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Human Behavioral Sciences Course 303

 

 

Course:                   303 Human Behavioral Sciences

Credits:                  1  (1 + 0)

Academic Year:    Third Year

Duration:               15 weeks

Prerequisites:                None

 


HUMAN BEHAVIORAL SCIENCES - COURSE 303

 

 

Objectives:

a.        To introduce the student to the basic scientific information in behavioral sciences basic to clinical psychiatry especially psychology and sociology.

b.       To emphasize positive and therapeutic human psychological interaction between the student and his patients, colleagues and seniors.

c.       To prepare the student with basic knowledge and terminology for courses of psychiatry, child development, neuro-psychological assessment and other related subjects in the college curriculum.

 

 

Course Format:

Consist of fourteen lectures one hour each. Practical demonstrations are encouraged within the lectures as appropriate.

 

 

Language of Teaching:

To be taught in English.

 

 

Teaching Staff:

To be taught by the Department Staff and others.

 

 

Lectures Contents:

1 – Introduction:

·        Objectives of the Course.

·        Teachers.

·        Examinations.

·        Behavioral Sciences basic to clinical psychiatry: psychology, sociology.

2 – Learning, Language, Thinking:

·        Definition and theories.

·        Links with associated clinical disorders.

 

3 – Motivations, Emotions, Stress:

·        Definition and theories.

·        Links with associated clinical disorders.

 

 

4 – Biopsychosocial  Medicine:

·        Body mind interaction.

·        Psychosomatic Theories.

·        Links with associated clinical disorders.

 

5 – Memory, Perception, Consciousness, Sleep:

·        Definition and theories.

·        Links with associated clinical disorders.

 

6 – Outline of Child Development:

·        Theories of Development.

·        Cognition Development.

·        Emotion Development.

·        Social Development.

 

7 – Personality:

·        Theories.

·        Links with associated clinical disorders.

 

8 – Psychological Testing I:

·        Assessment of personality.

·        MMPI and EPI.

 

9 – Intelligence.

·        Definition and theories.

·        Links with associated clinical disorders.

 

10 – Psychological Testing II:

·        Assessment of intelligence.

·        WISC and Binnee.

 

11 – Models of the Mind:

·        Theories of the mind.

·        Integrative models.

·        Links with clinical disorders.

 

12 – Psychiatric Terminology:

·        English = Arabic.

 

 

 

 

13 – Psychopathology:

·        Descriptive phenomenology.

·        Links with associated clinical disorders.

 

14 – Communication Skills:

·        Interviewing Skills.

·        Doctor-patient relationship, nature and boundaries.

 

 

Method of Assessment:

 

1-     Continuous Assessment Examination consist of MCQs within the College regulations of examinations, thirty in total, twenty of true-false type and ten of single best answer, and this forms 40 marks.

 

2-      Final examination consists of MCQs within the College regulations of examinations which will be applied clinical type and this forms 60 marks.  30 questions in total, 20 of true/false type and 10 of single best answer.

 

 

References:

 

1.       The Scientific Principles of Psychopathology.

          P. McGuffin, M.F. shanks, R.J. Hodgson

          Academic Press Inc. (London) Ltd.

 

2.       An Outline of Psychology (as applied to Medicine)

          John Weinman

          John Wright & Sons Ltd.,

 

3.       Medical Psychology (for undergraduate Medical Students)

          Prof. Afaf Hamed Khalil

          El Shazly Printing House

 

4.      For clinical subjects please refer to recommended textbooks of Psychiatry Course 462.

 

 

Contacts:

 

-               Course Organizer:  Tel: 467-1719

-               Department of Psychiatry: Tel: 467-1717 / 467-2360

 

 

 

CLINICAL PSYCHIATRY COURSE 462

 

 

اسم المقرر: الطب النفسي                           Course Name: Psychiatry

رقم المقرر ورمزه: 462 طنف                Course Code & No: 462 Psych   

الساعات المعتمدة: 4 ( 2+2 )                                  Credits: 4 ( 2+2 )

مدة المقرر: 6 أسابيع                                          Duration: 6 weeks             سنة الدراسة: السنة الرابعة                                 Study Year: 4th Year

     تطلب سابق: 303 كطب                Prerequisite: 303 Human Behavior

 

 

 

 

MANUAL

FOR

TUTORS AND STUDENTS

 

VERSION: 2007
TABLE OF CONTENTS

 

 

Page          Subject

 

3                                           Introduction

4                                           Objectives

5                                           Course Overview

6       – 32       Course Content

           6             I.        Lectures

               7 – 8      II.        Interview Skills Sessions

8 – 17   III.      Subject Discussion

              18 – 28   IV.      Case Scenario Discussion

 29          V.       Video Case Discussion

 30          VI.      Clinical Sessions

               31         VII.      Outpatient Clinics Attendance

               32        VIII.      Inpatient Round Attendance

33          Course Organization

34          Course Assessment and Examinations

35          Course References

36          Course Evaluation

37 –38 Feedback Form


 

INTRODUCTION

 

We welcome you to course 462 Psych (the clinical psychiatry course) and we hope it will be an enjoyable and stimulating educational experience. This course aims at studying psychiatry as one of the most rapidly growing specialties of medicine in our country and the world. Thus, you will learn basic psychiatric knowledge and clinical skills that will enable you to function at the level of primary care psychiatry and take safe decisions when assessing and treating psychiatric patients. This will be accomplished through a variety of educational activities.

 

We expect full commitment and punctuality in the course activities and high respect towards people with psychiatric problems.

 

This manual is written in details for the tutors and students to strictly adhere and comply with to maintain the excellence of the teaching process.

 

 

 

 

 


 

OBJECTIVES

 

To provide the undergraduate medical students with 1-knowledge  2-attitude  3- clinical skills relevant to clinical psychiatry and essential for their future career as non-psychiatric clinicians in whatever specialty they choose.

 

1-Knowledge:

To acquire basic essential facts in clinical psychiatry that includes:

a.      Phenomenological psychopathology (signs and symptoms) of psychiatric disorders.

b.     Classification and etiology in clinical psychiatry (bio-psycho-social).

c.     Common psychiatric disorders:

·        clinical features and course.

·        epidemiology and etiology.

·        differential diagnosis.

·        treatment (bio-psycho-social) and prognosis.

d.     Treatment modalities in psychiatry:

·        Physical: pharmacotherapy, electroconvulsive therapy (ECT) and others.

·        Psychological: behavioral, cognitive, supportive psychotherapy and others.

 

2-Attitude:

To develop the scientific attitude towards:

a.      Psychiatric patients and their families

b.     Psychiatric interventions (bio-psycho-social)

c.     Mental health and providers (psychiatrists, psychologists, social workers and others)

d.     Psychiatry as a branch of medicine.

 

3-Clinical Skills:

a.      To conduct a full psychiatric interview with:

·        Proper interview techniques and skills.

·        Sufficient psychiatric history.

