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  • Question 1 - Which cognitive function is the Stroop test intended to detect difficulties with? ...

    Incorrect

    • Which cognitive function is the Stroop test intended to detect difficulties with?

      Your Answer: Learning ability

      Correct Answer: Response inhibition

      Explanation:

      The Stroop test involves presenting words to the subject that spell a color but are written in a different color. The subject is required to identify the color of the text as quickly as possible, rather than reading the word itself. This test assesses the subject’s ability to make an appropriate response when presented with conflicting signals. This ability is believed to originate from the anterior cingulate, which is located between the left and right frontal lobes.

      Frontal Lobe Tests

      The frontal lobe is responsible for a variety of cognitive functions, including initiation, abstraction, problem-solving, decision-making, response inhibition, and set shifting. Different tests can be used to assess these functions.

      Verbal and categorical fluency tests can be used to assess initiation. These tests require individuals to generate as many words of items as possible within a specific category of starting letter.

      Proverbs, similarities, and cognitive estimates are examples of tests that can be used to assess abstraction. These tests require individuals to identify similarities between objects of concepts, make judgments based on incomplete information, of estimate quantities.

      Tower of London, Cambridge stockings, and gambling tasks are examples of tests that can be used to assess problem-solving and decision-making. These tests require individuals to plan and execute a sequence of actions to achieve a goal of make decisions based on uncertain outcomes.

      Alternating sequences, go-no-go test, Luria motor test, trail making test, Wisconsin card sorting test, and Stroop test are examples of tests that can be used to assess response inhibition and set shifting. These tests require individuals to inhibit prepotent responses, switch between tasks of mental sets, of ignore irrelevant information.

      Overall, these tests can provide valuable information about an individual’s frontal lobe functioning and can be used to diagnose and treat various neurological and psychiatric conditions.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 2 - A 25 year old woman perceives a silhouette of a cat in the...

    Incorrect

    • A 25 year old woman perceives a silhouette of a cat in the dim light, and believes it is a dangerous creature ready to pounce on her. What is the term used to describe this experience?

      Your Answer: A pseudo hallucination

      Correct Answer: An illusion

      Explanation:

      An illusion is when a person’s perception is altered by the shadow cast from a tree. On the other hand, hallucinations happen when there is no stimulus present. It’s important to note that a delusion is a belief, not a perception.

      Altered Perceptual Experiences

      Disorders of perception can be categorized into sensory distortions and sensory deceptions. Sensory distortions involve changes in the intensity, spatial form, of quality of a perception. Examples include hyperaesthesia, hyperacusis, and micropsia. Sensory deceptions, on the other hand, involve new perceptions that are not based on any external stimulus. These include illusions and hallucinations.

      Illusions are altered perceptions of a stimulus, while hallucinations are perceptions in the absence of a stimulus. Completion illusions, affect illusions, and pareidolic illusions are examples of illusions. Auditory, visual, gustatory, olfactory, and tactile hallucinations are different types of hallucinations. Pseudohallucinations are involuntary and vivid sensory experiences that are interpreted in a non-morbid way. They are different from true hallucinations in that the individual is able to recognize that the experience is an internally generated event.

      Understanding the different types of altered perceptual experiences is important in the diagnosis and treatment of various mental health conditions.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 3 - What factor played a significant role in the shift of psychiatric influence from...

    Incorrect

    • What factor played a significant role in the shift of psychiatric influence from Europe to the United States during the 20th century?

      Your Answer:

      Correct Answer: Second World War

      Explanation:

      The ascent of the National Socialist Party during the 1930s had a negative effect on psychiatry in Germany, which was previously a leading force in European psychiatry. As a result of the Second World War, numerous skilled scientists and psychiatrists fled Germany and sought refuge in the United States. Their contributions were instrumental in establishing the US as the dominant force in both academic and clinical psychiatry.

    • This question is part of the following fields:

      • History Of Psychiatry
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  • Question 4 - How can secondary delusion be best described? ...

    Incorrect

    • How can secondary delusion be best described?

      Your Answer:

      Correct Answer: An elderly woman believes her neighbours are spying on her. She believes this because the TV told her so

      Explanation:

      The belief that her neighbors are spying on her, which was triggered by the TV, is likely a secondary delusion stemming from a pathological encounter such as a hallucination of a referential experience.

