f. Lifestyle modifications such as exercise, healthy diet and sleep hygiene.
g. Psychotherapy or counseling to address any coexisting emotional or
psychological issues.
h. Support from family and friends.
i. Close monitoring for suicide risk and immediate intervention in case of
worsening symptoms or thoughts of self-harm.

30) A 30-year old housewife presented with history of repeated hand washing and use of
washroom for prolonged time for taking bath and delays in her daily all activities for
the last one year. What is the provisional diagnosis of the case? Give the management
according to your diagnosis. February 2018
Ans:

Provisional diagnosis: Obsessive-Compulsive Disorder (OCD)

Management:

a. Psychotherapy: Cognitive Behavioural Therapy (CBT) specifically Exposure

and Response Prevention (ERP)
b. Medications: SSRI's (e.g. fluoxetine, sertraline)
c. Psychoeducation for the patient and family
d. Collaboration with a psychiatrist for further evaluation and management.

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31) A 40-year old housewife came to psychiatric outpatient department with a history of
repeated hand washing, use washroom for prolonged period and slowness in her daily
all activities for the last one year. What is the provisional diagnosis of the patient?
Write the management of the case. February 2019
Ans:

Provisional diagnosis: Obsessive-Compulsive Disorder (OCD)

Management:

a. Psychotherapy: Cognitive Behavioural Therapy (CBT) specifically Exposure

and Response Prevention (ERP)
b. Medications: SSRI's (e.g. fluoxetine, sertraline)
c. Psychoeducation for the patient and family
d. Collaboration with a psychiatrist for further evaluation and management.

32) A 20-year old unemployed person came with aggressive and violent behavior, self
talking and laughing without reason, lack of self care, suspiciousness and hearing of
voices without any evidence for the last one year. What is the provisional diagnosis of
the case? Write the management of the case. February 2018
Ans:

Provisional Diagnosis: Schizophrenia

Management:

a. Medication: Antipsychotics can help manage symptoms such as delusions,

hallucinations and aggressive behavior.
b. Psychotherapy: Cognitive Behavioral Therapy or other forms of talk therapy
can help the individual learn coping skills and improve their quality of life.
c. Social support: Family and social support is crucial for the individual to
improve their overall functioning and recovery.
d. Rehabilitation: Vocational rehabilitation and skills training can help the
individual become self-sufficient and lead a productive life.
e. Monitoring of symptoms and side effects: Regular check-ups with a mental
health professional to monitor symptom control and side effects of medication
are important.

Md. Momin Uddin Page 21

33) A 45-year businessman presented to you with sadness, crying spell, loss of interest in
his daily activities, sleep disturbance in the form of early morning awakening, and
occasional suicidal ideation for the last three weeks. His symptoms started after
financial loss in his business. What is the provisional diagnosis of the patient? Write
the management plan. February 2019
Ans:
Provisional diagnosis: Major Depressive Disorder
Management Plan:
a. Evaluate for risk of suicide and provide a safe environment.
b. Start antidepressant medication, such as selective serotonin reuptake inhibitors
(SSRIs).
c. Refer for psychotherapy, such as cognitive behavioral therapy (CBT)
d. Encourage healthy lifestyle changes, such as regular exercise and sleep
hygiene.
e. Monitor for adverse effects and adjust treatment as needed.
f. Involve support system, such as family and friends.
g. Re-evaluate regularly to assess response to treatment and adjust as needed.
h. Consider augmenting treatment with other evidence-based options, such as
mood stabilizers or atypical antipsychotics, if needed.

34) A 35-year old housewife brought by her husband to a psychiatric outpatient

department with complaints of occasional aggressive and violent behavior, self
talking and laughing without any. reason, lack of self care, hearing of voices without
any evidence for the last one year. What is the provisional diagnosis of the case?
Write the management of the case. February 2020
Ans:
Provisional diagnosis: Schizophrenia

Management Plan:
a. Evaluate for risk of harm to self and others and provide a safe environment.
b. Start antipsychotic medication, such as second-generation antipsychotics
(SGAs).
c. Refer for psychotherapy, such as cognitive behavioral therapy (CBT) or
family therapy.
d. Encourage adherence to medication regimen and regular follow-up.
e. Monitor for adverse effects of medication and adjust treatment as needed.
f. Provide psychoeducation to the patient and family about the illness and its
treatment.
g. Consider adding mood stabilizers or other evidence-based treatments, if
necessary.
h. Consider involvement of community resources, such as rehabilitation
programs, for support.
i. Re-evaluate regularly to assess response to treatment and adjust as needed.