·        Standard “mental state examination”.

b.     To present a diagnostic formulation for common psychiatric disorders based on the most recent classificatory systems in psychiatry.

c.     To set an outline of a management plan for common psychiatric disorders following the bio-psycho-social approach (both short and long term).

d.     To assess and appropriately refer psychiatric patients in the primary care settings.

  1. To assess and deal competently and safely with psychiatric emergencies.
  2. To assess and dispose properly consultation-liaison cases.

 

COURSE OVERVIEW  

 

 

The course lasts for 6 weeks during which varieties of educational activities are conducted to fulfill the objectives of the course with great emphasis on the applied clinical psychiatry. These activities are namely:

 

1.     Twelve didactic lectures, in the first 8 days (see page 6 ).

2.     Seven interview skills sessions, in the first two weeks (see pages 7-8).

3.     Eight subject discussions, weeks 3 – 6 (see pages 8 - 17).

4.     Two case scenario discussions, weeks 3 – 6.

5.     Two video case discussions, weeks 3 – 6.

6.     Nine clinical sessions. (in-patient, outpatient, consultation-liaison, child psychiatry, other live patient case discussions) weeks 3 - 6.

7.     Outpatient clinics attendance at least one.

8.     Clinical rounds attendance at least one.

 

 

 


 

COURSE CONTENT 

 

I. Lectures:

 

1.     Introduction: Diagnostic process, Classification and Etiology in Psychiatry.

2.     Anxiety Disorders.

3.     Stress related and Adjustment Disorders and Grief.

4.     Schizophrenia and Other Psychotic Disorders.

5.     Mood Disorders.

6.     Cognitive Disorders.

7.     Substance Abuse.

8.     Personality Disorders.

9.     Child Psychiatry (common disorders).

10. Emergency Psychiatry.

11. Psychopharmacology.

12. Psychological Treatment.

 

Guidelines:

 

1.     Textbook clinical psychiatry factual knowledge.

2.     Applied clinical psychiatry teachings.

3.     Scientific evidence based approach.

4.     Avoid controversial and personal idiocyncratic views.

5.     Proper and sophisticated audiovisual aids.

 

 

 

 


 

 II. Interview Skills Sessions:

 

1.           Taking Psychiatric History:

Based on the “New patient psychiatric sheet” and the course textbook guidelines students are taught how to take proper psychiatric history.

 

2.           Conducting standard mental state examination (MSE):

Based on the “New patient psychiatric sheet” and the course textbook guidelines students are taught how to conduct proper mental state examination.

 

3.     Interview Techniques and Diagnostic Process:

Tutor will train students how to establish a relationship with a patient, elicit psychiatric symptoms, formulate the longitudinal history and the present mental state in one comprehensive view to reach a diagnosis, assess nature and severity of the patient’s problem, and how to reach to a relevant differential diagnosis.

 

4.    Video Demonstration of Patient’s Interview:

Tutor will show students a live video-taped interview demonstrating the process of psychiatric interview (History, MSE, Interview techniques,…) and allow students to critically comment on and enquire about the process of the interview.

 

5.     Students role play sessions:

Tutor will supervise students applying interview skills on each other in role play sessions simulating psychiatric presentation (e.g. anxiety, depression, cognitive impairment, hallucinations… etc.)

 

6.    Interviewing anxious and depressed patients:

Tutor will focus on how to interview patients with anxiety/depressed mood demonstrating the skills in assessing the mood, non-verbal behavior of such patients. This can be done with simulated cases, real live patients or video-taped cases.

 

7.     Interviewing psychotic patients and patients with cognitive problems:

Tutor will focus on how to interview patients with psychotic symptoms (particularly delusions & hallucination) and how to assess cognitive functions properly (consciousness, attention, concentration, orientation and memory). This can be done with simulated cases, real live patients or video-taped cases.

 

 

 

 

Guidelines:

1.     It is an essential activity in the course and probably the most extensive structured educational activity that the medical student is taught about interviewing skills.

2.     Important emphasis on simple, basic, detailed and scientifically based skills.

3.     Important emphasis on the professional attitude and the high ethical conduct with patients and their families.

4.     Important emphasis on communication skills, responses and non-verbal communications.

5.     Cases, videos and needed materials are available from the department secretary.

 

III. - Subject Discussion:

This activity aims at engagement of the students to participate actively in the discussion of subjects that are so essential for the clinical practice in non-psychiatry settings such as primary care in dealing with psychiatric patients and these subjects are:

 

1 – Assessment & Management of Agitated and Aggressive Patients

 

2 – Assessment & Management of Anxious Patients

 

3 – Assessment & Management of Patient Feeling Depressed

 

4 – Assessment & Management of Somatizing Patients

 

5 – Assessment & Management of Cognitively Impaired Patients

 

6 – Assessment & Management of Psychotic Patients

 

7 – Assessment & Management of Suicidal Patients

 

8 – Assessment & Management of Substance Related Disorders

 

Guidelines:

1.     Tutors can use the appropriate approach to conduct the activity, but he may like to divide students into two subgroups, one to discuss the assessment and the other to discuss the management.

2.     The tutor has to make the discussions lively and stimulating and leave room for students to think, analyze and present knowledge themselves and this can be accompanied by questions, associations, cues and other techniques used.

3.     The department has prepared some outline format for subject discussions and tutors are welcome to use it.

4.     The basic skeleton suggested is:

 

 

 

 

 

Aspects

 

Assessment

Management

Short-term

Long-term

 

Biological

-  Genetics

-  General medical conditions

-  Traumas & physical injuries

 

 

 

Psychological

-  Personality

-  Other mental disorders

-  Stress, conflicts.

 

 

 

Social

-  Separation and loss.

-  Support.

-  Social stresses

 

 

 

 

You will find an outline of the above subjects set by the department to help the tutors and students in the discussions. 

 

The following is a detailed suggested guidelines:
1.  Assessment and Management of Agitated and Aggressive Patients

 

I.  Assessment:

-          What is agitation:

o        Tension state in which anxiety is manifested in psychomotor area with hyperactivity. Seen in depression, schizophrenia & mania.

-          What is aggression:

o        Hostile or angry feelings, thoughts or actions directed towards an object or person. Seen in impulsive disorders, impulse control disorders & mania.

-          How to interview aggressive patient:

o        Do not be close in closed room

o        Sit near the door

o        Have security guard nearby or in the room

o        Sit limits

o        If patient seems too agitated terminate interview

-          How to manage agitated patient: 

o        Medication – Haloperidol, Benzodiazepines

o        Physical restraints

o        Rule out reaction to other medication, e.g. cortisol paranoia, anticholinergic delirium.

o        Examine for command hallucination or delusional (paranoid) to which patient is responding.

