MEQs

Seven cases/scenarios of cases done by roleplay/presentation
Each case possibly have these 4 questions
- What is most probable diagnosis
- How would you support your diagnosis for this scenario ( 2 diagnostic criterias)
- Differential Diagnosis related to the probable diagnosis
- specific cause of such condition
- Psychopathology mentioned case above?
- What is two best investigation (setting bio-psycho-social)
- What is two best Management/Treatment (setting bio-psycho-social)

Common medications

e-citalo haliperadol espradol lithium sodium valporate, benzodiazepine

Treats most cases
Side effects?

Psychosomatic Medicine

Case 1: Perinatal Psychiatry

Case Scenario:
Jane, a 28-year-old woman in her third trimester, has been experiencing intense anxiety and depressive symptoms following her first pregnancy. She reports persistent fears about harming her baby and difficulties in bonding.

What is the most probable diagnosis?
Perinatal Depression
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Depressed mood most of the day, nearly every day.
2. Diminished interest in activities, including bonding with the baby.
Differential Diagnosis related to the probable diagnosis:
Postpartum Psychosis, Generalized Anxiety Disorder
Mention likely specific cause of such condition?
Hormonal fluctuations during pregnancy and postpartum period.
Psychopathology mentioned case above?
Anxiety and depressive symptoms affecting maternal functioning.
What are two best investigations (biological, psychological, social investigations)?
1. Hormonal level assessments
2. Psychological evaluation for depression and anxiety
What are two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)?
1. SSRIs (e.g., Sertraline 50 mg daily, 4-6 weeks)
2. Cognitive Behavioral Therapy (12-16 sessions)

Case Scenario:
Mark, a 35-year-old male, presents with multiple, persistent physical complaints such as chronic pain and gastrointestinal issues without a clear medical cause. He is excessively worried about his symptoms and frequently seeks medical attention.

What is the most probable diagnosis?
Somatic Symptom Disorder
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. One or more somatic symptoms that are distressing and/or result in significant disruption of daily life.
2. Excessive thoughts, feelings, or behaviors related to the somatic symptoms.
Differential Diagnosis related to the probable diagnosis:
Illness Anxiety Disorder, Factitious Disorder
Mention likely specific cause of such condition?
Psychological stress and heightened bodily awareness.
Psychopathology mentioned case above?
Persistent anxiety and preoccupation with physical health.
What are two best investigations (biological, psychological, social investigations)?
1. Comprehensive medical evaluation to rule out underlying conditions
2. Psychological assessment for anxiety and depression
What are two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)?
1. SSRIs (e.g., Escitalopram 10 mg daily, 6-8 weeks)
2. Cognitive Behavioral Therapy (14-20 sessions)

Case 3: IAD - Illness Anxiety Disorder

Case Scenario:
Lisa, a 40-year-old woman, is preoccupied with having a serious illness despite medical evaluations showing no evidence. She frequently checks her body for signs of disease and avoids medical appointments out of fear.

What is the most probable diagnosis?
Illness Anxiety Disorder
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Preoccupation with having or acquiring a serious illness.
2. Excessive health-related behaviors or maladaptive avoidance.
Differential Diagnosis related to the probable diagnosis:
Somatic Symptom Disorder, Generalized Anxiety Disorder
Mention likely specific cause of such condition?
High health-related anxiety and cognitive distortions about illness.
Psychopathology mentioned case above?
Chronic worry and fear regarding health status.
What are two best investigations (biological, psychological, social investigations)?
1. Medical evaluation to rule out physical illnesses
2. Psychological assessment for anxiety disorders
What are two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)?
1. SSRIs (e.g., Fluoxetine 20 mg daily, 6-12 weeks)
2. Cognitive Behavioral Therapy (16-20 sessions)

Case 4: Conversion Disorder

Case Scenario:
Tom, a 22-year-old male, abruptly loses the ability to speak and experiences partial paralysis of his right arm following a traumatic event. Medical tests reveal no neurological abnormalities.

What is the most probable diagnosis?
Conversion Disorder
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. One or more symptoms affecting voluntary motor or sensory function.
2. Clinical findings are incompatible with recognized neurological or medical conditions.
Differential Diagnosis related to the probable diagnosis:
Stroke, Multiple Sclerosis
Mention likely specific cause of such condition?
Psychological trauma triggering neurological-like symptoms.
Psychopathology mentioned case above?
Acute stress reaction manifesting as physical symptoms.
What are two best investigations (biological, psychological, social investigations)?
1. Neurological examination and imaging
2. Psychological evaluation for trauma and stress
What are two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)?
1. Physical therapy as needed
2. Trauma-focused Cognitive Behavioral Therapy (12-16 sessions)

Case 5: PFAOMC - Psychological Factors Affecting Other Medical Conditions

Case Scenario:
Sarah, a 50-year-old diabetic patient, has poor glycemic control attributed to her significant stress from work and family issues. Her psychological state is negatively impacting her medical condition management.

What is the most probable diagnosis?
Psychological Factors Affecting Other Medical Conditions
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Emotional or behavioral factors adversely affect the course of a medical condition.
2. Evidence of stress impacting diabetes management.
Differential Diagnosis related to the probable diagnosis:
Adjustment Disorder, Depression
Mention likely specific cause of such condition?
Chronic stress and inadequate coping mechanisms affecting disease management.
Psychopathology mentioned case above?
Stress and potential depressive symptoms interfering with self-care.
What are two best investigations (biological, psychological, social investigations)?
1. Glycemic monitoring and medical evaluation
2. Psychological assessment for stress and coping strategies
What are two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)?
1. Adjustment of diabetes treatment plan as needed
2. Stress management therapy or counseling (8-12 sessions)

Case 6: Factitious Disorder

Case Scenario:
Michael, a 30-year-old healthcare worker, frequently presents with self-induced symptoms such as gastrointestinal pain and seizures. Medical evaluations cannot find an organic cause, and he seems eager to undergo invasive procedures.

What is the most probable diagnosis?
Factitious Disorder
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Intentional production or feigning of physical or psychological symptoms.
2. Deception evident in the presentation, without external incentives.
Differential Diagnosis related to the probable diagnosis:
Malingering, Somatic Symptom Disorder
Mention likely specific cause of such condition?
Psychological need to assume the sick role for internal gratification.
Psychopathology mentioned case above?
Manipulative behavior to receive medical attention.
What are two best investigations (biological, psychological, social investigations)?
1. Comprehensive medical evaluation to identify fabricated symptoms, if it were already investigated by numerous doctors without any findings dont do it.
2. Psychiatric assessment for underlying personality disorders
What are two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)?
1. Psychotherapy, particularly Cognitive Behavioral Therapy (ongoing)
2. Establishing a therapeutic relationship to address underlying issues

Personality disorders

Case 1: Cluster A - Paranoid Personality Disorder

Case Scenario:
John, a 45-year-old accountant, believes that his coworkers are plotting against him to undermine his position. He constantly looks over his shoulder, rarely shares personal information, and reacts aggressively to perceived slights.

What is the most probable diagnosis?
Paranoid Personality Disorder
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Pervasive mistrust and suspicion of others’ motives
2. Reluctance to confide in others due to fear of betrayal
Differential Diagnosis related to the probable diagnosis
Delusional Disorder, Schizophrenia
Mention likely specific cause of such condition?
Genetic predisposition and early childhood experiences of mistrust
Psychopathology mentioned case above?
Persistent distrust and hypervigilance towards others
What is two best investigation (biological, psychological, social investigations)
1. Comprehensive psychological assessment
2. Family history evaluation
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Cognitive Behavioral Therapy (CBT)
2. Social skills training

Case 2: Cluster A - Schizoid Personality Disorder

Case Scenario:
Lisa, a 30-year-old graphic designer, prefers working alone and shows little interest in forming friendships. She rarely expresses emotions and seems indifferent to praise or criticism.