Md. Momin Uddin Page 22

35) A 20-year college student came to you with history of repeated hand washing without
appropriate reasons, repeated checking the lock of the doors though she knew that
doors were locked properly and slowness of her daily all activities. All the symptoms
were started two years back. What is the provisional diagnosis and management of the
case. February 2020.
Ans:

Provisional diagnosis: Obsessive-Compulsive Disorder (OCD)

Management:

a. Referral to a mental health professional for an accurate diagnosis and

treatment.
b. Cognitive Behavioral Therapy (CBT) with exposure and response prevention
(ERP) is the most effective form of treatment for OCD.
c. Medication, such as selective serotonin reuptake inhibitors (SSRIs), can also
be used to reduce symptoms.
d. Psychoeducation and support for the patient and their family can help with
coping and improving quality of life.

36) A 40-year-old homemaker presented with loss of interest, sadness, crying spell, sleep
disturbance, and sometimes suicidal thinking for the last two weeks. Her symptoms
started after break of relationship with her husband. What is the provisional diagnosis
of the case? Write the management for this case. June2022
Ans:

Provisional diagnosis: Major Depressive Disorder (MDD)

Management:

a. Psychotherapy: Cognitive-behavioral therapy (CBT) or Interpersonal therapy

(IPT) to help the patient process their feelings and improve their mood.
b. Antidepressant medication: Selective serotonin reuptake inhibitors (SSRIs) are
commonly used for treatment of depression.
c. Lifestyle changes: Encouraging regular exercise, a healthy diet, and adequate
sleep.
d. Supportive care: Encouraging the patient to connect with friends and family,
engage in activities they enjoy, and attend regular follow-up appointments
with a mental health professional.
e. Monitoring for suicidality: If the patient expresses suicidal ideation,
immediate intervention is necessary to ensure their safety.

Md. Momin Uddin Page 23

37) A 10-year-old boy brought by his mother to a child psychiatric outpatient facility with
the complaints of lack of concentration during his study time which decreased his
school performance, hyperactivity, impulsivity for the last eight months. What is the
provisional diagnosis of this case? Write the management plan for this child.
June2022
Ans:

Provisional diagnosis: Attention Deficit Hyperactivity Disorder (ADHD)

Management:

a. Comprehensive evaluation: A comprehensive evaluation should be done to

assess the child's symptoms, ruling out any other underlying conditions.
b. Behavioral therapy: Parent-child interaction therapy, social skills training, and
behavioral modification techniques may help in improving the child's
behavior.
c. Medication: Stimulant medications such as methylphenidate or amphetamines
may be prescribed for treatment of ADHD symptoms.
d. School accommodations: Working with the school to make necessary
accommodations such as allowing extra time for assignments, seating the child
near the teacher, and providing structure and routine.
e. Parent training: Providing the parents with tools and techniques to support
their child at home and manage their behavior.

38) Write the clinical features and management of enuresis February 2018
Ans:
Clinical features of enuresis:

➢ Involuntary or unconscious passing of urine, typically during sleep.

➢ Common in children and adolescents, but can occur in adults.
➢ May be associated with embarrassment, shame, and social stigma.

Management of enuresis:

➢ Behavioral therapy, such as bedwetting alarms or scheduled bathroom trips.

➢ Medications, such as desmopressin or imipramine.
➢ Bladder retraining and pelvic floor muscle exercises.
➢ In severe cases, surgical options may be considered.
➢ Psychological support and education for the patient and family.
➢ Avoidance of bladder irritants, such as caffeine and alcohol.

Md. Momin Uddin Page 24

39) What is autism? What are the clinical features of autism? Write the management of
autism. February 2017, Feb 18, Feb 19, Feb 20, June22
Ans:

Autism:

A neurodevelopmental disorder that affects communication, social interaction, and

behavior.

Clinical features of autism:

a. Difficulty with social communication and interaction.

b. Repetitive behaviors, interests, or activities.
c. Delay or lack of development of language and play skills.
d. Restricted interests and repetitive behavior patterns.

Management of autism:

a. Early diagnosis and intervention.

b. Behavioral and educational therapies, such as applied behavior analysis
(ABA), speech therapy, and occupational therapy.
c. Medications, such as antipsychotics, antidepressants, and stimulants, may be
used to manage specific symptoms.
d. Family and caregiver support and education.
e. Inclusion in mainstream education and social activities.
f. Collaboration with multidisciplinary team, including behavioral therapists,
physicians, and special educators.

Md. Momin Uddin Page 25

40) What are the common child psychiatric disorders? Write the clinical features and
management of autism spectrum disorder. February 2020
Ans:
Common child psychiatric disorders include:
a. Attention Deficit Hyperactivity Disorder (ADHD)
b. Oppositional Defiant Disorder (ODD)
c. Conduct Disorder (CD)
d. Anxiety Disorders
e. Depression
f. Bipolar Disorder
g. Autism Spectrum Disorder (ASD)

Autism Spectrum Disorder (ASD): Clinical Features:

a. Impaired social interaction

b. Impaired communication
c. Repetitive behaviors or interests
d. Unusual responses to sensory stimuli

Management:

a. Early intervention and behavioral therapy

b. Medications for co-occurring conditions
c. Speech therapy
d. Occupational therapy
e. Special education services.