-          Causes:

o        Mental illness:  Depression, Acute psychosis, mania, schizophrenia

o        Physical: Delirium, dementia, epilepsy, alcohol and drug intoxication, W.D.

o        Personality Disorder: Borderline, antisocial

-          General strategy in evaluating the patient:

o        Protect self

o        Prevent harm to self or others

o        Assess the suicidal risk factors

o        Assess the violent risk: ideas, wishes, intention, male, lower S.E. status, few social support, past history, substance abuse, psychosis.

o        Assessment of dangerousness

 

 

II. Management:

-          Hospitalization:

o        Locked vs. unlocked ward

o        Voluntary vs. involuntary

o        1 – 1 precaution vs. no precaution

-          Crisis intervention:

o        Reliable and motivated patient

o        Reliable accessory persons

o        Confrontation

o        Restraint (physical)

o        Immediate follow up

o        Avoidance of provocation

-          Medication:

o        Major tranquilizer

o        Benzodiazepines

o        Mood stabilizer

o         ECT

 


 

2. Assessment and Management of Anxious Patients

 

 

I. Assessment:

-         Definition of anxiety and anxious mood

-         Acute vs. chronic

-         Continuous vs. episode

-         ? Fear of unknown

-         ? Fear of certain objects, activity of situation

-         ? Avoidance behaviour

-         Relationship to life stressors

-         Presence of recurrent intrusive thoughts and/or compulsive behavior

-         Associated physical symptoms

 

-         MSE:

o       Appearance

o       Physical symptoms

 

-         Differential Diagnosis:

o       GAD

o       Depressive Neurosis (Dysthymia)

o       Major depressive disorder with agitation

o       Drug abuse

o       Stress related disorders

 

 

II. Management:

-         Reassurance and explanation

-         Pharmacotherapy:

o       SSRIs

o       TCAs

o       Other antidepressants

o       Benzodiazepines

o       Buspirone

o       B-blockers

 

-         Psychotherapy:

o       CBT

o       Group therapy

o       Relaxation training

o       Systemic desensitization

o       Exposure

o       Thought stopping

o       Response prevention

 


 

3. Assessment and Management of Patient Feeling Depressed

 

I. Assessment:

-          Definition of the mood state depression,

-          Terminology: low mood, dysphoria, unhappiness, chest tightness, boredom, sadness, etc.

-          Analysis of the problem:

·             Presentation

·             Duration

·             Severity: crying, decreased interest, decreased enjoyment, suicidal ideas or plans, etc.

·             Constancy: relief, change with environment, diurnal variation, etc.

·             Course: fluctuating, episodic, progressive

·             Associated symptoms

-          MSE:

·         Facial expression

·         Psychomotor retardation

·         Psuedodementia cognitive impairment

·         Suicidal risk

-          Physical Examination:

·         Thyroid dysfunction and others

·         Medication history e.g. steroids

-          Investigations:

·         Thyroid Function Tests

·         Others

-          Differential Diagnosis

·         Major Depressive Disorders

·         Bipolar Affective Disorder                 – Depressive episode

                                                                        - Mixed affective episode

·         Dysthymic Disorders – Depressive Neurosis

·         GAD

·         Adjustment Disorders (Grief)

·         Stress Related Disorders

·         Schizophrenia with depression

·         Schizoaffective Disorders – Depressive episode

II.  Management:

-          Immediate:            

·         Admission justifications

·         Sedation for agitation in psychotic symptoms

·         Suicide close observation

-          Establish Diagnosis:

·         Informants

·         Medication history

·         Past reports

·         Investigations

-          Short Term:

·         Antidepressant selection

·         Adjunctive medications e.g. sedatives, antipsychotics

·         ECT

-          Long Term:

·         Maintenance therapy: duration, dose, others.

·         Psychotherapy

·         Social support

·         Prognosis


 

4. Assessment and Management of Somatizing Patients

 

I. Assessment:

   - Definition of somatization

   – Acute vs. chronic

   – Persistent vs. transient

   – Multiplicity of physical symptoms

   – Relationship with life stressors

   – Association with occupational and social dysfunction

   – Personality features

   – Illness behaviour and sick role

   – Social support

   – Health services abuse

 

   - MSE:

-         How the patient describes his symptoms

-         Thoughts, behaviors and emotions associated with symptoms

-         Patient’s explanation of his physical symptoms and the meaning of negative tests.

 

   - Physical Examination

 

   - Investigations:

-         Minimum and for common diseases

-         Thyroid tests, LFT, FBS, skull x-ray, etc.

 

   -  Differential Diagnosis:

-         Mood disorders, depression

-         GAD

-         Schizophrenia

-         Drug abuse

-         Somatoform disorders

-         Factitious disorders

-         Malingering

 

II. Management:

-         To establish a therapeutic relationship

-         Explanation with emphasis on psychosomatic unity

-         Regular follow up

-         Treat concurrent psychiatric disorders

-         Avoid polypharmacy

-         Avoid Benzodiazepine dependence risk

-         Provide specific therapy when indicated

-         Social & marital intervention.

 


 

5. Assessment and Management of the Cognitively Impaired Patients

 

 

I. Assessment:

-         Definition of Cognition

-         What are the cognitive functions

-         How do we assess cognitive functions:

o       Direct observation

o       Collateral information

o       Direct examination

o       Standardized tests

-           How do people with cognitive impairment present: 

e.g.  forgetfulness, inappropriate behavior, poor academic performance.

-         Differential Diagnoses:

1.      Acute:  Delirium

2.      Chronic:  Dementia

-         Aetiological causes:

e.g. a) Trauma

       b) Nutritional

       c) Toxins and substances

       d) Endocrine

       e)  Neurological

                   f)  Psychiatric

 

 

II. Management:

-         Establish diagnosis

-         Ward management of delirium

-         Assessment of demented patients for rehabilitation

-         Common causes and their psychiatric management

 

 

 


 

6. Assessment and Management of the Psychotic Patient

 

I. Assessment:

-          Definition of psychosis vs. neurosis

-          Definition of psychotic symptoms

-          Some types and examples of psychotic symptoms

-          Analysis of the problem:

o         Presentations:

·          Muttering to self

·          Behavioral change

·          Laugh inappropriately

·          Clear symptom description

o         Aetiological factors:

·          Compliance

·          Drug abuse

·          Others

o         Course:    - Incidious

-  Acute

o         Associated factors:

·          Social impairment

·          Personality change

·          Mood change

·          Biological symptoms 

-          MSE:

o         Self care

o         Excitement

o         Talkativeness, incoherence, flight of ideas

o         Affect; blunted, flat, disorganized, elated, depressed, perplexed, others.

o         Psychotic symptoms

o         Cognitive functions impairment

-          Physical examinations:

o         Jaundice

o         Injection marks

-          Investigations

o         Drugs screening

o         Others

-          Differential Diagnosis:

o         Schizophrenia

o         Schizoaffective disorders

o         BAD – mania or depressive with psychotic symptoms

o         Major depression with psychotic symptoms

o         Delusional disorders

o         Dementia with psychotic symptoms

o         Substance related psychosis

o         Psychosis due to general medical condition

II. Management:

-          Immediate:             

·          Control violence if present

·          Sedation

·          Admission vs OPD

-          Establish Diagnosis:

-          Short Term:

·          Medication selection: past response to drugs, compliance and depot, atypical, suicidal risk, ECT,  others.

