revision ques

1).All of the following constitute bipolar disorder I except

a) pts having both major depressive and manic episodes

b) pts having both manic and hypomanic episode

c) pts having multiple major depressive episodes only

d) pts having multiple manic episodes only

2).Interpersonal therapy for depression was developed by

a) Aaron Beck

b) Gerald Klerman

c) Sigmund Freud

d) Emil Kraepelin

3).Which of the following is not a Schneiderian first rank symptom of schizophrenia

a) Sudden delusional idea

b) Thought broadcasting

c) Audible thoughts

d) Delusional perception

4).Which of the following movement disorder is delayed effect of antipsychotics

a) Akathasia

b) Dystonia

c) Parkinsonism

d) tardive dyskinesia

5). Which of the following is not a selective serotonin and norepinephrine reuptake inhibitors

a) Milnacipran

b) Duloxetine

c) Escitalopram

d) Venlafaxine

6). All of the following are common side effects of valproate except

a) Thrombocytopenia

b) hair loss

c) tremor

d) weight gain

7). Which of the following is most commonly used in the adjuvant treatment of depression?

a) Progesterone

b) Cortisol

c) ACTH

d) Levothyroxine

8). A patient reports that she has become depressed with the onset of winter every year for the past

6 years. Which of the following treatments is most likely to be helpful?

a) Phototherapy

b) Biofeedback

c) Electroconvulsive therapy

d) Benzodiazepines

9). All of the following are side effects of methylphenidate except

a) Tics

b) cardiac conduction defects

c) weight loss

d) headache

10). Which of the following is not a mature defence mechanism

a) Sublimation

b) Intellectualization

c) Asceticism

d) Humour

11). Oniomania is

a) compulsive buying

b) internet compulsion

c) mobile phone compulsion

d) compulsive sexual behaviour

12). Mild mental retardation as per WHO is defined as

a) IQ: 70 to 89

b) 50 to 69

c) 35 to 49

d) 20 to 34

13). All of the following neuroendocrine changes are seen in anorexia nervosa except

a) decreased plasma cortisol lecel

b) decreased Luteinizing hormone

c) decreased triiodothyronine

d) decreased somatomedin

14). Unconscious unintentional production of symptoms occurs in following disorders except

a) Conversion disorder

b) Somatization disorder

c) Somatoform disorder

d) Factitious disorder

15). Approximate answers are characteristically seen in

a) cotard’s syndrome

b) ganser’s syndrome

c) Capgras syndrome

d) Clérambault's syndrome

Solutions

1.All of the following constitute bipolar disorder I except

a) pts having both major depressive and manic episodes

b) pts having both manic and hypomanic episode

c) pts having multiple major depressive episodes only

d) pts having multiple manic episodes only

Ans). C).pts having multiple major depressive episodes only

· Patients afflicted with only major depressive episodes are said to have major depressive disorder or unipolar depression.

· Patients with both manic and depressive episodes or patients with manic episodes alone are said to have bipolar disorder. The terms unipolar mania and pure mania are sometimes used for patients who are bipolar, but who do not have depressive episodes.

2).Interpersonal therapy for depression was developed by

a) Aaron Beck

b) Gerald Klerman

c) Sigmund Freud

d) Emil Kraepelin

Ans). B) Gerald Klerman

· Aaron Beck: developed cognitive therapy which focuses on the cognitive distortions.

· Gerald Klerman: developed interpersonal therapy which focuses on current interpersonal problems.

· Sigmund freud: Founder of Classic Psychoanalysis

· Emil Kraeplin: Coined the term dementia precox [change in cognition (dementia) and early onset (precox)]. Dementia precox were described as having a long-term deteriorating course and the clinical symptoms of hallucinations and delusions.

3).Which of the following is not a Schneiderian first rank symptom of schizophrenia

a) Sudden delusional idea

b) Thought broadcasting

c) Audible thoughts

d) Delusional perception

Ans). A) Sudden delusional idea

· Kurt Schneider identified a set of phenomena that he considered were strongly indicative of schizophrenia in the absence of overt brain disease.

· These symptoms, have become known as first-rank symptoms.

· Schneider did not consider that the diagnosis could be made simply on the presence of one such symptom

· Eleven Schneiderian first rank symptoms are

1. Voices commenting: A hallucinatory voice commenting on one’s actions in third person

2. Voices discussing or arguing: Hallucinations of two or more voices discussing or arguing about oneself

3. Audible thoughts: Hearing one’s own thoughts aloud

4. Thought insertion: The insertion by, an alien source, of thoughts that are experienced as not being one’s own

5. Thought withdrawal: The withdrawal of thoughts from the mind by an alien agency.

6. Thought broadcast: The experience that one’s own thought are broadcast so as to be accessible to others

7. Made will: The experience of one’s will being controlled by an alien influence

8. Made acts: The experience that acts executed by one’s own body are the actions of an alien agency, rather than oneself.