      Borderline Learning Disability

      Borderline learning disability is a term used to describe individuals with an IQ between 70-85. This category is not officially recognized as a diagnosis by the ICD-11. It is estimated that approximately 15% of the population falls within this range (Chaplin, 2005). Unlike mild learning disability, borderline learning disability is not typically associated with deficits in adaptive functioning, such as grooming, dressing, safety, of money management.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 5 - What is a true statement about the Brief Psychosis Rating Scale (BPRS)? ...

    Incorrect

    • What is a true statement about the Brief Psychosis Rating Scale (BPRS)?

      Your Answer:

      Correct Answer: It can be used for patients who are unable to read of write

      Explanation:

      Brief Psychiatric Rating Scale: An Instrument for Evaluating Psychopathology in Psychiatric Patients

      The Brief Psychiatric Rating Scale (BPRS) is a widely used tool for assessing psychopathology in psychiatric patients. It was developed in the 1960s by Overall and Gorham, using factor analysis, to evaluate the severity of schizophrenic states and provide clinicians with a quick way to assess patient change. Initially, the BPRS consisted of 16 items, but two more items were added to create the standard 18-item version. Later, an expanded 24-item version was introduced to measure additional aspects of schizophrenia, such as bizarre behavior, self-neglect, suicidality, elevated mood, motor hyperactivity, and distractibility.

      The BPRS is rated by a clinician, who assesses each item on a 7-point scale of severity. Higher scores indicate greater severity of symptoms. The assessment relies on a combination of self-report and observation. Several variables are rated based on observation, while the rest are assessed through a short interview. The total score severity, using the 18-item version, has been estimated as mildly ill (31), moderately ill (41), and markedly ill (53). The administration of the BPRS can take 10-40 minutes, and versions have been validated for use in both children and older adults. As it is clinician-administered, the BPRS does not require patients to be able to read of write.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 6 - You are asked to evaluate a woman on a general medical ward who...

    Incorrect

    • You are asked to evaluate a woman on a general medical ward who has been admitted for a chest infection. The medical team suspects that she may be experiencing depression and has initiated treatment. You notice that her QTc interval measures at 490 msec and are concerned about the medications she is taking. If she were to be prescribed any of the following medications, which one would be the most likely culprit for her prolonged QTc?

      Your Answer:

      Correct Answer: Erythromycin

      Explanation:

      Amantadine and QTc Prolongation

      Amantadine is a medication used to treat Parkinson’s disease and influenza. It has been associated with QTc prolongation, which can increase the risk of Torsades de points. Therefore, caution should be exercised when prescribing amantadine to patients with risk factors for QT prolongation. If a patient is already taking amantadine and develops a prolonged QTc interval, the medication should be discontinued and an alternative treatment considered. It is important to monitor the QTc interval in patients taking amantadine, especially those with risk factors for QT prolongation.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 7 - A boy who is secretly struggling with their sexuality puts on a show...

    Incorrect

    • A boy who is secretly struggling with their sexuality puts on a show of being interested in the opposite sex and constantly talks about their crushes on girls to their peers. What defense mechanism are they exhibiting?

      Your Answer:

      Correct Answer: Reaction formation

      Explanation:

      Intermediate Mechanism: Rationalisation

      Rationalisation is a defense mechanism commonly used by individuals to create false but credible justifications for their behavior of actions. It involves the use of logical reasoning to explain away of justify unacceptable behavior of feelings. The individual may not be aware that they are using this mechanism, and it can be difficult to identify in oneself.

      Rationalisation is considered an intermediate mechanism, as it is common in healthy individuals from ages three to ninety, as well as in neurotic disorders and in mastering acute adult stress. It can be dramatically changed by conventional psychotherapeutic interpretation.

      Examples of rationalisation include a student who fails an exam and blames the teacher for not teaching the material well enough, of a person who cheats on their partner and justifies it by saying their partner was neglectful of unaffectionate. It allows the individual to avoid taking responsibility for their actions and to maintain a positive self-image.

      Overall, rationalisation can be a useful defense mechanism in certain situations, but it can also be harmful if it leads to a lack of accountability and an inability to learn from mistakes.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 8 - Which antidepressant is commonly linked to priapism? ...

    Incorrect

    • Which antidepressant is commonly linked to priapism?

      Your Answer:

      Correct Answer: Trazodone

      Explanation:

      Priapism: A Painful and Persistent Erection

      Priapism is a condition characterized by a prolonged and painful erection, which can occur in males and even in the clitoris. Although rare, certain medications such as antipsychotics and antidepressants have been known to cause priapism. The primary mechanism behind this condition is alpha blockade, although other mechanisms such as serotonin-mediated pathways have also been suggested. Some of the drugs most commonly associated with priapism include Trazodone, Chlorpromazine, and Thioridazine. Treatment involves the use of alpha-adrenergic agonists, which can be administered orally of injected directly into the penis. Priapism is a serious condition that can lead to complications such as penile amputation, although such cases are extremely rare.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 9 - Which assessment tools can individuals rate themselves? ...