-          Long Term:

·          Maintenance medication, dose, duration

·          OPD follow up

·          Rehabilitation services

·          Others

-          Prognosis

·          Positive factors

·          Negative factors


 

7. Assessment and Management of Suicidal Patients

 

 

 

I.  Assessment:

-         Definition of suicide

-         Definition of terminology related, parasuicide, deliberate self-harm, attempted suicide, completed suicide, suicide risk.

-         Assessment of the suicide risk:

a.       The present attempt:

·        Situation

·        Mean

·        Suicidal note

·        Planning

·        MSE

b.      Past History:

·        Past attempts

·        Past psychiatric disorder

·        Medical disease

·        Present factors

·        Living status

·        Social support

 

II. Management:

-         Immediate:

o       Admission: psychiatric vs. medical wards

o       Instructions to nurses

o       Management of medical problems

o       Involvement of family

-         Short-term:

o       Transfer to psychiatric ward

o       Treat psychiatric disorder

o       Manage social stress

o       Psychological treatments

-         Long-term:

o       Maintenance of treatment

o       OPD follow-up

o       Social support

o       Samaritans (easy contact to service)

o       Watch of relapse


 

8. Assessment and Management of Substance Related Disorders

 

I.  Assessment:

-         Definitions:

a.       Addiction.

b.      Dependence.

c.       Abuse.

d.      Tolerance.

e.       Withdrawal.

 

-         History:

o       Type of drugs and duration.

o       Daily doses.

o       Withdrawal States.

o       Complications

·        Medical

·        Psychological

·        Social

·        Crime

o       Money spent

o       Source of money

 

 

II. Management:

-         Short-term:

o       Physical examination

o       Investigations

o       Admissions

o       Precautions for abuse related medical diseases.

o       Detoxification.

-         Long-term:

o       Biopsychosocial plan

o       Rehabilitation and after care

 


 

IV.  Case Scenario Discussion:

 

This activity was developed to ensure the wide variety an scope of clinical teaching in this course and to provide settings to discuss, cases that may not be available in the wards or outpatient clinics at the time of the course. These case are based on interactive learning, realistic patients, and common psychiatric problems but may not be available most of the time in real patients. Each case to be discussed on its own merits and with the tutor systematic clinical approach. Cases will be selected  by the course organizer for each group and given to the tutor by the secretary of the department.

 

Guidelines:

1.     To use the basic systematic clinical assessment approach.

2.     To teach students to pick up cues correctly and build up the formulation of the case.

3.     To follow realistic clinical approach in the setting of each case such as the emergency room, primary care settings and inpatient ward.

4.     Emphasize assessment skills and outline of management and prognosis, at level of primary care psychiatry.

 


 

CASE DISCUSSION 1

 

A 68 yr-old woman known case of severe bronchial asthma and diabetes mellitus for more than 20 years was brought by family to Emergency Department because of disorientation, irritability, disturbed behavior and fearfulness.

 

Discussion Guidelines:

-         The most likely diagnosis.

-         How to establish the diagnosis.

-         Possible etiological causes in this case.

-         Management plan:

o       Immediate drug treatment

o       Admission; where, why.

o       Ward management.

o       Short-term and long-term plans.

 

 


 

CASE DISCUSSION 2

 

A 79 yr-old man brought by the family to psychiatry clinic because of poor judgment, rigid attitude, and reverse sleep pattern. During Ramadan “fasting month” he insists to have his meals as usual: breakfast in the morning, lunch in the afternoon.

 

Discussion Guidelines:

-         Further history information needed.

-         MSE aspects to be done.

-         Investigations you suggest and why.

-         Diagnosis and differential diagnoses.

-         List the etiological causes of such condition.

-         Psychiatric management plan:

o       Psychotropic medication,

o       Psychological.

o       Social.

 


 

CASE DISCUSSION 3

 

A 30 yr-old housewife referred to psychiatry out-patient clinic by cardiologist with several months history of sudden attacks of shortness of breath, sweating, fearfulness and tremor. Her investigations were normal.

 

Discussion Guidelines:

-         Further history information needed and why.

-         The most likely diagnosis.

-         The differential diagnoses discussion.

-         Comorbidity and associated psychiatric disorders.

-         Management plan:

o       Psychotherapy.

o       Psychotropic drugs and side-effect and precautions.

 


 

CASE DISCUSSION 4

 

A 47 yr-old businessman referred to outpatient psychiatric clinic by GI group who investigated him for liver disease and found no abnormality.  The patient is still suffering from abdominal vague symptoms and thinks he has undiscovered serious disease.

 

Discussion Guidelines:

-         Further history information needed and why.

-         The most likely diagnosis and why.

-         Differential diagnoses.

-         Comorbid psychiatric disorders.

-         Principles of Management:

o       Regarding mainline of treatment.

o       Regarding investigations.

o       Regarding abuse of health care.

 


 

CASE DISCUSSION 5

 

A 25 yr-old single Saudi male student in the College of Education (final year), presented with one year history of: 

a.      Feeling tense and anxious in social situation.

b.     Shyness when shaking hands with others.

 

Discussion Guidelines:

-         Further history information to reaching a diagnosis.

-         The most likely diagnosis.

-         Differential diagnoses.

-         Comorbidity and associated personality disorders.

-         Social etiology in cultural perspectives

-         Outline of Management:

o       First choice treatment.

o       Other suggested treatments.

-         Prognosis

 


 

CASE DISCUSSION 6

 

 A 50 yr-old man brought to A/E at 3 a.m. by his concerned wife who found him awake, has just written a farewell note and searching for his pistol.

 

Discussion Guidelines:

-         The most serious worry of the clinician.

-         Assessment of such problem.

-         Immediate clinical management plan.

-         Instructions to staff.

-         Differential diagnosis in this patient.

-         Comorbidity and associated personality disorders.

-         Management Plan:

o       Immediate rapid treatment.

o       Maintenance treatment.

 


 

CASE DISCUSSION 7

 

A 26 yr-old male brought to A/E by his brother with 3 hours history of uprolling eyes, neck tilted to one side, protruding tongue dripling saliva. He has been seen in this hospital and maintained on treatment for the last 3 months.

 

Discussion Guidelines:

-         The clinical diagnosis of such presentation.

-         The likely causes

-         Prevalence and time course of such problem.

-         Management Plan:

o       Immediate treatment.

o       Long-term steps to prevent its re-occurrence

o       What to say to patient and family (psycho-education) in such problems.

 

 


 

CASE DISCUSSION 8

 

A 17 yr-old Saudi female forced by her poor family to marry a rich man 55 year-old with whom she stayed only 3 days. Today morning she ingested 20 tablets of Paracetamol intentionally.