41) Write the clinical features of social phobia February 2019

Ans:

Social Phobia (Social Anxiety Disorder): Clinical Features:

a. Extreme fear of being scrutinized or judged by others in social or performance

situations
b. Avoidance of social situations or enduring them with intense anxiety
c. Physical symptoms such as sweating, trembling, or a rapid heartbeat in social
situations
d. Negative impact on daily functioning and quality of life
e. Onset usually in childhood or adolescence.

Md. Momin Uddin Page 26

 Write short note:

a. Selective Mutism November-2021

Ans:
Definition: Selective Mutism is a childhood anxiety disorder where a child is unable
to speak in certain social situations, despite being able to speak normally in other
situations.
Signs and symptoms:
a. Avoiding eye contact
b. Withdrawing from social situations
c. Limited ability to communicate in specific environments, such as school
d. Anxiety or distress in social situations where speaking is expected
e. Normal speech and communication ability in non-social situations

Management:
a. Cognitive Behavioral Therapy (CBT)
b. Medication (e.g. antidepressants, anti-anxiety medication)
c. Family and teacher support
d. Speech therapy
e. Positive reinforcement and gradual exposure to speaking situations

b. Substance abuse. November-2021,June 2022, Feb 2020, Feb 2019, Aug 2018, Feb
2017, Feb 2018,
Ans:
Definition: Substance abuse is the harmful use of psychoactive substances, including
alcohol and drugs, leading to dependence, toxicity, and/or harm to oneself or others.

Signs and Symptoms:

a. Increased tolerance to the substance
b. Withdrawal symptoms when use is reduced or stopped
c. Inability to control use or quit
d. Neglect of responsibilities and social activities
e. Continued use despite harm to physical or mental health
f. Increased risk-taking behaviors

Management:
a. Behavioral therapy (e.g. cognitive-behavioral therapy, motivational
interviewing)
b. Medications (e.g. to reduce cravings or manage withdrawal symptoms)
c. Support groups (e.g. Alcoholics Anonymous)
d. Inpatient or outpatient rehabilitation
e. Medical detoxification (under supervision)
f. Integrated treatment for co-occurring mental health conditions

Md. Momin Uddin Page 27

c. Enuresis June 2022, Feb 2020, November-2021, Feb 2017, Feb 2018,
Ans:
Definition: Enuresis is a medical term for bedwetting, which is the repeated inability
to control urination during sleep.

Signs and Symptoms: Some of the signs and symptoms of enuresis include:

1) Wetting the bed at night after the age of 5-6 years old
2) Inability to control urination during the night
3) Daytime urinary accidents

Management: Some strategies for managing enuresis include:

1) Bladder training exercises to increase capacity and control

2) Scheduled bathroom trips
3) Avoiding caffeine and limiting fluid intake before bedtime
4) Bedwetting alarms to help train the bladder to wake up when full
5) Medications to reduce urine production or increase bladder control
6) Cognitive-behavioral therapy to address any underlying emotional or
psychological issues.

d. Delusion November-2021,June 2022, Feb 2020, Feb 2017, Feb 2019, Aug 2019, Feb
2018
Ans:

Definition: Delusion is a false belief that is firmly held despite evidence to the
contrary.

Signs and Symptoms: Some of the signs and symptoms of delusion include:
1) Holding a belief that is not based in reality
2) Refusal to consider alternative explanations or evidence
3) Persistence of the belief despite attempts to challenge it
4) Disruptive behavior and strained relationships due to the belief
5) Difficulty functioning in daily life due to the belief

Management: Some strategies for managing delusions include:

1) Medications such as antipsychotics to reduce symptoms of psychosis
2) Cognitive-behavioral therapy to address underlying thought patterns and
beliefs
3) Family therapy to address interpersonal relationships affected by the delusion
4) Psycho-education for the individual and their family to understand the
condition and develop coping strategies
5) Support groups to provide a sense of community and to foster positive coping
mechanisms

Md. Momin Uddin Page 28

e. Mental state examination November-2021,June 2022, Feb 2018
Ans:
Definition: Mental State Examination (MSE) is an assessment tool used by mental
health professionals to evaluate the current state of an individual's mental health,
including their thoughts, emotions, behaviors, and general functioning.

Mental healths professionals may look for during an MSE include:

1) Appearance and behavior
2) Mood and affect
3) Thought content and process
4) Perception and cognition
5) Insight and judgment.

f. Psychological treatment. June 22,November-2021

Ans:
Psychological treatment: Psychological treatments refer to various forms of therapy
used to treat mental health conditions. Some common forms of psychological
treatments include:
1) Cognitive behavioral therapy (CBT)
2) Psychodynamic therapy
3) Interpersonal therapy
4) Mindfulness-based therapy
5) Solution-focused therapy

g. Pica November-2021,Feb 19, February 2019

Ans: Definition: Pica is a condition characterized by the persistent consumption of
non-food items, such as dirt, chalk, ice, paper, and hair, for a minimum of one month.