    Incorrect

    • Which assessment tools can individuals rate themselves?

      Your Answer:

      Correct Answer: EPDS (Edinburgh postnatal major depression scale)

      Explanation:

      In psychiatry, various questionnaires and interviews are used to assess different conditions and areas. It is important for candidates to know whether certain assessment tools are self-rated of require clinical assistance. The table provided by the college lists some of the commonly used assessment tools and indicates whether they are self-rated of clinician-rated. For example, the HAMD and MADRS are clinician-rated scales used to assess the severity of depression, while the GDS is a self-rated scale used to screen for depression in the elderly. The YMRS is a clinician-rated scale used to assess the severity of mania in patients with bipolar disorder, while the Y-BOCS is used to measure both the severity of OCD and the response to treatment. The GAF provides a single measure of global functioning, while the CGI requires the clinician to rate the severity of the patient’s illness at the time of assessment. The CAMDEX is a tool developed to assist in the early diagnosis and measurement of dementia in the elderly.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 10 - What is the term used to describe the approach of an Asian immigrant...

    Incorrect

    • What is the term used to describe the approach of an Asian immigrant in England who practices his religion and cultural traditions at home but adapts well to the English language and culture at work?

      Your Answer:

      Correct Answer: Integration

      Explanation:

      Multiculturalism is the coexistence of various cultural of ethnic groups within a shared social and political framework. Acculturation is the process of cultural and psychological change that occurs when different cultural groups come into contact with each other. Canadian psychologist John Berry identified four paths to acculturation: assimilation, integration, separation, and marginalization. Assimilation involves giving up one’s home culture and adopting the dominant culture, while integration involves maintaining one’s home culture while also embracing the dominant culture. Separation involves maintaining one’s home culture while being isolated from the dominant culture, and marginalization involves giving up one’s home culture and failing to related properly to the dominant culture. There is a cultural debate regarding assimilation and multiculturalism, with two forms of assimilation recognized: total assimilation, which involves the obliteration of the non-dominant culture, and melting pot assimilation, which refers to a less extreme version where a new form of the dominant culture emerges. Laissez-faire multiculturalism refers to multiculturalism that occurs without planning, such as the existence of Chinatowns in most cities.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 11 - A patient in their 60s taking an antipsychotic is found to have a...

    Incorrect

    • A patient in their 60s taking an antipsychotic is found to have a QTc of 490ms. What would be the most appropriate alternative to their current antipsychotic medication?

      Your Answer:

      Correct Answer: Aripiprazole

      Explanation:

      Amantadine and QTc Prolongation

      Amantadine is a medication used to treat Parkinson’s disease and influenza. It has been associated with QTc prolongation, which can increase the risk of Torsades de points. Therefore, caution should be exercised when prescribing amantadine to patients with risk factors for QT prolongation. If a patient is already taking amantadine and develops a prolonged QTc interval, the medication should be discontinued and an alternative treatment considered. It is important to monitor the QTc interval in patients taking amantadine, especially those with risk factors for QT prolongation.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 12 - Which drugs are attributed to Kuhn's discovery of their antidepressant effects? ...

    Incorrect

    • Which drugs are attributed to Kuhn's discovery of their antidepressant effects?

      Your Answer:

      Correct Answer: Imipramine

      Explanation:

      A Historical Note on the Development of Zimelidine, the First Selective Serotonin Reuptake Inhibitor

      In 1960s, evidence began to emerge suggesting a significant role of serotonin in depression. This led to the development of zimelidine, the first selective serotonin reuptake inhibitor (SSRI). Zimelidine was derived from pheniramine and was marketed in Europe in 1982. However, it was removed from the market in 1983 due to severe side effects such as hypersensitivity reactions and Guillain-Barre syndrome.

      Despite its short-lived availability, zimelidine paved the way for the development of other SSRIs such as fluoxetine, which was approved by the FDA in 1987 and launched in the US market in 1988 under the trade name Prozac. The development of SSRIs revolutionized the treatment of depression and other mood disorders, providing a safer and more effective alternative to earlier antidepressants such as the tricyclics and MAO inhibitors.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 13 - What medications have the potential to cause elevated levels of lithium in the...