9. Made affect: The experience of emotion that is not one’s own, attributed to an alien influence.

10. Somatic passivity: Bodily function is controlled by an alien influence

11. Delusional perception: Theattribution of an totally unwarranted meaning to a normal perception.

4) Which of the following movement disorder is delayed effect of antipsychotics

a) Akathasia

b) Dystonia

c) Parkinsonism

d) tardive dyskinesia

Ans). D) Tardive dyskinesia

· Tardive dyskinesia is a delayed effect of antipsychotics

· rarely occurs until after 6 months of treatment

· disorder consists of abnormal, involuntary, irregular choreoathetoid movements of the muscles of the head, limbs, and trunk.

· Dyskinesia is exacerbated by stress and disappears during sleep.

· Women, children, patients who are more than 50 years of age, and patients with brain damage or mood disorders are at higher risk.

· The atypical antipsychotics are associated with less tardive dyskinesia than the older antipsychotics. Clozapine is the only antipsychotic to have minimal risk of tardive dyskinesia, and can even help improve preexisting symptoms of tardive dyskinesia.

5). Which of the following is not a selective serotonin and norepinephrine reuptake inhibitors

a) Milnacipran

b) Duloxetine

c) Escitalopram

d) Venlafaxine

Ans) c) Escitalopram

· Escitalopram is a selective serotonin reuptake inhibitor rather than selective serotonin and norepinephrine reuptake inhibitors

· Various selective serotonin reuptake inhibitors are fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram and escitalopram.

· Various selective serotonin and norepinephrine reuptake inhibitors are duloxetine, venlafaxine, desvenlaflaxine succinate, milnacipran and sibutramine.

6). All of the following are common side effects of valproate except

a) Thrombocytopenia

b) hair loss

c) tremor

d) weight gain

Ans). A) Thrombocytopenia

· Side effects of valproate:

o Common: GI irritation, Nausea, Sedation, Tremor, Weight gain, Hair loss

o Uncommon: Vomiting, Diarrhea, Ataxia, Dysarthria, Persistent elevation of hepatic transaminases

o Rare: Fatal hepatotoxicity (primarily in pediatric patients), Reversible thrombocytopenia, Platelet dysfunction, Coagulation disturbances, Edema
Hemorrhagic pancreatitis, Agranulocytosis, Encephalopathy and coma, Respiratory muscle weakness and respiratory failure

7). Which of the following is most commonly used in the adjuvant treatment of depression?

a) Progesterone

b) Cortisol

c) ACTH

d) Levothyroxine

Ans). D) Levothyroxine

· Augmentation strategies are helpful with patients who have gained some benefit from the initial treatment but who have not achieved remission.

· The best-documented augmentation strategies involve lithium or thyroid hormone.

· liothyronine use converts about 50 percent of antidepressant nonresponders to responders.

8). A patient reports that she has become depressed with the onset of winter every year for the past 6 years. Which of the following treatments is most likely to be helpful?

a) Phototherapy

b) Biofeedback

c) Electroconvulsive therapy

d) Benzodiazepines

Ans) a) Phototherapy

· Patients with a seasonal pattern to their mood disorders tend to experience depressive episodes during a particular season, most commonly winter.

· The pattern has become known as seasonal affective disorder (SAD)

· DSM IV have seasonal pattern specifier defined as

o There has been a regular temporal relationship between the onset of major depressive episodes in bipolar I or bipolar II disorder or major depressive disorder, recurrent, and a particular time of the year (e.g., regular appearance of the major depressive episode in the fall or winter).

o Full remissions (or a change from depression to mania or hypomania) also occur at a characteristic time of the year (e.g., depression disappears in the spring).

• In the last 2 years, two major depressive episodes have occurred that demonstrate the temporal seasonal relationships defined in Criteria A and B, and no nonseasonal major depressive episodes have occurred during that same period.
• Seasonal major depressive episodes substantially outnumber nonseasonal major depressive episodes that may have occurred over the individual's lifetime.

· patients with SAD are likely to respond to treatment with light therapy(phototherapy)

· Other major indication for phototherapy may be in sleep disorders.

o has been used to decrease the irritability and diminished functioning associated with shift work.