What is the most probable diagnosis?
Schizoid Personality Disorder
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Detachment from social relationships
2. Restricted range of emotional expression
Differential Diagnosis related to the probable diagnosis
Avoidant Personality Disorder, Autism Spectrum Disorder
Mention likely specific cause of such condition?
Genetic factors and early emotional neglect
Psychopathology mentioned case above?
Emotional coldness and preference for solitary activities
What is two best investigation (biological, psychological, social investigations)
1. Psychological evaluation for social functioning
2. Genetic history assessment
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Psychodynamic therapy
2. Social skills training

Case 3: Cluster A - Schizotypal Personality Disorder

Case Scenario:
Mark, a 28-year-old artist, has unusual beliefs in supernatural phenomena and experiences odd perceptual distortions. He has few close friends and displays eccentric behavior in social settings.

What is the most probable diagnosis?
Schizotypal Personality Disorder
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Peculiar thinking and odd beliefs
2. Social anxiety and limited interpersonal relationships
Differential Diagnosis related to the probable diagnosis
Schizophrenia, Bipolar Disorder
Mention likely specific cause of such condition?
Genetic vulnerability and early life stressors
Psychopathology mentioned case above?
Eccentric behavior and unusual perceptual experiences
What is two best investigation (biological, psychological, social investigations)
1. Comprehensive psychiatric evaluation
2. Family history of psychotic disorders
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Low-dose antipsychotic medication
2. Cognitive Behavioral Therapy (CBT)

Case 4: Cluster B - Antisocial Personality Disorder

Case Scenario:
Tom, a 35-year-old with a history of criminal activities, frequently engages in deceitful behavior and shows no remorse for his actions. He often disregards the rights and feelings of others.

What is the most probable diagnosis?
Antisocial Personality Disorder
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Persistent disregard for the rights of others
2. Deceitfulness and manipulative behavior
Differential Diagnosis related to the probable diagnosis
Borderline Personality Disorder, Narcissistic Personality Disorder
Mention likely specific cause of such condition?
Genetic factors and childhood abuse or neglect
Psychopathology mentioned case above?
Lack of remorse and manipulative tendencies
What is two best investigation (biological, psychological, social investigations)
1. Criminal history review
2. Psychological assessment for impulsivity
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Cognitive Behavioral Therapy (CBT)
2. Social rehabilitation programs

Case 5: Cluster B - Borderline Personality Disorder

Case Scenario:
Sarah, a 25-year-old woman, experiences intense and unstable relationships. She exhibits impulsive behaviors, such as reckless spending and substance abuse, and frequently engages in self-harm.

What is the most probable diagnosis?
Borderline Personality Disorder
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Intense and unstable interpersonal relationships
2. Impulsivity in potentially self-damaging areas
Differential Diagnosis related to the probable diagnosis
Bipolar Disorder, Post-Traumatic Stress Disorder
Mention likely specific cause of such condition?
Childhood trauma and genetic predisposition
Psychopathology mentioned case above?
Emotional instability and self-harm behaviors
What is two best investigation (biological, psychological, social investigations)
1. Comprehensive psychological evaluation
2. Assessment of trauma history
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Dialectical Behavior Therapy (DBT)
2. Medications for mood stabilization (e.g., SSRIs)

Case 6: Cluster B - Histrionic Personality Disorder

Case Scenario:
Emma, a 30-year-old actress, seeks constant attention and becomes uncomfortable when not the center of attention. She uses her appearance and theatrical behavior to draw focus in social interactions.

What is the most probable diagnosis?
Histrionic Personality Disorder
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Excessive attention-seeking behavior
2. Inappropriately seductive or provocative behavior
Differential Diagnosis related to the probable diagnosis
Narcissistic Personality Disorder, Borderline Personality Disorder
Mention likely specific cause of such condition?
Early childhood experiences and genetic factors
Psychopathology mentioned case above?
Dramatic and attention-seeking actions
What is two best investigation (biological, psychological, social investigations)
1. Psychological assessment for attention-seeking behaviors
2. Social history review
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Psychodynamic therapy
2. Group therapy for social skills

Case 7: Cluster B - Narcissistic Personality Disorder

Case Scenario:
Robert, a 40-year-old executive, has an inflated sense of self-importance and expects special treatment. He lacks empathy and often exploits others to achieve his goals.

What is the most probable diagnosis?
Narcissistic Personality Disorder
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Grandiose sense of self-importance
2. Lack of empathy for others
Differential Diagnosis related to the probable diagnosis
Antisocial Personality Disorder, Histrionic Personality Disorder
Mention likely specific cause of such condition?
Genetic predisposition and childhood environment
Psychopathology mentioned case above?
Exploitative behavior and entitlement
What is two best investigation (biological, psychological, social investigations)
1. Comprehensive personality assessment
2. Evaluation of interpersonal relationships
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Psychotherapy focusing on empathy development
2. Cognitive Behavioral Therapy (CBT)

Case 8: Cluster C - Avoidant Personality Disorder

Case Scenario:
Alice, a 29-year-old teacher, avoids social gatherings due to intense fear of criticism. She feels inadequate and restricts her career choices to roles that require minimal interaction.

What is the most probable diagnosis?
Avoidant Personality Disorder
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Feelings of inadequacy and hypersensitivity to negative evaluation
2. Avoidance of social interactions despite desire for relationships
Differential Diagnosis related to the probable diagnosis
Schizoid Personality Disorder, Social Anxiety Disorder
Mention likely specific cause of such condition?
Genetic factors and early experiences of rejection
Psychopathology mentioned case above?
Social inhibition and extreme sensitivity to criticism
What is two best investigation (biological, psychological, social investigations)
1. Psychological assessment for anxiety
2. Social history evaluation
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Cognitive Behavioral Therapy (CBT)
2. Group therapy for social skills

Case 9: Cluster C - Dependent Personality Disorder

Case Scenario:
Michael, a 32-year-old nurse, relies heavily on his partner for decision-making. He fears abandonment and feels helpless when alone, often making submissive choices to keep his relationship intact.

What is the most probable diagnosis?
Dependent Personality Disorder
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Excessive need to be taken care of
2. Difficulty making everyday decisions without reassurance
Differential Diagnosis related to the probable diagnosis
Borderline Personality Disorder, Avoidant Personality Disorder
Mention likely specific cause of such condition?
Early childhood dependency and lack of autonomy
Psychopathology mentioned case above?
Submissive behavior and fear of separation
What is two best investigation (biological, psychological, social investigations)
1. Psychological evaluation for dependency issues
2. Social support system assessment
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Cognitive Behavioral Therapy (CBT)
2. Skills training for independence

Case 10: Cluster C - Obsessive-Compulsive Personality Disorder

Case Scenario:
Karen, a 38-year-old librarian, is excessively devoted to work and perfectionism. She struggles with delegating tasks and spends long hours organizing books, often neglecting leisure activities.

What is the most probable diagnosis?
Obsessive-Compulsive Personality Disorder
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Preoccupation with orderliness, perfectionism
2. Inflexibility and control over work and relationships
Differential Diagnosis related to the probable diagnosis
Obsessive-Compulsive Disorder, Autism Spectrum Disorder
Mention likely specific cause of such condition?
Genetic factors and early life experiences emphasizing perfection
Psychopathology mentioned case above?
Rigidity in routines and excessive focus on details
What is two best investigation (biological, psychological, social investigations)
1. Psychological assessment for perfectionism
2. Occupational history review
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Cognitive Behavioral Therapy (CBT)
2. Relaxation techniques and stress management training

Childhood mental disorders

Case 1: Separation Anxiety Disorder of Childhood

Case Scenario:
Emma, a 9-year-old girl, becomes extremely distressed when her mother leaves for work. She frequently complains of headaches and stomachaches to avoid going to school. Emma refuses to attend classes and becomes tearful at the thought of separation from her mother.

