Pass the CASC for MRCPsych

641 Pages·8.025 MB·English

by  Dr Seshni Moodliar

Pass the CASC
For the MRCPsych

First Edition

By Dr Seshni Moodliar

Cambridgeshire and Peterborough Foundation NHS trust

Forewords by Dr Dinesh Sinha, Dr MS Thambirajah, Professor Fabrizio
Schifano and Dr Asif Zia

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Published by Dr Seshni Moodliar

Printed and bound in Poland by Kozak Druk for Seshni Moodliar

© copyright Dr Seshni Moodliar

The right of Seshni Moodliar to be identified as the author of this work
has been asserted by her in accordance with the Copyright, Patents,
Design and Patients Act 1998.

All rights reserved. Apart from any dealing for the purpose of private
study, research, review or critism, as permitted by the UK Copyright,
Designs and Patents Act 1998, no part of this publication may be
reproduced, stored or transmitted in any forms or means, electronic,
mechanical, photocopying, recording or otherwise, without prior
permission in writing from the publisher .

In the terms of reproduction of this publication, this needs to be in
accordance with the terms of licences issued by the Copyright Licensing
Reproduction Rights organization outside the UK.

British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library

Notice
Medical knowledge is constantly changing. Readers are advised to check
the most current information on medication and treatment. Neither the
publisher not the author assumes liability for any injury or damage to
persons or property arising from this publication

ISBN 978-0-9569941-0-3

First published 2012

Designer: Illustrations and cover
Aleksandra Rykala

Distribution
For distribution by Seshni Moodliar

Contact:
www.easterpsychcourse.com or www.easternpsychcourse.co.uk

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Examinations are formidable even to the best prepared, for the greatest
fool may ask more than the wisest man can answer."

-Charles Caleb Colton

“Put your confidence in us. Give us your faith and your blessing, and
under providence all will be well. We shall not fail or falter; we shall not
weaken or tire. Neither the sudden shock of battle nor the long-drawn
trials of vigilance and exertion will wear us down.

“Give us the tools and we will finish the job.”

-W. Churchill 1941 to Roosevelt

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This book is dedicated to my husband and children Shreeya, Aryan and
Sitara.
To our families and friends in South Africa and United Kingdom
Our Gratitude and thanks to all those who contributed in compiling this
book.
A special thanks to my dear friend Gosia Demetriou.
And last but not the least this book is dedicated to our patients, their
families, carers and mental health professionals.

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CONTENTS
Contributors 12
Forewords 14
Introduction 19
Past CASC exam stations- discussed with Dr Albert Michael 23
A) June 2008
B) November 2008
C) March 2009
D) October 2009
E) March 2010
F) October 2010
G) January 2011
H) June 2011

1. General Adult Psychiatry- 36
Dr Esam Hassan, Dr Animesh Tripathi
1.1 Depression-History-Dr Nisha Rani/ Dr Rajeeve Parkianathan
1.2 Depression- Diagnosis and management-Dr Nisha Rani
1.3 Overdose assess- Dr Esam Hassan
1.4 Deliberate Self harm-DSH- Dr Esam Hassan
1.5 Post Myocardial Infarct Depression -Assess social History and capacity-
Dr Saravanan Balasubramanian/ Dr Swali Malanda
1.6 Post Myocardial Infarct Depression -Assess social History and capacity-Dr
Saravanan Balasubramanian/ Dr Swali Malanda
1.7 Antidepressants-Sexual side effects-Dr Amit Jain/ Dr Ravi Prakash
1.8 Antidepressants-Sexual side effects-Dr Amit Jain/ Dr Ravi Prakash
1.9 Lithium- Dr Nicholas Stafford
1.10 Treatment resistant Depression- Dr Esam Hassan
1.11 Electro Convulsive Therapy (ECT) Dr Animesh Tripathi
1.12 Bereavement- Dr Animesh Tripathi
1.13 Breaking bad news-Dr Animesh Tripathi
1.14 Bipolar Affective disorder- Dr Sepehr Hafizi
1.15 Bipolar Affective disorder- Dr Nicholas Stafford/ Dr Sepehr Hafizi
1.16 Psychosis Assess-Delusions and first rank symptoms- Dr Esam Hassan
1.17 Psychosis Assess-Delusional disorder- Dr Esam Hassan
1.18 Hallucinations- Dr Esam Hassan
1.19 Schizophrenia- Dr Simon Edgar/ Dr Rajeeve Parkianathan
1.20 Clozapine Rehabilitation-Dr Kumar Gandamaneni
1.21 Clozapine Rehabilitation-Dr Kumar Gandamaneni
1.22 AOT Assertive outreach team -Dr Kumar Gandamaneni
1.23 AOT Assertive outreach team –Dr Kumar Gandamaneni
1.24 Depot Antipsychotic-Dr Esam Hassan
1.25 Neuroleptic Malignant Syndrome (NMS) - Dr Animesh Tripathi
1.26 Generalised Anxiety- Dr Animesh Tripathi
1.27 Panic attacks Assess- Dr Animesh Tripathi
1.28 Panic Attacks Discuss management with mother- Dr Animesh Tripathi/
Dr Rajeeve Parkianathan,
1.29 Conversion Disorder-Dr Jothi Naidoo/Dr Rajeeve Parkianathan
1.30 Conversion Disorder-Dr Jothi Naidoo
1.31 Social phobia-Dr Esam Hassan
1.32 Obsessive Compulsive Disorder-OCD- Dr Animesh Tripathi