    Incorrect

    • What medications have the potential to cause elevated levels of lithium in the body?

      Your Answer:

      Correct Answer: Bendroflumethiazide

      Explanation:

      Lithium – Pharmacology

      Pharmacokinetics:
      Lithium salts are rapidly absorbed following oral administration and are almost exclusively excreted by the kidneys unchanged. Blood samples for lithium should be taken 12 hours post-dose.

      Ebstein’s:
      Ebstein’s anomaly is a congenital malformation consisting of a prolapse of the tricuspid valve into the right ventricle. It occurs in 1:20,000 of the general population. Initial data suggested it was more common in those using lithium but this had not held to be true.

      Contraindications:
      Addison’s disease, Brugada syndrome, cardiac disease associated with rhythm disorders, clinically significant renal impairment, untreated of untreatable hypothyroidism, low sodium levels.

      Side-effects:
      Common side effects include nausea, tremor, polyuria/polydipsia, rash/dermatitis, blurred vision, dizziness, decreased appetite, drowsiness, metallic taste, and diarrhea. Side-effects are often dose-related.

      Long-term use is associated with hypothyroidism, hyperthyroidism, hypercalcemia/hyperparathyroidism, irreversible nephrogenic diabetes insipidus, and reduced GFR.

      Lithium-induced diabetes insipidus:
      Treatment options include stopping lithium (if feasible), keeping levels within 0.4-0.8 mmol/L, once-daily dose of the drug taken at bedtime, amiloride, thiazide diuretics, indomethacin, and desmopressin.

      Toxicity:
      Lithium salts have a narrow therapeutic/toxic ratio. Risk factors for lithium toxicity include drugs altering renal function, decreased circulating volume, infections, fever, decreased oral intake of water, renal insufficiency, and nephrogenic diabetes insipidus. Features of lithium toxicity include GI symptoms and neuro symptoms.

      Pre-prescribing:
      Before prescribing lithium, renal function, cardiac function, thyroid function, FBC, and BMI should be checked. Women of childbearing age should be advised regarding contraception, and information about toxicity should be provided.

      Monitoring:
      Lithium blood levels should be checked weekly until stable, and then every 3-6 months once stable. Thyroid and renal function should be checked every 6 months. Patients should be issued with an information booklet, alert card, and record book.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 14 - Which of the following emphasizes the outcomes resulting from a choice rather than...

    Incorrect

    • Which of the following emphasizes the outcomes resulting from a choice rather than the behaviors leading up to it?

      Your Answer:

      Correct Answer: Teleology

      Explanation:

      Teleology, derived from the Greek words for goal and theory, is a moral philosophy that emphasizes the outcomes of actions as the initial consideration in evaluating ethical behavior. This category of theories is also known as consequentialism, as it focuses on the consequences of an action as the basis for determining its morality. Consequentialism evaluates the morality of an action based on the balance of its positive and negative outcomes. Utilitarianism of social consequentialism is the most prevalent form of consequentialism, although it is not the only one.

      Ethical theory and principles are important in medical ethics. There are three key ethical theories that have dominated medical ethics: utilitarianism, deontological, and virtue-based. Utilitarianism is based on the greatest good for the greatest number and is a consequentialist theory. Deontological ethics emphasize moral duties and rules, rather than consequences. Virtue ethics is based on the ethical characteristics of a person and is associated with the concept of a good, happy, flourishing life.

      More recent frameworks have attempted to reconcile different theories and values. The ‘four principles’ of ‘principlism’ approach, developed in the United States, is based on four common, basic prima facie moral commitments: autonomy, beneficence, non-maleficence, and justice. Autonomy refers to a patient’s right to make their own decisions, beneficence refers to the expectation that a doctor will act in a way that will be helpful to the patient, non-maleficence refers to the fact that doctors should avoid harming their patients, and justice refers to the expectation that all people should be treated fairly and equally.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 15 - Through which route does the caudate nucleus obtain its blood supply? ...

    Incorrect

    • Through which route does the caudate nucleus obtain its blood supply?

      Your Answer:

      Correct Answer: Anterior and middle cerebral arteries

      Explanation:

      The blood supply to the caudate nucleus primarily comes from the deep penetrators of the anterior and middle cerebral arteries. The effects of caudate infarcts can differ depending on the study, but typically include behavioral symptoms such as abulia and agitation, loss of executive function, and motor weakness.