What is the most probable diagnosis?
Separation Anxiety Disorder of Childhood
How would you support your diagnosis for this scenario (2 diagnostic criteria)?
1. Excessive fear or anxiety concerning separation from attachment figures.
2. Persistent reluctance or refusal to go to school despite academic performance.
Differential Diagnosis related to the probable diagnosis
Generalized Anxiety Disorder, School Refusal due to other reasons, Adjustment Disorder
Mention likely specific cause of such condition?
Genetic predisposition and environmental factors such as recent family changes or stressors.
Psychopathology mentioned case above?
Anxiety related to separation and avoidance behavior.
What is two best investigation (biological, psychological, social investigations)
1. Psychological assessment through structured interviews.
2. Evaluation of family dynamics and recent life stressors.
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Cognitive Behavioral Therapy (12-16 weeks) to address anxiety symptoms.
2. Family therapy to improve family relationships and support systems.

Case 2: ADHD

Case Scenario:
Liam, a 7-year-old boy, is constantly fidgeting in class, interrupts his teacher frequently, and has difficulty completing his homework. His parents report that he is easily distracted and often forgets to bring his school materials home.

What is the most probable diagnosis?
Attention-Deficit/Hyperactivity Disorder (ADHD)
How would you support your diagnosis for this scenario (2 diagnostic criteria)?
1. Hyperactivity and impulsivity evidenced by constant fidgeting and interrupting.
2. Inattention demonstrated by difficulty completing tasks and being easily distracted.
Differential Diagnosis related to the probable diagnosis
Oppositional Defiant Disorder, Anxiety Disorders, Learning Disabilities
Mention likely specific cause of such condition?
Genetic mutations in dopamine receptor and transporter genes.
Psychopathology mentioned case above?
Impulsivity, hyperactivity, and inattention affecting academic performance and social interactions.
What is two best investigation (biological, psychological, social investigations)
1. Neuropsychological testing to assess attention and executive functions.
2. Family history evaluation for genetic factors.
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Stimulant medications (e.g., Methylphenidate 10 mg daily for 6 weeks).
2. Behavioral therapy to develop coping strategies and improve self-regulation.

Case 3: Conduct Disorder

Case Scenario:
Jake, a 12-year-old boy, frequently engages in aggressive behavior toward peers, including bullying and physical fights. He has a history of stealing items from stores and lying to cover his actions. His parents have noticed a decline in his behavior since the introduction of a new stepfather.

What is the most probable diagnosis?
Conduct Disorder
How would you support your diagnosis for this scenario (2 diagnostic criteria)?
1. Aggressive behavior towards people and animals, such as bullying and fighting.
2. Deceitfulness or theft, evidenced by stealing and lying.
Differential Diagnosis related to the probable diagnosis
Oppositional Defiant Disorder, ADHD, Substance Use Disorders
Mention likely specific cause of such condition?
Dysfunctional family environment and disruption of attachment due to new family member.
Psychopathology mentioned case above?
Aggressive and antisocial behavior disrupting social and familial relationships.
What is two best investigation (biological, psychological, social investigations)
1. Comprehensive behavioral assessment through clinical interviews.
2. Evaluation of family dynamics and history of abuse or neglect.
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Family therapy to enhance emotional support and understanding (12-20 sessions).
2. Behavioral interventions and possibly court-mandated supervised residence if necessary.

Case 4: Autism Spectrum Disorder (ASD)

Case Scenario:
Sophia, a 3-year-old girl, shows limited eye contact and prefers to play alone with her toys. She engages in repetitive hand-flapping movements and becomes extremely upset when her daily routine is altered. Sophia has difficulty communicating her needs and often responds to questions with non-verbal gestures.

What is the most probable diagnosis?
Autism Spectrum Disorder (ASD)
How would you support your diagnosis for this scenario (2 diagnostic criteria)?
1. Persistent deficits in social communication and social interaction.
2. Restricted, repetitive patterns of behavior, interests, or activities.
Differential Diagnosis related to the probable diagnosis
Social (Pragmatic) Communication Disorder, Developmental Coordination Disorder, Intellectual Disability
Mention likely specific cause of such condition?
Abnormalities in brain and central nervous system development, possibly genetic and environmental factors.
Psychopathology mentioned case above?
Impaired social interaction, communication difficulties, and repetitive behaviors affecting daily functioning.
What is two best investigation (biological, psychological, social investigations)
1. Comprehensive developmental evaluation by a multidisciplinary team.
2. Genetic testing to rule out associated genetic conditions.
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Applied Behavior Analysis (ABA) therapy (intensive, 20-40 hours per week) to improve social and communication skills.
2. Speech and occupational therapy to address communication challenges and sensory sensitivities.

Anxiety & OCD

Case 1: Panic Disorder

Case Scenario:
John, a 34-year-old male, experiences sudden and recurrent panic attacks characterized by heart palpitations, shortness of breath, and fear of losing control. These episodes occur unexpectedly and have led him to avoid certain places where he previously had attacks.

What is the most probable diagnosis?
Panic Disorder
How would you support your diagnosis for this scenario (2 diagnostic criterias)
1. Recurrent unexpected panic attacks
2. Persistent concern about additional attacks leading to behavioral changes
Differential Diagnosis related to the probable diagnosis
Generalized Anxiety Disorder, Hyperthyroidism, Cardiovascular Disorders
Mention likely specific cause of such condition?
Serotonin dysregulation
Psychopathology mentioned case above?
Acute physiological arousal and catastrophic thinking
What is two best investigation (biological, psychological, social investigations)
1. Biological: Thyroid function tests
2. Psychological: Detailed panic attack history
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Biological: Start an SSRI (e.g., Sertraline 50 mg daily) for 12 weeks
2. Psychological: Cognitive Behavioral Therapy focusing on exposure and coping strategies

Case 2: Agoraphobia

Case Scenario:
Emily, a 45-year-old woman, avoids leaving her home due to fear of having a panic attack in public places. She feels trapped and experiences significant distress when considering venturing outside alone.

What is the most probable diagnosis?
Agoraphobia
How would you support your diagnosis for this scenario (2 diagnostic criterias)
1. Marked fear of using public transportation, being in open spaces, or being in enclosed places
2. Avoidance of situations that may cause panic, leading to significant distress and impairment
Differential Diagnosis related to the probable diagnosis
Panic Disorder, Social Anxiety Disorder, Major Depressive Disorder
Mention likely specific cause of such condition?
Learned safety behaviors and avoidance reinforcement
Psychopathology mentioned case above?
Fear of helplessness in public situations and avoidance behavior
What is two best investigation (biological, psychological, social investigations)
1. Biological: Rule out medical conditions like cardiovascular issues
2. Psychological: Assess for co-occurring anxiety or depressive disorders
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Biological: SSRIs (e.g., Escitalopram 10 mg daily) for at least 12 weeks
2. Psychological: Exposure therapy combined with Cognitive Behavioral Therapy

Case 3: Specific Phobia

Case Scenario:
Alex, a 22-year-old college student, has an intense fear of spiders. The sight of a spider causes immediate anxiety, leading him to avoid places where spiders might be present, such as gardens and basements.

What is the most probable diagnosis?
Specific Phobia (Arachnophobia)
How would you support your diagnosis for this scenario (2 diagnostic criterias)
1. Marked fear or anxiety about a specific object or situation (spiders)
2. Immediate fear response upon exposure and active avoidance of the feared object
Differential Diagnosis related to the probable diagnosis
Social Anxiety Disorder, Obsessive-Compulsive Disorder, Generalized Anxiety Disorder
Mention likely specific cause of such condition?
Traumatic experience with spiders or genetic predisposition
Psychopathology mentioned case above?
Immediate fear response and avoidance behavior
What is two best investigation (biological, psychological, social investigations)
1. Biological: Rule out any physiological conditions that may mimic anxiety
2. Psychological: Detailed history of fear onset and triggers
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Biological: SSRIs are not typically first-line; consider short-term benzodiazepines if necessary
2. Psychological: Exposure Therapy and Cognitive Behavioral Therapy

Case 4: Generalized Anxiety Disorder (GAD)

Case Scenario:
Maria, a 30-year-old teacher, constantly worries about various aspects of her life, including work, health, and family. She finds it difficult to control her worry, which has persisted for over a year and affects her daily functioning.