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1.33 Obsessive Compulsive Disorder-OCD- Dr Animesh Tripathi
1.34 Body dysmorphic disorder-Dr Esam Hassan
1.35 Post Traumatic Stress Disorder-PTSD-History- Dr Animesh Tripathi/ Dr
Rajeeve Parkianathan,
1.36 Somatoform pain disorder- Dr Animesh Tripathi
1.37 Hypochondriasis-Dr Manaan Kar-Ray
1.38 Hypochondriasis-Dr Manaan Kar-Ray
1.39 Dissociative Motor Disorder- Dr Jothi Naidoo
1.40 Dissociative motor disorder- Dr Jothi Naidoo
1.41 Head injury
1.42 Head injury
1.43 Haematemesis- Dr Swali Malanda
1.44 Haematemesis- Dr Swali Malanda
1.45 Temporal Lobe Epilepsy (TLE) and Pseudo seizures -Dr Nauman Khalil
1.46 Borderline Personality Disorder (BPD)

2. Old Age Psychiatry Dr Ehab Hegazi- 227
2.1 Elderly Psychosis- Assess psychopathology and do cognitive examination-
Dr Manjula Atmakur
2.2 Elderly Psychosis –Dr Manjula Atmakur
2.3 Behavioural and Psychological Symptoms of Dementia-Dr Mike Walker
2.4 BPSD-Collateral history-Dr Mike Walker
2.5 Wandering -risk assessment Dr Ashaye Kunle
2.6 Vascular Dementia-Dr Ehab Hegazi
2.7 Vascular Dementia-Dr Ehab Hegazi
2.8 Vascular Dementia-Dr Ehab Hegazi //Dr Rajeeve Parkianathan
2.9 Recurrent Depression-collateral history-Dr Manjula Atmakur/d/w Dr
Tom Dening
2.10 Recurrent Depression-Lithium Augmentation-Dr Manjula Atmakur d/w
Dr Tom Dening
2.11 Recurrent Depression-ECT-Dr Ehab Hegazi
2.12 Fronto Temporal Dementia
2.13 Frontal Lobe Tests
2.14 Lewy body Dementia - Dr Manjula Atmakur/ d/w Dr Tom Dening
2.15 Alzheimer’s Dementia history Dr Arun Jha
2.16 Alzheimer’s treatment Antidementia drugs Dr Arun Jha
2.17 Depression psychotic-Dr Ashaye Kunle
2.18 Elderly man- Indecent exposure -assess-Dr Raghavakurup
Radhakrisknan
2.19 Elderly man- Indecent exposure -discuss management with wife- Dr
Raghavakurup Radhakrisknan
2.20 Acute confusional state Delirium -Dr Champa Ballale
2.21 Acute confusional state Delirium -Dr Champa Balalle