      Brain Blood Supply and Consequences of Occlusion

      The brain receives blood supply from the internal carotid and vertebral arteries, which form the circle of Willis. The circle of Willis acts as a shunt system in case of vessel damage. The three main vessels arising from the circle are the anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA). Occlusion of these vessels can result in various neurological deficits. ACA occlusion may cause hemiparesis of the contralateral foot and leg, sensory loss, and frontal signs. MCA occlusion is the most common and can lead to hemiparesis, dysphasia/aphasia, neglect, and visual field defects. PCA occlusion may cause alexia, loss of sensation, hemianopia, prosopagnosia, and cranial nerve defects. It is important to recognize these consequences to provide appropriate treatment.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 16 - What substance of drug directly inhibits the dopamine transporter, resulting in elevated levels...

    Incorrect

    • What substance of drug directly inhibits the dopamine transporter, resulting in elevated levels of dopamine in the synaptic cleft?

      Your Answer:

      Correct Answer: Cocaine

      Explanation:

      Amphetamine engages in competition with the DAT instead of obstructing it.

      Mechanisms of action for illicit drugs can be classified based on their effects on ionotropic receptors of ion channels, G coupled receptors, of monoamine transporters. Cocaine and amphetamine both increase dopamine levels in the synaptic cleft, but through different mechanisms. Cocaine directly blocks the dopamine transporter, while amphetamine binds to the transporter and increases dopamine efflux through various mechanisms, including inhibition of vesicular monoamine transporter 2 and monoamine oxidase, and stimulation of the intracellular receptor TAAR1. These mechanisms result in increased dopamine levels in the synaptic cleft and reuptake inhibition.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 17 - Which of the following is the most probable outcome of muscarinic receptor antagonism?...

    Incorrect

    • Which of the following is the most probable outcome of muscarinic receptor antagonism?

      Your Answer:

      Correct Answer: Memory impairment

      Explanation:

      The sole anticholinergic side effect is memory impairment, while the remaining choices are instances of cholinergic side effects.

      Receptors and Side-Effects

      Histamine H1 Blockade:
      – Weight gain
      – Sedation

      Alpha 1 Blockade:
      – Orthostatic hypotension
      – Sedation
      – Sexual dysfunction
      – Priapism

      Muscarinic Central M1 Blockade:
      – Agitation
      – Delirium
      – Memory impairment
      – Confusion
      – Seizures

      Muscarinic Peripheral M1 Blockade:
      – Dry mouth
      – Ataxia
      – Blurred vision
      – Narrow angle glaucoma
      – Constipation
      – Urinary retention
      – Tachycardia

      Each receptor has specific effects on the body, but they can also have side-effects. Histamine H1 blockade can cause weight gain and sedation. Alpha 1 blockade can lead to orthostatic hypotension, sedation, sexual dysfunction, and priapism. Muscarinic central M1 blockade can cause agitation, delirium, memory impairment, confusion, and seizures. Muscarinic peripheral M1 blockade can result in dry mouth, ataxia, blurred vision, narrow angle glaucoma, constipation, urinary retention, and tachycardia. It is important to be aware of these potential side-effects when using medications that affect these receptors.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 18 - What is the origin of the concept of first rank symptoms? ...

    Incorrect

    • What is the origin of the concept of first rank symptoms?

      Your Answer:

      Correct Answer: Kurt Schneider

      Explanation:

      It is important to note that Carl Schneider should not be mistaken for Kurt Schneider. While Carl Schneider was a psychiatrist who had ties to the Nazi party and played a significant role in the Action T4 Euthanasia program, Kurt Schneider was a different individual altogether.

      First Rank Symptoms: Their Significance in Identifying Schizophrenia

      First rank symptoms were introduced by Kurt Schneider in 1938 as a practical tool for non-psychiatrists to identify schizophrenia. While they are highly suggestive of schizophrenia, they are not pathognomonic and can also be seen in affective and personality disorders. Additionally, there is no evidence to support their prognostic significance.

      A systematic review in 2015 found that first rank symptoms differentiated schizophrenia from nonpsychotic mental health disorders with a sensitivity of 61.8% and a specificity of 94.1%. They also differentiated schizophrenia from other types of psychosis with a sensitivity of 58% and a specificity of 74.7%.

      The first rank symptoms include running commentary, thought echo, voices heard arguing, thought insertion, thought withdrawal, thought broadcast, delusional perception, somatic passivity, made affect, and made volition. While they can be helpful in identifying schizophrenia, they should not be relied upon as the sole diagnostic criteria.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 19 - What SPECT finding is indicative of Alzheimer's disease? ...