What is the most probable diagnosis?
Generalized Anxiety Disorder (GAD)
How would you support your diagnosis for this scenario (2 diagnostic criterias)
1. Excessive anxiety and worry occurring more days than not for at least six months
2. Difficulty controlling the worry and associated with symptoms like restlessness and fatigue
Differential Diagnosis related to the probable diagnosis
Panic Disorder, Major Depressive Disorder, Obsessive-Compulsive Disorder
Mention likely specific cause of such condition?
Chronic stress and imbalance in neurotransmitters like GABA and serotonin
Psychopathology mentioned case above?
Persistent worry and physical symptoms of anxiety
What is two best investigation (biological, psychological, social investigations)
1. Biological: Thyroid function tests to rule out hyperthyroidism
2. Psychological: Comprehensive anxiety assessment
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Biological: SSRIs (e.g., Escitalopram 10 mg daily) for 12 weeks
2. Psychological: Cognitive Behavioral Therapy focusing on anxiety management techniques

Case Scenario:
Lisa, a 19-year-old university student, has an intense fear of social situations where she might be judged or embarrassed. She avoids public speaking, social gatherings, and often feels anxious during interactions, significantly impacting her academic and personal life.

What is the most probable diagnosis?
Social Anxiety Disorder (SAD)
How would you support your diagnosis for this scenario (2 diagnostic criterias)
1. Marked fear of social or performance situations involving possible scrutiny
2. Fear leads to avoidance or enduring with intense anxiety, causing significant impairment
Differential Diagnosis related to the probable diagnosis
Generalized Anxiety Disorder, Specific Phobia, Obsessive-Compulsive Disorder
Mention likely specific cause of such condition?
Negative social experiences and heightened sensitivity to evaluation
Psychopathology mentioned case above?
Fear of negative evaluation and avoidance of social interactions
What is two best investigation (biological, psychological, social investigations)
1. Biological: Rule out medical conditions that may mimic anxiety
2. Psychological: Social anxiety assessment and history
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Biological: SSRIs (e.g., Paroxetine 20 mg daily) for 12 weeks
2. Psychological: Cognitive Behavioral Therapy with social skills training

Case 6: Obsessive-Compulsive Disorder (OCD)

Case Scenario:
Tom, a 26-year-old software engineer, is plagued by intrusive thoughts about contamination. To alleviate his anxiety, he engages in excessive hand-washing multiple times a day, which interferes with his daily activities and social interactions.

What is the most probable diagnosis?
Obsessive-Compulsive Disorder (OCD)
How would you support your diagnosis for this scenario (2 diagnostic criterias)
1. Presence of obsessions (intrusive thoughts about contamination)
2. Engagement in compulsions (excessive hand-washing) to reduce anxiety
Differential Diagnosis related to the probable diagnosis
Generalized Anxiety Disorder, Body Dysmorphic Disorder, Tic Disorders
Mention likely specific cause of such condition?
Serotonin dysregulation and genetic predisposition
Psychopathology mentioned case above?
Intrusive thoughts and repetitive behaviors to manage anxiety
What is two best investigation (biological, psychological, social investigations)
1. Biological: Neuroimaging to rule out neurological conditions
2. Psychological: Detailed assessment of obsessive and compulsive symptoms
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Biological: SSRIs (e.g., Fluoxetine 60 mg daily) for at least 12 weeks
2. Psychological: Exposure and Response Prevention (ERP) Therapy

Psychotic Disorders

Case 1: Major Depressive Disorder (MDD) with Psychotic Features

Case Scenario:
35-year-old male presents with a two-week history of persistent sadness, loss of interest in activities, significant weight loss, insomnia, and feelings of worthlessness. He reports hearing voices that tell him he is useless and should end his life. There is no history of manic episodes or substance use.

What is the most probable diagnosis?
Major Depressive Disorder (MDD) with Psychotic Features
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Presence of a major depressive episode.
2. Presence of psychotic symptoms (auditory hallucinations) during the depressive episode.
Differential Diagnosis related to the probable diagnosis
Schizophrenia, Substance-Induced Psychotic Disorder, Delusional Disorder
Mention likely specific cause of such condition?
Neurochemical imbalances, particularly involving serotonin and dopamine.
Psychopathology mentioned case above?
Auditory hallucinations and depressive cognitions.
What is two best investigation (biological, psychological, social investigations)
1. Blood tests to rule out medical causes.
2. Psychiatric evaluation for severity of depression and psychosis.
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Antidepressant with antipsychotic (e.g., Sertraline 50mg daily + Risperidone 2mg daily) for 6-8 weeks.
2. Cognitive Behavioral Therapy and social support interventions.

Case 2: Bipolar I Disorder, Manic with Psychotic Features

Case Scenario:
28-year-old female exhibits a one-week period of elevated mood, increased energy, reduced need for sleep, grandiose ideas, rapid speech, and impulsive spending. She also experiences delusions of having special powers and hears voices praising her abilities. No prior depressive episodes reported.

What is the most probable diagnosis?
Bipolar I Disorder, Manic or Mixed with Psychotic Features
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Presence of a manic episode.
2. Presence of psychotic features during the manic phase.
Differential Diagnosis related to the probable diagnosis
Schizophrenia, Substance-Induced Psychotic Disorder, Delusional Disorder
Mention likely specific cause of such condition?
Genetic predisposition and dysregulation of dopamine pathways.
Psychopathology mentioned case above?
Grandiose delusions and auditory hallucinations.
What is two best investigation (biological, psychological, social investigations)
1. Comprehensive psychiatric assessment.
2. Substance use screening to rule out induced psychosis.
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Mood stabilizer such as Lithium 600mg daily + Antipsychotic like Olanzapine 10mg daily for acute management.
2. Psychoeducation and family therapy.

Case 3: Schizophrenia

Case Scenario:
22-year-old male presents with a six-month history of social withdrawal, disorganized speech, and reduced emotional expression. He reports hearing multiple voices conversing about him and experiencing delusions of persecution. There is a decline in academic performance and occupational functioning.

What is the most probable diagnosis?
Disorganized Schizophrenia
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Presence of delusions and hallucinations for more than six months.
2. Significant social and occupational dysfunction.
Differential Diagnosis related to the probable diagnosis
Schizophreniform Disorder, Bipolar I Disorder with Psychotic Features, Psychotic Disorder NOS
Mention likely specific cause of such condition?
Genetic factors and neurodevelopmental abnormalities affecting dopamine pathways.
Psychopathology mentioned case above?
Auditory hallucinations and persecutory delusions.
What is two best investigation (biological, psychological, social investigations)
1. MRI or CT scan to rule out brain abnormalities.
2. Comprehensive psychiatric evaluation.
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Atypical antipsychotic such as Risperidone 4mg daily for symptom control.
2. Cognitive Behavioral Therapy and supported employment programs.

Case 4: Substance-Induced Psychotic Disorder

Case Scenario:
40-year-old male with a history of chronic cocaine use presents with acute paranoia, visual hallucinations, and delusions of being watched. These symptoms began two days after a binge and have persisted despite abstinence efforts.

What is the most probable diagnosis?
Substance-Induced Psychotic Disorder
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Onset of psychotic symptoms during or shortly after substance intoxication.
2. Evidence of substance use (cocaine) related to the psychosis.
Differential Diagnosis related to the probable diagnosis
Schizophrenia, Delusional Disorder, Psychotic Disorder due to a GMC
Mention likely specific cause of such condition?
Neurotoxicity from cocaine affecting dopamine pathways.
Psychopathology mentioned case above?
Paranoia, visual hallucinations, and delusional persecution.
What is two best investigation (biological, psychological, social investigations)
1. Urine toxicology screen.
2. Medical evaluation to rule out other causes.
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Antipsychotic such as Haloperidol 5mg as needed.
2. Substance abuse counseling and rehabilitation programs.