Signs and Symptoms: Some of the signs and symptoms of pica may include:
1) Consuming non-food items
2) Lack of interest in normal food
3) Stomach pain, nausea, vomiting, or constipation
4) Anemia or other nutrient deficiencies
5) Dental problems

Management: The management of pica will depend on the underlying cause of the
condition and may involve the following:
1) Nutritional therapy to correct nutrient deficiencies
2) Behavioral therapy to address compulsive or harmful behaviors
3) Medication to address underlying mental health conditions (such as obsessive-
compulsive disorder)
4) Avoidance of triggering environments and stimuli
5) Monitoring of medical and dental problems
6) Close collaboration with a healthcare provider to ensure adequate management
and monitoring.

Md. Momin Uddin Page 29

h. Sleep disorder November-2021,Feb 2020, Aug 2018, Aug 2019 February 2019
Ans: Definition: Sleep disorder is a medical condition where a person has difficulty in
falling asleep, staying asleep, or both, leading to impaired sleep quality and quantity.
Signs:
1) Trouble falling asleep or staying asleep
2) Daytime fatigue or sleepiness
3) Irritability or mood changes
4) Difficulty concentrating or memory problems
5) Snoring or other sleep-related noises

Symptoms:
1) Insomnia or difficulty falling asleep
2) Excessive daytime sleepiness
3) Nightmares or vivid dreams
4) Sleepwalking or night terrors
5) Restless leg syndrome or periodic limb movement disorder

Management:
1) Lifestyle changes such as regular exercise and sleep schedule
2) Cognitive-behavioral therapy
3) Medications such as sleeping pills, hypnotics
4) Treatment of underlying medical conditions like anxiety or depression
5) Devices like continuous positive airway pressure (CPAP) for sleep apnea.

i. Psychotherapy August 2019 , August 2018,February 2017

Ans: Psychotherapy is a form of treatment for mental health problems that involves talking
with a trained therapist or counselor to help improve psychological well-being. Here are the
steps or procedures of psychotherapy:
✓ Assessment: The therapist will gather information about the client's history,
current symptoms, and other relevant factors to understand the client's
concerns.
✓ Goal setting: Together with the client, the therapist will set specific,
measurable goals for the therapy process.
✓ Treatment planning: The therapist will develop a treatment plan that outlines
the strategies and techniques that will be used to achieve the agreed-upon
goals.
✓ Implementation: The client and therapist will engage in regular sessions where
they work together to implement the treatment plan and address the client's
concerns.
✓ Evaluation: The therapist will regularly evaluate the effectiveness of the
treatment plan and make adjustments as needed.
✓ Termination: When the client has achieved their goals, or if the therapy is no
longer effective, the therapist and client will work together to end the therapy
process.

Md. Momin Uddin Page 30

j. Antidepressants August 2019
Ans:
Definition:
Antidepressants are a class of medications that work by changing the levels of certain
chemicals in the brain, including serotonin, norepinephrine, and dopamine.
Indications:
✓ Depression
✓ Anxiety disorders
✓ Obsessive-compulsive disorder (OCD)
✓ Post-traumatic stress disorder (PTSD)
✓ Chronic pain conditions
✓ Eating disorders
Contraindications:
✓ Known allergy or hypersensitivity to the medication
✓ Recent use of monoamine oxidase inhibitors (MAOIs)
✓ Uncontrolled narrow-angle glaucoma
✓ History of seizures or epilepsy
✓ Pregnancy and breastfeeding (some antidepressants may not be safe for use
during these periods)
Adverse effects:
✓ Nausea, vomiting, and diarrhea
✓ Headache and dizziness
✓ Insomnia or drowsiness
✓ Weight gain or loss
✓ Sexual dysfunction
✓ Increased risk of suicidal thoughts or behavior in children, adolescents, and
young adults (especially in the early stages of treatment)

Md. Momin Uddin Page 31

k. Obsession, August 2019
Ans:
Definition:
Obsessions are a type of mental health symptom that are typically associated with
obsessive-compulsive disorder (OCD) but can also occur in other conditions.