 

Discussion Guidelines:

-         How would you assess this problem?

o       History information and related psychosocial facts.

o       Assessment of the incident.

o       Associated psychiatric disorders.

o       Risk of harm.

-         Management Plan:

o       Immediate clinical actions.

o       Instructions to staff.

o       Family role.

o       Treatments suggested.

o       Comparative discussion with similar self-harm problems.

 


 

CASE DISCUSSION 9

 

A 25 yr-old single female teacher had two episodes of major depression the last was 2 months ago. Currently she uses an antidepressant drug. Her mother has history of bipolar mood disorder and one of her sisters had post-partum psychosis. The patient over the past 4 days doesn’t want to sleep, she feels energetic and wants to finish her delayed tasks. Her mother thinks to increase the dose of medication to control the recent symptoms:

 

Discussion Guidelines:

a)     - The most immediate actions and why?

- The likely diagnosis of the recent 4 days presentation.

- The drug treatment of your choice.

 

b) A year later the patient was referred by Gynecology because of amenorrhoea and galactorrhoea and was investigated fully with no underlying pathological cause.

-   The psychiatric causes of such presentation.

-   The possible drugs may be given to this patient to cause such problem.

-   The management guidelines of the case.

 

c)  Two years later she came with her husband to plan pregnancy.

-   The drug treatment plan and why?

-   The psycho-education for such patient about psychotropic drugs in pregnancy.

 

 


 

CASE DISCUSSION 10

 

A 26 yr-old  housewife seen at outpatient clinic with 3 months history of palpitation, poor sleep, poor appetite and reduced interest:

 

Discussion Guidelines:

a)           - The most likely diagnosis.

- The possible drug treatment of the patient.

- The short-term side-effects profile expected of these drugs.

- The advice you will give to her.

 

b)          She improved but was over-sedated and feels laziness, and her husband doubts your drugs to be just sedatives and may be addictive.

- The advice to the patient.

- The psycho-education to patient and husband.
Video Case Discussion:

 

This activity is supposed to provide a teaching setting for the student to develop skills of eliciting appropriately signs and symptoms in psychiatry. Videoed live interviews will be shown to students and then they are asked to show positive psychopathology and critically comment on interview if not complete and delineate signs and symptoms as clear as possible where they will be guided by the tutor to reach a possible diagnosis or a differential diagnosis. There is a good number of video cases prepared by the department and selected by the course organizer for each session and taken from the department secretary.

 

Guidelines:

1.          The student is supposed to learn the interview skills of eliciting psychopathology and comment on the video.

2.          The tutor will leave students to infere and name symptoms and signs of psychopathology and relate them to a proper diagnostic formulation.

3.          Discussion is supposed to emphasize history taking, mental state examination and diagnosis and differential diagnosis.

 

 


 

VI.  Clinical Sessions:

 

This activity is the equivalent bedside teaching in clinical medicine. A real case will be selected and interviewed by students for about 30 – 45 minutes taking history and mental state examination as clarified in the guidelines. The discussion of all aspects of diagnosis, differential diagnosis and management will take place. To make sure that cases selected cover all variations, the course organizer specified the specialty of each case for each session and it is compulsory that the tutor strictly adhere to that selection whether it is from inpatient wards, outpatient clinics, consultation liaison cases, child psychiatry cases and others.

 

Guidelines:

1.       Usually the tutor nominates two students to conduct the interview for about 30 minutes, to take full history and mental state examination.

2.       While the patient is waiting, the tutor will hear to the presentation by the students in front of the group.

3.       The tutor then interviews the patient in front of the students to complete and verify and then send the patients to the ward or to the clinic.

4.       Discussion then goes in a systematic approach to verify psychopathology, formulate the case diagnostically and propose a differential diagnosis and set a plan of management.

5.       Contribution of students is mandatory.

 


 

VII.  Out-patient Clinic Attendance:

 

Students will be assigned in small numbers to attend the outpatient clinics (new and follow-up). This provides an opportunity to observe the real clinical setting in psychiatry where, receiving the patient, interviewing the patient and his family, watching response of the patients, responses to treatments, side-effects of drugs and all possible interactions that occur in real life practice.

 

Guidelines:

1.     Students in these activities are observers.

2.     Discussions of some aspects of the cases and involving the students is important.

 

 


 

VIII.  In-patient Round Attendance:

 

This activity is similar to the outpatient clinics attendance where students will be assigned to attend the usual round of consultants in the wards and have the same experience as in the outpatient clinics. 

 

Guidelines:

Same guidelines applicable to outpatient clinics attendance is applied here.

 


 

 

COURSE ORGANIZATION

 

 

I.  Administrative Responsibility:

a.      The course is under the direct supervision of the chairman of the department and in close collaboration with the undergraduate teaching committee in the department and the course organizer.

b.     The  course organizer responsibilities are:

·        Prepares timetable of the educational activities.

·        Follows attendance / absence of the students.

·        Prepares and arranges for quizzes and exams (CAT & Final).

·        Supervise marking of student answers and registers their marks.

·        Presents the results to the educational committee and the departmental board meetings.

·        Keeps in direct contact with the students.

 

 

II.  Students Distribution:

In the first two weeks lectures and clinical skills activities will be delivered to all students as one group. Then students will be divided into groups (usually two A & B) and the rest of activities are provided to each group individually.

 

Lectures and interviews skills sessions are delivered at teaching center, College of Medicine.

 

The rest of activities take place in the Psychiatry Department, level 0 (Wards 01 – 02 & outpatient psychiatry clinic, King Khalid University Hospital).

 

Students’ distribution for exams will be announced ahead of time.

 

 

III.  Secretary of the Department:

-         Responsible for secretarial work of the course through the course organizer.

 


 

 

COURSE ASSESSMENT & EXAMINATION

 

1.     Continuous Assessment Test (CAT):  30 Marks

-         30 questions; 15 True & False and 15 Single Best Answer

-         CAT is held in the fourth week, Tuesday morning.

 

2.     Quiz Assessment: 10 Marks

-         Multiple (5 – 7) quizzes / course

-         At the end of subject discussions and case scenario discussions.

 

3.     Final Examination: 60 Marks

-         It is an OSCE exam of nine stations of short cases three minutes each and one station of a long case of nine minutes duration and forms 30 marks.

-         Held in the sixth week; Tuesday morning.

-         An oral OSCE exam to be conducted by two examiners on the basis of a pre-proposed case vignettes for 10 minutes and to be left to the examiners to arrange it for the nominated student list over the three days of the last week, Saturday, Sunday and Monday; and it forms 30 marks. 

 

The pass mark is 60 out of 100.

