NOV 2011 PSYCHIATRY, SOLUTIONS

PSYCHIATRY

198. Panic disorder involves all of the following except?
A. GABA
B. Serotinin
C. CCK-PZ
D. Glutamate

Ans) Glutamate

The major neurotransmitter systems that have been implicated are those for norepinephrine (presynaptic alpha₂-adrenergic receptors, serotonin (postsynaptic serotonin hypersensitivity), and GABA (attenuation of local inhibitory GABAergic transmission).

CCK is an anxiogenic neuropeptide present in the gastrointestinal (GI) tract, as well as the brain, that has recently been suggested as a neural substrate for human anxiety.

GLUTAMATE AND DOPAMINE IS IMPLICATED IN SCHIZOPHRENIA NOT ANXIETY DISORDERS.

199. Type D personality was recently found to risk for?
A. Coronary artery disease
B. Depression
C. Personality disorder
D. Schizophrenia

ANS) CORONARY ARTERY DISEASE

type-D personality was a significant predictor of long-term mortality in patients with established CHD, independently of biomedical risk factors.

letter D stands for 'distressed'.Individuals with a Type D personality have the tendency to experience increased negative emotions across time and situations and tend not to share these emotions with others, because of fear of rejection or disapproval.

Type C: related to cancer, DIFFICULTY EXPRESSING NEGATIVE SYMPTOMS

Type H personality, also called hardy personality; Actually seem to thrive on stress rather than letting stress wear them; Given by Suzanne Kossaba, Type H personality is characterised by sense of commitment, complete sense of control over their life and correct interpretation of things going around

Type A and Type B given by Friedman and Rosenman

Type A behavior is expressed in three major symptoms: free-floating hostility, which can be triggered by even minor incidents; time urgency and impatience, which causes irritation andexasperation; and a competitive drive, which causes stress and an achievement-driven mentality.

Type A behavior doubles the risk of coronary heart disease in otherwise healthy individuals.

People with Type B personalities are generally patient, relaxed, easy-going, and at times lacking an overriding sense of urgency.

REMEMBER BOTH TYPE A AND TYPE D RELATED TO CORONARY ARTERY DISEASE

200. Which of the following is not a somatoform disorder?
A. Somatization Disorder
B. Fibromyalgia
C. Chronic fatigue syndrome
D. Irritable bowel syndrome

Ans) b) FIBROMYALGIA

Somatoform disorder consists of

1. Somatisation disorder

2.Hypochondriasis

3.Conversion disorder

4.Body dysmorphic disorder

4. Somatoform pain disorder

5. Undiffrentiaten pain disorder

Undifferentiated somatoform disorders, which include medically unexplained symptoms, chronic fatigue syndrome, irritable bowel syndrome and noncardiac chest pain. Group

F45.30 Heart and cardiovascular system

Includes: cardiac neurosis, neurocirculatory asthenia, and Da Costa's syndrome.

F45.31 Upper gastrointestinal tract

Includes: psychogenic aerophagy, hiccough, and gastric neurosis.

F45.32 Lower gastrointestinal tract

Includes: psychogenic irritable bowel syndrome, psychogenic diarrhea, and gas syndrome.

F45.33 Respiratory system

Includes: hyperventilation.

F45.34 Genitourinary system

Includes: psychogenic increase of frequency of micturition and dysuria.

201. Counter transference is?
A. Patient feeling towards doctor
B. Doctors feeling towards patient
C. Defense mechanism
D. Energy channeled from body to brain

Ans)Doctors feeling towards patient

a)is transference

b) is countertransference

202. A 30 yrs old executive complains of excessive sleepiness in
daytime and lack of sleep at night. Once at a party his friends
noticed of his sudden fall due to sleep. He may have
A. Precipitation of seizures on prolonged awake
B. Night mares & Hallucination at sleep awake transition
C. Snoring & visible apnea spell
D. Nocturnal leg pain / restlessness

Ans)Night mares & Hallucination at sleep awake transition

Excessive sleepiness in daytime with sleep attacks along with cataplexy( sudden loss of muscle tone) is characteristic of narcolepsy

CRITERIA FOR NARCOLEPSY

1. Irresistible attacks of refreshing sleep that occur daily over at least 3 months.
2. The presence of one or both of the following:
   1. cataplexy (i.e., brief episodes of sudden bilateral loss of muscle tone, most often in association with intense emotion)
   2. recurrent intrusions of elements of rapid eye movement (REM) sleep into the transition between sleep and wakefulness, as manifested by either hypnopompic or hypnagogic hallucinations or sleep paralysis at the beginning or end of sleep episodes

203. Somatic passivity is seen in
A. Paranoid Schizophrenia
B. Hypochondriac disorder
C. Body dimorphic disorder
D. Depression

Ans) paranoid schizophrenia

Somatic passivity is a scheneider first rank symptom and is characteristic of schizophrenia.

• Audible thoughts (thought echo)
• Voices heard arguing
• Voices heard commenting on one's actions
• (delusions of control) (made affect, made volition, made volition)
• Somatic passivity
• Thought withdrawal
• Thought insertion - Thoughts are ascribed to other people who intrude their thoughts upon the patient
• Thought broadcasting (also called thought diffusion)
• Delusional perception (i.e. taking a normal sensory perception to mean a bizarre situation such as taking seeing an aeroplane as indicating the patient should be the next president)