Signs and symptoms:

✓ Intrusive and unwanted thoughts or images
✓ Repetitive and compulsive behaviors or mental acts (such as counting,
checking, or organizing) performed to reduce anxiety or prevent harm
✓ Distress or impairment in social, occupational, or other areas of functioning

Management:
✓ Cognitive-behavioral therapy (CBT) is a type of psychotherapy that is often
used to treat obsessions and other symptoms of OCD.
✓ Exposure and response prevention (ERP) is a specific type of CBT that
involves gradually exposing the individual to feared situations or stimuli and
preventing them from engaging in compulsive behaviors.
✓ Medications such as selective serotonin reuptake inhibitors (SSRIs) and
tricyclic antidepressants (TCAs) may be used to treat obsessions and other
symptoms of OCD.
✓ Mindfulness techniques and relaxation exercises may also be helpful in
managing symptoms.

l. Dementia August 2018

Ans:
Definition: Dementia is a progressive brain disorder that affects memory, thinking,
behavior, and daily functioning.

Signs & Symptoms:

1) Memory loss and confusion
2) Difficulty with communication and language
3) Inability to focus or pay attention
4) Mood swings and changes in behavior
5) Difficulty with daily activities and problem-solving
6) Disorientation and confusion about time and place

Management:
1) Medications to treat specific symptoms
2) Lifestyle changes, such as regular exercise, social activities, and a healthy diet
3) Cognitive stimulation and memory training
4) Management of behavioral symptoms with therapy
5) Support for caregivers and family members
6) Hospice and palliative care for end-of-life care.

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m. ADHD August 2019
Ans:
Definition:
Attention Deficit Hyperactivity Disorder (ADHD) is a disorder characterized by
inattention, hyperactivity, and impulsivity both Children and Adult.

Signs and symptoms:

✓ Difficulty paying attention to details and sustaining attention on tasks or
activities.
✓ Excessive fidgeting, restlessness, and talking.
✓ Impulsive behaviors such as interrupting or blurting out responses.
✓ Difficulty organizing tasks and activities.
✓ Forgetfulness and distractibility.

Management:
✓ Behavioral therapy is often the first-line treatment for children with ADHD.
✓ Medications such as stimulants (e.g. Ritalin, Adderall) and non-stimulants
(e.g. Strattera) may be used to manage symptoms in children and adults.
✓ Parent training and education can help parents develop effective strategies for
managing their child's symptoms.
✓ Classroom accommodations such as a structured routine, a designated study
area, and preferential seating can be helpful for children with ADHD.
✓ Regular exercise, a healthy diet, and adequate sleep can also help manage
symptoms.

Md. Momin Uddin Page 33

n. Personality disorder August 2018
Ans:
Definition: Personality disorder is a mental health condition characterized by patterns
of thinking, feeling, and behavior that deviate significantly from cultural and social
norms and cause distress or impairment in daily life.
Signs & Symptoms:
✓ Extreme mood swings, anger, or irritability
✓ Chronic feelings of emptiness or boredom
✓ Difficulty in forming and maintaining relationships
✓ Impulsive or reckless behavior
✓ Aggression or violence
✓ Self-harm or suicidal ideation
✓ Inability to recognize or understand the thoughts and feelings of others
✓ Persistent fear of abandonment or rejection

Management:
✓ Psychotherapy, such as cognitive-behavioral therapy or dialectical behavior
therapy
✓ Medication, such as antidepressants or antipsychotics, to treat specific
symptoms
✓ Skills training, such as stress management and communication skills
✓ Group therapy, to provide support and help with socialization
✓ Family therapy, to address relationship issues and improve communication.

Md. Momin Uddin Page 34

o. Cognitive behavior therapy August 2018 ,June2022, February 2018
Ans:
Definition:
CBT is a type of therapy that helps individuals identify and change negative thought
patterns and behaviors that contribute to mental health problems.

Indications:
✓ Depression
✓ Anxiety disorders (e.g. generalized anxiety disorder, panic disorder, social
anxiety disorder)
✓ Obsessive-compulsive disorder (OCD)
✓ Post-traumatic stress disorder (PTSD)
✓ Eating disorders
✓ Substance use disorders

Procedure:
✓ Assessment: The therapist will gather information about the individual's
history, symptoms, and goals to develop a treatment plan.
✓ Psychoeducation: The therapist will provide information about the relationship
between thoughts, feelings, and behaviors and how to identify negative
patterns.
✓ Cognitive restructuring: The therapist will work with the individual to identify
and challenge negative thoughts and beliefs and replace them with more
positive, realistic ones.
✓ Behavioral activation: The therapist will help the individual identify and
engage in activities that promote positive emotions and behaviors.
✓ Exposure therapy (if indicated): The therapist will gradually expose the
individual to feared situations or stimuli to help them learn to manage anxiety.
✓ Homework: The individual will be given assignments to practice the skills
learned in therapy between sessions.
✓ Evaluation: The therapist will regularly evaluate the individual's progress and
adjust the treatment plan as needed.

Md. Momin Uddin Page 35

p. Hallucination February 2017 February 2018
Ans: Hallucination: A perception of something that is not actually present in the
environment.