 


 

COURSE REFERENCES 

 

I.                  Course Textbook:

 

Basic Psychiatry – Professor M. A. Al-Sughayir

King Saud University Academic Publishing & Press

 

II.               Recommended References:

 

1.     Textbook of Psychiatry, by Linford Rees, Oxford University Press.

2.     Pocket Handbook of Clinical Psychiatry by Kaplan & Sadock, Williams & Wilkins.

3.     Emergency Psychiatry by Allen, Micheal. American Psychiatric Press.

4.     Clinical Manual to Psychosomatic Medicine: A guide to Consultation-liaison Psychiatry (Concise Guide), By Michael Wise & James Rundle, American Psychiatric Publishing.

 

 


 

COURSE EVALUATION 

 

 

Evaluation forms will be given to students at the end of the course (after the final exam) to have a feedback about the course process, activities and tutors. Feedback will be discussed in the undergraduate teaching committee and departmental board for further improvement and development.  A copy of the feedback form is attached.

 


 

 

بسم الله الرحمن الرحيم

    استمارة تقويم

Feedback Form

 

 

 

 

 


 

جامعة الملك سعود

كلية الطب

قسم الطب النفسي

مقرر 462 طنف

الشعبة :                                     طلبة / طالبات

الفترة:                                       العام:

 

 

عزيزي الطالب / عزيزتي الطالبة :

نرجو تقويم الأنشطة التعليمية المختلفة التي مررت بها خلال مقرر الطب النفسي 462 طنف وسيكون هذا التقويم أساساً في تطوير المقرر وتحسين مستوى التجربة العلمية المستقبلية.

 

يمكن استعمال المفتاح التالي لتقويم كل نشاط على حدة:

 

1= لا أوافق بشدة   2= لا أوافق  3=  لا تعليق   4= أوافق   5= أوافق بشدة

 

يجب أن يستمر هذا النشاط

تزيد رغبتي لتعلم المزيد

أتطلع لهذا النشاط

اكتسبت مهارة سريرية مفيدة

حصلت على معلومات جديدة

النشاط

 

 

 

 

 

 

المحاضرات

Lectures

1

 

 

 

 

 

مناقشة المواضيع

Subject Discussion

2

 

 

 

 

 

مناقشة الحالات النظرية

Case Scenario Discussion

3

 

 

 

 

 

مهارات المقابلة

Skills Interview

4

 

 

 

 

 

التعليم السريري

Clinical Session

5

 

 

 

 

 

حضور العيادات الخارجية

Out_pt Clinics

6

 

 

 

 

 

حضور المرور على المرضى

Round Ward

7

 

 

 

 

 

مناقشة حالات الفيديو

Video Case Discussion

8

 

ملحوظات أخرى : أكتب ما لديك بكل صراحة ووضوح , وليكن نقدك بناءاً وإيجابياً.

 

 

 

 

 

 

 

 

 

نرجو تقويم أعضاء هيئة التدريس و الاستشاريين حسب النقاط الموضحة وباستعمال نفس مفتاح التقويم السابق. ومن لم يشارك خلال الفترة التي درست خلالها المقرر بإمكانك وضع علامة ( - ).

 

1 = لا أوافق بشدة 2 = لا أوافق  3 = لا تعليق         4 = أوافق         5 =  أوافق بشدة

 

 

 

تدريسه يوصل الموضوع لذهن الطالب بشكل واضح

يربط بين المادة والحياة العلمية

يستخدم أسلوب تعليمي مشوق

يلتزم بالوقت المحدد حسب الجدول الدراسي

يلتزم بالموضوع

يعامل الطلبة باحترام

الأسماء

 

 

 

 

 

 

1- أ.د عبدالرزاق الحمد

 

 

 

 

 

 

2- أ.د عبدالله السبيعي

 

 

 

 

 

 

3- أ.د طارق الحبيب

 

 

 

 

 

 

4- أ.د محمد الصغير

 

 

 

 

 

 

5- د. فاطمة الحيدر

 

 

 

 

 

 

6- د. فهد الوهابي

 

 

 

 

 

 

7- د. ياسر الهذيل

 

 

 

 

 

 

8- د. ربيع الحواري

 

 

 

 

 

 

9- د. خالد السبهان

 

 

 

 

 

 

10- د. عبدالله السنيدي

 

 

 

 

 

 

11- د. عفاف منصور

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ملحوظات أخرى : أكتب ما لديك بكل صراحة ووضوح , وليكن نقدك بناءاً وإيجابياً.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1) Dopamine receptors

a)  research shows that 5-10 mg of haloperidol is enough to block 80% dopamine receptors.

b)    D 1 receptors are linked to Aden late cyclase

c)    D 3 receptors exist in high concentration in the limbic system

d)    Sulpiride specifically blocks D 1

e)    Are found in retina 

 

2) Dopamine neurons

a)                                              also secrete Nor adrenaline

b)                                              exist in ruboropinal tract

c)                                              exist in mesolimbic tract

d)                                              exist in tuberoinlundibular tract

e)                                              have a role in stimulating prolactin release

 

3) Eysenck’s theory

a)                            is an idiographic theory

b)                            extroverts are slower to condition

c)                            extroverts seek external stimulation

d)                            introverts have high cortical arousal

e)                            can be used to predict prognosis in personality disordered

 

4) Authoritative parenting

a)                                              improve self esteem

b)                                              set home rules

c)                                              excess of emotional warmth is related to the onset of psychosis in children

d)                                              laisser faire parenting associated with drug abuse in children

e)                                              retain veto

 

5) ECT

a)                                                    increases prolactin

b)                                                    memory loss directly  related to voltage

c)                                                    produces irreversible memory loss

d)                                                    less memory loss if minimal dose of anesthetic is used

e)                                                    should be given on the left side if left handed

 

6) Screening tests in General Hospital setting

a)                                                    should have cut off points with high sensitivity and specificity

b)                                                    includes CAGE

c)                                                    scores must have a normal distribution

d)                                                    includes MMSE

e)                                                    includes HADS

 


 

7) Serotonin mediates

a)                                                    aggressive behavior

b)                                                    sexual behavior

c)                                                    sleep

d)                                                    weight gain

e)                                                    problem solving behavior in animals

 

8) lithium interferes with the activity of

a)                                              inositol

b)                                              TSH

c)                                              Prolactin

d)                                              CRH

e)                                              FSH

 

9) The Following can be measured on the scalp

a)                                                    CNV

b)                                                    P 300

c)                                                    Theta waves

d)                                                    Brainstem auditory potential

e)                                                    VEP


 

10) with regards to neuroleptic treatment

a)                                                    D 3 is most frequently in the limbic system

b)                                                    D 1 activates adenyl cyclase

c)                                                    Thixanthines show stereo isomerism

d)                                                    Clopromaxine and promazine enhances each others effects

e)                                                    5-10 mgs of haloperidol blocks most of the D2 preceptors

 

11) chronic barbiturate intoxication causes

a)                                                    dysarthria

b)                                                    nystagmus  

c)                                                    increased frontal fast activity on EEG

d)                                                    withdrawal delirium

e)                                                    caused by D2 receptor blockade

 