Case 5: Psychotic Disorder due to a General Medical Condition (GMC)

Case Scenario:
50-year-old female with a recent diagnosis of thyroid carcinoma presents with confusion, visual hallucinations, and delusions of impending doom. Laboratory tests reveal severe hypercalcemia.

What is the most probable diagnosis?
Psychotic Disorders Due to a General Medical Condition (GMC)
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Presence of psychotic symptoms concurrent with a medical condition (hypercalcemia).
2. Temporal relationship between the medical condition and onset of psychosis.
Differential Diagnosis related to the probable diagnosis
Delirium, Substance-Induced Psychotic Disorder, Schizophrenia
Mention likely specific cause of such condition?
Metabolic disturbances (hypercalcemia) affecting brain function.
Psychopathology mentioned case above?
Visual hallucinations and paranoid delusions.
What is two best investigation (biological, psychological, social investigations)
1. Comprehensive metabolic panel.
2. Neurological assessment.
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Treat underlying hypercalcemia with intravenous fluids and bisphosphonates.
2. Supportive psychotherapy and monitoring.

Case 6: Delusional Disorder

Case Scenario:
45-year-old male believes that his neighbor is secretly poisoning his food to harm his health. He has no other psychotic symptoms and maintains normal functioning in his job and social relationships. The belief has persisted for three months.

What is the most probable diagnosis?
Delusional Disorder
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Presence of a nonbizarre delusion for at least one month.
2. Absence of other psychotic symptoms and relatively preserved functioning.
Differential Diagnosis related to the probable diagnosis
Paranoid Personality Disorder, Schizophrenia, Psychotic Disorder NOS
Mention likely specific cause of such condition?
Genetic predisposition and cognitive biases towards suspicion.
Psychopathology mentioned case above?
Persecutory delusions.
What is two best investigation (biological, psychological, social investigations)
1. Psychiatric evaluation to assess delusion severity.
2. Medical assessment to rule out other causes of paranoid ideation.
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Antipsychotic medication such as Risperidone 2mg daily if needed.
2. Cognitive Behavioral Therapy focused on reality testing and coping strategies.

Depressive disorder & Suicide

Case 1: MDD

Case Scenario:
A 28-year-old male presents with a two-month history of feeling down, significant weight gain, increased appetite, fatigue, and difficulty concentrating at work. He reports a loss of interest in his hobbies and has had occasional thoughts of self-harm but no specific plan.

What is the most probable diagnosis?
Major Depressive Disorder
How would you support your diagnosis for this scenario (2 diagnostic criterias)
1. Persistent low mood for at least two months
2. Significant weight gain and increased appetite
Differential Diagnosis related to the probable diagnosis
Bipolar Disorder, Hypothyroidism, Adjustment Disorder
Mention likely specific cause of such condition?
Biochemical deficit of Serotonin and Noradrenaline
Psychopathology mentioned case above?
Anhedonia, impaired concentration
What is two best investigation (biological, psychological, social investigations)
Thyroid function tests
Clinical interview for psychosocial stressors
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
Biological:
- Start Sertraline 50 mg daily
- Duration: 6-9 months
- Time to work: 4-6 weeks
Psychological & Social:
- Cognitive Behavioral Therapy
- Social support interventions

Case 2: MDD

Case Scenario:
A 45-year-old divorced woman has been experiencing persistent sadness, insomnia, and feelings of worthlessness for the past three weeks. She has withdrawn from social activities and has missed several days of work. She denies any suicidal ideation.

What is the most probable diagnosis?
Major Depressive Disorder
How would you support your diagnosis for this scenario (2 diagnostic criterias)
1. Depressed mood for more than two weeks
2. Insomnia and feelings of worthlessness
Differential Diagnosis related to the probable diagnosis
Dysthymia, Bipolar Disorder, Grief
Mention likely specific cause of such condition?
Psychosocial stressors related to divorce
Psychopathology mentioned case above?
Social withdrawal, impaired occupational functioning
What is two best investigation (biological, psychological, social investigations)
Complete blood count and chemistries
Assessment of social support systems
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
Biological:
- Begin Fluoxetine 20 mg daily
- Duration: 6 months
- Time to work: 4-6 weeks
Psychological & Social:
- Interpersonal Therapy
- Family therapy to enhance social support

Case 3: MDD

Case Scenario:
A 60-year-old male with a history of hypertension and coronary artery disease presents with a two-month history of decreased interest in activities, fatigue, and difficulty concentrating. He has noticed a decline in his work performance and has minimal engagement with family members. He denies any thoughts of self-harm.

What is the most probable diagnosis?
Major Depressive Disorder associated with coronary disease
How would you support your diagnosis for this scenario (2 diagnostic criterias)
1. Persistent low mood for over two months
2. Decreased interest in activities and fatigue
Differential Diagnosis related to the probable diagnosis
Chronic Medical Illness-related Depression, Dementia, Adjustment Disorder
Mention likely specific cause of such condition?
Chronic medical illness contributing to depressive symptoms
Psychopathology mentioned case above?
Anhedonia, impaired occupational and social functioning
What is two best investigation (biological, psychological, social investigations)
Thyroid function tests
Evaluation of psychosocial stressors related to chronic illness
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
Biological:
- Initiate Escitalopram 10 mg daily
- Duration: 6-12 months
- Time to work: 4-6 weeks
Psychological & Social:
- Behavioral Activation Therapy
- Support groups for individuals with chronic illnesses

Bipolar Disorders

Case 1: Bipolar Depression

Case Scenario:
A 28-year-old female presents with persistent feelings of sadness, loss of interest in activities, and significant weight loss over the past two months. She reports difficulty concentrating and feelings of hopelessness. She has a history of elevated mood episodes treated intermittently with lithium.

What is the most probable diagnosis?
Bipolar Depression
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Presence of at least one major depressive episode.
2. History of previous manic or hypomanic episodes.
Differential Diagnosis related to the probable diagnosis:
Major Depressive Disorder, Cyclothymia
Mention likely specific cause of such condition?
Heritability and genetic predisposition.
Psychopathology mentioned case above?
Depression
What are two best investigations (biological, psychological, social investigations)?
1. Comprehensive psychiatric evaluation.
2. Family history assessment.
What are two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)?
1. Biological: Start Lithium 300 mg BID, monitor levels; duration: indefinite prophylaxis.
2. Psychological: Cognitive Behavioral Therapy (CBT).

Case 2: Acute Treatment of Mania, Mixed State, Rapid Cycling

Case Scenario:
A 35-year-old male is brought to the emergency department exhibiting excessive energy, reduced need for sleep, grandiose ideas, and rapid speech lasting for five days. His behavior is erratic, and he has been impulsively spending large sums of money. There is a history of similar episodes occurring four times in the past year.

What is the most probable diagnosis?
Bipolar I Disorder, Acute Mania with Rapid Cycling
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Presence of a manic episode lasting at least one week.
2. History of four or more mood episodes within the past year.
Differential Diagnosis related to the probable diagnosis:
Substance-induced mood disorder, Schizophrenia
Mention likely specific cause of such condition?
Neurochemical imbalances, genetic factors.
Psychopathology mentioned case above?
Mania
What are two best investigations (biological, psychological, social investigations)?
1. Laboratory tests including CBC, electrolytes, liver function tests.
2. Psychiatric evaluation for substance use.
What are two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)?
1. Biological: Start Divalproex 500 mg BID; duration: acute management.
2. Biological: Initiate Risperidone 2 mg/day; time to work: within days.
3. Psychological & Social: Psychoeducation and family therapy.