Signs and Symptoms:

1) Seeing, hearing, feeling, smelling, or tasting things that are not actually there
2) Experiencing vivid and convincing sensory experiences
3) Difficulty distinguishing between reality and hallucination
4) Behaving or responding to the hallucination as if it were real

Management:
1) Medication: Antipsychotic medications are often used to treat hallucinations.
2) Therapy: Psychotherapy, such as cognitive-behavioral therapy, can help
individuals better understand and manage their hallucinations.
3) Lifestyle changes: Stress reduction and sleep hygiene practices can help
reduce the frequency and severity of hallucinations.

q. ECT February 2017

Ans:
Definition:
ECT is a treatment for mental illness that involves passing electrical currents through
the brain to induce a seizure.
Indications:
✓ Severe depression that has not responded to other treatments.
✓ Bipolar disorder, especially in cases with psychotic features or rapid cycling.
✓ Schizophrenia, especially in cases with catatonia or severe symptoms.
✓ Other mental health conditions that have not responded to other treatments or
are life-threatening.

Procedure:
✓ Pre-treatment evaluation: The individual will receive a thorough medical
evaluation to ensure that ECT is safe and appropriate for them.
✓ Anesthesia: The individual will be given anesthesia and muscle relaxants to
minimize discomfort and prevent injury during the procedure.
✓ Electrical stimulation: The healthcare provider will use an electrode to deliver
an electrical current to the brain, typically for a few seconds, to induce a
seizure.
✓ Recovery: The individual will be monitored as they wake up from the
anesthesia and may experience confusion and short-term memory loss
immediately after the procedure.
✓ Course of treatment: The number and frequency of ECT treatments vary
depending on the individual's response and the severity of their condition. A
typical course of treatment involves multiple sessions per week for several
weeks.

Md. Momin Uddin Page 36

r. Mental retardation February 2018 February 2019
Ans:
Definition: Mental retardation, also known as intellectual disability, is a
neurodevelopmental disorder characterized by significant limitations in intellectual
functioning and adaptive behaviors such as communication, self-care, and social
skills.

Signs and symptoms:

✓ Delayed speech and language development
✓ Difficulty in learning basic skills such as potty training, dressing, and feeding
oneself
✓ Poor memory and problem-solving abilities
✓ Limited attention span and difficulty following instructions
✓ Inappropriate social behavior and difficulty forming relationships
✓ Poor judgement and impulsiveness

Management:
✓ Early Intervention: Children with mental retardation may benefit from early
intervention programs that focus on language, social, and academic skills.
✓ Special Education: Special education programs can help children with mental
retardation learn basic skills and improve their cognitive abilities.
✓ Medication: Certain medications can help with specific symptoms such as
hyperactivity, impulsiveness, and depression.
✓ Therapy: Behavioral, speech, and physical therapy can help individuals with
mental retardation improve their communication, social, and physical abilities.
✓ Support: Family and community support are crucial for individuals with
mental retardation to lead fulfilling lives. This can include support from
government agencies, advocacy groups, and community-based programs.

s. Biological features of depression February 2018 ,February 2020

Ans:

✓ Altered activity in brain regions related to mood regulation

✓ Changes in neurotransmitter levels, such as decreased serotonin
✓ Hormonal imbalances, such as elevated cortisol levels
✓ Inflammation
✓ Impaired functioning of the stress response system
✓ Abnormal activity in circadian rhythm pathways.

Md. Momin Uddin Page 37

t. Relaxation therapy February 2019
Ans:
Relaxation therapy is a set of techniques designed to help individuals reduce physical
and mental tension, leading to a state of deep relaxation and calm. Techniques may
include:

✓ Progressive muscle relaxation

✓ Breathing exercises
✓ Guided imagery
✓ Meditation
✓ Yoga
✓ Tai chi
✓ Massage therapy these techniques can help lower stress and anxiety levels,
improve sleep and boost overall wellbeing.

u. Group therapy February 2020

Ans:

Group therapy is a form of psychotherapy that involves a small group of individuals

meeting with a therapist to discuss and work through common mental health
concerns. Some benefits of group therapy include:

✓ Improved social support and sense of belonging

✓ Increased self-awareness and insight
✓ Opportunity to practice communication and interpersonal skills
✓ Exposure to different perspectives and experiences
✓ Reduced feelings of isolation and stigma. Group therapy can be structured in
various formats, such as cognitive behavioral therapy, interpersonal therapy,
or supportive therapy.

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v. Conduct disorder February 2020, Aug 2018
Ans:
Conduct disorder (CD) is a mental health disorder characterized by persistent and
pervasive patterns of aggressive, antisocial, or violation of the rights of others.

Signs and symptoms of CD may include:

✓ Aggression towards people and animals
✓ Destruction of property
✓ Deceitfulness or theft
✓ Serious violation of rules
✓ Aggressive or bullying behavior
✓ Lack of empathy and disregard for others' feelings
✓ Impulsiveness and irritability.