    Incorrect

    • What SPECT finding is indicative of Alzheimer's disease?

      Your Answer:

      Correct Answer: Decreased temporal perfusion

      Explanation:

      Given the medial temporal lobe atrophy commonly observed in Alzheimer’s disease, a reduction in perfusion of the temporal lobe would be anticipated.

      Alzheimer’s disease can be differentiated from healthy older individuals by using SPECT imaging to detect temporal and parietal hypoperfusion, according to studies such as one conducted by W. Jagust in 2001. Additionally, SPECT imaging has proven to be a useful tool in distinguishing between Alzheimer’s disease and Lewy body dementia, as demonstrated in a study by Vaamonde-Gamo in 2005. The image provided shows a SPECT scan of a patient with Alzheimer’s disease compared to one with Lewy body dementia, with the latter showing lower perfusion in the occipital cortex and the former showing lower perfusion in medial temporal areas.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 20 - What is the incidence of birth defects in infants born to mothers who...

    Incorrect

    • What is the incidence of birth defects in infants born to mothers who used valproate while pregnant?

      Your Answer:

      Correct Answer: 6-11%

      Explanation:

      Pregnant women who take valproate have a high risk of giving birth to children with congenital malformations, with rates ranging from 6-11%. The North American Antiepileptic Drug Registry found that 10.7% of children born to women taking valproate monotherapy had major malformations, while the UK Epilepsy and Pregnancy Register reported a rate of 6.2%. The most common malformations are heart and facial defects, as well as neural tube, urogenital, and skeletal defects. While folic acid supplementation may help reduce the risk of malformations, it is strongly recommended that women avoid taking valproate during pregnancy.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 21 - Where is serotonin primarily produced in the body? ...

    Incorrect

    • Where is serotonin primarily produced in the body?

      Your Answer:

      Correct Answer: Raphe nuclei

      Explanation:

      Serotonin: Synthesis and Breakdown

      Serotonin, also known as 5-Hydroxytryptamine (5-HT), is synthesized in the central nervous system (CNS) in the raphe nuclei located in the brainstem, as well as in the gastrointestinal (GI) tract in enterochromaffin cells. The amino acid L-tryptophan, obtained from the diet, is used to synthesize serotonin. L-tryptophan can cross the blood-brain barrier, but serotonin cannot.

      The transformation of L-tryptophan into serotonin involves two steps. First, hydroxylation to 5-hydroxytryptophan is catalyzed by tryptophan hydroxylase. Second, decarboxylation of 5-hydroxytryptophan to serotonin (5-hydroxytryptamine) is catalyzed by L-aromatic amino acid decarboxylase.

      Serotonin is taken up from the synapse by a monoamine transporter (SERT). Substances that block this transporter include MDMA, amphetamine, cocaine, TCAs, and SSRIs. Serotonin is broken down by monoamine oxidase (MAO) and then by aldehyde dehydrogenase to 5-Hydroxyindoleacetic acid (5-HIAA).

    • This question is part of the following fields:

      • Neurosciences
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  • Question 22 - Which of the following factors has not been found to offer protection against...

    Incorrect

    • Which of the following factors has not been found to offer protection against suicide?

      Your Answer:

      Correct Answer: Having siblings

      Explanation:

      Marital status, having both parents alive and in a stable relationship, and having young offspring have all been found to be protective factors against suicide. However, while being a twin has been linked to a lower risk of suicide, having siblings does not appear to have the same effect.

    • This question is part of the following fields:

      • Epidemiology
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  • Question 23 - What are the components of behavioural activation in the treatment of depression? ...

    Incorrect

    • What are the components of behavioural activation in the treatment of depression?

      Your Answer:

      Correct Answer: Types and degree of avoidance

      Explanation:

      Understanding Behavioural Activation Therapy for Depression

      Behavioural activation therapy is a formal treatment for depression that emphasizes activity scheduling to encourage patients to approach activities they are avoiding. Unlike traditional cognitive therapy, it involves less cognitive therapy and is easier to train staff in its use. The therapy was introduced by Martell in 2001 and has two primary focuses: the use of avoided activities as a guide for activity scheduling and functional analysis of cognitive processes that involve avoidance.

      Behavioural activation theory suggests that when people become depressed, many of their activities function as avoidance and escape from aversive thoughts, feelings, of external situations. As a result, someone with depression engages less frequently in pleasant of satisfying activities and obtains less positive reinforcement than someone without depression. To address this, the patient is encouraged to identify activities and problems that they avoid and to establish valued directions to be followed. These are set out on planned timetables (activity schedules).