Case 3: Bipolar & Pregnancy

Case Scenario:
A 30-year-old pregnant woman at 8 weeks gestation with Bipolar I Disorder is experiencing a depressive episode. She is currently on Valproic Acid but is concerned about the effects on her pregnancy.

What is the most probable diagnosis?
Bipolar I Disorder, Depressive Episode during Pregnancy
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Presence of a major depressive episode.
2. History of at least one manic episode.
Differential Diagnosis related to the probable diagnosis:
Major Depressive Disorder with psychotic features, Adjustment Disorder with depressed mood
Mention likely specific cause of such condition?
Medication-related teratogenic effects and hormonal changes during pregnancy.
Psychopathology mentioned case above?
Depression
What are two best investigations (biological, psychological, social investigations)?
1. Fetal ultrasound for neural tube defects.
2. Comprehensive risk-benefit analysis of medication use during pregnancy.
What are two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)?
1. Biological: Switch from Valproic Acid to Lamotrigine; dose: start at 25 mg daily, titrate gradually.
2. Biological: Continue Lithium with dose adjustments as needed; monitor levels closely.
3. Psychological & Social: Initiate psychotherapy (e.g., Interpersonal Therapy) and provide social support.

Cognitive disorders

Case 1: Delirium

Case Scenario:
A 78-year-old man is admitted to the hospital for pneumonia. On the second day of hospitalization, he becomes increasingly confused, has difficulty paying attention, and exhibits fluctuating levels of consciousness. His family reports that he was alert and oriented at admission but now is disoriented to time and place, with episodes of agitation and periods of lethargy.

What is the most probable diagnosis?
Delirium
How would you support your diagnosis for this scenario (2 diagnostic criteria)?
1. Disturbance in attention and awareness
2. Acute onset with a fluctuating course
Differential Diagnosis related to the probable diagnosis
Major Neurocognitive Disorder, Depression, Schizophrenia
Mention likely specific cause of such condition?
Infection (pneumonia) leading to physiological disturbances
Psychopathology mentioned case above?
Agitation and periods of lethargy
What is two best investigation (biological, psychological, social investigations)
1. Electrolyte panel
2. Cognitive assessment (e.g., MMSE)
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Treat underlying pneumonia
2. Antipsychotic medication (e.g., Haloperidol 0.5 mg IV as needed)

Case 2: Dementia

Case Scenario:
A 68-year-old woman presents with progressive memory loss over the past two years. She struggles to remember recent events, has difficulty planning and organizing daily tasks, and occasionally experiences confusion about familiar places. Her family has noticed a gradual decline in her ability to manage finances and perform household chores.

What is the most probable diagnosis?
Major Neurocognitive Disorder (Dementia)
How would you support your diagnosis for this scenario (2 diagnostic criteria)?
1. Significant cognitive decline in memory and executive function
2. Impairment in independence with daily activities
Differential Diagnosis related to the probable diagnosis
Depression (Pseudodementia), Mild Neurocognitive Disorder, Alzheimer’s Disease
Mention likely specific cause of such condition?
Alzheimer’s Disease
Psychopathology mentioned case above?
Memory loss, executive dysfunction, confusion
What is two best investigation (biological, psychological, social investigations)
1. Neuropsychological testing
2. MRI of the brain
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Cholinesterase inhibitor (e.g., Donepezil 5 mg daily, titrate as needed)
2. Supportive therapy and caregiver education

Case 3: Alcohol Withdrawal (Delirium Tremens)

Case Scenario:
A 55-year-old man with a history of chronic alcohol use presents to the emergency department 4 days after his last drink. He is agitated, disoriented, has tremors, excessive sweating, tachycardia, and visual hallucinations. His family reports that he has been unable to sleep and is experiencing severe anxiety and confusion.

What is the most probable diagnosis?
Delirium Tremens (Severe Alcohol Withdrawal)
How would you support your diagnosis for this scenario (2 diagnostic criteria)?
1. Acute onset with confusion and disorientation
2. Autonomic hyperactivity (tachycardia, sweating) and tremors
Differential Diagnosis related to the probable diagnosis
Sepsis-induced delirium, Benzodiazepine withdrawal, Acute psychosis
Mention likely specific cause of such condition?
Chronic alcohol use leading to severe withdrawal
Psychopathology mentioned case above?
Agitation, anxiety, confusion, visual hallucinations
What is two best investigation (biological, psychological, social investigations)
1. Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar)
2. Electrolyte panel
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Benzodiazepines (e.g., Lorazepam 2 mg IV every 1 hour as needed)
2. Thiamine supplementation (e.g., Thiamine 100 mg IV daily)

Case Scenario:
A 60-year-old chronic alcoholic is brought to the hospital with confusion, unsteady gait, and abnormal eye movements. He has a history of poor dietary intake and prolonged vomiting. On examination, he is disoriented, has nystagmus, and exhibits ataxia of stance and gait.

What is the most probable diagnosis?
Wernicke’s Encephalopathy
How would you support your diagnosis for this scenario (2 diagnostic criteria)?
1. Encephalopathy (confusion, disorientation)
2. Oculomotor dysfunction (nystagmus) and gait ataxia
Differential Diagnosis related to the probable diagnosis
Delirium Tremens, Basal Nerve Thiamine Deficiency, Multiple Sclerosis
Mention likely specific cause of such condition?
Thiamine (Vitamin B1) deficiency due to chronic alcohol use
Psychopathology mentioned case above?
Confusion and disorientation
What is two best investigation (biological, psychological, social investigations)
1. Thiamine level
2. MRI of the brain
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Thiamine supplementation (e.g., Thiamine 500 mg IV daily)
2. Nutritional support and hydration

Case Scenario:
A 65-year-old man with a long history of alcohol abuse is brought to the clinic by his family. They report that he has severe memory loss, especially for recent events, and often makes up stories to fill in gaps in his memory. Despite his memory issues, he maintains his long-term memories and social skills. He is unaware of his memory deficits.

What is the most probable diagnosis?
Korsakoff’s Syndrome
How would you support your diagnosis for this scenario (2 diagnostic criteria)?
1. Severe anterograde and retrograde amnesia
2. Confabulation and lack of awareness of memory deficits
Differential Diagnosis related to the probable diagnosis
Alzheimer’s Disease, Delirium, Depression
Mention likely specific cause of such condition?
Chronic thiamine deficiency due to prolonged alcohol abuse
Psychopathology mentioned case above?
Memory loss, confabulation
What is two best investigation (biological, psychological, social investigations)
1. Neuropsychological testing
2. Thiamine level assessment
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Thiamine supplementation (e.g., Thiamine 500 mg IV daily)
2. Cognitive rehabilitation and supportive psychotherapy

Case 6: Alcohol Use Disorder

Case Scenario:
A forty-year-old woman presents for evaluation with a history of increasing alcohol consumption over the past five years. She reports drinking daily, often unable to reduce her intake despite wanting to. She has experienced unsuccessful attempts to cut down, and her drinking has led to problems at work and strained family relationships.

What is the most probable diagnosis?
Alcohol Use Disorder - alcoholism
How would you support your diagnosis for this scenario (2 diagnostic criteria)?
1. Persistent desire or unsuccessful efforts to cut down alcohol use
2. Continued use despite social and occupational problems
Differential Diagnosis related to the probable diagnosis
Depression, Anxiety Disorders, Personality Disorders
Mention likely specific cause of such condition?
Genetic predisposition and environmental factors contributing to dependency
Psychopathology mentioned case above?
Dependence on alcohol, impaired control over drinking
What is two best investigation (biological, psychological, social investigations)
1. Alcohol use history and screening (e.g., AUDIT)
2. Liver function tests
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Pharmacotherapy (e.g., Naltrexone 50 mg daily)
2. Cognitive-behavioral therapy and support groups

Substance abuse

Case 1: Hallucinogens

Case Scenario:
A 22-year-old university student is brought to the emergency department by friends after exhibiting erratic and unpredictable behavior following a party. He is experiencing visual hallucinations, believes he can communicate with extraterrestrial beings, and has difficulty distinguishing reality from his perceptions.