3. Child and Adolescent Psychiatry Dr MS Thambirajah- 302
3.1 Early onset Psychosis-Assess- Dr MS Thambirajah
3.2 Early onset Psychosis-discuss with mother Dr MS Thambirajah
3.3 Early onset Psychosis-discuss with consultant Dr MS Thambirajah
3.4 Overdose-risk assessment (precipitator Rape)-Dr Ken Ma
3.5 Overdose-discuss management- Dr MS Thambirajah
3.6 Overdose-risk assessment (precipitator Bullying)- Dr Ken Ma
3.7 Overdose - discuss management-Dr Ken Ma/ Gosia Demetriou

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3.8 ADHD (Attention Deficit Hyperactivity Disorder)-Collateral History Dr Ken
Ma/ Dr Rajeeve Parkianathan
3.9 ADHD (Attention Deficit Hyperactivity Disorder)-Explain management to
father- Dr Ken Ma
3.10 Autism -collateral history-Dr Meera Roy
3.11 Autism -Explain diagnosis and management
3.12 Enuresis -Dr MS Thambirajah

4. Learning Disability Psychiatry Dr Nauman Khalil/ Dr Nilofar Ahmed-
353
4.1 Challenging behaviour in Learning Disability-Dr Ashok Roy/ Dr Jay
Thamizhirai
4.2 Downs’ Syndrome-Dementia vs. Depression-Dr Kamalaika Mukerji
4.3 Downs’ Syndrome-bruising-Dr Rajnish Attavar
4.4 Indecent exposure-Dr Asif Zia
4.5 Indecent exposure-Dr Asif Zia
4.6 Asperger’s Syndrome-Dr Paul Bradley/ Dr Rajeeve Parkianathan
4.7 Epilepsy-Dr Nauman Khalil
4.8 Arson-Dr Regi Alexander

5. Forensic Psychiatry Dr Piyal Sen, Dr MS Thambirajah- 387
5.1 Indecent exposure-risk assessment-Dr Ravi Prakash
5.2 Morbid Jealousy – Assess - Dr Ravi Prakash
5.3 Morbid Jealousy - Discuss with wife- Dr Ravi Prakash
5.4 Morbid Jealousy -Discuss with consultant
5.5 Morbid Jealousy - displacement
5.6 Arson-Dr Regi Alexander
5.7 Erotomania - Assess -Dr Denzil Mitchell
5.8 Erotomania - Discuss management with nurse-Dr Denzil Mitchell
5.9 Erotomania - Discuss management with consultant-Dr Denzil Mitchell/
Gosia Demetriou
5.10 Violence Risk Assessment
5.11 Paedophile
5.12 Assault on the ward
5.13 Assault on the ward

6. Addictions psychiatry Dr Zahoor Syed- 439
6.1 Opiate history -Dr Zahoor Syed
6.2 Delirium Tremens -Assess psychopathology-Dr Christos Koumistidis
6.3 Delirium Tremens - Discuss management with orthopaedic nurse-Dr
Christos Koumistidis
6.4 Alcohol Dependence - Dr Zahoor Syed
6.5 Methadone in pregnancy - Professor Fabrizio Schifano
6.6 Methadone in pregnancy - Professor Fabrizio Schifano
6.7 Alcohol and Depression - Professor Fabrizio Schifano
6.8 Cannabis and Schizophrenia - Professor Fabrizio Schifano

7. Psychotherapy Dr Dinesh Sinha/ Dr Furhan Iqbal- 475
7.1 Footballer- Cognitive distortions-assess- Dr Dinesh Sinha
7.2 Footballer -Cognitive distortions- discuss -Dr Dinesh Sinha
7.3 Psychodynamic psychotherapy- Dr Dinesh Sinha
7.4 Psychoanalytical psychotherapy-Dr Dinesh Sinha

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7.5 Cognitive behavioural therapy (CBT)- Dr Furhan Iqbal
7.6 Interpersonal psychotherapy (IPT)-Dr Franco Orsucci
7.7 Systematic desensitization-Dr Furhan Iqbal
7.8 Exposure and response prevention(ERP)-Dr Furhan Iqbal / Dr Franco
Orsucci
7.9 Psychotherapy-transference- Dr Furhan Iqbal
7.10 Borderline Personality Disorder
7.11 Other Personality Disorders
7.12 Dialectical behavioural therapy (DBT)- Dr Furhan Iqbal