Management of CD typically involves a combination of therapies, such as:

✓ Behavioral therapy to address problematic behaviors
✓ Family therapy to improve relationships and support at home
✓ Cognitive-behavioral therapy to modify thinking patterns
✓ Medications to manage co-occurring conditions such as ADHD
✓ Skill-building to enhance social and problem-solving skills
✓ Multisystemic therapy to address multiple factors contributing to CD.

w. Agoraphobia June2022
Ans:

Definition: Agoraphobia is a type of anxiety disorder characterized by intense fear or

anxiety when faced with situations where escape may be difficult, or help may not be
available.

Signs & Symptoms:

✓ Fear of leaving home or a safe place

✓ Avoidance of public places or situations that trigger anxiety
✓ Physical symptoms such as sweating, shaking, or heart palpitations
✓ Depression or feelings of hopelessness

Management:
✓ Cognitive-behavioral therapy (CBT)
✓ Medications such as anti-anxiety or antidepressants
✓ Exposure therapy
✓ Mindfulness and stress reduction techniques
✓ Group therapy or support groups

Md. Momin Uddin Page 39

 University of Dhaka
February 2023
Subject: Psychiatry

1. What are the types of anxiety disorders? Write the clinical presentation of
generalized anxiety disorder.
Ans:
There are several types of anxiety disorders, including:
✓ Generalized Anxiety Disorder (GAD)
✓ Panic Disorder
✓ Social Anxiety Disorder
✓ Specific Phobias
✓ Obsessive-Compulsive Disorder (OCD)
✓ Post-Traumatic Stress Disorder (PTSD)

Generalized Anxiety Disorder (GAD) is a type of anxiety disorder characterized by

excessive and persistent worry or anxiety about everyday situations, events, or
activities. The anxiety and worry associated with GAD are difficult to control, and
they often interfere with daily functioning. The following are some common clinical
presentations of GAD:

✓ Excessive and pervasive worry about a range of everyday events and activities
✓ Difficulty controlling worry
✓ Restlessness or feeling on edge
✓ Fatigue or feeling easily tired
✓ Difficulty concentrating or mind going blank
✓ Irritability
✓ Muscle tension
✓ Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying
sleep)

Md. Momin Uddin Page 40

2. What are the types of bipolar disorders? Write the clinical features of manic
episode of bipolar disorder.
Ans:
There are three types of bipolar disorders:
a) Bipolar I disorder: At least one manic episode and one depressive episode
b) Bipolar II disorder: At least one hypomanic episode and one depressive
episode
c) Cyclothymic disorder: At least two years of numerous hypomanic and
depressive symptoms that do not meet the criteria for a manic or depressive
episode
Clinical features of a manic episode of bipolar disorder include:
✓ Abnormally elevated, expansive, or irritable mood
✓ Increased energy, activity, and restlessness
✓ Grandiose thinking or delusions
✓ Racing thoughts and speech
✓ Decreased need for sleep
✓ Impulsive or reckless behavior
✓ Aggressiveness or agitation
✓ Substance abuse
✓ Hypersexuality
✓ Poor judgment and insight.

3. Describe the presentation and management of obsessive-compulsive disorders.

Ans:
See on the page no 07

4. What are the types of somatic symptoms and related disorders? Write the clinical
Presentation of conversion disorder.
Ans:
See on the page no 03

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5. A 30-year-old housewife presented with loss of interest, sadness, crying spell,
sleep disturbance, and sometimes suicidal behavior for the last one month. What
is the provisional diagnosis of the case? Write the management for this case.
Ans:
The provisional diagnosis for this case could be major depressive disorder.

Management for major depressive disorder typically includes a combination of

psychotherapy and medication. Here are some possible treatment options:

✓ Psychotherapy: Cognitive-behavioral therapy (CBT) or interpersonal therapy

(IPT) can be effective in treating depression. These therapies can help the
individual identify negative thought patterns and develop coping strategies to
manage symptoms.
✓ Antidepressant medication: Selective serotonin reuptake inhibitors (SSRIs),
such as fluoxetine, sertraline, or escitalopram, are commonly used to treat
depression. Other types of antidepressants, such as serotonin-norepinephrine
reuptake inhibitors (SNRIs) or tricyclic antidepressants (TCAs), may also be
prescribed.
✓ Supportive care: Providing emotional support and encouraging participation in
enjoyable activities can help alleviate some of the symptoms of depression.
✓ Hospitalization: In severe cases, hospitalization may be necessary to ensure
the individual's safety and provide intensive treatment.

6. Write short notes on (any two)

a) Substance abuse
Ans:
See on the page no 27

b) Hallucination
Ans:
See on the page no 37

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 c) Counseling
Ans:
Definition: Counseling is a collaborative process between a trained professional and
an individual or group of individuals seeking help to improve their mental health and
well-being.

