Revise FMGE 2023 syllabus with Kings

Revise FMGE 2023 syllabus with Kings

Revise FMGE 2023 syllabus with Kings

  As the National Board of Examinations in Medical Sciences (NBEMS) has announced that the Foreign Medical Graduate Examination (FMGE 2023) will be held on July 30, you must be nervous, right? We advise you to prepare for the exam by joining us. You still have time on your hands. FMGE classes are going on fervently at Kings right now. We have invited Dr. Mohan Sunil Kumar for Psychiatry classes for our FMGE students. Learn about ‘Bipolar & Double Depression’ topic with us!

              Types of Bipolar

Bipolar 1 Bipolar 2
Repeated episodes of:
M+ Hy
Hypomania + Depression
Mania: Never goes beyond Hypo
Depression: Any intensity

Even if there is single episode of Mania --> Bipolar 1

Hypomania Mania
Symptoms for >4 days
Prolixity of speech
Never need admission
Seen in: Bipolar 1, 2
> 1 week
Flight of ideas
Moderate to Severe
Need admission
Seen in: Bipolar 1 only

1 week: Mania
2 week: Depression
3 week: Anti-depressants effect
4 days: Hypomania

Dysthymia Cyclothymia Chronic major depression
PERSISTENT MOOD DISORDER: 2 years Cycle of active & depressive (minimal level) DOC: Divalproate / Valproate Chronically depressed for >2 years


A dysthymia patient going onto develop a full flexed depression

Rapid Cycling Disorder:

  Type of Bipolar disorder
  >/=4 episodes/year (irrespective of type)

Risk factors:

  • Female Bipolar patients (High risk)
  • Hypothyroid
  • Substance use
  • Anti-Depressant w/o mood developers/stabilizers
  • Bipolar type 2
  • Cyclothymia patients
  • Hyperthymic personality

  • DOC: Divalproate / Valproate

    Lithium doesn’t work

    Acute Mania:

    TOC: Anti-Psychotics

    Mood stabilizers: Mainly used for Maintenance /


    Carb + Valproate -->act in manic phase

    Absolutelet C/I in pregnancy: Carbamazepine, Valproate

    Can be given, but avoided for best: Lithium

    Gold standard mood stabilizer: Lithium

     Long term use can cause --> hypothyroidism

    Can also cause: Diabetes Insipidus kind of Nephropathy

     Tremors: Both Fine (Benign) and Coarse (Malignant)

    Mx of bening tremors → Beta blockers, THP

    Coarse tremors → indicate Lithium toxicity

    Lithium toxicity:

  • Coarse tremors
  • Myoclonic jerks
  • Nystagmus
  • Ataxia
  • Delirium
  • Incontinence
  • Seizures
  • COMA
  • Death

  • Management of Bipolar disorder:

    Psychological intervention → IPSRT (Inter Personal Social Rhythm Therapy)