8. Eating Disorder Dr MS Thambirajah, Dr Rajini Rajeswaran- 524
8.1 Anorexia Nervosa - History taking -Dr Tony Jaffa
8.2 Anorexia Nervosa-Discuss with mother-Dr Tony Jaffa
8.3 Anorexia Nervosa - Discuss management with nurse on medical ward
8.4 Anorexia Nervosa-assess personal and family history
8.5 Anorexia Nervosa-discuss aetiological factors and psychological
management with nurse
8.6 Refeeding syndrome-discuss management with nurse
8.7 Bulimia Nervosa- Assess for prognostic factors

9. Perinatal Psychiatry Dr Theresa Xeurub, Dr Jothi Naidoo, Dr Rajini
Rajeswaran- 559
9.1 Puerperal illness-Postnatal Depression
9.2 Puerperal illness-Postnatal Depression- Gosia Demetriou
9.3 Puerperal Psychosis- Dr Humphrey Enow
9.4 Puerperal Psychosis- Gosia Demetriou

10. Examinations- 583
10.1 EPSES- Extra pyramidal side effects- Dr Ruqayyah Zafar
Cognitive examination
10.2 Akathisia- Dr Ruqayyah Zafar
10.3 Thyroid examination- Dr Chris Robak
10.4 Frontal Lobe tests
10.5 Mini mental State Examination
10.6 Fundoscopy-Dr Chris Robak Neurological examination
10.7 Alcohol Dependence Upper limbs
10.8 Alcohol Dependence-Cerebellar examination Lower limbs
10.9 Korsakoff syndrome
10.10 Respiratory examination
10.11 Cardiovascular examination
10.12 Examination of Cranial nerves
10.13 Examination of upper limb motor and sensory system
10.14 Physical Examinations
10.15 Opiate withdrawal history
10.16 Record a 12 Lead ECG
10.17 Interpretation of ECG
10.18 Interpretation of ECG
10.19 Management of Neuroleptic Malignant Syndrome NMS
10.20 Management of Serotonergic Syndrome
10.21 Parietal lobe tests
10.22 Temporal lobe tests
Index 633

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CONTRIBUTORS

Dr Nilofar Ahmed, MBBS, Staff Grade Learning Disability, Milton Keynes, UK
Dr Regi Alexander, MBBS, MRCPsych, Consultant Learning Disability
Psychiatrist, MRCPsych, UK
Dr Manjula Atmakur MBBS, MRCPsych, ST5 in Old Age Psychiatry,
Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr Rajnish Attavar MBBS, MRCPsych Consultant Learning disability
Psychiatrist, Oxfordshire ,UK
Dr Champa Ballale, MBBS, MRCPsych, Consultant Old Age Psychiatrist,
Kettering, UK
Dr Saravanan Balasubramanian MBBS DPM DNB MD Phd Consultant
General Adult Psychiatrist, Cambridgeshire and Peterborough NHS
Foundation Trust, UK
Dr Paul Bradley, MBBS BSc MRCPsych, ST6 in Learning Disability Psychiatry,
Cambridgeshire and Peterborough NHS Foundation Trust, UK
Gosia Demetriou, Social Worker, Luton, UK
Dr Tom Dening MBBS, MRCPsych, Consultant Old age psychiatrist ,
Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr Simon Edgar, MB ChB MRCPsych Consultant General Adult Psychiatrist
and Clinical Director, Milton Keynes, UK
Dr Sepehr Hafizi,MBBS, MRCPsych, Consultant General Adult Psychiatrist,
Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr Essam Hassan, MBBS, MRCPsych, Consultant General Adult Psychiatrist,
Milton Keynes, UK
Dr Ehab Hegazi, MBBS, MRCPsych, MSc Consultant Old Age Psychiatrists,
Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr Furhan Iqbal MBBS, MRCPsych, Consultant Psychotherapist
Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr Tony Jaffa, MBBS, MRCPsych Consultant Child and Adolescent
Psychiatrist, Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr Amit Jain MBBS, MRCPsych Staff Grade Herefordshire
Dr Arun Jha, Consultant Old Age Psychiatrist, Hertfordshire, UK
Dr Manaan Kar-Ray MBBS, MRCPsych, MSc, MS Consultant General Adult
Psychiatrist, Clinical director, Cambridgeshire and Peterborough NHS
Foundation Trust, UK
Dr Nauman Khalil, MBBS, MRCPsych, Consultant Learning Disability
Psychiatrist, Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr Christos Koumistidis, MBBS, MSc, MRCPsych, PhD, Consultant Addictions
Psychiatrist, Hertfordshire, UK
Dr Ashaye Kunle, MBBS, MRCPsych Consultant Old Age Psychiatrist,
Hertfordshire, UK
Dr Ken Ma, MBBS, MRCPsych Consultant Child and Adolescent Psychiatrist,
Coventry and Warwickshire, UK
Dr Nigel Lester, MBBS, MRCPsych Consultant Psychiatrist, Associate Clinical
Director Camden and Islington NHS Foundation Trust
Dr Franco Orsucci MBBS, DPsych MD Consultant Psychiatrist in
Rehabilitation & Recovery Cambridgeshire and Peterborough NHS Foundation
Trust, UK ,(Visiting Professor, Research Department of Psychology and
Linguistics, University College London)
Dr Denzil Mitchell, MBBS, MRCPsych Consultant General Adult Psychiatrist,