9). All of the following are side effects of methylphenidate except

a) tics

b) cardiac conduction defects

c) weight loss

d) headache

Ans) b) cardiac conduction defects

· most common adverse effects include headaches, stomachaches, nausea, and insomnia.

· Can exacerbate tics, so caution in children with history of tics

· Association with growth suppression.

10). Which of the following is not a mature defence mechanism

a) Sublimation

b) Intellectualization

c) Asceticism

d) Humour

Ans). B) Intellectualisation

· Mature defences

o Altruism: Using constructive and instinctually gratifying service to others to undergo a vicarious experience

o Anticipation: Realistically anticipating or planning for future inner discomfort.

o Asceticism: Eliminating the pleasurable effects of experiences.

o Humor: Using comedy to overtly express feelings and thoughts without personal discomfort or immobilization and without producing an unpleasant effect on others.

o Sublimation: Achieving impulse gratification and the retention of goals but altering a socially objectionable aim or object to a socially acceptable one.

o Suppression: Consciously or semiconsciously postponing attention to a conscious impulse or conflict.

· Intellectualization is a neurotic defence mechanism

o Excessively using intellectual processes to avoid affective expression or experience.

11). Oniomania is

a) compulsive buying

b) internet compulsion

c) mobile phone compulsion

d) compulsive sexual behaviour

Ans) a) compulsive buying

12). Mild mental retardation as per WHO is defined as

a) IQ: 70 to 89

b) 50 to 69

c) 35 to 49

d) 20 to 34

Ans) b) 50 to 69

Category	Mental retardation	IQ range	Mental age (years)
F70	Mild	50 to 69	9 to under 12
F71	Moderate	35 to 49	6 to under 9
F72	Severe	20 to 34	3 to under 6
F73	Profound	Below 20	Less than 3

13). All of the following neuroendocrine changes are seen in anorexia nervosa except

a) decreased plasma cortisol level

b) decreased Luteinizing hormone

c) decreased triiodothyronine

d) decreased somatomedin

e) Ans) a) decreased plasma cortisol level

· Plasma cortisol levels are increased in anorexia nervosa.

Hormone	Anorexia Nervosa
Corticotropin-releasing hormone (CRH)	Increased
Plasma cortisol levels	Mildly increased
Diurnal cortisol difference	Blunted
Luteinizing hormone (LH)	Decreased, prepubertal pattern
Follicle-stimulating hormone (FSH)	Decreased, prepubertal pattern
Growth hormone (GH)	Impaired regulation Increased basal levels and limited response to pharmacological probes
Somatomedin C	Decreased
Thyroxine (T4)	Normal or slightly decreased
Triiodothyronine (T3)	Mildly decreased
Reverse T3	Mildly increased
Thyrotropin-stimulating hormone (TSH)	Normal
TSH response to thyrotropin-releasing hormone (TRH)	Delayed or blunted
Insulin	Delayed release
C-peptide	Decreased
Vasopressin	Secretion uncoupled from osmotic challenge
Serotonin	Increased function with weight restoration
Norepinephrine	Reduced turnover
Dopamine	Blunted response to pharmacological probes

14). Unconscious unintentional production of symptoms occurs in following disorders except

a) Conversion disorder

b) Somatization disorder

c) Somatoform disorder

d) Factitious disorder

Ans) d) Factitious disorder

· Conscious intentional production of physical or psychological symptoms is present in factitious disorder

· Motive in factitious disorder is to assume sick role whereas external incentives are motive in malingering

15). Approximate answers are characteristically seen in

a) cotard’s syndrome

b) ganser’s syndrome

c) Capgras syndrome

d) Clérambault's syndrome

Ans) b) ganser’s syndrome

· Ganser’s syndrome

o giving of approximate answers (paralogia) together with a clouding of consciousness, and frequently accompanied by hallucinations

o symptom of passing over (vorbeigehen) the correct answer for a related, but incorrect one, is the hallmark of Ganser syndrome

· Cotard’s syndrome( nilhistic delusional disorder)

o Patients with the syndrome complain of having lost not only possessions, status, and strength, but also their heart, blood, and intestines. The world beyond them is reduced to nothingness.

o This relatively rare syndrome is usually considered a precursor to a schizophrenic or depressive episode.

• Capgras syndrome

o The delusion in Capgras syndrome is the belief that a familiar person has been replaced by an impostor.

· Clérambault's syndrome

o patient has the delusional conviction that another person, usually of higher status, is in love with him or her.