12) following are features of neuroleptic malignant syndrome  

a)    increased neutrophils

b)    males affected more than females

c)    untreated mortality is 20%

d)    worse with drug

e)    caused by D2 receptor blockade


 

13) Dopamine receptors

a)                                                    D1 causes E.P. side effects

b)                                                    D2 is found in mesolimbic area

c)                                                    Suipride affects D1+D2

d)                                                    All neuroliptics influence D2

e)                                                    Post – synaptic adenylate is affected by D1 antagonists

 

14) the half – life of the following benzodiazepines is more than 24 hours

a)                                                    nitrazepam

b)                                                    lorazepam

c)                                                    oxazepam

d)                                                    flurazepam

e)                                                    diazepam

 

15) Fluoxetine

a)                                                    is related to suicide

b)                                                    is contra-indicated with MAOIs

c)                                                    is a 5HT reuptake inhibitor

d)                                                    causes tardive dy skinesia

e)                                                    is a  known to cause insomnia

 


 

16) the following drugs prevent ejaculation

a)                                                    beta-adrenergic blockers

b)                                                    alpha-adrenergic blockers

c)                                                    diazepam / benzodiazepines

d)                                                    lithium

e)                                                    paroxetine

 

 

17) the following statements are true

a)                                                    Ist pass metabolism in bebxodiazepines produce active metabolites

b)                                                    lithium potentiates  the action of  TCADs

c)                                                    tryptopan potentiates  the action of  TCADs

d)                                                    lithium is less effective in elderly compared with middle aged patients I prophylaxis for depression

e)                                                    thioridazine causes retinal pigmentation

18) Side-effects of Chlopromazine

a)                                                    rabbit syndrome

b)                                                    PISA syndrome

c)                                                    Tardive akathesia

d)                                                    Torticollis

e)                                                    Hyperprolactinemia

 

19) Regarding heroin  

a)                                                    there is 4% mortality in 2 years

b)                                                    it is associated with criminality

c)                                                    there is depression on withdrawal

d)                                                    associated with during pregnancy will not cause withdrawl in infants

 

20) Visual hallucination are caused by

a)                                                    cannabis

b)                                                    opium

c)                                                    phency clidine

d)                                                    butane

e)                                                    pentazocine

 

21) lithium reacts dangerously with

a)                                                    phenelzine

b)                                                    clomipramine

c)                                                    haloperidol

d)                                                    carbamazepine

e)                                                    alcohol

 


 

22) Regarding LSD

a)                                                    it constricts the pupil

b)                                                    is detectable in urine by radio-immune assay

c)                                                    it is a 5HT antagonist

d)                                                    it is found in magic mushrooms

e)                                                    25 micrograms are required for psychosomatic effect

 

23) Opiate addicts

a)                                                    80% will serve a prison sentence

b)                                                    pregnant addicts can be prescribed methadone so as to avoid withdrawal symptom in the neonate

c)                                                    4% will be dead in 2 years

d)                                                    depression is a common sequelae of  withdraw patients

e)                                                    depression is a common sequelae after withdrawal

 

24) Regarding Benzodiazepines

a)                                                    the longer acting preparations are less likely to cause dependence

b)                                                    there is a direct relationship between the quantity of alcohol consumed and mortality figures

c)                                                    prevalence is related to the price of alcohol

d)                                                    drinking protects against coronary heart disease

e)                                                    the CAGE is a reliable screening test in the general population

 

25) in alcohol dependence

a)                                                      women have a higher incidence of physical complications at lower levels of intake than men

b)                                                      there is a direct relationship between the quantity of alcohol consumed and mortality figures

c)                                                      prevalence is related to the price of alcohol

d)                                                      drinking protects against coronary heart disease

e)                                                      the CAGE is reliable screening test in the general population

 

26) Alcohol abuse in women

a)                                                    is a problem in less than 10% medical admissions

b)                                                    most women have drunk alcohol by age of 14

c)                                                    women have an increased risk of cirrhosis copared to men

d)                                                    women who have been murdered have often been drinking

e)                                                    there is reduced family history of alcoholism

 

27) In acute alcohol withdrawl

a)                                                    there is increased autonomic activity

b)                                                    hallucinations occur in 15% of the patients

c)                                                    benzodiazepines are effective in suppressing hallucinations

d)                                                    mild cases can be treated at home

e)                                                    patients should be nursed in a quite dark room on their own


 

28) confusional state may be caused by

a)                                                    paracetmol

b)                                                    cimetidine

c)                                                    procyclidine

d)                                                    dothiepin

e)                                                    methylcellulose

 

29) Alcohol dependence  syndrome is associated with

a)                                                    family history of alcoholism

b)                                                    family history of depressive illness

c)                                                    alcohol dehydrogenase deficiency

d)                                                    maternal separation in childhood

e)                                                    histrionic personality disorder

 

30) Benzodiazepines

a)                                                    commongy lead to dependence within 2 month

b)                                                    are especially indicated when panic attack are associated with GAD

c)                                                    are better than TCAs

d)                                                    short acting compounds cause less dependence

e)                                                    dependence in elderly can easily treated by rapid withdrawl

 


 

31) Clozapine has less of the following side-effects

a)                                                    sedation

b)                                                    dry mouth

c)                                                    postural hypotension

d)                                                    weight gain

e)                                                    blurred vision

 

32) lithium causes

a)                                                    drowsiness

b)                                                    fine tremors

c)                                                    nephrogenic diabetes mellitus

d)                                                    hyperparathyroidism

e)                                                    hypothyroidism

 

33) Benzodiazepine partial agonists

a)                                                    causes hyperpolarisation  of cells

b)                                                    are antagonized by BNZ antagonists

c)                                                    antagonists GABA 

d)                                                    includes zimovane

e)                                                    are better than benzodiazepines for treating anxiety


 

34) Alcohol withdrawl is associated with

a)                                                    absence seizures

b)                                                    auditory hallucinations

c)                                                    hypersomnolence

d)                                                    affect-laden dreams

e)                                                    coarse tremors

 

35) Clozapine acts on the following receptors

a)                                                    5HT2 agonists

b)                                                    mostly on D1 receptors

c)                                                    has selective striatal D2 blockade

d)                                                    mostly on D3 and D4 receptors

e)                                                    is an alpha 2 adrenergic antagonist

36) In drug addiction

a)                                                    nalorphine (naloxone) has longer half-life than maltrexate

b)                                                    methadone is given twice daily

c)                                                    heroin causes more euphoria than morphine

d)                                                    heroin abuse is commoner than cocaine abuse

e)                                                    heminevrin is safe for detoxification at hom


 

37) the following are precursors of Monoamines

a)                                                    5 OH tryptophan

b)                                                    5 OH tryptamine

c)                                                    dihydroxy phenylalanine

d)                                                    5OH DOPA

e)                                                    L tryphtophan

38) the following are recognized neurotransmitters

a)                                                    nor-adrenaline

b)                                                    glycine

c)                                                    glutamic acid

d)                                                    taurine

e)                                                    cholecystokinin

39) the following drugs cause a decrease in libido in males

a)                                                    carbamazepine

b)                                                    benperidol

c)                                                    trifluoperazine

d)                                                    benzodiazepines

e)                                                    lithium


 