What is the most probable diagnosis?
Hallucinogen Intoxication
How would you support your diagnosis for this scenario (2 diagnostic criterias)
1. Distorted perception with visual hallucinations
2. Unpredictable and dangerous behavior
Differential Diagnosis related to the probable diagnosis
Acute psychotic disorder, Substance-induced psychosis, Schizophrenia
Mention likely specific cause of such condition?
Use of LSD or similar hallucinogenic substances
Psychopathology mentioned case above?
Delusions of communication with extraterrestrial beings
What is two best investigation (biological, psychological, social investigations)
1. Toxicology screening (biological)
2. Psychological assessment for underlying mental health conditions
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Supportive care and benzodiazepines for agitation (biological)
2. Cognitive Behavioral Therapy (psychological)

Case 2: Cannabinoids

Case Scenario:
A 19-year-old female presents with red, bloodshot eyes, dry mouth, increased appetite, and a rapid heart rate after attending a social gathering where marijuana was consumed. She appears relaxed but slightly anxious.

What is the most probable diagnosis?
Cannabis Intoxication
How would you support your diagnosis for this scenario (2 diagnostic criterias)
1. Recent use of cannabis
2. Two or more signs: conjunctival injection and tachycardia
Differential Diagnosis related to the probable diagnosis
Acute anxiety episode, Allergic conjunctivitis, Other substance intoxications
Mention likely specific cause of such condition?
Consumption of marijuana containing high levels of THC
Psychopathology mentioned case above?
Anxiety related to intoxication
What is two best investigation (biological, psychological, social investigations)
1. Urine drug screen for cannabinoids (biological)
2. Social history to assess frequency and context of use
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Supportive care and hydration (biological)
2. Motivational Interviewing to address use behaviors (psychological)

Case 3: Stimulants

Case Scenario:
A 28-year-old male presents with elevated blood pressure, tachycardia, dilated pupils, and reports feeling extremely energetic and unable to sleep after taking methamphetamine to enhance his work performance. He exhibits hypervigilance and paranoia about his colleagues.

What is the most probable diagnosis?
Stimulant Intoxication (Methamphetamine)
How would you support your diagnosis for this scenario (2 diagnostic criterias)
1. Recent use of methamphetamine
2. Symptoms of increased heart rate and paranoia
Differential Diagnosis related to the probable diagnosis
Acute psychotic disorder, Cocaine intoxication, Hyperthyroidism
Mention likely specific cause of such condition?
Abuse of methamphetamine leading to excessive CNS stimulation
Psychopathology mentioned case above?
Paranoid delusions and hypervigilance
What is two best investigation (biological, psychological, social investigations)
1. Urine toxicology for stimulants (biological)
2. Psychological evaluation for potential psychosis
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Benzodiazepines to manage agitation and prevent seizures (biological)
2. Cognitive Behavioral Therapy for stimulant abuse (psychological)

Case 4: Opioids

Case Scenario:
A 35-year-old male with a history of heroin use is brought to the clinic for evaluation. He reports needing to use heroin daily to function normally and experiences severe withdrawal symptoms, including muscle aches, nausea, and anxiety when attempting to reduce use.

What is the most probable diagnosis?
Opioid Dependence Syndrome
How would you support your diagnosis for this scenario (2 diagnostic criterias)
1. Strong desire or compulsion to take heroin
2. Withdrawal symptoms upon cessation
Differential Diagnosis related to the probable diagnosis
Alcohol dependence, Benzodiazepine dependence, Chronic pain syndrome
Mention likely specific cause of such condition?
Prolonged use of heroin leading to physical and psychological dependence
Psychopathology mentioned case above?
Compulsive drug-seeking behavior despite harmful consequences
What is two best investigation (biological, psychological, social investigations)
1. Urine toxicology for opioids (biological)
2. Assessment of social factors contributing to dependence
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Methadone maintenance therapy, dose 60-120 mg/day, long-term
2. Buprenorphine therapy combined with Behavioral Therapy (psychological)

Case 5: Sedatives & Hypnotics

Case Scenario:
A 45-year-old female with a history of insomnia has been taking high doses of benzodiazepines for the past year. She reports experiencing anxiety, tremors, and seizures upon attempting to reduce her medication without medical supervision.

What is the most probable diagnosis?
Sedative, Hypnotic or Anxiolytic Dependence
How would you support your diagnosis for this scenario (2 diagnostic criterias)
1. Evidence of tolerance and withdrawal symptoms
2. Difficulty controlling benzodiazepine use
Differential Diagnosis related to the probable diagnosis
Generalized Anxiety Disorder, Panic Disorder, Epilepsy
Mention likely specific cause of such condition?
Chronic use and dependence on benzodiazepines for insomnia
Psychopathology mentioned case above?
Physical dependence with withdrawal-induced seizures
What is two best investigation (biological, psychological, social investigations)
1. Clinical assessment for withdrawal symptoms (biological)
2. Psychological evaluation for anxiety and dependence patterns
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Slow tapering of benzodiazepine dose combined with anticonvulsants as needed (biological)
2. Cognitive Behavioral Therapy for insomnia and anxiety (psychological)

Case 6: Volatile Solvents

Case Scenario:
A 16-year-old adolescent is brought to the emergency room exhibiting disorientation, incoordination, and slurred speech after being found inhaling glue to alleviate peer pressure stress. He reports feeling euphoric but is now confused and unable to stand steadily.

What is the most probable diagnosis?
Volatile Solvent Intoxication
How would you support your diagnosis (2 diagnostic criterias)
1. Recent inhalant use (glue)
2. Acute onset of disorientation and incoordination
Differential Diagnosis related to the probable diagnosis
Alcohol intoxication, Cannabis intoxication, Acute psychotic episode
Mention likely specific cause of such condition?
Inhalation of volatile solvents present in glue leading to CNS depression
Psychopathology mentioned case above?
Acute confusion and impaired motor coordination
What is two best investigation (biological, psychological, social investigations)
1. Blood tests to rule out other intoxications (biological)
2. Social assessment for substance use patterns and peer influences
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Supportive care with oxygen therapy as needed (biological)
2. Behavioral counseling and family therapy to address substance use (psychological & social)

Stress

Case 1: Acute Stress Disorder

Case Scenario:
John, a 28-year-old firefighter, was involved in a severe house fire where he narrowly escaped while rescuing a family. In the weeks following the incident, he experiences frequent flashbacks, nightmares, and avoids places that remind him of the fire. He also feels constantly on edge and has difficulty concentrating at work.

What is the most probable diagnosis?
Acute Stress Disorder
How would you support your diagnosis for this scenario (2 diagnostic criterias)
1. Exposure to a traumatic event (severe house fire).
2. Presence of dissociative symptoms (flashbacks, nightmares).
Differential Diagnosis related to the probable diagnosis
Adjustment Disorder, Posttraumatic Stress Disorder (PTSD)
Mention likely specific cause of such condition?
Exposure to life-threatening trauma.
Psychopathology mentioned case above?
Reexperiencing, avoidance, hyperarousal.
What is two best investigation (biological, psychological, social investigations)
1. Clinical interview (Psychological).
2. Assessment of sleep patterns and stress levels (Biological).
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Biological: SSRI e.g., Sertraline 50 mg daily for 6 months.
2. Psychological: Cognitive Behavioral Therapy (CBT).

Case 2: Posttraumatic Stress Disorder (PTSD)

Case Scenario:
Maria, a 35-year-old nurse, witnessed a colleague’s sudden death during a night shift at the hospital. Six months later, she continues to have intrusive memories of the event, avoids thinking about work, and has become increasingly irritable and hypervigilant, affecting her personal and professional relationships.