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Southampton, UK
Dr Swali Malanda BSc MB ChB MSc MA MRCPsych Consultant General Adult
33Psychiatrist, Milton Keynes, UK
Dr Jothi Naidoo, MBBS, MRCPsych ST5 in General Adult Psychiatry,
Southampton, UK
Dr Rajeeve Parkianathan BSc MBBS MSc CT3 Psychiatry, Cambridge and
Peterborough NHS Foundation Trust.
Dr Ravi Prakash, CT3 in General Adult Psychiatry, Peterborough and
Cambridge, UK
Dr Raghavakurup Radhakrisknan DPM(NIMHANS), DNB(Psychiatry),
MRCPsych Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr Rajini Rajeswaran, MBBS, MRCPsych London, UK
Dr Nisha Rani MBBS, MRCPsych ST4 General Adult Psychiatry
Cambridgeshire and Peterborough NHS Foundation Trust, UK
Ferdinand Rensburg, BOJ, London, UK
Dr Chris Robak, MBBS MRCGP, Cambridgeshire and Peterborough NHS
Foundation Trust, UK
Dr Ashok Roy, MBBS, MRCPsych Consultant Learning Disability Psychiatrist,
Birmingham, UK
Dr Meera Roy, Consultant Learning Disability Psychiatrist, Birmingham, UK
Miss Mary P Ryan Bsc (hons), Consultant Medical Devices & Healthcare,
London, UK.
Professor Fabrizio Schifano, Consultant Addictions Psychiatrist, MD,
MRCPsych, Dip Psychiatry, Dip Clin Pharmacology Hertfordshire, UK
Dr Piyal Sen., MBBS, DPM, FRCPsych, DFP Consultant Forensic Psychiatrist,
Northampton, UK
Dr Dinesh Sinha, MBBS MRCPsych MSc MBA, Consultant Psychotherapy
Psychiatrist, Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr Nicholas Stafford, MBBS, MRCPsych Consultant General Adult
Psychiatrist, London, UK
Dr Zahoor Syed, MBBS, MRCPsych Consultant General Adult and Substance
misuse Psychiatrist, Cambridgeshire and Peterborough NHS Foundation
Trust, UK
Dr MS Thambirajah, MBBS, MRCPsych Consultant Child and Adolescent
Psychiatrist, Birmingham, UK
Dr Jay Thamizhirai Staff Grade, Cambridgeshire and Peterborough NHS
Foundation Trust, UK
Dr Animesh Tripathi, MBBS, MRCPsych ST5 in General Adult Psychiatry,
Hertfordshire, UK
Dr Mike Walker, MBBS, MRCPsych Consultant Old Age Psychiatrist,
Hertfordshire, UK
Dr Theresa Xeurub, MBBS, MRCPsych Consultant Perinatal Psychiatrist,
Coventry and Warwickshire, UK
Dr Rugia Zafar GP ST2 Cambridgeshire and Peterborough NHS Foundation
Trust, UK
Dr Asif Zia, MBBS, Mrcpsych, MD Consultant Learning Disability Psychiatrist,
Peterborough and Cambridge, UK

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