Procedure: The counseling process typically involves the following steps:

✓ Assessment: The counselor conducts an initial assessment to understand the
individual's or group's concerns, challenges, and goals.
✓ Goal setting: The counselor and individual or group work together to set
specific, achievable goals for the counseling sessions.
✓ Intervention: The counselor uses various therapeutic techniques and
interventions to help the individual or group work through their challenges and
achieve their goals.
✓ Evaluation: The counselor regularly evaluates the progress of the individual or
group and adjusts the intervention plan as needed to ensure progress is being
made.
✓ Termination: The counseling relationship ends when the individual or group
has achieved their goals or when they decide to end the counseling
relationship.

Techniques: The counselor may use a variety of therapeutic techniques, including but
not limited to:
✓ Cognitive-behavioral therapy (CBT)
✓ Mindfulness-based therapy
✓ Solution-focused therapy
✓ Psychodynamic therapy
✓ Family therapy

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7. What are the common child psychiatric disorders? Write the clinical presentation
of attention deficit hyperactivity disorder.
Ans
Common child psychiatric disorders include:
a. Attention Deficit Hyperactivity Disorder (ADHD)
b. Oppositional Defiant Disorder (ODD)
c. Conduct Disorder (CD)
d. Anxiety Disorders
e. Depression
f. Bipolar Disorder
g. Autism Spectrum Disorder (ASD)

Signs and symptoms:

✓ Difficulty paying attention to details and sustaining attention on tasks or
activities.
✓ Excessive fidgeting, restlessness, and talking.
✓ Impulsive behaviors such as interrupting or blurting out responses.
✓ Difficulty organizing tasks and activities.
✓ Forgetfulness and distractibility.

8. Define delirium and dementia. What are the clinical features of delirium?
Ans:
Delirium is an acute, fluctuating disturbance of consciousness and attention that often
occurs in older adults and those with underlying medical conditions. It is typically
reversible once the underlying cause is treated.

Dementia, on the other hand, is a chronic and progressive decline in cognitive

function, including memory, language, and problem-solving abilities, that affects
daily functioning and independence. It is not typically reversible, although certain
treatments can help slow its progression.

Clinical features of delirium include:

✓ Disturbance in attention and awareness, with reduced ability to focus and
maintain attention
✓ Disorganized thinking, with difficulty following a conversation or
understanding instructions
✓ Fluctuating mental status, with periods of lucidity and confusion
✓ Altered level of consciousness, ranging from hyperalert to stupor
✓ Disturbances in sleep-wake cycle, with insomnia or excessive drowsiness
✓ Changes in perception, such as hallucinations or illusions
✓ Emotional instability, with rapid mood swings, anxiety, or agitation
✓ Physical symptoms, such as tremors, sweating, and rapid heart rate

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9. Write in short about behavioral therapy.
Ans:
Definition: Behavioral therapy is a goal-oriented and structured therapy that uses
evidence-based techniques to modify problematic behaviors and thought patterns.

Techniques: Behavioral therapy techniques include but are not limited to:
✓ Exposure therapy: Gradual exposure to feared or anxiety-provoking stimuli to
reduce avoidance behaviors.
✓ Systematic desensitization: Gradual exposure to feared stimuli paired with
relaxation techniques to reduce anxiety.
✓ Cognitive restructuring: Identifying and challenging negative or irrational
thoughts that contribute to distress.
✓ Behavioral activation: Encouraging engagement in positive and enjoyable
activities to improve mood and motivation.
✓ Social skills training: Teaching skills to improve communication and
interpersonal relationships.

Applications: Behavioral therapy can be used to treat a variety of mental health

conditions, including but not limited to:
✓ Anxiety disorders, such as generalized anxiety disorder, social anxiety
disorder, and obsessive-compulsive disorder.
✓ Mood disorders, such as depression and bipolar disorder.
✓ Substance use disorders.
✓ Eating disorders, such as anorexia nervosa and bulimia nervosa.

10. Define personality and personality disorder. What are the types of personality
disorders?
Ans: See on the page no 04, 34

11. A 40-year-old man was brought by his family member with the complaints of
undue suspiciousness, lack of self-care, hearing of voices without any evidence,
occasional aggressive behavior for the last one year. What is the provisional
diagnosis of this case? Write the management plan for the case.
Ans:
Provisional diagnosis: Schizophrenia
Management plan:
1. Conduct comprehensive psychiatric evaluation
2. Confirm diagnosis and assess severity of symptoms
3. Prescribe antipsychotic medication to reduce symptoms
4. Provide psychotherapy to help patient cope with symptoms
5. Offer social support and education to the patient and family
6. Monitor and adjust treatment plan as needed.

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12. Write short notes on (any two)
a) Antidepressants
Ans:
See on the page no 31

b) Pica
Ans:
See on the page no 29

c) Agoraphobia
Ans:
See on the page no 39

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