      In behavioural activation therapy, therapists do not engage in the content of the patient’s thinking. Instead, they use functional analysis to focus on the context and process of the individual’s response. The most common cognitive responses are rumination, fusion, and self-attack. A typical session has a structured agenda to review homework and progress towards goals, discuss feedback on the previous session, and focus on one of two specific issues. The number of sessions required to treat depression is typically between 12 and 24.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 24 - What are some common symptoms that are typically observed in the initial phases...

    Incorrect

    • What are some common symptoms that are typically observed in the initial phases of Alzheimer's disease?

      Your Answer:

      Correct Answer: Hippocampal atrophy

      Explanation:

      The medial temporal lobe, comprising the hippocampus and parahippocampal gyrus, exhibits the earliest neuropathological alterations.

      Alzheimer’s disease is characterized by both macroscopic and microscopic changes in the brain. Macroscopic changes include cortical atrophy, ventricular dilation, and depigmentation of the locus coeruleus. Microscopic changes include the presence of senile plaques, neurofibrillary tangles, gliosis, degeneration of the nucleus of Meynert, and Hirano bodies. Senile plaques are extracellular deposits of beta amyloid in the gray matter of the brain, while neurofibrillary tangles are intracellular inclusion bodies that consist primarily of hyperphosphorylated tau. Gliosis is marked by increases in activated microglia and reactive astrocytes near the sites of amyloid plaques. The nucleus of Meynert degenerates in Alzheimer’s, resulting in a decrease in acetylcholine in the brain. Hirano bodies are actin-rich, eosinophilic intracytoplasmic inclusions which have a highly characteristic crystalloid fine structure and are regarded as a nonspecific manifestation of neuronal degeneration. These changes in the brain contribute to the cognitive decline and memory loss seen in Alzheimer’s disease.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 25 - After several sessions over a period of six weeks, a female therapist and...

    Incorrect

    • After several sessions over a period of six weeks, a female therapist and female client meet to discuss the therapist's understanding of the client's issues. The therapist presents the client with two diagrams. The first illustrates the client's relationship with her partner, the therapist, and the client's mother. The second diagram depicts the interplay between the unconscious feeling of abandonment, the defense mechanism of denial, and the feeling of fear.

      Which prominent psychoanalytic theorist's approach to therapy is reflected in this formulation?

      Your Answer:

      Correct Answer: David Malan

      Explanation:

      Malan’s research centered on the development of the client’s challenges using two ‘triangles’ – the triangle of person and the triangle of defence. Bowlby is recognized for his work on attachment theory, while Anna Freud is known for her work on defence mechanisms and object relations. Sigmund Freud is linked to time-limited psychotherapies, and Ryle created cognitive analytic therapy.

    • This question is part of the following fields:

      • Advanced Psychological Processes And Treatments
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  • Question 26 - A couple in their 30s, where one partner has an autosomal recessive condition...

    Incorrect

    • A couple in their 30s, where one partner has an autosomal recessive condition and the other is a carrier for the same condition, are planning to have a child. What is the likelihood of their child inheriting the condition?

      Your Answer:

      Correct Answer: 50%

      Explanation:

      Mendelian Inheritance (Pedigrees)

      Mendelian inheritance refers to the transmission patterns of genetic conditions caused by a mutation in a single gene. There are four types of Mendelian inheritance patterns: autosomal dominant, autosomal recessive, X-linked recessive, and X-linked dominant. Each pattern follows a predictable inheritance pattern within families.

      Autosomal dominant conditions are expressed in individuals who have just one copy of the mutant allele. Affected males and females have an equal probability of passing on the trait to offspring. In contrast, autosomal recessive conditions are clinically manifest only when an individual has two copies of the mutant allele. X-linked recessive traits are fully evident in males because they only have one copy of the X chromosome, while women are rarely affected by X-linked recessive diseases. X-linked dominant disorders are clinically manifest when only one copy of the mutant allele is present.

      Common examples of conditions with specific inheritance patterns include neurofibromatosis type 1 and 2, tuberous sclerosis, achondroplasia, Huntington disease, Noonan’s syndrome for autosomal dominant; phenylketonuria, homocystinuria, Hurler’s syndrome, galactosaemia, Tay-Sach’s disease, Friedreich’s ataxia, Wilson’s disease, cystic fibrosis for autosomal recessive; vitamin D resistant rickets, Rett syndrome for X-linked dominant; and cerebellar ataxia, Hunter’s syndrome, Lesch-Nyhan for X-linked recessive.