What is the most probable diagnosis?
Posttraumatic Stress Disorder (PTSD)
How would you support your diagnosis for this scenario (2 diagnostic criterias)
1. Recurrent intrusive memories of the traumatic event.
2. Persistent avoidance of stimuli associated with the trauma.
Differential Diagnosis related to the probable diagnosis
Acute Stress Disorder, Major Depressive Disorder
Mention likely specific cause of such condition?
Witnessing a colleague’s sudden and traumatic death.
Psychopathology mentioned case above?
Intrusive thoughts, avoidance behavior, increased arousal.
What is two best investigation (biological, psychological, social investigations)
1. Structured Clinical Interview for criteria’s.
2. Evaluation of social support systems (Social).
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Biological: SSRI e.g., Fluoxetine 20 mg daily for 6 months.
2. Psychological: Trauma-focused Cognitive Behavioral Therapy (CBT).
3. Social: education

Case 3: Adjustment Disorder

Case Scenario:
Sara, a 22-year-old university student, recently moved to a new city for her studies. Within three months, she has been feeling unusually sad, has lost interest in her studies, and has started isolating herself from friends and family. She reports difficulty managing her daily responsibilities and experiences significant distress.

What is the most probable diagnosis?
Adjustment Disorder
How would you support your diagnosis for this scenario (2 diagnostic criterias)
1. Emotional symptoms (sadness, loss of interest) in response to an identifiable stressor (moving to a new city).
2. Occurring within three months of the onset of the stressor.
Differential Diagnosis related to the probable diagnosis
Major Depressive Disorder, Acute Stress Disorder
Mention likely specific cause of such condition?
Significant life change and relocation.
Psychopathology mentioned case above?
Depressed mood, social withdrawal, impaired functioning.
What is two best investigation (biological, psychological, social investigations)
1. Psychological assessment using DSM-5 criteria.
2. Evaluation of social support and coping mechanisms (Social).
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Biological: Low-dose antidepressants if depressive symptoms are severe, e.g., Escitalopram 10 mg daily for 3 months.
2. Psychological: Supportive counseling and stress management techniques. CBT

Women health

Case 1: Postpartum Depression

Case Scenario:
Jane, a 28-year-old mother, has been experiencing persistent feelings of sadness, fatigue, and anxiety for the past two months following the birth of her first child. She finds it difficult to bond with her baby and has lost interest in activities she once enjoyed. Jane also struggles with feelings of worthlessness and fears she cannot cope with motherhood.

What is the most probable diagnosis?
Postpartum Depression
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Major depressive episode occurring within 6 weeks postpartum.
2. Persistent feelings of sadness, fatigue, and anxiety affecting daily functioning.
Differential Diagnosis related to the probable diagnosis
Postpartum Blues, Adjustment Disorder with Depressed Mood
Mention likely specific cause of such condition?
Hormonal changes after childbirth
Psychopathology mentioned case above?
Major Depressive Disorder
What is two best investigation (biological, psychological, social investigations)
1. Clinical interview assessing depressive symptoms
2. Hormonal level tests
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Biological: Start SSRIs (e.g., Sertraline 50mg daily) for 6-12 months
2. Psychological: Interpersonal Therapy (IPT) for 12 weeks

Case 2: Anorexia Nervosa

Case Scenario:
Emily, a 17-year-old female, has lost significant weight over the past three months. She restricts her food intake severely, exercises excessively, and exhibits an intense fear of gaining weight. Emily frequently excuses herself from meals and expresses a distorted body image, believing she is overweight despite being underweight.

What is the most probable diagnosis?
Anorexia Nervosa
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Restriction of energy intake leading to significantly low body weight.
2. Intense fear of gaining weight and distorted body image.
Differential Diagnosis related to the probable diagnosis
Major Depressive Disorder, Body Dysmorphic Disorder
Mention likely specific cause of such condition?
Combination of genetic predisposition and environmental factors related to body image.
Psychopathology mentioned case above?
Distortion of body image, anxiety about weight gain
What is two best investigation (biological, psychological, social investigations)
1. Biological: Complete blood count (CBC) and electrolyte panel
2. Psychological: Eating Disorder Inventory (EDI-2)
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Biological: Hospitalization for severe weight loss if necessary
2. Psychological: Cognitive Behavioral Therapy (CBT) for 6 months

Case 3: Bulimia Nervosa

Case Scenario:
Mark, a 20-year-old male, engages in recurrent episodes of binge eating, consuming large amounts of food in a short period. Following these episodes, he compensates by self-induced vomiting and excessive use of laxatives. Mark expresses a significant concern over his body shape and weight despite maintaining a relatively normal body weight.

What is the most probable diagnosis?
Bulimia Nervosa
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Recurrent episodes of binge eating followed by inappropriate compensatory behaviors.
2. Self-evaluation is unduly influenced by body shape and weight.
Differential Diagnosis related to the probable diagnosis
Anorexia Nervosa (binge-eating/purging subtype), Borderline Personality Disorder
Mention likely specific cause of such condition?
Psychological factors including low self-esteem and societal pressure on body image.
Psychopathology mentioned case above?
Binge-purge cycle, body dissatisfaction
What is two best investigation (biological, psychological, social investigations)
1. Biological: Electrolyte imbalance assessment
2. Psychological: Structured Clinical Interview for DSM Disorders
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Biological: Start SSRIs (e.g., Fluoxetine 60mg daily) for 6 months
2. Psychological: Cognitive Behavioral Therapy (CBT) for 6-12 months

Case 4: Woman Health Psychiatry

Case Scenario:
Maria, a 35-year-old woman, experiences depressive symptoms during her perimenopausal period. She reports mood swings, anxiety, and a lack of interest in daily activities. Maria also faces challenges related to hormonal changes and increased responsibilities at work and home, contributing to her mental health struggles.

What is the most probable diagnosis?
Perimenopause-related Depression
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Depressive symptoms temporally associated with perimenopausal hormonal changes.
2. Onset of symptoms during the perimenopausal period.
Differential Diagnosis related to the probable diagnosis
Major Depressive Disorder, Adjustment Disorder with Depressed Mood
Mention likely specific cause of such condition?
Hormonal fluctuations during perimenopause
Psychopathology mentioned case above?
Mood swings, anxiety, depressive symptoms
What is two best investigation (biological, psychological, social investigations)
1. Biological: Hormone level tests (e.g., estrogen, progesterone)
2. Psychological: Beck Depression Inventory (BDI)
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Biological: Hormone Replacement Therapy (HRT) as appropriate
2. Psychological: Cognitive Behavioral Therapy (CBT) for 12 weeks

Case 5: Eating Disorders

Case Scenario:
Sophia, a 22-year-old university student, exhibits an intense fear of gaining weight and engages in extreme dietary restrictions and excessive exercise. She is preoccupied with her body weight and shape, often skipping meals and avoiding social situations involving food. Despite her low body weight, Sophia denies feeling fat and continues her restrictive behaviors.

What is the most probable diagnosis?
Anorexia Nervosa
How would you support your diagnosis for this scenario (2 diagnostic criterias)?
1. Restriction of energy intake leading to significantly low body weight.
2. Intense fear of gaining weight and distorted body image.
Differential Diagnosis related to the probable diagnosis
Bulimia Nervosa, Body Dysmorphic Disorder
Mention likely specific cause of such condition?
Genetic predisposition and societal pressure on thinness.
Psychopathology mentioned case above?
Body image distortion, anxiety about weight gain
What is two best investigation (biological, psychological, social investigations)
1. Biological: Electrolyte panel and BMI calculation
2. Psychological: SCOFF questionnaire
What is two best Management/Treatment (biological; dose, duration, time to work) (psychological & social investigations)
1. Biological: Nutritional rehabilitation with a structured meal plan
2. Psychological: Family Therapy for 6 months

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Psychiatry MEQs