40) the following are parts of hypothalamus

a)                                                    medical eminence

b)                                                    stria terminals

c)                                                    4th ventricle

d)                                                    ventromedial

e)                                                    red nucleus

41) the following nuclei are neuro secretory

a)                                                    Edinger - Westphal

b)                                                    Supra-optic

c)                                                    Para-ventricular

d)                                                    Amygdala

e)                                                    Caudate nucleus

42) protein found in the CSF above the level of 2 gms/ml is indicative of

a)                                                    Guilian-Barre Syndrome

b)                                                    Alzheimers Disease

c)                                                    Multiple sclerosis

d)                                                    Spinal epidural abcess

e)                                                    Acoustic neuroma


 

43) the following are precursors of Nor-Adrenaline

a)                                                    tyrosine

b)                                                    serotonin

c)                                                    adrenaline

d)                                                    acetyl choline

e)                                                    dopamine

44) complications of alcohol abuse include

a)                                                    cardiomyopathy

b)                                                    carcinoma of oesophagus

c)                                                    hypertension

d)                                                    parkinson’s disease

e)                                                    reduced serum testosterone

 

45) Alcohol detoxification at home is contra-indicated

a)                                                    if there is severe craving

b)                                                    never had supervised detoxification previously

c)                                                    if an in-patient bed is available

d)                                                    had DTs previously

e)                                                    had a seizure in last 2 years

 


 

46) drug receptors

a)                                                    bezodiazepines are antagonists to GABA receptor complex

b)                                                    D2 blockers are more effective antipsychotics than D1 blockers

c)                                                    Buspirone is a 5HT2 receptor agonist

d)                                                    D3 receptors ar in high densithy in limbic system

e)                                                    5-10 mgs of haloperidol effectively block D2 receptors

 

47) side-effects of trifluoperazine are

a)                                                    jaundice

b)                                                    dystonic reaction

c)                                                    myoclonic jerks

d)                                                    oculogyric crisis

e)                                                    NMS

 

48) Methyl Alcohol poisoning causes

a)                                                    blindness

b)                                                    vomiting

c)                                                    acute paranoid reaction

d)                                                    depressive illness

e)                                                    tactile hallucinosis


 

49) Unwated side-effects of TCADs include

a)                                                    hypotension

b)                                                    diarrhoea

c)                                                    weigh gain

d)                                                    difficulty in micturition

e)                                                    blurred vision

 

50) the following features help the general practitioner in detecting alcoholism

a)                                                    morning nausea

b)                                                    shaking on waking

c)                                                    smell of alcohol on breath unexplained absence from work

d)                                                    unexplained absence from work

e)                                                    hypnologic hallucination

 

      

 

 

 

 

 

 


 

Answers

 

1-         TTTFT

2-         FFTTF

3-         FTTTF

4-         TTFTT

5-         TTFFF

6-         FTFTT

7-         TTTTF

8-         TTFFF

9-         TTTTT

10-    TTTTT

11-    TTTTT

12-    TTFTF

13-    FTFTT

14-    TFFTT

15-    FTTTT

16-    TFFFT

17-    TTTFT

18-    TTTTT

19-    TTTFF

20-    TFTTT

21-    FTFFF

22-    FFFFF

23-    FTTFT

24-    FTFFF

25-    FTTFF

26-    TTTTF

27-    TTFTF

28-    TTTTF

29-    TFFFF

30-    FTFFF

31-    FTFFF

32-    TTFFT

33-    TTFFF

34-    FTTTT

35-    FFFTT

36-    FFTFF

37-    TFTTT

38-    TTTTT

39-    FTTTF

40-    TFFTF

41-    FTTFF

42-    TFFTT

43-    TFFFT

44-    TTTFT

45-    FFFTT

46-    FTFTT

47-    TTFTT

48-    TTFFT

49-    TFTTT

50-    FFFFF

 


 

51-                                                                                       Case Question

 

A  24 years  old man presented to the clinic with three years history of inability to take in front of others.

 

Q1 : What is your likely diagnosis ?

A1 : Social Phobia

 

Q2 : Name two differential diagnoses

A2 :  1- Panic Attack     2- OCD

 

Q3 : What is favorite drug treatment ?

A3 : Antidepressants (ex: SSRI-Tricyclic – MAOI)

 

Q4 : Do you consider any other treatment modality ?

A4 : Psychotherapy

 

Q5 : for how long you will continue drug  Rx

A5 : 6 month   

 

الدورات التدريبية:  

تم عقد عدد كبير من الدورات التدريبية في العديد من الدول العربية التي تعنى بالقضايا الجوهرية للمجتمع ووضع  الحلول العلمية للأسس الحياتية الشائكة وذلك من خلال منهج علمي قويم ورسم الخطط والبرامج في تطبيق هذه الحلول عملياً وستجد أدناه قائمة بعناوين هذه الدورات :

1- فن التعامل مع الخلافات الزوجية

2-  الطلاق الناجح

3-  العلاج النفسي والعلاج بالقرآن ( للأطباء والمعالجين بالقرآن)

4-  فن التعامل مع المشكلات

5-  كيف أفهم نفسي والناس من حولي ( للمراهقين ) حتى تساعدهم في فهم المتغيرات الطبيعية التي تحدث لهم في فترة المراهقة وكيف يتعاملون معها ومع نظرة البالغين لهم.

6-  كيف أفهم نفسي والناس من حولي ( للبالغين ) حتى تساعدهم في فهم شخصياتهم وشخصيات من حولهم.

7-  لمسات نفسية في تربية النشء

8- المقبلين على الزواج ( وضع أسس الحياة الزوجية )

9-  تعريف بالأمراض النفسية ( للقضاة ) حتى تساعدهم في معرفة أهلية المريض النفسي من عدمها.

10-       نحو فهم أعمق لنفسية الطالب والمعلم ( للمعلمين ورجال التربية والتعليم)

11-       لمسات نفسية في بر الوالدين ( فن التعامل مع كبار السن )

12-      فن التعامل مع العناد عند المراهقين

13-      دورة الطلاق الناجح

14-      تهيئة نفوس الأطفال لطلاق الوالدين 

15-      كيف أجعل ذاتي واثقة مطمئنة

16-                    دورة أنماط الشخصية

17-                    فن التعامل مع التغيرات الجنسية لدى المراهقين.

18-                    تنمية المهارات والتعامل مع ضغوط الحياة

19-                    إدارة الغضب

20-                    فن الحوار والتعامل مع الآخرين

21-                    مهارات التعامل مع ذوي الطباع الصعبة

22-                    فن اختيار الرفقة الجيدة للأبناء والبنات ( للآباء والأمهات )

23-                    استراتيجيات التفاوض.

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