    • This question is part of the following fields:

      • Genetics
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  • Question 27 - Samantha is a 35-year-old woman visiting her psychiatrist in the outpatient clinic. She...

    Incorrect

    • Samantha is a 35-year-old woman visiting her psychiatrist in the outpatient clinic. She has had bipolar disorder for fifteen years. It has been well controlled over the last five years since she was started on a mood stabilizer, lithium. She has been able to maintain a stable job and has a supportive partner.
      However, her psychiatrist who has known Samantha for eight years, has noticed her increasingly making facial grimaces and lip smacking during outpatient reviews over the last year. She also keeps fidgeting with her hair and clothes in an odd manner. This behavior has become progressively more noticeable.
      When asked about it, Samantha says she cannot control what she does. She denies experiencing any manic or depressive episodes of hearing voices.
      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Tardive dyskinesia

      Explanation:

      The patient’s long-term use of a first-generation depot antipsychotic and the involuntary symptoms presented suggest a diagnosis of tardive dyskinesia. Acute anxiety is unlikely as the patient has a long standing relationship with their psychiatrist and the symptom combination does not fit. Akathisia, characterized by restlessness and leg movement, is also an unlikely diagnosis. Neuroleptic malignant syndrome (NMS) can be ruled out as the patient has had symptoms for two years. The patient is compliant with medication, has no psychotic symptoms, and is well-functioning in their job and home life, making a relapse of schizophrenia an incorrect diagnosis.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 28 - A junior researcher in the field of psychiatry is currently undertaking a six-month...

    Incorrect

    • A junior researcher in the field of psychiatry is currently undertaking a six-month research placement as part of their training program. They are collaborating with a team of psychopharmacologists who are studying the mechanism of action of a novel antidepressant medication.
      What is the primary group of molecules that most known antidepressants target?

      Your Answer:

      Correct Answer: Transmembrane transporters

      Explanation:

      Most antidepressants and stimulants target monoamine transporters, which are crucial molecular targets. These transporters are also targeted by 30% of all psychotropic drugs. Another 30% of psychotropic drugs target G-protein-linked receptors, while enzymes are targeted by about 10% of these drugs. Monoamine oxidase inhibitors (MAOIs) are a type of antidepressant that targets the enzyme monoamine oxidase. Ligand-gated and voltage-gated ion channels are targeted by 20% and 10% of all psychotropic drugs, respectively.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 29 - To which category of memory does procedural memory belong? ...

    Incorrect

    • To which category of memory does procedural memory belong?

      Your Answer:

      Correct Answer: Implicit

      Explanation:

      Memory Forms

      Memory is the ability to store, retain, and retrieve information. There are different forms of memory, including sensory memory, short-term/working memory, and long-term memory.

      Sensory memory is the capacity for briefly retaining the large amounts of information that people encounter daily. It includes echoic memory (gathered through auditory stimuli), iconic memory (gathered through sight), and haptic memory (acquired through touch).

      Short-term memory is the ability to keep a small amount of information available for a short period of time. Atkinson and Shiffrin’s multistore model (1968) suggests the existence of a short-term storehouse with limited capacity. Baddeley and Hitch (1974) further developed the concept of short-term memory, which eventually became known as Baddeley’s multi-storehouse model (2000). This model includes the central executive, visuospatial sketchpad, phonological buffer/loop, and episodic buffer.

      Long-term memory includes declarative (of explicit) memories, which can be consciously retrieved, and nondeclarative (of implicit) memories, which cannot. Declarative memory includes episodic memory (stores personal experiences) and semantic memory (stores information about facts and concepts). Non-declarative memory includes procedural memory (recalls motor and executive skills), associative memory (storage and retrieval of information through association with other information), and non-associative memory (refers to newly learned behavior through repeated exposure to an isolated stimulus).

      Overall, memory is a complex and essential cognitive function that plays a crucial role in learning, reasoning, and understanding.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 30 - Which antipsychotic medication belongs to the substituted benzamide class? ...

    Incorrect

    • Which antipsychotic medication belongs to the substituted benzamide class?

      Your Answer:

      Correct Answer: Sulpiride

      Explanation:

      Sulpiride belongs to the substituted benzamide class of drugs.
      Chlorpromazine falls under the phenothiazine category.
      Flupentixol is classified as a thioxanthene medication.
      Haloperidol is a butyrophenone compound.
      Pimozide is a diphenylbutylpiperidine drug.

    • This question is part of the following fields:

      • Psychopharmacology
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